Novo Nordisk has agreed to buy Akero Therapeutics in a deal rising to a potential $5.2bn, as the Danish drugmaker looks to solidify its recent entry into the liver disease market amid restructuring efforts.
Novo will pay Akero shareholders $54 per share in cash, which represents a premium of around 16% to Akero stock’s last close of $46.49 on 8 October.
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The semaglutide manufacturer will also pay an additional $6 per share upon US approval of Akero’s lead product candidate, efruxifermin (EFX), for treatment of compensated cirrhosis due to metabolic dysfunction-associated steatohepatitis (MASH) by mid-2031.
The deal represents the first major financial outlay by Novo’s CEO, Mike Doustdar, who joined the company in August 2025. Doustdar is tasked with turning around the company’s fortunes after falling behind Eli Lilly in the weight loss and type 2 diabetes treatment market. The new CEO already cut 9,000 jobs last month.
The liver disease market could represent a strong growth avenue for the company in the future. Novo’s Wegovy (semaglutide) became the first glucagon-like peptide 1 receptor agonist (GLP-1RA) to gain US approval for MASH treatment in August 2025.
According to GlobalData estimates, the MASH market is anticipated to reach sales of $25.7bn in 2032 across the seven major markets (7MM: US, France, Germany, Italy, Spain, the UK, and Japan).
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By GlobalDataGlobalData is the parent company of Clinical Trials Arena.
The decision to acquire Akero Therapeutics, therefore, makes strategic sense when combined with Novo’s recent MASH win and obesity treatment expertise. More than 40% of MASH patients also have type 2 diabetes, and over 80% of MASH patients are overweight or living with obesity, representing the closely linked nature of the diseases, according to Novo Nordisk.
“If approved, we believe it could become a cornerstone therapy, alone or together with Wegovy (semaglutide), to tackle one of the fastest-growing metabolic diseases of our time,” said Doustdar in a statement.
Adding flavour in a conference call on 9 October, Doustdar commented that: “We have been looking at a number of assets for a long period of time… [this deal] reflects the fact that we are continuously on the lookout for best in class and possibly first in class assets that fit within our strategy.”
The CEO stated the drug could become a “building block” for strengthening the company’s top line.
EFX is currently being evaluated as a once-weekly subcutaneous injection in the SYNCHRONY programme, which consists of three Phase III clinical trials in patients with pre-cirrhotic (F2-F3) MASH or compensated cirrhosis (F4) due to MASH. The triplet of randomised trials (NCT06215716, NCT06528314, NCT06161571) has enrolled 3,500 patients in total.
EFX has already demonstrated positive results in two Phase IIb trials. Akero’s drug significantly improved liver fibrosis and reversed compensated cirrhosis due to MASH. Over 96 weeks, the HARMONY (F2-F3) trial (NCT04767529) and SYMMETRY (F4) trial (NCT05039450) demonstrated 49% and 29% reduction in fibrosis without worsening of MASH respectively, compared to 19% and 11% in the respective placebo groups.
FGF21’s market buzz
Akero’s EFX is a fibroblast growth factor 21 (FGF21) analogue that works by reducing liver fat, inflammation, and fibrosis. While EFX is the only treatment to have shown significant fibrosis regression in F4 patients in a Phase II trial at this stage, it is far from the only FGF21 to be on the market this year.
“Novo Nordisk’s acquisition of Akero is the third and largest major acquisition of an FGF21 analog by a big pharma company in the MASH therapy space over the last few months,” said Jay Patel, senior analyst at GlobalData.
Roche acquired pegozafermin-developer 89bio for $3.5bn in Sep 2025, while GSK agreed to buy efimosfermin from Boston Pharma for $2bn in May 2025. Novo’s deal is the most expensive, suggesting the treatment’s potential in MASH F4 is a strong revenue driver.
“[The deals this year] signal strong industry confidence in the potential of FGF21 analogs in MASH, suggesting this drug class could be the future of MASH treatment,” Patel added.
Novo Nordisk’s decision follows the discontinuation of its own FGF21 analog, zalfermin, which was being developed in combination with Wegovy and the amylin analog cagrilintide for MASH F2-3 and ALD.
