Madrigal Pharmaceuticals Expands MASH Portfolio with $2B+ CSPC Deal

Madrigal Pharmaceuticals has announced a significant partnership with China-based CSPC Pharmaceutical Group Limited, marking a major expansion of its metabolic dysfunction-associated steatohepatitis (MASH) portfolio. The deal, valued at potentially over $2 billion, centers around the development of SYH2086, an oral preclinical GLP-1 therapy.

Deal Structure and Financial Terms

The collaboration, announced on Wednesday, involves an upfront payment of $120 million from Madrigal to CSPC. The agreement includes potential future payments of up to $2 billion, contingent on meeting various development, regulatory, and commercial milestones. Additionally, CSPC will be eligible for royalties on net product sales. Both companies expect to finalize the transaction by the end of 2025, subject to regulatory approvals.

SYH2086: A Promising GLP-1 Analog

SYH2086, the focal point of this partnership, is described as an orally available GLP-1 analog derived from Eli Lilly's orforglipron. While still in preclinical development, early data suggest promising glucose-lowering and weight-loss benefits in in vitro models. Importantly, preclinical safety findings have not identified any concerning signals.

Madrigal CEO Bill Sibold emphasized the strategic importance of this acquisition, stating, "This agreement to acquire global rights to SYH2086 aligns perfectly with our long-term goal to extend our leadership in MASH by building a pipeline anchored by Rezdiffra."

Combination Therapy Strategy

Madrigal plans to investigate SYH2086 in combination with its FDA-approved MASH drug, Rezdiffra. The company's chief medical officer, David Soergel, highlighted the potential of this approach: "We believe we can optimize efficacy and tolerability in MASH by balancing the weight loss from a GLP-1 with the fibrosis and lipid reduction of Rezdiffra in a once-a-day pill."

Clinical trials for this combination therapy are expected to commence in the first half of 2026, with Madrigal projecting it could become a best-in-class MASH treatment.

Rezdiffra's Market Performance

Rezdiffra, approved by the FDA in March 2024, remains the only approved drug for MASH. Since its launch, the drug has demonstrated strong market performance:

• Over 11,800 patients treated in 2024
• Sales of $180.1 million in 2024
• More than 17,000 patients treated as of March 31, 2025
• Q1 2025 sales exceeding $137 million

Madrigal anticipates Rezdiffra will achieve blockbuster status in the coming year, as indicated in their presentation at the 43rd J.P. Morgan Healthcare Conference in January.