Madrigal Pharmaceuticals (MDGL) 10-Q 9 May 23 2023 Q1 Quarterly report Financial data

Cover Page

Cover Page - shares	3 Months Ended
	Mar. 31, 2023	May 05, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Transition Report	false
Entity Interactive Data Current	Yes
Amendment Flag	false
Document Fiscal Year Focus	2023
Document Period End Date	Mar. 31, 2023
Document Fiscal Period Focus	Q1
Entity Registrant Name	MADRIGAL PHARMACEUTICALS, INC.
Entity Central Index Key	0001157601
Entity File Number	001-33277
Current Fiscal Year End Date	--12-31
Entity Tax Identification Number	04-3508648
Entity Incorporation, State or Country Code	DE
Entity Current Reporting Status	Yes
Entity Filer Category	Large Accelerated Filer
Entity Emerging Growth Company	false
Entity Small Business	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		18,289,173
City Area Code	267
Local Phone Number	824-2827
Trading Symbol	MDGL
Security Exchange Name	NASDAQ
Title of 12(b) Security	Common Stock, $0.0001 Par Value Per Share
Entity Address, Address Line One	Four Tower Bridge
Entity Address, Address Line Two	200 Barr Harbor Drive, Suite 200
Entity Address, City or Town	West Conshohocken
Entity Address, Postal Zip Code	19428
Entity Address, State or Province	PA

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 113,308	$ 331,549
Marketable securities	216,169	27,225
Prepaid expenses and other current assets	1,807	2,595
Total current assets	331,284	361,369
Property and equipment, net	512	601
Right-of-use asset	653	602
Total assets	332,449	362,572
Current liabilities:
Accounts payable	12,128	23,831
Accrued expenses	85,567	91,461
Lease liability	653	602
Total current liabilities	98,348	115,894
Long term liabilities:
Loan payable, net of discount	83,965	49,289
Total long term liabilities	83,965	49,289
Total liabilities	182,313	165,183
Stockholders' equity:
Preferred stock, par value $0.0001 per share authorized: 5,000,000 shares at March 31, 2023 and December 31, 2022; 2,369,797 and 2,369,797 shares issued and outstanding at March 31, 2023 and December 31, 2022, respectively
Common stock, par value $0.0001 per share authorized: 200,000,000 at March 31, 2023 and December 31, 2022; 18,283,074 and 18,102,523 shares issued and outstanding at March 31, 2023 and December 31, 2022, respectively	2	2
Additional paid-in-capital	1,189,776	1,160,079
Accumulated other comprehensive loss	(86)	(32)
Accumulated deficit	(1,039,556)	(962,660)
Total stockholders' equity	150,136	197,389
Total liabilities and stockholders' equity	$ 332,449	$ 362,572

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Preferred stock, shares authorized	5,000,000	5,000,000
Preferred stock, shares issued	2,369,797	2,369,797
Preferred stock, shares outstanding	2,369,797	2,369,797
Common stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	18,283,074	18,102,523
Common stock, shares outstanding	18,283,074	18,102,523

Condensed Consolidated Statemen

Condensed Consolidated Statements Of Operations - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Revenues:
Total revenues
Operating expenses:
Research and development	62,154	47,929
General and administrative	16,182	9,658
Total operating expenses	78,336	57,587
Loss from operations	(78,336)	(57,587)
Interest income	3,776	69
Interest expense	(2,336)	0
Net loss	$ (76,896)	$ (57,518)
Net loss per common share:
Basic net loss per common share	$ (4.23)	$ (3.36)
Diluted net loss per common share	$ (4.23)	$ (3.36)
Basic weighted average number of common shares outstanding	18,187,924	17,103,395
Diluted weighted average number of common shares outstanding	18,187,924	17,103,395

Condensed Consolidated Statem_2

Condensed Consolidated Statements Of Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Statement of Comprehensive Income [Abstract]
Net Loss	$ (76,896)	$ (57,518)
Other comprehensive income (loss):
Unrealized loss on available-for-sale securities	(54)	(322)
Comprehensive loss	$ (76,950)	$ (57,840)

Condensed Consolidated Statem_3

Condensed Consolidated Statements Of Stockholders' Equity - USD ($) $ in Thousands	Total	Preferred Stock	Common stock	Additional paid-in Capital	Accumulated other comprehensive income (loss)	Accumulated deficit
Balance at Dec. 31, 2021	$ 196,107		$ 2	$ 863,495	$ (80)	$ (667,310)
Balance (in shares) at Dec. 31, 2021		1,969,797	17,103,395
Increase (Decrease) in Stockholders' Equity
Compensation expense related to stock options for services	7,477			7,477
Unrealized loss on marketable securities	(322)				(322)
Net loss	(57,518)					(57,518)
Balance at Mar. 31, 2022	145,744		$ 2	870,972	(402)	(724,828)
Balance (in shares) at Mar. 31, 2022		1,969,797	17,103,395
Balance at Dec. 31, 2022	$ 197,389		$ 2	1,160,079	(32)	(962,660)
Balance (in shares) at Dec. 31, 2022	18,102,523	2,369,797	18,102,523
Increase (Decrease) in Stockholders' Equity
Sale of common shares to related parties and exercise of common stock options, net of transaction cost	$ 17,903			17,903
Sale of common shares to related parties and exercise of common stock options, net of transaction cost ( in shares)			180,551
Compensation expense related to stock options for services	11,250			11,250
Unrealized loss on marketable securities	(54)				(54)
Hercules warrant	544			544
Net loss	(76,896)					(76,896)
Balance at Mar. 31, 2023	$ 150,136		$ 2	$ 1,189,776	$ (86)	$ (1,039,556)
Balance (in shares) at Mar. 31, 2023	18,283,074	2,369,797	18,283,074

Condensed Consolidated Statem_4

Condensed Consolidated Statements Of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash flows from operating activities:
Net loss	$ (76,896)	$ (57,518)
Adjustments to reconcile net loss to net cash used in operating activities:
Stock-based compensation expense	11,250	7,477
Depreciation and amortization expense	124	107
Amortization of debt issuance costs and discount	433	0
Changes in operating assets and liabilities:
Prepaid expenses and other current assets	788	121
Accounts payable	(11,703)	1,400
Accrued expense	(5,894)	(1,606)
Accrued interest, net of interest received on maturity of investments	(2,169)	106
Net cash used in operating activities	(84,067)	(49,913)
Cash flows from investing activities:
Purchases of marketable securities	(198,822)	(37,567)
Sales and maturities of marketable securities	11,993	93,545
Purchases of property and equipment, net of disposals	(35)	(52)
Net cash provided by (used in) investing activities	(186,864)	55,926
Cash flows from financing activities:
Proceeds from the sale of related party stock and exercise of common stock options, net of transaction costs	17,903	0
Proceeds from issuance of loan payable	35,000	0
Payment of debt issuance costs	(213)	0
Net cash provided by financing activities	52,690	0
Net increase (decrease) in cash and cash equivalents	(218,241)	6,013
Cash and cash equivalents at beginning of period	331,549	36,269
Cash and cash equivalents at end of period	$ 113,308	$ 42,282

Organization, Business and Basi

Organization, Business and Basis of Presentation	3 Months Ended
	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization, Business and Basis of Presentation	1. Organization, Business, and Basis of Presentation Organization and Business Madrigal Pharmaceuticals, Inc. (the “Company” or “Madrigal”) is a clinical-stage pharmaceutical company developing novel, high-quality, small-molecule drugs addressing major unmet needs in cardiovascular, metabolic, and liver diseases. The Company’s lead compound, resmetirom, is being advanced for non-alcoholic non-alcoholic MAESTRO-NAFLD-1 Basis of Presentation Certain information and footnote disclosures normally included in financial statements prepared in accordance with accounting principles generally accepted in the United States (“GAAP”) have been condensed or omitted. Accordingly, the unaudited condensed consolidated financial statements do not include all information and footnotes required by GAAP for complete annual financial statements. However, we believe that the disclosures included in these financial statements are adequate to make the information presented not misleading. The unaudited condensed consolidated financial statements, in the opinion of management, reflect all adjustments, which include normal recurring adjustments, necessary for a fair statement of such interim results. The interim results are not necessarily indicative of the results that we will have for the full year ending December 31, 2023 or any subsequent period. These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and the notes to those statements for the year ended December 31, 2022.

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Principle of Consolidation The consolidated financial statements include the financial statements of the Company and its wholly owned subsidiaries. All significant intercompany balances have been eliminated in consolidation. Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect certain reported amounts of assets and liabilities, and the reported amounts of revenues and expenses during the reporting periods. The Company bases its estimates on historical experience and various other assumptions that management believes to be reasonable under the circumstances. Changes in estimates are recorded in the period in which they become known. Actual results could differ from those estimates. Cash and Cash Equivalents The Company considers all highly liquid investments with original maturities of three months or less at the date of purchase to be cash equivalents. The Company maintains its cash in bank accounts, the balance of which, at times, exceeds Federal Deposit Insurance Corporation insured limits. The primary objective of the Company’s investment activities is to preserve its capital for the purpose of funding operations and the Company does not enter into investments for trading or speculative purposes. The Company’s cash is deposited in highly rated financial institutions in the United States. The Company invests in money market funds and high-grade, commercial paper and corporate bonds, which management believes are subject to minimal credit and market risk. Marketable Securities Marketable securities consist of investments in high-grade corporate obligations and government and government agency obligations that are classified as available-for-sale. The Company adjusts the cost of available-for-sale available-for-sale Marketable securities are stated at fair value, including accrued interest, with their unrealized gains and losses included as a component of accumulated other comprehensive income or loss, which is a separate component of stockholders’ equity. The fair value of these securities is based on quoted prices and observable inputs on a recurring basis. Realized gains and losses are determined on the specific identification method. During the three months ended March 31, 2023 and 2022, the Company did not have any realized gains or losses on marketable securities. Fair Value of Financial Instruments The carrying amounts of the Company’s financial instruments, which include cash equivalents and marketable securities, approximate their fair values. The fair value of the Company’s financial instruments reflects the amounts that would be received upon sale of an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. The fair value hierarchy has the following three levels: Level 1—quoted prices in active markets for identical assets and liabilities. Level 2—observable inputs other than Level 1 inputs. Examples of Level 2 inputs include quoted prices in active markets for similar assets or liabilities and quoted prices for identical assets or liabilities in markets that are not active. Level 3—unobservable inputs that reflect the Company’s own assumptions about the assumptions market participants would use in pricing the asset or liability. Financial assets and liabilities are classified in their entirety within the fair value hierarchy based on the lowest level of input that is significant to the fair value measurement. The Company measures the fair value of its marketable securities by taking into consideration valuations obtained from third- party pricing sources. The pricing services utilize industry standard valuation models, including both income and market based approaches, for which all significant inputs are observable, either directly or indirectly, to estimate fair value. These inputs include reported trades of and broker-dealer quotes on the same or similar securities, issuer credit spreads, benchmark securities and other observable inputs. As of March 31, 2023, the Company’s financial assets valued based on Level 1 inputs consisted of cash and cash equivalents in a money market fund, its financial assets valued based on Level 2 inputs consisted of high-grade corporate and government agency bonds and commercial paper, and it had no financial assets valued based on Level 3 inputs. During the three months ended March 31, 2023 and 2022, the Company did not have any transfers of financial assets between Levels 1 and 2. As of March 31, 2023 and December 31, 2022, the Company did not have any financial liabilities that were recorded at fair value on a recurring basis on the balance sheet. Research and Development Costs Research and development costs are expensed as incurred. Research and development costs are comprised of costs incurred in performing research and development activities, including internal costs (including stock-based compensation), costs for consultants, milestone payments under licensing agreements, and other costs associated with the Company’s preclinical and clinical programs. In particular, the Company has conducted safety studies in animals, optimized and implemented the manufacturing of our drug, and conducted clinical trials, all of which are considered research and development expenditures. Management uses significant judgment in estimating the amount of research and development costs recognized in each reporting period. Management analyzes and estimates the progress of its clinical trials, completion of milestone events per underlying agreements, invoices received and contracted costs when estimating the research and development costs to accrue in each reporting period. Actual results could differ from the Company’s estimates. Patents Costs to secure and defend patents are expensed as incurred and are classified as general and administrative expense in the Company’s consolidated statements of operations. Stock-Based Compensation The Company recognizes stock-based compensation expense based on the grant date fair value of stock options and restricted stock units granted to employees, officers, and directors. Awards that vest as the recipient provides service are expensed on a straight-line basis over the requisite service period. The Company uses the Black-Scholes option pricing model to determine the grant date fair value of stock options as management believes it is the most appropriate valuation method for its option grants. The Black-Scholes model requires inputs for risk-free interest rate, dividend yield, volatility and expected lives of the options. The expected lives for options granted represent the period of time that options granted are expected to be outstanding. The Company uses the simplified method for determining the expected lives of options. Expected volatility is based upon an industry estimate or blended rate including the Company’s historical trading activity. The risk-free rate for periods within the expected life of the option is based on the U.S. Treasury yield curve in effect at the time of the grant. The Company estimates the forfeiture rate based on historical data. This analysis is re-evaluated Income Taxes The Company uses the asset and liability method to account for income taxes. Deferred tax assets and liabilities are determined based on the expected future tax consequences of temporary differences between the Company’s financial statement carrying amounts and the tax basis of assets and liabilities using enacted tax rates expected to be in effect in the years in which the differences are expected to reverse. The Company currently maintains a 100% valuation allowance on its deferred tax assets. Comprehensive Loss Comprehensive loss is defined as the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner Basic and Diluted Loss Per Common Share Basic net loss per share is computed using the weighted average number of common shares outstanding during the period. Diluted net loss per common share is computed using the weighted average number of common shares outstanding and the weighted average dilutive potential common shares outstanding using the treasury stock method. However, for the three months ended March 31, 2023 and 2022, diluted net loss per share is the same as basic net loss per share because the inclusion of weighted average shares of common stock issuable upon the exercise of stock options and warrants or vesting of restricted stock units, and common stock issuable upon the conversion of preferred stock would be anti-dilutive. The following table summarizes outstanding securities not included in the computation of diluted net loss per common share, as their inclusion would be anti-dilutive: Three Months Ended March 31, 2023 2022 Common stock options 2,676,598 2,878,399 Restricted stock units 199,125 — Preferred stock 2,369,797 1,969,797 Warrants 17,352 — Recent Accounting Pronouncements None

Liquidity and Uncertainties

Liquidity and Uncertainties	3 Months Ended
	Mar. 31, 2023
Liquidity and Uncertainties
Liquidity and Uncertainties	3. Liquidity and Uncertainties The Company is subject to risks common to development stage companies in the biopharmaceutical industry including, but not limited to, uncertainty of product development and commercialization, dependence on key personnel, uncertainty of market acceptance of products and product reimbursement, product liability, uncertain protection of proprietary technology, potential inability to raise additional financing necessary for development and commercialization, and compliance with the U.S. Food and Drug Administration (FDA) and other government regulations. The Company has incurred losses since inception, including approximately $76.9 million for the three months ended March 31, 2023, resulting in an accumulated deficit of approximately $1,040 million as of March 31, 2023. Management expects to incur losses for the foreseeable future. To date, the Company has funded its operations primarily through proceeds from sales of the Company’s capital stock and debt financings. The Company believes that its cash, cash equivalents and marketable securities at March 31, 2023 will be sufficient to fund operations past one year from the issuance of these financial statements. To meet its future capital needs, the Company intends to raise additional capital through debt or equity financings, collaborations, partnerships or other strategic transactions. However, there can be no assurance that the Company will be able to complete any such transactions on acceptable terms or otherwise. The inability of the Company to obtain sufficient funds on acceptable terms when needed could have a material adverse effect on the Company’s business, results of operations and financial condition. The Company has the ability to delay certain research activities and related clinical expenses if necessary due to liquidity concerns until a date when those concerns are relieved.

Cash, Cash Equivalents and Mark

Cash, Cash Equivalents and Marketable Securities	3 Months Ended
	Mar. 31, 2023
Cash and Cash Equivalents [Abstract]
Cash, Cash Equivalents and Marketable Securities	4. Cash, Cash Equivalents and Marketable Securities A summary of cash, cash equivalents and available-for-sale March 31, 2023 Cost Unrealized Unrealized Fair value Cash and cash equivalents: Cash $ 10,094 $ — $ — $ 10,094 Money market funds (Level 1) 84,750 — — 84,750 Corporate debt securities due within 3 months of date of purchase (Level 2) 18,464 — — 18,464 Total cash and cash equivalents 113,308 — — 113,308 Marketable securities: Corporate debt securities due within 1 year of date of purchase (Level 2) 207,138 7 (96 ) 207,049 U.S. government and government sponsored entities due within 1 year of date of purchase (Level 2) 9,117 3 — 9,120 Total cash, cash equivalents and marketable securities $ 329,563 $ 10 $ (96 ) $ 329,477 December 31, 2022 Cost Unrealized Unrealized Fair value Cash and cash equivalents: Cash $ 15,100 $ — $ — $ 15,100 Money market funds (Level 1) 316,449 — — 316,449 Total cash and cash equivalents 331,549 — — 331,549 Marketable securities: Corporate debt securities due within 1 year of date of purchase (Level 2) 27,257 7 (39 ) 27,225 Total cash, cash equivalents and marketable securities $ 358,806 $ 7 $ (39 ) $ 358,774

Accrued Liabilities

Accrued Liabilities	3 Months Ended
	Mar. 31, 2023
Accrued Liabilities, Current [Abstract]
Accrued Liabilities	5. Accrued Liabilities Accrued liabilities as of March 31, 2023 and December 31, 2022 consisted of the following (in thousands): March 31, December 31, 2023 2022 Contract research organization costs $ 57,984 $ 53,119 Other clinical study related costs 6,638 6,582 Manufacturing and drug supply 2,996 11,262 Compensation and benefits 11,208 14,864 Professional fees 4,741 4,867 Other 2,000 767 Total accrued liabilities $ 85,567 $ 91,461

Long Term Debt

Long Term Debt	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Long Term Debt	6. Long Term Debt In May 2022 the Company and its wholly-owned subsidiary, Canticle Pharmaceuticals, Inc., entered into the $250.0 million Loan Facility with the several banks and other financial institutions or entities party thereto (each, a “Lender” and collectively referred to as the “Lenders”), and Hercules Capital, Inc. (“Hercules”), in its capacity as administrative agent and collateral agent for itself and the Lenders. Under the terms of the Loan Facility, the first $50.0 million tranche was drawn at closing. The Company also could draw up to an additional $125.0 million in two separate tranches upon achievement of certain resmetirom clinical and regulatory milestones. A fourth tranche of $75.0 million could be drawn by the Company, subject to the approval of Hercules. The Loan Facility had a minimum interest rate of 7.45% and adjusts with changes in the prime rate. The Company will pay interest-only monthly payments of accrued interest under the Loan Facility for a period of 30 months, which period may be extended to 36, 48, and 60 months upon the successive achievement of certain clinical and regulatory milestones and if the Company maintains compliance with applicable covenants. The Loan Facility matures in May 2026 and may be extended an additional year upon the achievement of certain clinical and regulatory milestones. The Loan Facility is secured by a security interest in substantially all of the Company’s assets, other than intellectual property. It includes an end of term charge of 5.35% of the aggregate principal amount, which is accounted for in the loan discount. In connection with the first tranche drawn at closing, the Company issued Hercules a warrant to purchase 14,899 shares of Company common stock, which had a Black-Scholes value of $0.6 million. On February 3, 2023, the Company entered into the First Amendment (the “Amendment”) to the Loan Facility (as amended, the “Amended Loan Facility”). Under the Amended Loan Facility, an additional $35.0 million was drawn under a second, expanded, $65.0 million tranche (“Tranche 2”) in February of 2023 following the Company’s achievement of the Phase 3 clinical development milestone. The Company has the ability to draw an additional $15.0 million under Tranche 2 by June 19, 2023 and an additional $15.0 million under Tranche 2 by September 30, 2023 (for a total of $30.0 million in additional committed Tranche 2 capacity). The third tranche (“Tranche 3”) of $75.0 million remains unchanged by the Amendment, and such borrowings are available subject to the Company obtaining a certain FDA approval for resmetirom. Coincident with the expansion of Tranche 2 borrowing capacity by $15 million, the Amendment reduced the fourth tranche under the Loan Facility (“Tranche 4”) by $15.0 million to $60.0 million , which amount is available subject to Hercules’ sole discretion. In connection with the $35.0 million drawn under the second tranche at the closing of the Amendment, the Company issued to Hercules and affiliates Tranche 2 Warrants to purchase 2,453 shares of common stock, which had a Black-Scholes value of $0.5 million. The Amendment reduced the interest rate under the Amended Loan Facility to the greater of (i) the prime rate as reported in The Wall Street Journal plus 2.45% and (ii) 8.25%. The Amendment and the Amended Loan Facility summary terms were disclosed in the Company’s Current Report on Form 8-K The Loan Facility includes affirmative and restrictive financial covenants commencing on January 1, 2023, including maintenance of a minimum cash, cash equivalents and liquid funds covenant of $35.0 million, which may decrease in certain circumstances if the Company achieves certain clinical milestones and a revenue milestone, and a revenue-based covenant that could apply commencing at or after the time that financial reporting is due for the quarter ending September 30, 2024. The Loan Facility contains event of default provisions for: the Company’s failure to make required payments or maintain compliance with covenants under the Loan Facility; the Company’s breach of certain representations or default under certain obligations outside the Loan Facility; insolvency, attachment or judgment events affecting the Company; and any circumstance which has occurred or could reasonably be expected to have a material adverse effect on the Company, provided that, any failure to achieve a clinical milestone or approval milestone under the Loan Facility shall not in and of itself constitute a material adverse effect. The Loan Facility also includes customary covenants associated with a secured loan facility, including covenants concerning financial reporting obligations, and certain limitations on indebtedness, liens (including a negative pledge on intellectual property and other assets), investments, distributions (including dividends), collateral, investments, distributions, transfers, mergers or acquisitions, taxes, corporate changes, and deposit accounts. As of March 31, 2023, the outstanding principal under the Loan Facility was $85.0 million. The interest rate as of March 31, 2023 was 10.45%. As of March 31, 2023, the Company was in compliance with all loan covenants and provisions. Future minimum payments, including interest and principal, under the loans payable outstanding as of March 31, 2023 are as follows (in thousands): Period Ending March 31, 2023: Amount 2023 $ 6,772 2024 9,031 2025 58,537 Thereafter 39,356 $ 113,696 Less amount representing interest (24,149 ) Less unamortized discount (5,582 ) Loans payable, net of discount $ 83,965

Stockholders' Equity

Stockholders' Equity	3 Months Ended
	Mar. 31, 2023
Stockholders' Equity Note [Abstract]
Stockholders' Equity	7. Stockholders’ Equity Common Stock Each common stockholder is entitled to one vote for each share of common stock held. The common stock will vote together with all other classes and series of stock of the Company as a single class on all actions to be taken by the Company’s stockholders. Each share of common stock is entitled to receive dividends, as and when declared by the Company’s board of directors. The Company has never declared cash dividends on its common stock and does not expect to do so in the foreseeable future. Preferred Stock The Series A and B Preferred Stock have a par value of $0.0001 per share and are convertible into shares of the common stock at a one-to-one winding-up as-if-converted-to-Common-Stock as-converted December 2022 Registered Direct Offering In December 2022, the Company entered into a Securities Purchase Agreement (the “Purchase Agreement”) with a group of institutional accredited investors, who were existing, non-controlling At-The-Market In June 2021, the Company entered into an at-the-market “at-the-market” In December 2022, the Company sold 738,900 shares under the 2021 Sales Agreement for an aggregate of $159.1 million in gross proceeds, with net proceeds to the Company of $155.9 million after deducting commissions and other transaction costs. In total, under the 2021 Sales Agreement the Company sold 1,235,943 shares for an aggregate of $199.9 million in gross proceeds, with net proceeds to the Company of approximately $195.8 million after deducting commissions and other transaction costs. Of those shares sold, 738,900 were sold in 2022, and 497,043 were sold in 2021. All shares were sold pursuant to the Company’s effective shelf registration statement and the prospectus supplement relating thereto. As of March 31, 2023, no amounts remained reserved and available for sale under the 2021 Sales Agreement and the related prospectus supplement.

Stock-based Compensation

Stock-based Compensation	3 Months Ended
	Mar. 31, 2023
Share-based Payment Arrangement [Abstract]
Stock-based Compensation	8. Stock-based Compensation The Company’s 2015 Stock Plan, as amended, is our primary equity incentive compensation plan through which equity based grants are awarded. The 2015 Stock Plan provides for the grant of incentive stock options, non-statutory Stock Options The following table summarizes stock option activity during the three months ended March 31, 2023: Shares Weighted Outstanding at January 1, 2023 2,857,054 $ 81.78 Options granted 5,205 283.08 Options exercised (180,551 ) 99.16 Options cancelled (5,110 ) 76.07 Outstanding at March 31, 2023 2,676,598 $ 81.02 Exercisable at March 31, 2023 1,637,134 $ 75.71 The total cash received by the Company as a result of stock option exercises was $17.9 million and $0 million, respectively, for the three months ended March 31, 2023 and 2022. The total intrinsic value of options exercised was $32.5 million and $0 million, respectively, for the three months ended March 31, 2023 and 2022. The weighted-average grant date fair values, based on the Black-Scholes option model, of options granted during the three months ended March 31, 2023 and 2022 were $219.02 and $59.63, respectively. Restricted Stock Units The Company’s share-based compensation plan provides for awards of restricted stock units to employees, officers, directors and consultants to the Company. Restricted stock units vest over the service period, and are subject to forfeiture if employment or service terminates before vesting. As of March 31, 2023, the Company had 199,125 restricted stock units outstanding, with a weighted average grant date fair value of $297.18 per unit., Stock-Based Compensation Expense Stock-based compensation expense during the three months ended March 31, 2023 and 2022 was as follows (in thousands): Three Months Ended March 31, 2023 2022 Stock-based compensation expense by type of award: Stock options $ 8,598 $ 7,477 Restricted stock units 2,652 — Total stock-based compensation expense $ 11,250 $ 7,477 Effect of stock-based compensation expense by line item: Research and development $ 5,385 $ 3,187 General and administrative 5,865 4,290 Total stock-based compensation expense included in net loss $ 11,250 $ 7,477 Unrecognized stock-based compensation expense on stock options as of March 31, 2023 was $52.3 million with a weighted average remaining period of 2.42 years.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	9. Commitments and Contingencies The Company has a Research, Development and Commercialization Agreement with Hoffmann-La The agreement requires future milestone payments to Roche. Remaining milestones under the agreement total $8 million and are payable upon Madrigal achieving specified objectives related to future regulatory approval in the United States and Europe of resmetirom or a product developed from resmetirom. Furthermore, a tiered single-digit royalty is payable on net sales of resmetirom or a product developed from resmetirom, subject to certain reductions. The Company has not achieved any additional product development or regulatory milestones and had no Licensed Product sales for the three months ended March 31, 2023 and 2022. The Company has entered into customary contractual arrangements and letters of intent in preparation for and in support of the clinical trials.

Subsequent Event

Subsequent Event	3 Months Ended
	Mar. 31, 2023
Subsequent Events [Abstract]
Subsequent Event	10. Subsequent Event In May 2023, the Company amended the 2021 Agreement (the “2023 Sales Agreement Amendment”), with Cowen, pursuant to which the Company may, from time to time, issue and sell shares of its common stock. The Company is not obligated to make any sales of its common stock under this arrangement. Any shares sold will be sold pursuant to the Company’s effective shelf registration statement on Form S-3 (the “Registration Statement”) and a prospectus supplement filed pursuant to the Registration Statement. The Sales Agreement Amendment authorizes an additional aggregate offering of up to $ million in shares of our common stock, from time to time, at the Company’s option, through Cowen as its sales agent. Sales of common stock through Cowen may be made by any method that is deemed an “at-the-market” offering as defined in Rule 415 promulgated under the Securities Act of 1933, as amended, and as described in the prospectus supplement.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2023
Accounting Policies [Abstract]
Principle of Consolidation	Principle of Consolidation The consolidated financial statements include the financial statements of the Company and its wholly owned subsidiaries. All significant intercompany balances have been eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect certain reported amounts of assets and liabilities, and the reported amounts of revenues and expenses during the reporting periods. The Company bases its estimates on historical experience and various other assumptions that management believes to be reasonable under the circumstances. Changes in estimates are recorded in the period in which they become known. Actual results could differ from those estimates.
Cash and Cash Equivalents	Cash and Cash Equivalents The Company considers all highly liquid investments with original maturities of three months or less at the date of purchase to be cash equivalents. The Company maintains its cash in bank accounts, the balance of which, at times, exceeds Federal Deposit Insurance Corporation insured limits. The primary objective of the Company’s investment activities is to preserve its capital for the purpose of funding operations and the Company does not enter into investments for trading or speculative purposes. The Company’s cash is deposited in highly rated financial institutions in the United States. The Company invests in money market funds and high-grade, commercial paper and corporate bonds, which management believes are subject to minimal credit and market risk.
Marketable Securities	Marketable Securities Marketable securities consist of investments in high-grade corporate obligations and government and government agency obligations that are classified as available-for-sale. The Company adjusts the cost of available-for-sale available-for-sale Marketable securities are stated at fair value, including accrued interest, with their unrealized gains and losses included as a component of accumulated other comprehensive income or loss, which is a separate component of stockholders’ equity. The fair value of these securities is based on quoted prices and observable inputs on a recurring basis. Realized gains and losses are determined on the specific identification method. During the three months ended March 31, 2023 and 2022, the Company did not have any realized gains or losses on marketable securities.
Fair Value of Financial Instruments	Fair Value of Financial Instruments The carrying amounts of the Company’s financial instruments, which include cash equivalents and marketable securities, approximate their fair values. The fair value of the Company’s financial instruments reflects the amounts that would be received upon sale of an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. The fair value hierarchy has the following three levels: Level 1—quoted prices in active markets for identical assets and liabilities. Level 2—observable inputs other than Level 1 inputs. Examples of Level 2 inputs include quoted prices in active markets for similar assets or liabilities and quoted prices for identical assets or liabilities in markets that are not active. Level 3—unobservable inputs that reflect the Company’s own assumptions about the assumptions market participants would use in pricing the asset or liability. Financial assets and liabilities are classified in their entirety within the fair value hierarchy based on the lowest level of input that is significant to the fair value measurement. The Company measures the fair value of its marketable securities by taking into consideration valuations obtained from third- party pricing sources. The pricing services utilize industry standard valuation models, including both income and market based approaches, for which all significant inputs are observable, either directly or indirectly, to estimate fair value. These inputs include reported trades of and broker-dealer quotes on the same or similar securities, issuer credit spreads, benchmark securities and other observable inputs. As of March 31, 2023, the Company’s financial assets valued based on Level 1 inputs consisted of cash and cash equivalents in a money market fund, its financial assets valued based on Level 2 inputs consisted of high-grade corporate and government agency bonds and commercial paper, and it had no financial assets valued based on Level 3 inputs. During the three months ended March 31, 2023 and 2022, the Company did not have any transfers of financial assets between Levels 1 and 2. As of March 31, 2023 and December 31, 2022, the Company did not have any financial liabilities that were recorded at fair value on a recurring basis on the balance sheet.
Research and Development Costs	Research and Development Costs Research and development costs are expensed as incurred. Research and development costs are comprised of costs incurred in performing research and development activities, including internal costs (including stock-based compensation), costs for consultants, milestone payments under licensing agreements, and other costs associated with the Company’s preclinical and clinical programs. In particular, the Company has conducted safety studies in animals, optimized and implemented the manufacturing of our drug, and conducted clinical trials, all of which are considered research and development expenditures. Management uses significant judgment in estimating the amount of research and development costs recognized in each reporting period. Management analyzes and estimates the progress of its clinical trials, completion of milestone events per underlying agreements, invoices received and contracted costs when estimating the research and development costs to accrue in each reporting period. Actual results could differ from the Company’s estimates.
Patents	Patents Costs to secure and defend patents are expensed as incurred and are classified as general and administrative expense in the Company’s consolidated statements of operations.
Stock-Based Compensation	Stock-Based Compensation The Company recognizes stock-based compensation expense based on the grant date fair value of stock options and restricted stock units granted to employees, officers, and directors. Awards that vest as the recipient provides service are expensed on a straight-line basis over the requisite service period. The Company uses the Black-Scholes option pricing model to determine the grant date fair value of stock options as management believes it is the most appropriate valuation method for its option grants. The Black-Scholes model requires inputs for risk-free interest rate, dividend yield, volatility and expected lives of the options. The expected lives for options granted represent the period of time that options granted are expected to be outstanding. The Company uses the simplified method for determining the expected lives of options. Expected volatility is based upon an industry estimate or blended rate including the Company’s historical trading activity. The risk-free rate for periods within the expected life of the option is based on the U.S. Treasury yield curve in effect at the time of the grant. The Company estimates the forfeiture rate based on historical data. This analysis is re-evaluated
Income Taxes	Income Taxes The Company uses the asset and liability method to account for income taxes. Deferred tax assets and liabilities are determined based on the expected future tax consequences of temporary differences between the Company’s financial statement carrying amounts and the tax basis of assets and liabilities using enacted tax rates expected to be in effect in the years in which the differences are expected to reverse. The Company currently maintains a 100% valuation allowance on its deferred tax assets.
Comprehensive Loss	Comprehensive Loss Comprehensive loss is defined as the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner
Basic and Diluted Loss Per Common Share	Basic and Diluted Loss Per Common Share Basic net loss per share is computed using the weighted average number of common shares outstanding during the period. Diluted net loss per common share is computed using the weighted average number of common shares outstanding and the weighted average dilutive potential common shares outstanding using the treasury stock method. However, for the three months ended March 31, 2023 and 2022, diluted net loss per share is the same as basic net loss per share because the inclusion of weighted average shares of common stock issuable upon the exercise of stock options and warrants or vesting of restricted stock units, and common stock issuable upon the conversion of preferred stock would be anti-dilutive. The following table summarizes outstanding securities not included in the computation of diluted net loss per common share, as their inclusion would be anti-dilutive: Three Months Ended March 31, 2023 2022 Common stock options 2,676,598 2,878,399 Restricted stock units 199,125 — Preferred stock 2,369,797 1,969,797 Warrants 17,352 —
Recent Accounting Pronouncements	Recent Accounting Pronouncements None

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2023
Accounting Policies [Abstract]
Summary of the outstanding securities not included in the computation of diluted net loss per common share as their inclusion would be anti-dilutive	The following table summarizes outstanding securities not included in the computation of diluted net loss per common share, as their inclusion would be anti-dilutive: Three Months Ended March 31, 2023 2022 Common stock options 2,676,598 2,878,399 Restricted stock units 199,125 — Preferred stock 2,369,797 1,969,797 Warrants 17,352 —

Cash, Cash Equivalents and Ma_2

Cash, Cash Equivalents and Marketable Securities (Tables)	3 Months Ended
	Mar. 31, 2023
Cash and Cash Equivalents [Abstract]
Summary of cash, cash equivalents and available-for-sale marketable securities	A summary of cash, cash equivalents and available-for-sale March 31, 2023 Cost Unrealized Unrealized Fair value Cash and cash equivalents: Cash $ 10,094 $ — $ — $ 10,094 Money market funds (Level 1) 84,750 — — 84,750 Corporate debt securities due within 3 months of date of purchase (Level 2) 18,464 — — 18,464 Total cash and cash equivalents 113,308 — — 113,308 Marketable securities: Corporate debt securities due within 1 year of date of purchase (Level 2) 207,138 7 (96 ) 207,049 U.S. government and government sponsored entities due within 1 year of date of purchase (Level 2) 9,117 3 — 9,120 Total cash, cash equivalents and marketable securities $ 329,563 $ 10 $ (96 ) $ 329,477 December 31, 2022 Cost Unrealized Unrealized Fair value Cash and cash equivalents: Cash $ 15,100 $ — $ — $ 15,100 Money market funds (Level 1) 316,449 — — 316,449 Total cash and cash equivalents 331,549 — — 331,549 Marketable securities: Corporate debt securities due within 1 year of date of purchase (Level 2) 27,257 7 (39 ) 27,225 Total cash, cash equivalents and marketable securities $ 358,806 $ 7 $ (39 ) $ 358,774

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	3 Months Ended
	Mar. 31, 2023
Accrued Liabilities, Current [Abstract]
Schedule of Accrued Liabilities	Accrued liabilities as of March 31, 2023 and December 31, 2022 consisted of the following (in thousands): March 31, December 31, 2023 2022 Contract research organization costs $ 57,984 $ 53,119 Other clinical study related costs 6,638 6,582 Manufacturing and drug supply 2,996 11,262 Compensation and benefits 11,208 14,864 Professional fees 4,741 4,867 Other 2,000 767 Total accrued liabilities $ 85,567 $ 91,461

Long Term Debt (Tables)

Long Term Debt (Tables)	3 Months Ended
	Mar. 31, 2023
Debt Disclosure [Abstract]
Schedule of Maturities of Long-Term Debt [Table Text Block]	Future minimum payments, including interest and principal, under the loans payable outstanding as of March 31, 2023 are as follows (in thousands): Period Ending March 31, 2023: Amount 2023 $ 6,772 2024 9,031 2025 58,537 Thereafter 39,356 $ 113,696 Less amount representing interest (24,149 ) Less unamortized discount (5,582 ) Loans payable, net of discount $ 83,965

Stock-based Compensation (Table

Stock-based Compensation (Tables)	3 Months Ended
	Mar. 31, 2023
Share-based Payment Arrangement [Abstract]
Summary of stock option activity	The following table summarizes stock option activity during the three months ended March 31, 2023: Shares Weighted Outstanding at January 1, 2023 2,857,054 $ 81.78 Options granted 5,205 283.08 Options exercised (180,551 ) 99.16 Options cancelled (5,110 ) 76.07 Outstanding at March 31, 2023 2,676,598 $ 81.02 Exercisable at March 31, 2023 1,637,134 $ 75.71
Schedule of stock-based compensation expense	Stock-based compensation expense during the three months ended March 31, 2023 and 2022 was as follows (in thousands): Three Months Ended March 31, 2023 2022 Stock-based compensation expense by type of award: Stock options $ 8,598 $ 7,477 Restricted stock units 2,652 — Total stock-based compensation expense $ 11,250 $ 7,477 Effect of stock-based compensation expense by line item: Research and development $ 5,385 $ 3,187 General and administrative 5,865 4,290 Total stock-based compensation expense included in net loss $ 11,250 $ 7,477

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Income Taxes (Details)	3 Months Ended
	Mar. 31, 2023
Income Taxes
Valuation allowance on deferred tax assets (as a percent)	100%

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Basic and Diluted Loss Per Common Share (Details) - shares	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Stock options
Anti-dilutive securities
Outstanding securities not included in the computation of diluted net loss per common share as their inclusion would be anti-dilutive (in shares)	2,676,598	2,878,399
Restricted stock units
Anti-dilutive securities
Outstanding securities not included in the computation of diluted net loss per common share as their inclusion would be anti-dilutive (in shares)	199,125	0
Preferred Stock
Anti-dilutive securities
Outstanding securities not included in the computation of diluted net loss per common share as their inclusion would be anti-dilutive (in shares)	2,369,797	1,969,797
Warrants
Anti-dilutive securities
Outstanding securities not included in the computation of diluted net loss per common share as their inclusion would be anti-dilutive (in shares)	17,352	0

Liquidity and Uncertainties (De

Liquidity and Uncertainties (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Liquidity and Uncertainties
Net loss	$ (76,896)	$ (57,518)
Accumulated deficit	$ (1,039,556)		$ (962,660)

Cash, Cash Equivalents and Ma_3

Cash, Cash Equivalents and Marketable Securities (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Cash, Cash Equivalents and Marketable Securities
Total cash, cash equivalents and marketable securities, Unrealized gains	$ 10	$ 7
Total cash, cash equivalents and marketable securities, Unrealized losses	(96)	(39)
Carrying value
Cash, Cash Equivalents and Marketable Securities
Cash and cash equivalents	113,308	331,549
Total cash, cash equivalents and marketable securities, Cost	329,563	358,806
Fair value
Cash, Cash Equivalents and Marketable Securities
Cash and cash equivalents	113,308	331,549
Total cash, cash equivalents and marketable securities, Fair value	$ 329,477	$ 358,774
Corporate debt securities due within 3 month of date of purchase
Cash, Cash Equivalents and Marketable Securities
Maturity period from date of purchase to classify an investment as marketable securities	3 months
Corporate debt securities due within 3 month of date of purchase | Carrying value | Level 2
Cash, Cash Equivalents and Marketable Securities
Cash and cash equivalents	$ 18,464
Corporate debt securities due within 3 month of date of purchase | Fair value | Level 2
Cash, Cash Equivalents and Marketable Securities
Cash and cash equivalents	$ 18,464
Corporate debt securities due within 1 year of date of purchase
Cash, Cash Equivalents and Marketable Securities
Maturity period from date of purchase to classify an investment as marketable securities	1 year	1 year
Corporate debt securities due within 1 year of date of purchase | Level 2
Cash, Cash Equivalents and Marketable Securities
Marketable securities, unrealized gains	$ 7	$ 7
Marketable securities, unrealized losses	(96)	(39)
Corporate debt securities due within 1 year of date of purchase | Carrying value | Level 2
Cash, Cash Equivalents and Marketable Securities
Marketable securities, cost	207,138	27,257
Corporate debt securities due within 1 year of date of purchase | Fair value | Level 2
Cash, Cash Equivalents and Marketable Securities
Marketable securities, fair value	$ 207,049	27,225
U.S. government and government sponsored entities due within 1 year of date of purchase
Cash, Cash Equivalents and Marketable Securities
Maturity period from date of purchase to classify an investment as marketable securities	1 year
U.S. government and government sponsored entities due within 1 year of date of purchase | Level 2
Cash, Cash Equivalents and Marketable Securities
Marketable securities, unrealized gains	$ 3
Marketable securities, unrealized losses	0
U.S. government and government sponsored entities due within 1 year of date of purchase | Carrying value | Level 2
Cash, Cash Equivalents and Marketable Securities
Marketable securities, cost	9,117
U.S. government and government sponsored entities due within 1 year of date of purchase | Fair value | Level 2
Cash, Cash Equivalents and Marketable Securities
Marketable securities, fair value	9,120
Cash | Carrying value
Cash, Cash Equivalents and Marketable Securities
Cash and cash equivalents	10,094	15,100
Cash | Fair value
Cash, Cash Equivalents and Marketable Securities
Cash and cash equivalents	10,094	15,100
Money market funds | Carrying value | Level 1
Cash, Cash Equivalents and Marketable Securities
Cash and cash equivalents	84,750	316,449
Money market funds | Fair value | Level 1
Cash, Cash Equivalents and Marketable Securities
Cash and cash equivalents	$ 84,750	$ 316,449

Accrued Liabilities (Details)

Accrued Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Accrued Liabilities, Current [Abstract]
Contract research organization costs	$ 57,984	$ 53,119
Other clinical study related costs	6,638	6,582
Manufacturing and drug supply	2,996	11,262
Compensation and benefits	11,208	14,864
Professional fees	4,741	4,867
Other	2,000	767
Total accrued liabilities	$ 85,567	$ 91,461

Long Term Debt - Schedule of M

Long Term Debt - Schedule of Maturities of Long-Term Debt (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($)
Long-Term Debt, Fiscal Year Maturity [Abstract]
2023	$ 6,772
2024	9,031
2025	58,537
Thereafter	39,356
Long-Term Debt	113,696
Less amount representing interest	(24,149)
Less unamortized discount	(5,582)
Loans payable, net of discount	$ 83,965

Long Term Debt (Details)

Long Term Debt (Details) - USD ($) $ in Millions					1 Months Ended
	Feb. 03, 2023	Jan. 02, 2023	May 09, 2022	May 01, 2022	May 31, 2022	Sep. 30, 2023	Jun. 19, 2023	Mar. 31, 2023	Jan. 01, 2023
Debt instrument, Face amount								$ 85
Interest rate								10.45%
Percenatge of Term charges on aggregate principal amount					5.35%
Debt conversion, converted instrument, warrants or options issued				14,899
Debt conversion, converted instrument, amount			$ 0.6
Loan Facility [Member]
Line of credit facility, maximum borrowing capacity									$ 35
Line of credit facility, expiration date		Sep. 30, 2024
Loan Facility And Amended Loan Facility [Member]
Long term debt floor interest rate percentage	8.25%
Loan Facility And Amended Loan Facility [Member] | Prime Rate [Member]
Long term debt floor interest rate percentage	2.45%
Loan Facility And Amended Loan Facility [Member] | Tranche Two [Member]
Proceeds from issuance of debt	$ 35
Line of credit facility, maximum borrowing capacity	$ 65
Debt conversion, converted instrument, warrants or options issued	2,453
Debt conversion, converted instrument, amount	$ 0.5
Line of Credit Facility, Current Borrowing Capacity	15
Loan Facility And Amended Loan Facility [Member] | Tranche three [Member]
Line of Credit Facility, Remaining Borrowing Capacity	75
Loan Facility And Amended Loan Facility [Member] | Tranche fouth [Member]
Line of Credit Facility, Remaining Borrowing Capacity	15
Loan Facility And Amended Loan Facility [Member] | Subsequent Event [Member] | Tranche Two [Member]
Line of credit facility, maximum borrowing capacity						$ 15	$ 15
Line of Credit Facility, Remaining Borrowing Capacity						$ 30
Loan Facility And Amended Loan Facility One [Member] | Tranche fouth [Member]
Line of Credit Facility, Remaining Borrowing Capacity	60
Drawn In Two Separate Tranches Upon Achievement of Resmetirom Clinical And Regulatory Milestone
Unused borrowing capacity that can be drawn					$ 125
Term Loan [Member]
Debt instrument, Face amount					250
Proceeds from issuance of debt					$ 50
Long term debt floor interest rate percentage					7.45%
Debt Instrument Interest Payments Terms					The Company will pay interest-only monthly payments of accrued interest under the Loan Facility for a period of 30 months, which period may be extended to 36, 48, and 60 months upon the successive achievement of certain clinical and regulatory milestones
Term Loan [Member] | Loan Facility And Amended Loan Facility [Member]
Proceeds from issuance of debt	$ 35
Term Loan [Member] | Drawn In Two Separate Tranches Upon Achievement of Resmetirom Clinical And Regulatory Milestone
Unused borrowing capacity that can be drawn					$ 75

Stockholders' Equity (Deficit)

Stockholders' Equity (Deficit) - Common Stock (Details)	3 Months Ended
	Mar. 31, 2023 Vote
Stockholders' Equity Note [Abstract]
Number of votes per share that common stockholders are entitled to receive	1

Stockholders' Equity (Deficit_2

Stockholders' Equity (Deficit) - Preferred Stock (Details)	1 Months Ended
	Jun. 30, 2017 Vote $ / shares shares	Mar. 31, 2023 $ / shares	Dec. 31, 2022 $ / shares
Stockholders' Equity (Deficit)
Preferred stock, par value (in dollars per share)		$ 0.0001	$ 0.0001
Convertible Series A and B Preferred Stock
Stockholders' Equity (Deficit)
Preferred stock, par value (in dollars per share)	$ 0.0001
Preferred stock conversion ratio | shares	1
Preferred shares number voting rights | Vote	0

Stockholders' Equity (Deficit_3

Stockholders' Equity (Deficit) - Registered Offering (Details) - 2022 Registered Direct Offering - Purchase Agreement $ / shares in Units, $ in Millions	1 Months Ended
	Dec. 23, 2022 USD ($) $ / shares shares
Stockholders' Equity (Deficit)
Proceeds from issuance or sale of equity, Gross | $	$ 100
Proceeds from issuance or sale of equity | $	$ 99.5
Common stock
Stockholders' Equity (Deficit)
Stock Issued During Period, Shares, New Issues | shares	44,444
Shares issued, Price per share | $ / shares	$ 225
Series B Preferred Stock
Stockholders' Equity (Deficit)
Stock Issued During Period, Shares, New Issues | shares	400,000
Shares issued, Price per share | $ / shares	$ 225

Stockholders' Equity (Deficit_4

Stockholders' Equity (Deficit) - At The Market Issuances (Details) - At-The-Market Issuance Sales Agreement - USD ($) $ in Millions	1 Months Ended	12 Months Ended		27 Months Ended
	Jun. 30, 2021	Dec. 31, 2022	Dec. 31, 2021	Mar. 31, 2023
2021 Sales Agreement
Stockholders' Equity (Deficit)
Number of shares sold by the entity		738,900	497,043	1,235,943
Value of shares sold by the entity		$ 159.1		$ 199.9
Net proceeds after deducting commissions and other transactions costs		$ 155.9		195.8
Remaining reserved amount under shelf registration				$ 0
Cowen & Co. LLC | Maximum
Stockholders' Equity (Deficit)
Maximum aggregate offering price	$ 200

Stock-based Compensation - Stoc

Stock-based Compensation - Stock Option (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Stock-based compensation expense
Options outstanding to purchase of common stock	2,875,723
Maximum
Stock-based compensation expense
Expiration period	10 years
Stock options
Stock-based compensation expense
Shares available for future issuance	690,809
Shares
Outstanding at the beginning of the year (in shares)	2,857,054
Options granted (in shares)	5,205
Options exercised (in shares)	(180,551)
Options cancelled (in shares)	(5,110)
Outstanding at the end of the year (in shares)	2,676,598
Exercisable at the end of the year (in shares)	1,637,134
Weighted average exercise price
Outstanding at the beginning of the year (in dollars per share)	$ 81.78
Options granted (in dollars per share)	283.08
Options exercised (in dollars per share)	99.16
Options cancelled (in dollars per share)	76.07
Outstanding at the end of the year (in dollars per share)	81.02
Exercisable at the end of the year (in dollars per share)	$ 75.71
Additional disclosures
Total intrinsic value of options exercised	$ 32.5	$ 0
Proceeds resulting from exercise of stock options	$ 17.9	$ 0
Weighted-average grant date fair value of options (in dollars per share)	$ 219.02	$ 59.63

Stock-based Compensation - Expe

Stock-based Compensation - Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Stock-based compensation expense
Stock-based compensation expense	$ 11,250	$ 7,477
Research and development
Stock-based compensation expense
Stock-based compensation expense	5,385	3,187
General and administrative
Stock-based compensation expense
Stock-based compensation expense	5,865	4,290
Stock options
Stock-based compensation expense
Stock-based compensation expense	8,598	7,477
Restricted Stock Units (RSUs)
Stock-based compensation expense
Stock-based compensation expense	$ 2,652	$ 0

Stock-based Compensation - Unre

Stock-based Compensation - Unrecognized Expense (Details) - Stock options $ in Millions	3 Months Ended
	Mar. 31, 2023 USD ($)
Unrecognized stock-based compensation expense
Unrecognized stock compensation expense	$ 52.3
Weighted average remaining period (in years)	2 years 5 months 1 day

Stock-based Compensation - Rest

Stock-based Compensation - Restricted Stock Units (Details) - Restricted Stock Units (RSUs)	Mar. 31, 2023 $ / shares shares
Stock-based compensation expense
Outstanding restricted units | shares	199,125
Weighted average grant date fair value | $ / shares	$ 297.18

Commitments and Contingencies (

Commitments and Contingencies (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Commitments and Contingencies
Licensed product sales	$ 0	$ 0
Research, Development and Commercialization Agreement | Hoffmann-La Roche ("Roche")
Commitments and Contingencies
Remainder of future milestone payments	$ 8

Subsequent Event (Details)

Subsequent Event (Details) - At The Market Issuance Sales Agreement - Cowen Co. Llc [Member] - Maximum [Member] - USD ($) $ in Millions	1 Months Ended
	May 31, 2023	Jun. 30, 2021
Subsequent Event [Line Items]
Maximum aggregate offering price		$ 200
Subsequent Event
Subsequent Event [Line Items]
Maximum aggregate offering price	$ 200