The MASH drug pipeline now spans more than 180 companies and 200 investigational therapies, research firm DelveInsight said in an October 20, 2026 announcement. Its latest competitive landscape assessment highlights late-stage trials, licensing agreements and multiple treatment approaches targeting the progressive liver disease.
Key Takeaways
- DelveInsight identifies more than 200 pipeline therapies, although most remain in early or middle stages of development.
- Inventiva reported completion of final patient visits in its Phase III NATiV3 trial in September 2026.
- Licensing agreements are expanding Madrigal Pharmaceuticals’ research portfolio beyond its approved treatment Rezdiffra.
Table of Contents
- MASH drug pipeline spans multiple treatment approaches
- Clinical milestones extend from early trials to Phase III
- Licensing broadens the competitive field
- Conclusion
MASH drug pipeline spans multiple treatment approaches
Metabolic dysfunction-associated steatohepatitis, or MASH, is an inflammatory form of fatty liver disease associated with obesity, type 2 diabetes and other metabolic risk factors. It can progress to fibrosis, cirrhosis and liver cancer, making both metabolic dysfunction and liver damage targets for drug developers.
DelveInsight’s 2026 MASH competitive landscape assessment groups development programs by stage, product type, administration route and molecule type. The research covers a broad field rather than a single clinical breakthrough: the announcement identifies more than five late-stage candidates and more than 100 drugs in early and middle development.
Approaches include FGF21-based therapies, glucagon and GLP-1 receptor agonists, and RNA interference. These programs remain investigational, and their inclusion in the pipeline does not establish regulatory approval or commercial success.
| Item | Details |
|---|---|
| Efimosfermin — GSK | Phase III; FGF21-based therapy administered by subcutaneous injection. |
| Zabopegdutide — D&D Pharmatech | Phase II; glucagon/GLP-1 receptor agonist administered by subcutaneous injection. |
| ALN-CIDEB — Alnylam/Regeneron | Phase II; RNA interference targeting CIDEB expression, administered by subcutaneous injection. |
| IMM-H014 — Changchun Intellicrown | Phase I/II; oral NF-E2 related factor agonist. |
Clinical milestones extend from early trials to Phase III
In September 2026, Inventiva announced that the last patient had completed the final 72-week visit in NATiV3, its Phase III trial of lanifibranor in patients with MASH and moderate or advanced fibrosis. Completion of patient visits is an operational milestone, not a statement of trial results.
Altimmune announced the start of its global PERFORMA Phase III trial of pemvidutide in August 2026, with a 52-week data readout anticipated in 2029. That followed its May announcement that the protocol had been finalized and submitted to the FDA.
Earlier-stage work also advanced. Tangram Therapeutics said in September 2026 that TGM-312 had progressed into Part B of its ongoing Phase I/II RESTORE-MASH trial. Rivus Pharmaceuticals reported the first patients dosed in its Phase II AMPLIFY study of HU6 in April 2026.
Licensing broadens the competitive field
The development activity sits alongside an established treatment market. Madrigal’s oral therapy Rezdiffra received FDA approval on March 14, 2024, for adults with noncirrhotic MASH and moderate-to-advanced fibrosis, in combination with diet and exercise.
Madrigal has also expanded its investigational portfolio. In May 2026, it announced an exclusive global license agreement with Arrowhead Pharmaceuticals for ARO-PNPLA3, a clinical-stage small interfering RNA therapy targeting a genetic driver of MASH.
In February 2026, Suzhou Ribo Life Science and its subsidiary Ribocure Pharmaceuticals announced a separate worldwide licensing agreement with Madrigal covering six preclinical small interfering RNA programs. The agreements illustrate how companies are adding different biological targets, but the announcement provides no basis for comparing their eventual commercial value.
Conclusion
The next substantive tests are clinical results rather than pipeline counts. Inventiva has completed NATiV3 patient visits, while Altimmune’s stated timetable places PERFORMA’s anticipated 52-week readout in 2029.
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