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Aroosha, patient ambassador 2Q26 Financial Results July 30, 2026
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Forward-looking Statements This presentation includes “forward-looking statements” made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, as amended, including statements related to the expected growth of Rezdiffra, expected growth of the MASH market, expectations regarding patent protection for resmetirom, Madrigal’s clinical development plans and timelines for its pipeline, Madrigal’s leadership position in the MASH sector, the potential benefit of resmetirom in patients with compensated MASH cirrhosis, Rezdiffra’s ability to potentially improve cardiovascular outcomes in patients with MASH, the potential benefit of Madrigal’s pipeline candidates for the treatment of MASH, the potential impact of positive results from the MAESTRO-NASH OUTCOMES trial and the competitive landscape and market dynamics. Forward- looking statements can be identified by terms such as “accelerate,” “achieve,” “allow,” “anticipates,” “appear,” “be,” “believes,” “can,” “confidence,” “continue,” “could,” “demonstrates,” ”design,” “estimates,” “expectation,” “expects,” “forecasts,” “future,” “goal,” “help,” “hopeful,” “inform,” “intended,” “intends,” “may,” “might,” “on track,” “planned,” “planning,” “plans,” “positions,” “potential,” “powers,” “predicts,” ”predictive,” “projects,” “seeks,” “should,” “will,” “will achieve,” “will be,” “would”, “future” or similar expressions and the negatives of those terms. Forward-looking statements are subject to a number of risks and uncertainties including, but not limited to: the assumptions underlying the forward-looking statements; our ability to successfully commercialize Rezdiffra in the U.S. and Europe; risks related to obtaining and maintaining regulatory approvals, including, but not limited to, potential regulatory delays or rejections; our history of operating losses and the possibility that we may never achieve or maintain profitability; risks associated with meeting the objectives of our clinical trials, including, but not limited to our ability to achieve enrollment objectives concerning patient numbers (including an adequate safety database), outcomes objectives and/or timing objectives for our trials; any delays or failures in enrollment, and the occurrence of adverse safety events; risks related to the effects of Rezdiffra’s (resmetirom’s) mechanism of action or of any other product candidate; market demand for and acceptance of Rezdiffra; our ability to service indebtedness and otherwise comply with debt covenants; outcomes or trends from competitors; future topline data timing or results; our ability to prevent and/or mitigate cyber-attacks; our ability to protect our intellectual property rights; the uncertainties inherent in clinical testing; uncertainties concerning analyses or assessments outside of a controlled clinical trial; and changes in laws and regulations applicable to our business and our ability to comply with such laws and regulations. Undue reliance should not be placed on forward-looking statements, which speak only as of the date they are made. Except as required by applicable law, Madrigal undertakes no obligation to update any forward- looking statements to reflect new information, events, or circumstances after the date they are made, or to reflect the occurrence of unanticipated events. Please refer to Madrigal’s reports filed with the U.S. Securities and Exchange Commission (SEC) for more detailed information regarding these risks and uncertainties and other factors that may cause actual results to differ materially from those expressed or implied. Madrigal specifically discusses these risks and uncertainties in greater detail in the sections appearing in Part I, Item 1A of its Annual Report on Form 10-K for the year ended December 31, 2025, and as updated from time to time by Madrigal’s other filings with the SEC. Madrigal may use its website to comply with its disclosure obligations under Regulation FD. Therefore, investors should monitor Madrigal’s website in addition to following its press releases, filings with the SEC, public conference calls, and webcasts. Madrigal Pharmaceuticals, Rezdiffra ® and associated logos are trademarks of Madrigal Pharmaceuticals, Inc. 2
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FIRST TO MARKET WITH BEST-IN-DISEASE PROFILE Madrigal: Exceptionally Well Positioned to Lead in MASH, a Highly Attractive Market Opportunity HIGHLY ATTRACTIVE MARKET DYNAMICS LEADERSHIP: TODAY & IN THE FUTURE 3
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Advancing Our 2026 Strategic Growth Priorities 1. Pending successful completion of MAESTRO-NASH OUTCOMES trial and FDA approval; F4c: Well-compensated MASH cirrhosis; LTM: Last twelve months; SAD: Single ascending dose. 4 Maximizing the Value of Rezdiffra Advancing Our Pipeline Delivering on best-in-industry drug launch Progressing toward F4c indication expansion Extending leadership through industry- leading pipeline • Net patients: >49K 2Q26 • LTM net sales: nearly $1.3B • Potential to double Rezdiffra opportunity1 • >10 programs; 4 in clinical stage • Initiated MGL-2086 Ph.1 SAD trial • Strengthened IP with 3 new patents, including F4c patent
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5 2Q26 Earnings Call Option D Agenda R&D Update Rezdiffra Launch Update Company Financials 2Q26 Earnings
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$212.8M $364.3M 2Q25 2Q26 6 2Q26 net sales $364.3M 71% YoY growth Rezdiffra Net Sales: Continuing to Generate Strong Uptake Rezdiffra Net Sales
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>2,000 >6,800 >11,800 >17,000 >23,000 >29,500 >36,250 >42,250 >49,000 2Q24 3Q24 4Q24 1Q25 2Q25 3Q25 4Q25 1Q26 2Q26 Steadily Adding Patients in a Large and Growing Market 7 Patients on Rezdiffra: Steadily Adding Patients1 >2x Patient growth vs. 2Q25 Strong Patient Growth YoY 1. Specialty pharmacy and distribution dispense data. >50K milestone achieved earlier in July
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Nearly 50% Growth in the F2-F3 Target MASH Market Since YE 2023 U.S. F2-F3 MASH Population has Increased Nearly 50 Percent Since YE 2023; Double-Digit Growth Anticipated Going Forward Key Drivers of MASH Market 1. Diagnosed F2-F3 U.S. MASH patients being seen by target liver specialists; Estes et al. (F2-F3 staging); Forian claims data. MASH Market Growth Since YE 20231 Diagnosis rate (~10% today) Urgency to treat 460K YE2023 YE2025 U.S. MASH market expected to grow double digits 315K 8 Disease awareness New entrants Treatment penetration (~10% today)
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MASH is Similar to Other Large Therapeutic Categories Where Additional Therapies Grow the Market Over Time Source: Evaluate Pharma; 1. Represents net sales of Rezdiffra only in FY25: $958.4M; IBD: Inflammatory bowel disease; RA: Rheumatoid arthritis. 9 ~$1B1 ~$23B ~$25B ~$32B Therapeutic Category MASH RA IBD Psoriasis # of approved therapies in 2025 2 13 20 15 Year first therapy was approved 2024 1999 1998 2004 Total Global Sales by Therapeutic Category in 2025
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460,000 Rezdiffra target market: F2-F3 patients diagnosed and seeing a treating specialist1 ~10% Penetrated in a Market with ~10% Diagnosis Rate; Addressable Patient Population Poised for Significant Expansion 10 Significant opportunity for market growth and Rezdiffra penetration ~10% Rezdiffra penetration ~10% of MASH Patients diagnosed 1. U.S. F2-F3 MASH Market; Forian claims data.
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11 Future market opportunity is significant ~$1.3B LTM net sales1 1. Rezdiffra net sales; LTM: Last twelve months. Rezdiffra is Already Tracking at Blockbuster Run Rate in a Market That is Still in its Infancy Screening Diagnosis Treatment Awareness 460,000
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Expansion into F4c has the Potential to Double the Opportunity for Rezdiffra F4c outcomes trial data expected in 2027 Estimated addressable U.S. patient population 1 ~245,000 Rezdiffra tracking to be first to market3 No treatments available today 2-year OLE data provides confidence in MAESTRO- NASH OUTCOMES4 Higher urgency to treat given 42x higher risk of liver- related mortality 2 Significant Unmet Need in Well-Compensated MASH Cirrhosis (F4c) 1. Forian claims data; 2. Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis. Hepatology. 2017;65(5):1557-1565; 3. Pending successful completion of MAESTRO-NASH OUTCOMES trial and FDA approval; 4. 2-year OLE data are from the F4c cohort of the Phase 3 MAESTRO-NAFLD-1 trial; OLE: Open-label extension. 12 New F4c patent
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13 Madrigal is Shaping the Future of MASH • Treatment available in F2-F3 • Treatment available in F2-F4c • Combination therapy strategies undefined • Combination therapies to drive better outcomes and tailored treatment approaches • ~10% patients diagnosed • ~10% patients treated • Awareness and screening expand diagnosed and treated patient population is the foundational therapy MASH Treatment Today MASH Treatment in the Future MASH is a complex, heterogeneous disease with a broad spectrum of comorbidities. We believe its future will include multiple therapies, combinations and personalized regimens.
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14 1. Higher percentages in fibrosis reduction relative to placebo reflect better outcomes, with points farther to the right indicating greater benefit; 2. Harrison SA, et al. A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis. N Engl J Med. 2024;390(6 Suppl 1):S31; 3. Resmetirom Effects on NASH With Liver Fibrosis in Patients With NASH Genetic Risk Alleles. Gastroenterol Hepatol (N Y). 2024;20(12 Suppl 11):16-17; Genetic subgroup data results are based on consensus reads and a standard unstratified analysis method; 4. Results displayed only show the effects of the use of 100mg resmetirom, 80mg data available in cited publications. BMI: Body mass index; CI: Confidence interval; HSD17B13: Hydroxysteroid 17-beta dehydrogenase 13, loss of function variant is protective against MASH; PBO: Placebo; PNPLA-3: Patatin-like phospholipase domain-containing protein 3, homozygous genotype strongly associated with MASH progression; T2D: Type-2 diabetes. Data from Ph.3 MAESTRO-NASH Supports Rezdiffra’s Broad and Consistent Efficacy Across Each Patient Subgroup Rezdiffra demonstrated efficacy across each key patient subgroup2,3,4 11.3 (4.4, 18.3) 11.4 (2.1, 20.8) 11.0 (4.8, 17.3) 13.2 (3.0, 23.4) F3 (n=207) F2 (n=99) T2D (n=212) No T2D (n=109) 22.0 (8.7, 35.3) 23.2 (7.5, 38.9) 19.2 (10.0, 28.4) 19.0 (6.5, 31.6) No PNPLA3 Variant (n=72) Homozygous PNPLA3 Variant (n=55) No HSD17B13 Variant (n=151) HSD17B13 Variant (n=78) 11.8 (4.2, 19.4) 11.1 (3.4, 18.9) BMI<35 kg/m2 (n=162) BMI≥35 kg/m2 (n=159) -10 0 10 20 30 40 % relative to PBO (95% CI) Fibrosis Reduction1 (Resmetirom 100mg) Key Patient Subgroup
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15 ANTICIPATE-NASH Score of CSPH Supports Resmetirom’s Potential in F4c F4c OLE cohort from the MAESTRO-NAFLD-1 Trial demonstrated improvements in ANTICIPATE-NASH CSPH risk score1 1. Alkouri, N. Baseline ANTICIPATE score and response predicts liver outcome events in a 180-patient MASH cirrhosis cohort treated with resmetirom [Poster], EASL Top Poster, May 27 – 30, 2026, Barcelona, Spain; CSPH: Clinically significant portal hypertension. EASL: European Association for the Study of the Liver; OLE: Open-label extension. 25% 39.7% 45.5% 31.9% 26.7% 28.7% 22.4% 25% 13.9% 20.7% 8.6% 11.9% 0% 20% 40% 60% 80% 100% Baseline Year 1 Year 2 Distribution of ANTICIPATE-NASH CSPH risk categories at baseline, Year 1, Year 2 ≤25% >25-50% >50-75% >75% Proportion of patients classified as higher risk for CSPH decreased from 75% at baseline to ~55% over two years
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16 Secondary Analysis of MAESTRO-NASH Trials Supports Rezdiffra’s Potential to Lower Cardiovascular Risk 1. Bansal, M. Reducing CV risk in patients with MASH independent of baseline statin use: Lp(a) and LDL-C lowering by resmetirom [Poster], EASL Congress, May 27 – 30, 2026, Barcelona, Spain; Results from the table are based on resmetirom use of 100mg, 80mg results are also available in the poster. EASL: European Association for the Study of the Liver; Apo-B: Apolipoprotein B; LDL-C: Low density lipoprotein cholesterol; Lp(a): Lipoprotein(a) TG: Triglyceride. -18.3 -20.8 -16.3 -38.3 -14.2 -19.4 -21.7 -32.7 -45 -40 -35 -30 -25 -20 -15 -10 -5 0 LDL-C Apo-B TG Lp(a) Percentage change from baseline at Week 24 Statin No Statin Significant reduction of multiple atherogenic lipids and lipoproteins associated with cardiovascular risk, including LDL-C and Lp(a) regardless of baseline statin use Rezdiffra’s Impact on Lipids Rezdiffra has the potential to address both liver disease and cardiometabolic risk1
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17 Rezdiffra’s Real World Data Supports its Benefit on Liver Health 1. Kim, Y. Early real-world effectiveness of resmetirom in adults with metabolic dysfunction associated steatohepatitis and moderate-to-advanced fibrosis [Poster], EASL Congress, May 27 – 30, 2026, Barcelona, Spain; 2. Parrinello, C. Twelve-month changes in liver function enzymes, lipids, and vibration-controlled transient elastography measures in patients receiving resmetirom [Poster], EASL Congress, May 27 – 30, 2026, Barcelona, Spain. EASL: European Association for the Study of the Liver; LDL-C: Low density lipoprotein cholesterol; LSM: Liver stiffness measurement; VCTE: Vibration-controlled transient elastography. 48.6% My patients on Rezdiffra are doing even better than I anticipated they would; my real-world experience with the therapy has surpassed my expectations. I have more than 200 patients on Rezdiffra for over a year who have been retested with NITs, and the vast majority of them have not only stabilized but are actually improving. – Pierre Gholam, M.D.; Hepatologist Rezdiffra demonstrated improvement of liver-related biomarkers, LDL-C, liver stiffness and steatosis in early real-world evidence1,2 Real-World Prescriber Experience ≥25% reduction in LSM<25% reduction in LSM Reduction in VCTE LSM (mean follow-up period ~9 months)
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18 Multiple Initiatives Geared Toward Understanding More About MASH Continued real world data generation demonstrating Rezdiffra’s efficacy in everyday clinical practice Presented multiple abstracts at EASL and more to come at AASLD 2026 Understanding Rezdiffra’s role in vulnerable patient populations Examples: Post-transplant MASH patients; HIV+ MASH patients Real World Evidence Special Populations
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Population Preclinical Phase 1 Phase 2 Phase 3 Approved MASH F2-F3 MASH F4c Ervogastat/resmetirom combo2 Oral DGAT-2 inhibitor/oral THR-β agonist MASH MGL-2086/resmetirom combo3 Oral GLP-1 RA/oral THR-β agonist MASH MGL-0795/resmetirom combo4 siRNA PNPLA3/oral THR-β agonist MASH siRNA/resmetirom combo (6 programs) MASH Additional MASH Assets 3 exploratory assets in varying stages of development MASH Advancing the Industry-Leading MASH Pipeline to Transform Patient Care 1. Rezdiffra in F2-F3 MASH is approved under accelerated (conditional) approval based on improvement of MASH and fibrosis; continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials; 2. Ervogastat monotherapy Phase 2b trial completed by Pfizer; drug-drug (resmetirom/ervogastat) interaction (DDI) trial expected to initiate in 4Q26; Phase 2 combination trial expected to initiate in 2027 following regulatory discussions; 3. MGL- 2086 Phase 1 single ascending dose (SAD) trial initiated in 2Q26; 4. MGL-0795 (formerly ARO-PNPLA3) monotherapy Phase 1 trial completed by Arrowhead; DGAT-2: Diacylglycerol O-acyltransferase 2; GLP-1 RA: Glucagon-like peptide-1 receptor agonist; siRNA: Small interfering RNA; THR-β: Thyroid hormone receptor beta. 19 Phase 1 Trial of MGL-2086 initiated June 2026 Resmetirom Oral THR-β agonist 1
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Consolidated Statement of Operations: 2Q26 20 Three Months Ended June 30 (in thousands)1 2026 2025 Revenues: Product revenue, net $364,252 $212,802 Operating expenses: Cost of sales $40,007 $9,065 Research and development $91,178 $54,081 Selling, general and administrative $289,375 $196,858 Total operating expenses2 $420,560 $260,004 Loss from operations ($56,308) ($47,202) Interest income $7,104 $8,227 Interest expense ($7,940) ($3,264) Other expense, net ($795) ($42) Net loss ($57,939) ($42,281) Basic and diluted net loss per common, Series A and Series B preferred share ($1.99) ($1.50) Basic and diluted weighted average number of shares outstanding3 29,145,271 28,232,604 Rezdiffra 2Q26 net sales: $364.3M Strong balance sheet: Strong balance sheet: $838.9M In cash, cash equivalents, restricted cash, and marketable securities as of June 30, 2026 1.In thousands except for basic and diluted loss per common share and average number of common shares outstanding; 2. Amounts include non-cash stock-based compensation expense as follows for 2Q26 and 2Q25: Cost of sales: $0.1 million and $0.0 million, respectively; Research and development: $6.9 million and $5.4 million, respectively; Selling, general and administrative: $28.4 million and $19.8 million, respectively; 3. Basic and diluted weighted average shares outstanding reflect the weighted-average impact of common stock, previously issued prefunded warrants, previously issued Series A and Series B convertible preferred shares outstanding, and earned PSUs during the period. Preparing for Profitability
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Madrigal is Well-Positioned for Continued Value Creation in 2026 and Beyond 21 Leading the Fight Against MASH ~$1.3B LTM net sales Rezdiffra F2-F3 Launch Building Our Pipeline Pipeline programs >10~50% F2-F3 MASH Market Growth Since YE 2023 Patient Growth Patient growth vs. 2Q25 >2x
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Aroosha, patient ambassador 2Q26 Financial Results July 30, 2026