Roche’s 89bio Deal Heats Up the Race for MASH Drugs

Roche’s acquisition of 89bio signals rising confidence in late-stage MASH drugs and sharpens competition for metabolic liver disease treatments

20 Jan 2026

A once-neglected corner of medicine is attracting serious money. With its acquisition of 89bio now complete, Roche has signalled that metabolic liver disease is no longer a peripheral interest. It is becoming a core part of the firm’s strategy.

The focus is MASH, metabolic dysfunction–associated steatohepatitis, a severe form of fatty liver disease linked to obesity and diabetes. It affects tens of millions of people worldwide and can progress to cirrhosis or cancer. Yet for years it has humbled drugmakers. Trials are long, endpoints hard to measure and regulators wary. Many promising candidates have failed late, draining confidence and capital.

Roche’s move suggests the balance is shifting. At the centre of the deal is pegozafermin, a late-stage therapy that has advanced further than most of its predecessors. The drug aims to reduce liver fat and slow the scarring that drives the disease. It has not yet been approved, but it has cleared enough hurdles to look like a risk Roche is willing to take.

That fits with a broader push. Metabolic disease offers large, growing markets and patients who need treatment for years. Drugmakers like such maths. Increasingly, they prefer to buy assets that have already been tested rather than start from scratch. In areas as complex as MASH, speed matters more than novelty.

Competition is intensifying. Novo Nordisk and others are exploring whether blockbuster weight-loss and diabetes drugs can also improve liver disease. Roche is taking a more targeted approach, aiming directly at liver pathology. If it works, that could help it stand apart in a crowded field.

Regulators remain a brake. Approval will depend on showing clear clinical benefit, not just improvements in scans or blood tests. Trials will be lengthy, prices contested and reimbursement uncertain.

Still, the mood has changed. After years of disappointment, a big pharmaceutical firm is betting that science, strategy and regulation may finally align. For patients and rivals alike, that is a sign that MASH’s long wait for progress may be nearing an end.