The THR‑B agonist market is witnessing rapid growth, fueled by the increasing global prevalence of metabolic disorders such as MASH and rare genetic conditions like X‑ALD. Progress in thyroid hormone receptor research has strengthened the therapeutic potential of selectively targeting THR‑B, especially within liver tissue, thereby driving its advancement in these critical areas of unmet need.
DelveInsight's THR-B Agonist Market Size, Target Population, Competitive Landscape & Market Forecastreport includes a comprehensive understanding of current treatment practices, addressable patient population, which includes top indications such as MASH, X-linked Adrenoleukodystrophy (X-ALD), and others. The selected indications are based on approved therapies and ongoing pipeline activity. The report also provides insights into the emerging THR-B agonist, market share of individual therapies, and current and forecasted market size from 2020 to 2034, segmented into 7MM.
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Key Takeaways from the THR-B Agonist Market Report
— As per DelveInsight's analysis, the total market size of THR-B agonistin the 7MM is expected to surge significantly by 2034.
— The report provides the total potential number of patients in the indications, such as MASH, X-linked Adrenoleukodystrophy (X-ALD), and others.
— Leading THR-B agonistcompanies, such as Viking Therapeutics, Aligos Therapeutics, Terns Inc., Eccogene, and others, are developing novel THR-B agoniststhat can be available in the THR-B agonist market in the coming years.
— Some of the key THR-B agonistsin the pipeline include VK2809, ALG‑055009, TERN-501, ECC4703, VK0214, and others.
— In June 2025, Madrigal received a positive Committee for Medicinal Products for Human Use (CHMP) opinion for REZDIFFRA (resmetirom) for the treatment of MASH with moderate to advanced fibrosis, based on data from the Phase III MAESTRO-NASH trial.
— In November 2024, Viking Therapeutics presented 52-week secondary endpoint results from the Phase IIb VOYAGE trial of VK2809 in biopsy-confirmed NASH/MASH at the 75th Liver Meeting hosted by the American Association for the Study of Liver Diseases (AASLD), further supporting its potential in advancing MASH therapy.
Discover which indication is expected to grab the major THR-B agonist market share @ THR-B Agonist Market Report
THR-B Agonist Market Dynamics
The THR-B agonist market is gaining significant momentum due to the growing prevalence of metabolic and liver diseases, particularly MASH and NAFLD. The approval of REZDIFFRA by the US FDA in March 2024 as the first THR-B agonist for treating adults with noncirrhotic MASH and moderate to advanced fibrosis (F2-F3) has marked a significant milestone in this space. This has created a favorable market environment and is expected to drive further investments and research efforts to expand the therapeutic potential of THR-B agonists.
Key drivers of the THR-B agonist market include the rising global burden of obesity, type 2 diabetes, and metabolic syndromes, which are strongly linked to NASH and NAFLD. Increasing awareness of liver health and the demand for targeted, noninvasive therapies are boosting interest in THR-B agonists as they address the underlying lipid dysregulation rather than just symptomatic management. The drug class has also gained attention for its favorable safety profile compared to traditional NASH treatments, such as pioglitazone or vitamin E. Additionally, advances in biomarker-based patient selection and non-invasive diagnostic tools are expected to improve clinical outcomes and accelerate the uptake of THR-B therapies.
However, market growth is not without challenges. A key restraint is the limited number of approved drugs in this class, with REZDIFFRA being the only FDA-approved THR-B agonist so far. High development costs, complex clinical trial designs, and stringent regulatory requirements for NASH drugs also pose barriers. Moreover, long-term efficacy and safety data are still being evaluated, and competition from alternative mechanisms of action, such as FXR agonists, PPAR modulators, and FGF21 analogs, may impact the market share of THR-B agonists.
The competitive landscape is expected to intensify as multiple companies are pursuing THR-B agonist candidates. Madrigal Pharmaceuticals, the developer of resmetirom, currently holds a first-mover advantage, but pipeline candidates such as VK2809 (Viking Therapeutics) are showing promising results in clinical trials. Collaborations, partnerships, and licensing agreements are becoming common strategies for companies to strengthen their foothold in this emerging therapeutic segment.
In the future outlook, the THR-B agonist market is poised for strong growth as more drugs reach late-stage trials and potential approvals. Expansion of indications beyond MASH could broaden the addressable market. As payer acceptance and reimbursement frameworks evolve, the commercial potential of this drug class is expected to improve. Overall, the combination of clinical innovation, unmet medical need, and supportive regulatory momentum will be critical in shaping the dynamics of the THR-B agonist market over the next decade.
THR-B Agonist Treatment Market
To date, REZDIFFRA (resmetirom, MGL‑3196) remains the only approved THR‑B agonist for treating adults with noncirrhotic MASH and moderate to advanced liver fibrosis (F2-F3), in combination with diet and exercise. The US FDA granted REZDIFFRA accelerated approval in March 2024, based on evidence of improvements in MASH and fibrosis, with continued approval contingent upon confirmation of clinical benefits in ongoing studies.
Madrigal is also advancing REZDIFFRA for compensated MASH cirrhosis (stage F4c), currently being assessed in the fully enrolled Phase III MAESTRO-NASH OUTCOMES trial, which is evaluating its effect on preventing liver decompensation events.
In June 2025, REZDIFFRA received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) for treating MASH with moderate to advanced fibrosis, supported by Phase III MAESTRO-NASH trial results. A final decision from the European Commission is anticipated by August 2025, which would make REZDIFFRA the first approved therapy for MASH in the EU if granted.
Following European approval, Madrigal plans a phased rollout across Europe, starting with Germany in the second half of 2025, marking the first availability of an authorized treatment for MASH-related liver fibrosis in the region.
In May 2025, Madrigal reported Phase III data showing that REZDIFFRA significantly reduced liver stiffness and the risk of portal hypertension in patients with compensated MASH cirrhosis, with 65% of patients shifting to lower risk categories by the second year of treatment.
Learn more about the THR-B agonist@ THR-B Agonist Analysis
Key Emerging THR-B Agonist and Companies
Key emerging THR‑B agonists such as VK2809 (Viking Therapeutics), ALG‑055009 (Aligos Therapeutics), TERN-501 (Terns Inc.), ECC4703 (Eccogene), and VK0214 (Viking Therapeutics), among others, are demonstrating therapeutic potential across a range of indications, with efforts focused on expanding treatment options in both metabolic and rare genetic diseases.
VK2809 is an orally administered, liver-directed, and subtype-selective THR‑beta agonist designed to precisely regulate lipid metabolism. By specifically activating THR‑B in liver tissue, it stimulates the expression of genes involved in lipid processing and clearance, resulting in improved cholesterol and lipoprotein levels. VK2809 has demonstrated strong therapeutic potential in lipid-related disorders, achieving both primary and secondary endpoints in the Phase IIb VOYAGE trial in patients with biopsy-confirmed NASH/MASH and fibrosis, as well as in a Phase IIa study in patients with elevated LDL-C and NAFLD.
In June 2024, Viking Therapeutics announced positive 52-week histological outcomes from the Phase IIb VOYAGE trial in biopsy-confirmed NASH patients, reinforcing VK2809's promise for treating MASH with fibrosis.
ALG‑055009, developed by Aligos Therapeutics, is an oral small-molecule THR‑beta agonist under investigation for MASH. Engineered for best-in-class potency and selectivity, it aims to enhance lipid metabolism, promote fatty acid oxidation, and improve bile acid synthesis, with the potential to reverse hepatic steatosis. By selectively activating THR‑B, ALG‑055009 reduces systemic lipid levels while avoiding off-target effects related to THR‑a. Aligos Therapeutics is exploring strategies to advance its development, including potential out-licensing.
In November 2024, the company presented positive Phase IIa HERALD trial data on ALG‑055009 in MASH patients during a late-breaker oral session at The Liver Meeting 2024 (AASLD). In September 2024, topline Phase IIa HERALD results showed that ALG‑055009 met its primary endpoint, achieving significant liver fat reduction at Week 12 as assessed by MRI-PDFF. Preparations for a Phase IIb trial are ongoing, with completion anticipated by mid-2025 and final trial designs under review.
VK0214, another novel oral THR‑B agonist from Viking Therapeutics, is being developed for X-linked adrenoleukodystrophy (X‑ALD), particularly the adrenomyeloneuropathy (AMN) form, and has received orphan drug designation from the US FDA. In a placebo-controlled Phase Ib study in adult males with AMN, VK0214 was well-tolerated with once-daily dosing over 28 days and produced significant reductions in plasma very long-chain fatty acids (VLCFAs) and other lipid markers. By upregulating ABCD2 expression, which encodes a compensatory transporter (ALDRP), VK0214 aims to normalize VLCFA metabolism and potentially reduce demyelination, offering a therapeutic approach for all forms of X‑ALD, a progressive metabolic disorder with no approved treatments.
In October 2024, Viking reported positive Phase Ib results for VK0214, meeting all primary and secondary endpoints. The therapy was well-tolerated, with most adverse events mild or moderate and one severe event, a wrist fracture, occurring in a placebo recipient.
Earlier, in June 2021, Viking announced positive results from a first-in-human Phase I trial of VK0214, which included single and multiple ascending dose cohorts in healthy volunteers. The study met its safety and efficacy objectives, with no serious adverse events or dose-related safety issues observed.
The anticipated launch of these emerging therapies are poised to transform the THR-B agonist market landscape in the coming years. As these cutting-edge therapies continue to mature and gain regulatory approval, they are expected to reshape the THR-B agonist market landscape, offering new standards of care and unlocking opportunities for medical innovation and economic growth.
To know more about THR-B agonist clinical trials, visit @ THR-B Agonist Treatment
THR-B Agonist Overview
THR‑B, the beta isoform of the thyroid hormone receptor, is a key regulator of lipid metabolism, cholesterol transport, bile acid production, and mitochondrial activity, particularly in the liver. Selective activation of THR‑B enhances hepatic fat oxidation, reduces inflammation, and suppresses fibrogenic pathways, mechanisms highly relevant to MASH therapy. Furthermore, THR‑B activation upregulates the ABCD2 gene, which encodes a compensatory peroxisomal transporter, offering therapeutic potential for rare genetic diseases like X‑ALD by lowering the accumulation of very long-chain fatty acids.
The therapeutic significance of THR‑B lies in its ability to provide metabolic benefits without triggering the adverse effects linked to THR‑a activation, such as cardiac and skeletal toxicity. Novel THR‑B agonists are being developed to achieve optimal liver targeting and subtype selectivity, to improve liver histology, reverse steatosis, and prevent cirrhosis progression. Current clinical programs aim to validate these benefits through robust long-term safety and efficacy studies, with ongoing trials in both MASH and X‑ALD underscoring THR‑B as a pivotal molecular target in metabolic and rare diseases.
THR-B Agonist Epidemiology Segmentation
The THR-B agonist market report proffers epidemiological analysis for the study period 2020-2034 in the 7MM, segmented into:
— Total Cases in Selected Indications for THR-B Agonist
— Total Eligible Patient Pool in Selected Indications for THR-B Agonist
— Total Treated Cases in Selected Indications for THR-B Agonist
Scope of the THR-B AgonistMarket Report
— THR-B Agonist Therapeutic Assessment: THR-B Agonist current marketed and emerging therapies
— THR-B AgonistMarket Dynamics: Conjoint Analysis of Emerging THR-B Agonist Drugs
— Competitive Intelligence Analysis:SWOT analysis and Market entry strategies
— Unmet Needs, KOL's views, Analyst's views, THR-B Agonist Market Access and Reimbursement
Discover more about THR-B agonist in development @ THR-B Agonist Clinical Trials
Table of Contents
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