AwesomeCapital: Madrigal backs ~$1.5B 2026 Rezdiffra revenue consensus after Q1 sales rise 127% year over year

Wednesday, May 6, 2026

Q1 2026 non-GAAP EPS -$3.25 vs -$3.61 consensus, reflecting a narrower loss than expected.
Rezdiffra Q1 2026 net sales were $311.3M, +127% YoY, bringing trailing 12-month sales to $1.1B and beating analyst revenue estimates.
Active Rezdiffra patients reached 42,250, 2.5x year over year, with strong momentum continuing into Q2.
Management endorsed 2026 Rezdiffra net sales consensus around $1.48B and gross-to-net in the mid–high 30s percent.
Cash and securities totaled about $818M, funding the Rezdiffra launch, outcomes trials, and multiple early-stage combination programs.
Operating expenses increased driven by business development and commercial spend, and the company expects 2026 will not be profitable.
GLP-1s are viewed as background therapy for MASH, with roughly 25% of Rezdiffra patients using combination treatment.
Pipeline expanded to more than 10 MASH programs, including a clinical-stage PNPLA3 siRNA candidate in-licensed from Arrowhead.
F4 cirrhosis outcomes trial for Rezdiffra remains expected in 2027, and success could roughly double the franchise opportunity.
Key risk remains commercial execution and event risk tied to the pivotal F4 outcomes readout planned for 2027.
Main concern is high ongoing spending and dependence on positive F4 outcomes data to support long-term growth trajectory.
Strong quarter driven by rapid Rezdiffra uptake and an expanding diagnosed MASH patient pool supporting durable demand.

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