MASH Development Map 2025: Industry Realignment Through M&A and Partnerships
Comprehensive analysis of major MASH acquisitions and partnerships in 2025. Detailed examination of GSK, Roche, and Novo Nordisk mega-deals, approvals, and the latest industry trends with interactive visualization.
Introduction
MASH (Metabolic Dysfunction-Associated Steatohepatitis) has emerged as an area of intense pharmaceutical industry focus due to extremely high unmet medical needs. The year 2025 has been transformative, with major Big Pharma acquisitions significantly reshaping the competitive landscape.
This article provides a comprehensive analysis of the MASH development race in 2025 from the perspectives of acquisitions, partnerships, and approvals.
MASH: Wave of Big Pharma Mega-Acquisitions
Major Acquisition Deals
The MASH space in 2025 witnessed three major Big Pharma acquisitions.
1. GSK → Boston Pharmaceuticals (May 2025)
In May 2025, GSK acquired Boston Pharmaceuticals' lead asset, efimosfermin alfa (formerly BOS-580), for an upfront payment of $1.2 billion, with up to $800 million in potential milestone payments12.
Key Asset Characteristics:
- Efimosfermin alfa demonstrated significant improvements in liver fibrosis and MASH resolution in Phase 2 trials involving patients with F2/F3 fibrosis34
- GSK plans to develop the drug for a broader range of steatotic liver diseases (SLD), including MASH and alcohol-related liver disease (ALD), targeting commercialization in 202925
2. Roche → 89bio (September 2025)
In September 2025, Roche acquired 89bio for an upfront payment of $2.4 billion, with an additional $1.1 billion in potential milestone payments (total deal value up to $3.5 billion)67.
Key Asset Characteristics:
- Lead candidate pegozafermin is a fibroblast growth factor 21 (FGF21) analog targeting moderate to severe MASH treatment68
- Phase 3 trials ENLIGHTEN-Fibrosis (non-cirrhotic F2-F3 patients) and ENLIGHTEN-Cirrhosis (compensated cirrhotic F4 patients) are ongoing89
- Topline results from ENLIGHTEN-Fibrosis expected in first half of 2027, and ENLIGHTEN-Cirrhosis in first half of 20289
3. Novo Nordisk → Akero Therapeutics (October 2025)
In October 2025, Novo Nordisk acquired Akero Therapeutics for an upfront payment of $4.7 billion, with up to an additional $500 million contingent upon FDA approval for compensated cirrhosis due to MASH1011.
Key Asset Characteristics:
- Lead candidate efruxifermin (EFX) is an FGF21 analog that Novo Nordisk believes has "first- and best-in-class" potential for MASH1012
- Under development in Phase 3 SYNCHRONY program for both pre-cirrhotic MASH (F2-F3) and compensated cirrhosis (F4)1314
- 96-week results from Phase 2b SYMMETRY trial announced in January 2025 showed statistically significant improvement of compensated cirrhosis (F4) due to MASH15
Approved Therapeutics
Madrigal Pharmaceuticals - Rezdiffra (resmetirom)
- FDA approval obtained in March 2024, conditional marketing authorization from European Commission in August 20251617
- Industry's first approved drug for MASH treatment with F2-F3 fibrosis, leading the market16
- Launched in Germany in September 202517
Novo Nordisk - Wegovy (semaglutide)
- In August 2025, FDA approved for treatment of adult MASH patients with moderate to advanced liver fibrosis (without cirrhosis)1819
- In December 2025, Health Canada also granted conditional marketing authorization for non-cirrhotic MASH (F2-F3 fibrosis)20
Companies Seeking Partners
Viking Therapeutics
- Phase 2b VOYAGE trial of lead candidate VK2809 showed favorable 52-week histological data2122
- CEO stated that "a large partner would be very helpful in driving the program through commercialization" and expressed openness to partnership negotiations2324
- Plans to discuss Phase 3 strategy with FDA23
Retreating Companies
Gilead Sciences
- In August 2025, discontinued partnership with Novo Nordisk (combination therapy of cilofexor + firsocostat + semaglutide)25
- Also terminated partnership with Korean company Yuhan in October 202426
- Fibrotic disease pipeline now "entirely empty"25
Industry Map: Visualizing Company Relationships
The following Mermaid diagram visualizes the major acquisitions, approvals, and development status in the MASH space in 2025.
Legend:
- 🔵 Blue: Big Pharma (acquiring companies)
- 🟢 Green: Approved companies
- 🔴 Red: Retreating/discontinued companies
- 🟠 Orange: Companies seeking partners
Analysis: Industry Trend Analysis
1. Big Pharma Acquisition of De-Risked Assets
All three major MASH acquisitions in 2025 (GSK/Boston, Roche/89bio, Novo/Akero) involved "de-risked" assets with positive Phase 2 or later data. This demonstrates Big Pharma's strategy of avoiding early-stage development risks and entering the market after some degree of efficacy has been confirmed.
2. Concentration on FGF21 Analogs
Both pegozafermin (89bio) and efruxifermin (Akero), acquired by Roche and Novo Nordisk respectively, are FGF21 analogs. This concentration indicates that the FGF21 pathway is being valued as a differentiated mechanism for anti-fibrotic and anti-inflammatory effects.
3. Indication Expansion and Combination Strategies
GSK's efimosfermin alfa is pursuing indication expansion beyond MASH to alcohol-related liver disease (ALD). Additionally, the possibility of combination therapy with existing anti-fibrotic drugs is being explored, suggesting that combination strategies will become increasingly important in future development.
Conclusion
The MASH space in 2025 experienced accelerated industry consolidation with multiple Big Pharma mega-acquisitions. GSK, Roche, and Novo Nordisk invested over $8 billion collectively to acquire promising biotech assets and secure market entry.
Moving forward, the Phase 3 results and regulatory approvals of these acquired assets will be closely watched. Particularly, the clinical performance of the FGF21 analogs acquired by Roche and Novo Nordisk from 2027 onwards will significantly shape the future of MASH treatment.