PresentationGood morning, everyone. We've made it to our last day of our London Healthcare Conference. It has been absolute pleasure seeing everyone, and it's great to see also just the atmosphere in the room. My name is Akash Tewari. I'm a pharma and biotech analyst here at Jefferies. I have the pleasure of hosting the Madrigal management team. Bill, why don't I hand it off to you for some intro remarks, and we'll get started.William SiboldCEO, President & Director Well, first of all, thank you for having ...

Summary of Madrigal Pharmaceuticals Conference Call Company Overview - **Company**: Madrigal Pharmaceuticals (NasdaqGS:MDGL) - **Product**: Rezdiffra, a treatment for MASH (Metabolic Dysfunction-Associated Steatotic Liver Disease) Key Industry Insights - **Market Opportunity**: There is a significant unmet need in the MASH market, with over 20 failed attempts by the industry to find a solution before Madrigal's success with Rezdiffra [2][3] - **Patient Population**: The diagnosed patient population in the U.S. is approximately 1.5 million, with the F2 and F3 indications accounting for about 525,000 patients. The target prescriber base is narrowed down to 14,000, leading to an actionable patient population of 315,000 [6][7] - **Current Treatment Penetration**: Currently, only about 10% of the identified patient population is being treated, indicating substantial growth potential [6][7] Product and Pipeline Development - **Rezdiffra's Profile**: The product is positioned as a foundational therapy for MASH, with a once-a-day oral dosage that is effective and well-tolerated, which is considered a "holy grail" in the industry [11] - **Sales Forecast**: Initial sales in 2024 are projected to be under $200 million, but the potential market size for Rezdiffra could reach $5 billion to $10 billion as penetration increases [3][12][15] - **Intellectual Property**: Madrigal has secured intellectual property for Rezdiffra until 2045, allowing ample time for market development [3] Competitive Landscape - **Comparison with Competitors**: Madrigal's focused approach contrasts with competitors like Novo, which have multiple indications and broader product lines. Madrigal's strategy is to engage directly with specialists, enhancing their market presence [18][19] - **Market Dynamics**: The company is observing the market entry of competitors and is prepared to adapt its strategy accordingly. The focus remains on building a strong presence in the specialty market [19][20] Sales and Marketing Strategy - **Adoption Rates**: Initial adoption rates in specialty clinics are reported to be as high as 80%, attributed to effective white-glove service and support for prescribers [21][24] - **Patient Adherence**: The persistence rate for patients on Rezdiffra is reported to be around 90% at the 12-month mark, significantly higher than the industry benchmark of 60-70% for well-tolerated oral medications [24][25] - **Sales Force Strategy**: The company has built a dedicated sales force to educate and support prescribers, which is crucial for navigating the complexities of specialty drug prescriptions [22][23] Financial Projections - **Gross Unit Projections**: For 2026, Madrigal anticipates gross unit sales to be in the high 30s percentage range, with a disciplined approach to contracting with commercial payers [29][30] - **Market Mix**: The revenue mix is expected to be 50-55% from commercial payers, 30-35% from Medicare, and the remainder from Medicaid and government sources [34] Research and Development - **Ongoing Studies**: The Maestro Outcomes study is ongoing, focusing on F4 cirrhosis patients, with confidence in positive outcomes based on previous open-label trial results [45][46] - **Patient Enrollment Criteria**: The study is designed to enroll patients with specific platelet counts, differentiating it from other ongoing studies that may include less severe populations [48][49] Conclusion - **Long-term Vision**: Madrigal aims to maintain its leadership in the MASH market for decades, supported by a robust pipeline and a strong foundational product in Rezdiffra [15][16]

Financial Data and Key Metrics Changes - Third quarter 2025 net sales totaled $287.3 million, up 35% from the second quarter of 2025 [23][24] - R&D expenses for the third quarter of 2025 were $174 million, compared to $68.7 million in the third quarter of 2024, primarily due to a one-time $117 million expense associated with the global licensing agreement for MGL-2086 [24][25] - SG&A expenses for the third quarter of 2025 were $209.1 million, compared to $107.6 million in the third quarter of 2024, reflecting higher commercial investment to support the Rezdiffra launch [25] Business Line Data and Key Metrics Changes - Rezdiffra's sales are annualizing at greater than $1 billion in only its sixth quarter of launch, with over 29,500 patients currently on therapy, up from more than 23,000 at the end of the second quarter [4][6][7] - The number of prescribers for Rezdiffra exceeded 10,000, indicating strong adoption and penetration in the market [8][27] Market Data and Key Metrics Changes - The MASH market is still in its early stages, with Rezdiffra positioned as a first-line therapy, benefiting from a unique profile that surpasses other first-to-market products [9][10] - The company anticipates that the market will expand, driven by increased awareness and diagnosis, particularly with the entry of competitors like Wegovy [10][11] Company Strategy and Development Direction - The company is focused on maximizing the value of Rezdiffra and building its pipeline, with a strong emphasis on payer contracting strategies for first-line access [4][12] - The strategy includes expanding globally, with a recent launch in Germany following European approval, and enhancing targeting efforts towards endocrinologists [15][16] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in Rezdiffra's growth potential, citing a strong adherence rate and the drug's well-tolerated profile as key factors for long-term chronic use [11][72] - The company is optimistic about the outcomes of ongoing trials, particularly the Maestro NASH outcomes trial, which is expected to read out in 2027 [16][47] Other Important Information - The company ended the third quarter of 2025 with $1.1 billion in cash and equivalents, providing strong resources to support the ongoing launch of Rezdiffra and advance multiple pipeline programs [25][26] - The gross-to-net impact is expected to be in the high 30% range starting January 1, 2026, consistent with other innovative specialty medicines [24][14] Q&A Session Summary Question: How could AASLD data further de-risk Maestro NASH outcomes? - Management highlighted the positive feedback from gastroenterologists and the foundational therapy status of Rezdiffra, expressing excitement about the upcoming AASLD meeting [31][32] Question: Pros and cons of combining Rezdiffra with MGL-2086 versus other GLP-1s? - Management clarified that MGL-2086 is an orforglipron derivative, emphasizing the rationale for combining it with Rezdiffra to enhance efficacy [37][38] Question: Thoughts on competitive positioning amid recent M&A in the space? - Management views recent M&A as validation of the MASH market and believes it will lead to greater diagnosis and treatment opportunities, favoring Rezdiffra's profile [45][46] Question: Feedback on Rezdiffra's adherence rate and net pricing expectations? - Management confirmed strong adherence rates and indicated that gross-to-net dynamics would likely lead to some future decline in pricing, but they remain optimistic about market access [51][53] Question: Comments on Aetna's formulary coverage decision? - Management stated that Rezdiffra will be available through prior authorization or medical exception, with no expected meaningful impact on patient access [59] Question: Observations on Novo's marketing campaign and its impact on the addressable patient pool? - Management noted that while it is early to quantify the impact, there are signs of increased referrals and diagnosis, which could benefit Rezdiffra [63][64] Question: Path to profitability and focus areas moving forward? - Management emphasized the focus on driving top-line growth and building out the pipeline, indicating that profitability will be considered in the future [68]

Financial Data and Key Metrics Changes - For Q3 2025, net sales totaled $287.3 million, representing a 35% increase quarter over quarter [23][24]. - The company ended Q3 2025 with $1.1 billion in cash and marketable securities, reflecting a strong cash position to support ongoing operations [25][26]. Business Line Data and Key Metrics Changes - Rezdiffra's sales are annualizing at over $1 billion within six quarters of launch, with over 29,500 patients currently on the therapy, up from more than 23,000 at the end of Q2 2025 [4][6][7]. - The number of prescribers for Rezdiffra exceeded 10,000, indicating strong physician penetration [8]. Market Data and Key Metrics Changes - The target population for Rezdiffra is 315,000 diagnosed patients, with a significant portion remaining untreated, providing substantial growth potential [7][10]. - The company is expanding its market presence in Europe, having launched in Germany following European approval [4][15]. Company Strategy and Development Direction - The company aims to maximize the value of Rezdiffra while building its pipeline, focusing on first-line access and payer contracting strategies for 2026 [4][12]. - The strategy includes expanding the pipeline with new assets, such as an oral GLP-1, to enhance treatment options for MASH [17][18]. Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in Rezdiffra's growth potential, citing its best-in-class profile and the expected impact of payer agreements starting January 1, 2026 [11][24]. - The management team highlighted the importance of sustained efficacy and tolerability for long-term chronic use of Rezdiffra [72][75]. Other Important Information - R&D expenses for Q3 2025 were $174 million, primarily due to a one-time expense related to the licensing agreement for MGL-2086 [24][25]. - SG&A expenses increased to $209.1 million, reflecting higher commercial investments to support the Rezdiffra launch [25]. Q&A Session Summary Question: How could AASLD data further de-risk Maestro NASH outcomes? - Management expressed excitement about AASLD and noted positive feedback from gastroenterologists regarding Rezdiffra's efficacy, which gives confidence in the Maestro outcomes trial [30][31][34]. Question: Pros and cons of combining Rezdiffra with MGL-2086 versus other GLP-1s? - Management clarified that MGL-2086 is an orforglipron derivative, emphasizing the rationale for combining it with Rezdiffra to enhance efficacy [37][38]. Question: Thoughts on competitive positioning amid recent M&A in the space? - Management viewed recent M&A as validation of the MASH market and expressed confidence in their long-term strategy and market access [45][46]. Question: Feedback on Rezdiffra's adherence rates and net pricing? - Management confirmed strong adherence rates and indicated that gross-to-net dynamics would likely lead to some future decline in pricing, but they remain optimistic about market access [51][53]. Question: Comments on Aetna's formulary coverage decision? - Management stated that Aetna's decision would not significantly impact access, as Rezdiffra would still be available through prior authorization [59]. Question: Observations on Novo's marketing campaign and path to profitability? - Management noted that while it is early to quantify the impact of Novo's campaign, they are optimistic about the potential for increased diagnoses and emphasized a focus on top-line growth [62][68].

Financial Data and Key Metrics Changes - In Q3 2025, net sales totaled $287.3 million, representing a 35% increase quarter over quarter [22][24] - R&D expenses increased to $174 million from $68.7 million in Q3 2024, primarily due to a one-time $117 million expense for a global licensing agreement [23][24] - SG&A expenses rose to $209.1 million compared to $107.6 million in Q3 2024, reflecting higher commercial investment for the Rezdiffra launch [24] Business Line Data and Key Metrics Changes - Rezdiffra's sales are annualizing at over $1 billion within six quarters of launch, with over 29,500 patients currently on therapy, up from over 23,000 at the end of Q2 2025 [3][5][25] - The number of prescribers for Rezdiffra exceeded 10,000, indicating strong adoption and penetration in the market [6][25] Market Data and Key Metrics Changes - The MASH market is still in its early stages, with Rezdiffra positioned as a first-line therapy, benefiting from a unique profile that surpasses other first-to-market products [8][10] - The company anticipates that the market will expand, driven by increased awareness and diagnosis, particularly with the entry of competitors like Novo [61] Company Strategy and Development Direction - The company is focused on maximizing the value of Rezdiffra and expanding its pipeline, with a strong emphasis on payer contracting for first-line access in 2026 [3][11] - The strategy includes a thoughtful approach to pipeline development, aiming to combine Rezdiffra with other mechanisms like GLP-1s to enhance treatment efficacy [15][16] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in Rezdiffra's growth potential, citing a strong adherence rate and a favorable market position [10][68] - The company is optimistic about the upcoming data presentations at AASLD, which are expected to bolster confidence in the Maestro NASH outcomes trial [32][19] Other Important Information - The company ended Q3 2025 with $1.1 billion in cash and equivalents, providing a strong financial position to support ongoing operations and pipeline advancements [25] - The gross-to-net impact is expected to rise to the high 30% range in 2026, consistent with other innovative specialty medicines [23][12] Q&A Session Summary Question: How could AASLD data further de-risk Maestro NASH outcomes? - Management highlighted the positive feedback from gastroenterologists and the foundational role of Rezdiffra in treatment, expressing excitement for the upcoming AASLD data [29][31] Question: Pros and cons of combining Rezdiffra with MGL-2086 versus other GLP-1s? - The company clarified that MGL-2086 is an orforglipron derivative, emphasizing the rationale for combining it with Rezdiffra to enhance efficacy [35][36] Question: Thoughts on competitive positioning amid recent M&A in the space? - Management views recent M&A as validation of the MASH market, believing it will lead to increased diagnosis and treatment opportunities for Rezdiffra [41][43] Question: Feedback on Rezdiffra's adherence rates and net pricing expectations? - Management confirmed strong adherence rates and indicated that while some gross-to-net decline is expected, they are well-positioned for stable pricing [49][51] Question: Insights on Aetna's formulary coverage decision? - Management stated that Aetna's non-coverage will not significantly impact access, as Rezdiffra will still be available through prior authorization [55][56] Question: Observations on Novo's marketing campaign and its impact on patient numbers? - Management noted that while it is early to quantify, there are signs of increased referrals and diagnosis, which could benefit Rezdiffra [60][62] Question: Path to profitability and future growth strategies? - The focus remains on driving top-line growth and expanding the pipeline, with profitability being a longer-term goal [63][68]

Core Viewpoint - Furuya Co., Ltd. is a leading enterprise in the liver disease sector in China, with a comprehensive industry chain layout and significant technological and market advantages [1] Group 1: Business Performance - For Q3 2025, Furuya's revenue was 1.101 billion yuan, ranking 16th among 42 companies in the industry, while the industry leader, Mindray Medical, reported revenue of 25.834 billion yuan [2] - The net profit for the same period was 162 million yuan, placing the company 10th in the industry, with Mindray Medical's net profit at 7.814 billion yuan [2] Group 2: Financial Ratios - As of Q3 2025, Furuya's debt-to-asset ratio was 26.94%, down from 31.78% year-on-year, which is lower than the industry average of 27.21% [3] - The gross profit margin was 75.26%, slightly down from 76.50% year-on-year, but still above the industry average of 48.67% [3] Group 3: Shareholder Information - As of September 30, 2025, the number of A-share shareholders increased by 3.24% to 26,700, with an average holding of 8,742.06 shares, a decrease of 3.09% [5] - Notable changes among the top ten shareholders include a decrease in holdings by Huabao Zhongzheng Medical ETF and Ruiyuan Growth Value Mixed A, while Hong Kong Central Clearing Limited and Ping An Medical Health Mixed A entered the list as new shareholders [5] Group 4: Management and Compensation - The chairman and general manager, Wang Guanyi, received a salary of 1.63 million yuan in 2024, an increase of 1.33 million yuan from 2023 [4] Group 5: Market Outlook and Forecast - Analysts from Shenwan Hongyuan noted that the MASH drug development is accelerating, which will benefit Furuya's subsidiary Theraclion, with a projected net profit of 210 million yuan, 313 million yuan, and 426 million yuan for 2025-2027 [6] - Guosheng Securities highlighted the continuous expansion of Furuya's medical device business and stable growth in pharmaceuticals and medical services, adjusting the net profit forecast for 2025-2027 to 203 million yuan, 306 million yuan, and 421 million yuan, with growth rates of 79%, 51%, and 38% respectively [6]

Group 1 - Brendan completed a Ph.D. in organic synthesis at Stanford University in 2009 and has a background in the pharmaceutical industry, having worked for Merck from 2009 to 2013 [1] - Brendan has experience in biotech startups, including Theravance and Aspira, and is a co-founder of 1200 Pharma, which received significant investment in the eight figures [1] - Brendan remains an avid investor with a focus on market trends, particularly in biotechnology stocks [1]

Core Insights - The market is forward-looking, and investors who achieve better-than-average returns often identify overlooked opportunities by looking further into the future [1] Company Analysis: Novo Nordisk - Novo Nordisk has experienced a significant loss in market value due to increased competition in its primary therapeutic areas: diabetes and weight management [4] - The company is expected to receive approval for an oral version of its obesity therapy Wegovy within the next 12 months, which could be the first oral GLP-1 approved for weight management [5] - The oral formulation is advantageous as it is easier to store, transport, and manufacture, and is more patient-friendly compared to injections [5] - Wegovy has also gained approval for treating metabolic dysfunction-associated steatohepatitis (MASH), addressing a significant unmet medical need [6] - The success of Rezdiffra, which generated over $200 million in quarterly sales, suggests Wegovy could achieve similar success in the MASH market [7] - Novo Nordisk has several promising mid- and late-stage programs, including an investigational triple agonist that could enhance efficacy in diabetes and weight management [8] - New product launches and label expansions are expected to help Novo Nordisk maintain a strong market position [9] - The company is also developing another oral weight-loss medicine currently in phase 3 studies [10] Company Analysis: Merck - Merck is preparing for the future beyond the Keytruda patent expiration with new product launches and a promising pipeline [9]

Core Insights - The acquisition of Akero Therapeutics by Novo Nordisk for $5.2 billion marks a significant move into the FGF21 space, indicating the growing importance of metabolic disease treatments, particularly for metabolic dysfunction-associated steatotic liver disease (MASH) [2][12] - FGF21 is rapidly becoming a key target in the treatment of metabolic diseases, with major pharmaceutical companies like GSK and Roche also making substantial investments in similar assets, reflecting a competitive landscape reminiscent of the GLP-1 market boom [3][19] - The market for MASH is projected to reach $32.2 billion by 2030, driven by the increasing prevalence of obesity and type 2 diabetes, highlighting the commercial potential of FGF21 therapies [13][19] Company Strategies - Novo Nordisk's acquisition of Akero Therapeutics is part of a broader strategy to enhance its portfolio in the metabolic disease sector, especially after facing competitive pressures [16][18] - GSK's acquisition of Boston Pharmaceuticals' FGF21 asset aims to fill gaps in its MASH treatment offerings and is expected to complement its existing therapies [15][18] - Roche's acquisition of 89bio's FGF21 drug pegozafermin is intended to strengthen its position in cardiovascular and metabolic disease markets, showcasing a trend of major companies consolidating their portfolios through strategic acquisitions [16][18] Market Dynamics - The FGF21 target is emerging as a lucrative opportunity, with the potential to replicate the success seen with GLP-1 drugs, which have transformed into leading treatments for metabolic disorders [19][23] - The unique ability of FGF21 therapies to address late-stage liver disease (F4) provides a competitive edge over existing treatments, which are limited to earlier disease stages [13][19] - The ongoing trend of mergers and acquisitions in the FGF21 space is expected to intensify, driven by the substantial market size and the need for innovative therapies in metabolic diseases [22][23] Clinical Developments - Akero's Efruxifermin has shown promising clinical results, with nearly 50% improvement in liver fibrosis for F2-F3 MASH patients after 96 weeks of treatment, indicating its potential as a leading therapy in this area [11][19] - The advancements in protein engineering have allowed FGF21 drugs to overcome previous limitations, such as short half-lives, enabling less frequent dosing and enhancing their commercial viability [9][19] - Chinese pharmaceutical companies are also making strides in the FGF21 space, focusing on multi-target agents that could provide synergistic effects in treating metabolic disorders [20][21]

Group 1: Banking Industry - The People's Bank of China has implemented structural monetary policies to increase credit support for key service consumption sectors, including a special loan quota of 500 billion yuan for service consumption and elderly care [4] - As of the end of July, the loan balance in key service consumption sectors reached 2.79 trillion yuan, showing a year-on-year growth of 5.3% [4] - With the implementation of fiscal interest subsidies and the activation of credit stock, financing costs in the service consumption sector are expected to decrease, stimulating credit demand [5] - The banking sector is expected to see improved credit demand due to ongoing fiscal subsidy policies, with a positive outlook on bank performance and stock value recovery [6] Group 2: New Materials Industry - The rare earth magnetic materials sector experienced a significant decline of 8.06%, underperforming the benchmark by 7.62 percentage points [8] - Light rare earth concentrate prices have mostly rebounded, while praseodymium and neodymium prices have shown weak fluctuations [9] - The supply of praseodymium and neodymium is expected to increase slightly, while demand remains stable, leading to a balanced market [10] - The overall valuation and performance of the rare earth sector are under pressure, but there are opportunities for recovery as prices stabilize [11] Group 3: Innovative Pharmaceutical Industry - The global biotechnology sector showed mixed performance, with the Nasdaq biotech index rising by 0.86% while other indices fell [12] - The innovative drug industry in China is entering a pivotal phase where research results are beginning to translate into commercial success [13] - The MASH (Metabolic Dysfunction-Associated Steatotic Liver Disease) market is expected to expand rapidly, with significant investment opportunities in related treatments [14] - The innovative drug sector is anticipated to experience a dual recovery in performance and valuation, driven by ongoing policy support and market demand [15]