Madrigal Pharmaceuticals vs Nektar Therapeutics: Why 2026 Investors Should Know the Difference

The Case for Madrigal Pharmaceuticals as a Biotech Play

Madrigal Pharmaceuticals has already crossed a critical threshold that most clinical-stage companies never reach. The company earned FDA approval in 2024 for Rezdiffra, marking the first medicine specifically indicated for metabolic dysfunction-associated steatohepatitis (MASH) in the U.S. market. This regulatory victory has translated into tangible commercial success.

The revenue numbers speak clearly. In the third quarter of 2025, Rezdiffra generated $287.3 million in net sales—a remarkable figure for a newly launched product. Industry analysts project the medicine will achieve blockbuster status (over $1 billion in annual sales) by 2026. With millions of potential MASH patients in the U.S. and minimal competitive landscape in this therapeutic category, Madrigal appears positioned for sustained growth.

While Rezdiffra operates under accelerated approval status and must demonstrate efficacy through confirmatory trials to maintain its market position, the strong demand signals and prescription trends suggest investor confidence is warranted. Regulators are likely to show more flexibility with approvals in underserved disease areas like MASH compared to crowded therapeutic markets.

Nektar Therapeutics: The Unproven Alternative

Nektar Therapeutics presents an entirely different risk profile. The company’s lead asset, rezpegaldesleukin, succeeded in phase 2b clinical trials for eczema treatment—a massive market dominated by blockbuster drugs like Dupixent and Rinvoq. On the surface, this represents promising clinical validation.

However, Nektar remains a pre-commercial biotech without a single product generating revenue. The company continues to post significant net losses—the hallmark of clinical-stage biotechs operating ahead of commercialization. This structural vulnerability cannot be ignored.

The path from phase 2b success to market approval is notoriously treacherous. Mid-stage data, while encouraging, offers no guarantee of late-stage study success. Consider aTyr Pharmaceuticals, which demonstrated strong mid-stage results for its lead candidate only to witness complete failure during phase 3 trials in September 2025. The resulting stock collapse became a stark reminder of biotech volatility. Rezpegaldesleukin could face a similar trajectory, potentially sending Nektar into financial distress or irrelevance.

A Tale of Two Companies

Both Madrigal Pharmaceuticals and Nektar Therapeutics operate in the life sciences sector, but they occupy vastly different positions in their corporate lifecycles.

Madrigal has moved beyond clinical uncertainty. With approved product, commercial infrastructure, and near-blockbuster revenue trajectory, the company can weather inevitable setbacks. Even if confirmatory trials present challenges, the medicine’s market presence provides a foundation that clinical-stage programs simply cannot offer.

Nektar remains dependent on the binary outcome of future clinical trials. While rezpegaldesleukin’s immunology potential is noteworthy, the risk of catastrophic failure remains material. Stock price movements for pre-commercial biotechs can swing dramatically on single clinical announcements.

The 2026 Investment Decision

For investors seeking biotech exposure in 2026, the choice between these companies reflects a fundamental decision about risk tolerance. Madrigal Pharmaceuticals offers a more established commercial footprint with proven market demand and revenue generation. Nektar Therapeutics presents higher volatility and greater downside exposure despite its clinical promise.

The biotech sector rewards both innovation and execution. Madrigal has demonstrated execution capability; Nektar remains in the execution phase. Understanding this distinction helps investors make more informed portfolio decisions for the year ahead.