Novo Nordisk Acquires Akero — A $5.2B MASH Bet

Under the terms of the deal, Novo Nordisk will purchase Akero for $54 per share in cash, representing a 19% premium to its 30-day volume-weighted average stock price. The transaction also includes a Contingent Value Right (CVR): shareholders will receive an additional $6 per share if Akero's core drug efruxifermin gains approval for treating compensated cirrhosis due to MASH by June 30, 2031. If this condition is met, the total transaction value will reach $5.2 billion. The market reacted positively to the news, with Akero's stock price surging 16% following the announcement.

Akero's primary asset, efruxifermin, is a fibroblast growth factor 21 (FGF21) analog considered a potential best-in-class drug for MASH treatment. The drug is currently undergoing Phase 3 SYNCHRONY clinical trials, evaluating its efficacy as a once-weekly subcutaneous injection for MASH patients with pre-cirrhotic (F2-F3) and compensated cirrhotic (F4) stages.

EFX's clinical data has been encouraging. In two 96-week Phase 2b trials, EFX demonstrated significant efficacy: in the HARMONY (F2-F3) trial, 49% of patients achieved liver fibrosis improvement without MASH worsening, significantly outperforming the placebo group's 19%; in the SYMMETRY (F4) trial, 29% of patients experienced liver fibrosis improvement, compared to just 11% in the placebo group. Notably, EFX is the only treatment to show significant fibrosis regression in F4 patients in Phase 2 trials.

MASH is a serious progressive liver disease affecting over 250 million people globally, with late-stage patient numbers expected to double by 2030. The disease can progress to cirrhosis, liver failure, and even liver cancer, with limited treatment options currently available. Approximately 20% of MASH patients develop cirrhosis, a stage associated with significantly increased mortality risk. MASH has become one of the fastest-growing causes of liver transplantation and liver cancer incidence in Western countries.

This acquisition aligns closely with Novo Nordisk's long-term strategy of developing innovative therapies for diabetes, obesity, and related complications. Notably, over 40% of MASH patients also have type 2 diabetes, and more than 80% are overweight or obese, creating strong synergies with Novo Nordisk's expertise in metabolic diseases.

By acquiring Akero, Novo Nordisk not only strengthens its position in liver metabolic diseases but also prepares for the growing demand for MASH treatments. As EFX progresses through further development and commercialization, Novo Nordisk is poised to secure a significant position in the multi-billion-dollar MASH treatment market.