After a cautious Q2 amid FDA workforce changes and drug pricing policy debates, deal flow accelerated dramatically in Q3-Q4. September alone saw $8.7B in activity, with the MASH land grab (Roche, Novo) and Pfizer’s obesity re-entry ranking among the largest deals. Note: Chart is not exhaustive.
Novo Nordisk’s $5.2 billion acquisition of Akero Therapeutics sits at the center of 2025’s hottest M&A space: MASH/metabolic disease. The deal, announced October 9, represents the largest of three major Fibroblast Growth Factor 21 (FGF21) analog acquisitions in five months. Across the broader landscape, 2025 pharma M&A activity reached approximately $70 billion in upfront consideration through October 10, featuring 17 deals valued at $1 billion or more.
The year’s activity breaks down into a few distinct waves. Three mega-deals account for roughly half the total: Johnson & Johnson’s $14.6 billion Intra-Cellular acquisition, Merck’s $10 billion Verona purchase, and Sanofi’s $9.1 billion Blueprint transaction. The MASH competition adds another $8.3 billion: GSK paid $1.2 billion for efimosfermin, Roche committed $2.4 billion for 89bio, and Novo topped both with $4.7 billion for Akero. The remaining 11 major transactions make up the balance, spanning cardiovascular, oncology and rare disease targets.
The MASH land grab: Novo’s $5.2B bet in context
The escalating competition for MASH assets is evident in rapidly increasing deal values. Within 150 days, three pharmaceutical giants committed $8.3 billion upfront to acquire FGF21 analogs. Novo Nordisk’s $4.7 billion payment for Akero nearly doubles the $2.4 billion Roche paid for 89bio just three weeks earlier and quadruples GSK’s $1.2 billion for Boston Pharmaceuticals’ efimosfermin-alfa in May.
The premium reflects efruxifermin’s unique clinical profile: it’s the only FGF21 analog to demonstrate significant fibrosis regression in Phase 2 for F4 compensated cirrhosis—driven by 96-week extension data showing statistically significant reversal versus placebo. Though less visible than obesity or diabetes, MASH affects approximately 5% of U.S. adults and represents a substantial market with few treatment options for advanced disease. The deal positions Novo to address the full disease spectrum, pairing GLP-1s like Wegovy (approved for MASH in August 2025) for early-stage patients with efruxifermin for those with advanced liver damage.
MASH/Liver disease acquisitions 2025
Novo Nordisk acquires Akero Therapeutics. Novo Nordisk announced on October 9, 2025, that it would acquire Akero Therapeutics for up to $5.2 billion, including $4.7 billion upfront in cash at $54 per share and a potential $500 million contingent value right worth $6 per share if Efruxifermin (EFX) gains full U.S. approval for compensated cirrhosis due to MASH by June 30, 2031. EFX, an FGF21 analog and Akero’s lead asset, is in three ongoing Phase 3 trials under the SYNCHRONY program, positioning it as the only FGF21 analog to demonstrate significant fibrosis regression in Phase 2 for F4 compensated cirrhosis. The deal marks the first major acquisition under Novo Nordisk CEO Mike Doustdar, who took office this summer, and bolsters the company’s MASH portfolio by complementing Wegovy’s recent approval for the condition while targeting advanced-stage patients with limited treatment options. The transaction is expected to close by year-end 2025, pending shareholder and regulatory approvals
Roche bags 89bio. Announced Sept. 18, 2025, Roche moved to lock down its FGF21 position with a $2.4B upfront tender for 89bio at $14.50/share plus a non-tradeable CVR worth up to $6.00/share (total up to $3.5B). The offer equates to 79% over the prior close (52% vs. 60-day VWAP). Lead asset pegozafermin, an FGF21 analog in Phase 3 for MASH with advanced fibrosis (including compensated cirrhosis), slots into Roche’s cardiovascular, renal and metabolism portfolio. CVR triggers are straightforward: $2.00 on first commercial sale in F4 by March 31, 2030; $1.50 at $3B global annual net sales by Dec 31, 2033; $2.50 at $4B by Dec 31, 2035. A tender offer began October 1, with closing expected by the end of the year.
GSK scoops up Boston Pharmaceuticals. Completed July 7, 2025, GSK closed its purchase of efimosfermin alfa from Boston Pharmaceuticals for $1.2 billion upfront plus up to $800 million in milestones. The once-monthly FGF21 analog is Phase 3-ready for steatotic liver disease (SLD), including MASH with cirrhosis, with GSK also planning to explore alcohol-related liver disease; the company frames efimosfermin as a potential best-in-class therapy and has flagged a possible first launch in 2029.
The x-axis shows “Total Deal Value ($B),” the total amount each company spent on acquisitions in billions of dollars.
Beyond MASH
Only two transactions exceeded $10 billion in 2025. Johnson & Johnson’s $14.6 billion acquisition of Intra-Cellular Therapies (completed April) secured Caplyta for schizophrenia and bipolar depression, with market exclusivity through 2040—the largest pure biopharma M&A since Novo Holdings’ 2024 Catalent deal. Merck paid $10 billion for Verona Pharma to acquire Ohtuvayre, an FDA-approved COPD treatment expanding its cardio-pulmonary pipeline. Sanofi’s $9.5 billion Blueprint Medicines acquisition (completed July) brought the only approved therapy for systemic mastocytosis, generating $479M in 2024 revenue with potential to reach $2B by 2030.
Pfizer made its obesity comeback with a $4.9 billion bet on Metsera (announced September), acquiring two assets—a GLP-1 showing 14.1% weight loss at 28 weeks and an amylin analog—after abandoning earlier obesity programs. The deal includes up to $2.4B in CVRs tied to Phase 3 initiation and FDA approvals, positioning Pfizer to compete in the projected $100B+ obesity market.
Mid-tier deals clustered in the $3-5B range: Mallinckrodt and Endo International completed a $6.7B specialty pharma merger (closed August 2025); Merck KGaA paid $3.5B for SpringWorks’ rare cancer assets (completed July); and Bain Capital carved out Mitsubishi Tanabe Pharma for $3.3B in a private equity play spanning immunology, CNS, and metabolic disease.
Filed Under: M&A trends
