Madrigal Pharmaceuticals has inked a deal worth up to $4.4bn with Chinese biotech Suzhou Ribo Life Science and its subsidiary Ribocure Pharmaceuticals in a bid to expand offerings in the metabolic dysfunction-associated steatohepatitis (MASH) market.
The agreement will see Madrigal pay $60m upfront for the development and commercialisation rights to six of Ribo’s preclinical, silent interfering RNA (siRNA)-based MASH therapies, which are designed to silence genes encoding proteins that drive the disease’s pathology.
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Ribo will also be eligible to receive up to $4.4bn in development, regulatory and commercial milestone payments, as well as potential royalties on sales involving these candidates.
Through this deal, Madrigal can also choose to license some of Ribo’s other early-stage development programmes at a later date. This includes multiple bispecific siRNA candidates, according to a separate release from Ribo.
A key component of the deal with Ribo is the potential to combine the newly in-licensed candidates with Rezdiffra (resmetirom), which is Madrigal’s already approved for MASH treatment.
Madrigal’s chief medical officer, David Soergel, said: “siRNAs are highly liver targeted, and there are several genes implicated in MASH that could be addressed with an mRNA-knockdown approach. The precision of siRNA gene silencing, combined with Rezdiffra, has the potential to create the next generation of MASH treatment: genetically targeted therapies for patients with unmet needs.”
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By GlobalDataAt the core of Madrigal and Ribo’s agreement is the latter’s GalSTAR platform, which is designed to aid the development of RNA interference (RNAi) therapeutics targeting disease-causing genes involved in liver disease pathology.
German pharmaceutical giant Boehringer Ingelheim previously struck a $2bn deal with Ribo to use the platform to develop siRNAs for liver diseases in 2024.
Madrigal seeks to strengthen MASH presence
MASH, previously known as nonalcoholic steatohepatitis (NASH), is characterised by an accumulation of fat within the liver – triggering chronic inflammation within the organ. This can lead to scarring, liver cirrhosis or hepatic cancer.
In 2024, Madrigal became the first company with a drug approved specifically for MASH in the form of thyroid hormone receptor beta (THR-β) agonist, Rezdiffra. Since then, the company has continued its MASH focus by acquiring Pfizer’s investigational candidate, ervogastat for $50m, as well as two other preclinical assets targeting the indication. Madrigal said there could be additive clinical benefit when combining ervogastat with Rezdiffra at the time.
Rezdiffra has been a significant driver of Madrigal’s recent growth – with the therapy bringing in $287.3m in Q3 2025. A patient-based forecast from GlobalData, parent company of Pharmaceutical Technology, estimates that Rezdiffra’s sales will balloon to $6.9bn in 2032. However, it is likely the drug will reach blockbuster status when 2025 results are announced.
However, Rezdiffra is now subject to competition from Novo Nordisk’s mega-blockbuster glucagon-like peptide 1 receptor agonist (GLP-1RA), Wegovy (semaglutide), which became the first drug in its class to gain approval in MASH in August 2025. Following this milestone, Novo Nordisk made steps to further extend its footprint within the MASH indication by acquiring indication specialist, Akero for up to $5.2bn.
GlobalData forecasts that the MASH market will reach a value of $20.3bn by 2032 – rising from 2022 at a compound annual growth rate (CAGR) of 38.2%.
