Pharmacy, Claims Data Show High Resmetirom Persistence in MASH

Most adults with metabolic dysfunction–associated steatohepatitis (MASH) who started resmetirom (Rezdiffra; Madrigal Pharmaceuticals) were still filling the drug 6 months later, and resmetirom persistence at 1 year ranged from 62.2% to 72.4%, according to 3 real-world analyses presented at The Liver Meeting 2026.^1-3

The posters offer a look at how the once-daily MASH therapy is being used outside clinical trials. The 3 persistence studies drew on pharmacy fill and multipayer claims data and were conducted by or in collaboration with Madrigal. A fourth study conducted by researchers at Cleveland Clinic and Summit Clinical Research using Epic Cosmos electronic health record data looked earlier in the treatment journey and found that fewer than 4 in 10 patients with a new resmetirom prescription filled it within 30 days.⁴

The FDA granted resmetirom accelerated approval on March 14, 2024, for adults with noncirrhotic MASH with moderate to advanced liver fibrosis to be used along with diet and exercise. At the time, the agency cited an estimate that 6 million to 8 million people in the United States have the disease, then called nonalcoholic steatohepatitis, with moderate to advanced liver scarring.⁵ Semaglutide (Wegovy; Novo Nordisk) followed with accelerated approval for the same population on August 15, 2025.⁶

Madrigal reported more than 55,850 patients on resmetirom therapy as of September 30, 2026.⁷ Because the histologic end points that supported approval were assessed at 52 weeks, whether patients stay on therapy beyond the first year is a key question for clinicians and payers.

Resmetirom Persistence in Pharmacy and Claims Data

The largest analysis used specialty and retail pharmacy fill data from CVS Healthspire for adults with at least 2 resmetirom fills, with follow-up starting at a first fill on or after the March 14, 2024, approval.¹ Among 11,469 patients assessed at 6 months (mean age, 57.5 years; 56.1% female), persistence was 89.4% using a 60-day grace period, and the mean proportion of days covered (PDC) was 85.7%, with 75.9% reaching a PDC of at least 80%. At 12 months, persistence was 72.4%, and the mean PDC was 76.4%, with 61.7% reaching a PDC of at least 80%.

A Carelon Research analysis of the Healthcare Integrated Research Database included 1592 adults with at least 1 resmetirom claim between April 2024 and October 2025.² Persistence, defined as no gap of 60 days or more between fills, was 81% at 6 months (n = 880) and 68.4% at 12 months (n = 392). Persistence at 12 months was 75% among patients with a liver biopsy in the prior 3 years and 66.0% among those without one, a difference that was not statistically significant (P = .116).

The third study used McKesson multipayer closed claims covering approximately 80 US commercial, Medicare, and Medicaid payers and included 304 new users with at least 2 resmetirom fills and continuous enrollment for 12 months before and after initiation.³ Persistence was 82.2% at 6 months and 62.2% at 12 months, with a mean (SD) of 299.8 (96.9) persistent days. Among patients who remained persistent through 12 months, mean (SD) PDC was 0.910 (0.07), and 91.0% had a PDC of at least 80%.

Fewer Than 4 in 10 Fill a New Resmetirom Prescription Within 30 Days

The Cleveland Clinic–led team measured primary adherence, defined as at least 1 dispense within 30 days of a new prescription, among 10,591 adults prescribed resmetirom between April 1, 2024, and March 1, 2026 (mean age, 57.9 years; 59.4% female).⁴ Of these, 6453 patients (60.9%) filled the prescription at any point during the study period. Of those who filled it, 64.7% did so within 30 days, 78.5% within 60 days, and 84.6% within 90 days, with a median of 18 days (IQR, 7-49) from prescription to first dispense.

In adjusted analyses, Medicare coverage (vs private insurance; adjusted OR, 1.16; 95% CI, 1.04-1.29), Asian race (vs White; adjusted OR, 1.39; 95% CI, 1.11-1.74), and a baseline liver biopsy (adjusted OR, 1.18; 95% CI, 1.04-1.34) were associated with higher odds of primary adherence. Medicaid coverage (adjusted OR, 0.73; 95% CI, 0.54-0.97), Hispanic ethnicity (adjusted OR, 0.86; 95% CI, 0.75-0.98), and type 2 diabetes (adjusted OR, 0.86; 95% CI, 0.79-0.95) were associated with lower odds.

“In this large real-world study, fewer than 4 in 10 patients prescribed resmetirom filled the prescription within 30 days, with notable differences by race, ethnicity and insurance,” the authors wrote.

Notably, all 4 studies were retrospective and observational, and none has yet been published as a full peer-reviewed article. The persistence analyses used different data sources, grace periods, and adherence calculations, so their estimates are not directly comparable. Pharmacy and claims data also do not capture why patients stopped treatment or whether persistence translated into histologic or clinical benefit. The CVS Healthspire authors called for further research on the drivers of persistence and on the relationship between adherence and clinical outcomes.

“Continued monitoring and targeted interventions may help sustain long-term treatment use,” they concluded.¹

References

1. Fernandes J, Kumar R, Thomas SM, Thomas B, Atreja N, Lobo F. Real-world medication adherence and persistence to resmetirom in patients with MASH. Poster presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO. Abstract 2530.

2. Dixon R, Wang Z, Teng CC, et al. Treatment persistence among patients prescribed resmetirom in a US claims-based cohort. Poster presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO. Abstract 3559.

3. Lobo F, Han Y, Atreja N, Felber G, DeKoven M. Treatment continuity with resmetirom: a real-world study of adherence and persistence in metabolic dysfunction-associated steatohepatitis (MASH). Poster presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO. Abstract 3514.

4. Le P, Alkhouri N, Tran H, Gasoyan H, Rothberg M. From prescription to dispense: primary adherence to resmetirom in real-world clinical practice. Hepatology. 2026;84(suppl 1):S1230-S1231. doi:10.1097/HEP.0000000000001842

5. FDA approves first treatment for patients with liver scarring due to fatty liver disease. News release. FDA. March 14, 2024. Accessed November 5, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-patients-liver-scarring-due-fatty-liver-disease

6. Novo Nordisk A/S: Wegovy approved in the US for the treatment of MASH. News release. Novo Nordisk. August 15, 2025. Accessed November 5, 2026. https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=916416

7. Madrigal Pharmaceuticals reports third-quarter 2026 financial results and provides corporate updates. News release. Madrigal Pharmaceuticals. November 3, 2026. Accessed November 9, 2026. https://ir.madrigalpharma.com/news-releases/news-release-details/madrigal-pharmaceuticals-reports-third-quarter-2026-financial