China Merchants Securities: The MASH market is broad and pharmaceuticals are limited, and a number of major pipelines will usher in key points

The Zhitong Finance App learned that China Merchants Securities released a research report saying that MASH is a type of multiple metabolic disease with a huge number of patients but drug treatment has just begun. It is a widespread chronic progressive liver disease and is the primary cause of liver cirrhosis and liver cancer. The need for treatment is urgent, but currently the FDA has only approved the launch of 2 drugs, which have huge unmet clinical needs. Since 2024, MASH drug development has made positive progress, attracting many MNCs to compete for deployment. It is expected that 2026H2-2027 will read core data from several major pipelines, and the market will usher in rapid expansion.

The main views of China Merchants Securities are as follows:

The MASH market is broad, but currently there are limited drugs on the market

As the incidence of diseases such as obesity, T2D, and dyslipidemia increases, the number of MASH patients worldwide and China is close to 400 million and 44 million, and MASH, as a chronic progressive liver disease, is one of the leading causes of liver cirrhosis and liver cancer, and there is an urgent need for treatment; however, due to the complexity of MASH treatment, no MASH treatment has been approved for a long time. As of 2026H1, the FDA has only accelerated approval of Resmetiron (2024) and simeglutide (2025) for F2-F3 MASH treatment, but domestically No drugs targeting MASLD/MASH have been approved for marketing. MASH clinical treatment is in high demand, and available medications are still limited.

THR-beta and GLP-1RA are the first to hit the line, focusing on novel mechanistic drugs and concomitant strategies such as FGF21, GLP-1RA+, and micronucleic acids

Anti-inflammation, improving fibrosis, and lipid metabolism are the core requirements of MASH drug development. THR-beta and GLP-1R targets have been verified by directly targeting the liver and regulating systemic metabolism. Follow-up, we need to focus on the differentiated advantages of GLP-1R+, FGF21, PPARs, Pan-PDE, and micronucleic acid therapy in improving efficacy and safety; 1) FGF21: Outstanding ability to reverse fibrosis. MNCs such as Novo Nordisk, GSK, and Roche have the potential to reverse F4 fibrosis, but we need to focus on their AE performance; 2) GLP -1R+: Simeglutide successfully confirmed the efficacy of GLP-1RA in the treatment of F2-F3 MASH. Dual- and triple-target agonists, including tirpotide, survodutide, and retaglutide, showed better anti-inflammatory and improved fibrosis effects. GLP-1R+ is expected to be a cornerstone drug for combined use; 3) PPARs: acts simultaneously within the liver and outside the liver. Multiple pathways treat MASH, focusing on AEs such as weight gain and peripheral edema; 4) Small nucleic acids: directly from the genetic level Interferes with disease progression and targets liver delivery Technology maturity is an important direction for MASH precision treatment. Targets such as DGAT2, 17β-HSD13, PNPLA3, CIDEB, and MARC1 have entered the clinical stage.

Resmetiron opens a new era of MASH treatment, and several major pipelines will read key data in 2026H2-2027

Resmetiron is the first MASH treatment approved by the FDA. Sales increased rapidly after launch in February 2024, reaching US$960 million in 2025. In addition, several major pipelines will read core data one after another, bringing new volume to the MASH treatment market; 1) Resmetiron's phase III clinical trial MAESTRO-NASHOUTCOMES for F4c MASH indications will read data in 2027, which is expected to become the first approved F4c MASH treatment, and the market space will double; 2) Pegozafermin developed by Roch/89 BIO will read top-line histological data for F2-F3 MASH and F4 MASH in 2027H1 and 2028; 3) eFruxifermin developed by Novo Nord/Akero will read p3 synchrony real-world and synchrony HISTORY data in 2026q4 and 2027, respectively; 4) pan-PPARS agonist developed by Inventiva LanifiBranor will read phase III top-line data at 26q4 and submit an NDA on 27H1.

Risk warning: R&D failure, policy changes, market promotion, increased competition, technology iteration risks, etc.