Novo Nordisk agrees to buy Akero Therapeutics for up to $5.2 billion

Novo Nordisk said on October 9, 2025 that it had agreed to buy Akero Therapeutics, a South San Francisco biotech developing a weekly injection for advanced fatty liver disease, for $54 per share in cash — about $4.7 billion — plus a contingent payment of $6 per share, or roughly $500 million, if the drug wins US approval for cirrhosis caused by MASH ^[1]. Together that values the deal at up to $5.2 billion ^[4].

It is the largest research and development acquisition in Novo Nordisk's history and the first deal signed by Mike Doustdar, who became chief executive in August ^[2].

What Novo is buying

Akero's drug is efruxifermin, an engineered version of a liver hormone called fibroblast growth factor 21 (FGF21) ^[1]. Natural FGF21 breaks down in under two hours; Akero redesigned it to last days, allowing once-weekly injections under the skin ^[2].

The target is metabolic dysfunction-associated steatohepatitis, or MASH — fat buildup in the liver that causes inflammation and scarring, measured on a scale from F0 (no scarring) to F4 (cirrhosis) ^[2]. Novo Nordisk estimates more than 250 million people worldwide have MASH, and the FDA puts the US figure at about 14.9 million ^[1][2]. More than 80% of people with MASH are overweight or living with obesity, and more than 40% also have type 2 diabetes ^[1]. About 20% of patients eventually progress to cirrhosis ^[1].

In two 96-week phase 2b trials, 49% of patients with F2–F3 scarring in the HARMONY trial had reduced fibrosis without worsening MASH, versus 19% on placebo ^[1]. In the SYMMETRY trial in patients with cirrhosis (F4), the figures were 29% versus 11% ^[1]. Novo says efruxifermin is the only treatment to show significant fibrosis regression in F4 patients in a phase 2 trial ^[1].

The phase 3 SYNCHRONY program enrolls roughly 3,500 people across three placebo-controlled trials: one in biopsy-confirmed F2–F3 MASH testing 28 mg and 50 mg, one in compensated cirrhosis at 50 mg, and a real-world safety study in noninvasively diagnosed F1–F4 disease ^[1].

How it fits with Wegovy

The FDA added MASH to the Wegovy (semaglutide) label in August 2025, but only for patients with F2 and F3 fibrosis ^[2][4]. That leaves patients with cirrhosis without a GLP-1 option, and Novo says some patients with moderate-to-severe disease may not respond to a GLP-1 drug at all ^[2]. Doustdar said efruxifermin "could become a cornerstone therapy, alone or together with Wegovy (semaglutide)" ^[1]. R&D chief Martin Lange said the company plans to explore combinations of efruxifermin with its GLP-1 portfolio ^[2].

The MASH field has grown crowded. Madrigal's Rezdiffra, approved in 2024, generated $350 million in the first half of 2025 ^[4]. Roche agreed last month to buy 89bio and its every-two-weeks FGF21 drug pegozafermin — reported as $2.4 billion by one outlet and up to $3.5 billion by another ^[2][4]. GSK paid $1.2 billion for Boston Pharmaceuticals' once-monthly efimosfermin ^[2]. Notably, Novo discontinued its own internal FGF21 program two months ago after a failed phase 2 study ^[2].

Why it matters for patients

Nothing changes today at the pharmacy counter. Efruxifermin is not approved anywhere and is still in phase 3 testing ^[1]. But the deal signals where obesity-drug makers are heading: beyond weight loss itself and toward the conditions that travel with obesity.

If efruxifermin eventually succeeds, it would be aimed at a group currently left out — people whose liver scarring has already reached cirrhosis, where Wegovy's label does not apply ^[2]. Whether it would be used instead of, or alongside, a GLP-1 medicine is not yet known; those combination studies are only planned ^[2].

Price and insurance coverage are not addressed in the announcement. Novo said the deal will be mainly debt financed, will reduce 2025 free cash flow by about $4 billion, and will cut 2026 operating profit growth by roughly 3 percentage points because of higher R&D spending ^[1].

What happens next

Akero's board approved the deal unanimously; it still needs shareholder and regulatory approval and is expected to close around the turn of the year ^[1][2]. A Leerink analyst said there could be Federal Trade Commission scrutiny given the two companies' pipeline overlap ^[2].

The first phase 3 readout, from the real-world study, is expected as early as next year, with the other trials reporting later ^[2][4]. The contingent $6-per-share payment requires FDA approval in compensated cirrhosis by June 30, 2031 ^[2].