A Tiny Korean Biotech Just Put Up MASH Numbers That Rival Novo Nordisk

So how does D&D's zabopegdutide stack up? On paper, surprisingly well. Its 57.2-percentage-point advantage in MASH resolution and 34.2-point edge in fibrosis improvement are in the same ballpark as semaglutide's numbers, possibly even better on certain measures.

But there's a catch.

The Asterisk You Can't Ignore

D&D's trial enrolled 67 patients, with 16 patients evaluable on the treatment dose and 19 on placebo for biopsy endpoints. Semaglutide's ESSENCE trial was a full-scale Phase 3 with hundreds of participants.

Small trials are like taste-testing a single grape and declaring the whole vineyard excellent. The signal might be real, but the confidence interval is wide enough to drive a truck through. In biotech, promising Phase 2 data from tiny studies has a long and inglorious history of falling apart in larger trials.

To be fair, D&D hit statistical significance on all three of its key endpoints, including the combined measure of both fibrosis improvement and MASH resolution (37.5% vs 5.3%, p = 0.0192). The company also showed strong earlier results: at week 12, 75.8% of patients had achieved at least a 30% reduction in liver fat by MRI, compared to 11.8% on placebo.

The trajectory looks real. But "looks real in a small evaluable cohort" and "holds up in 500" are very different sentences.

What Makes This Drug Different

Zabopegdutide isn't a plain GLP-1 agonist like semaglutide. It's a dual GLP-1/glucagon receptor agonist, which means it pulls two levers at once. The GLP-1 side handles appetite suppression, insulin secretion, and glucose control. The glucagon side directly promotes the breakdown of fat stored in the liver.

Think of it like attacking a house fire with two hoses instead of one: the GLP-1 component cuts off the fuel supply (excess calories, insulin resistance), while the glucagon component goes after the flames already burning in the liver.

D&D also has a triple agonist (DD15) in earlier development that adds GIP receptor activity on top of GLP-1 and glucagon. The company is clearly betting that more targets equal better outcomes, a hypothesis that tirzepatide's success in obesity has done a lot to validate.

The Competitive Landscape Is Getting Crowded

D&D isn't just competing with Novo Nordisk. The MASH space is turning into one of the most crowded arenas in biopharma.

Madrigal's Rezdiffra (resmetirom) was the first FDA-approved MASH drug, working through an entirely different mechanism: activating thyroid hormone receptor-beta to directly reduce liver fat. It pulled in over $180 million in its first partial year on the market and is projected to reach $3 billion in annual sales by 2030.

Behind Rezdiffra, there's a wall of contenders. Eli Lilly's tirzepatide is being studied in MASH but won't have an FDA filing before 2027 at the earliest. Boehringer Ingelheim's survodutide, another GLP-1/glucagon dual agonist like zabopegdutide, is in Phase 3, with initial results expected around 2027–2028. FGF21 analogues from Akero (efruxifermin) and 89bio (pegozafermin) offer yet another angle of attack.

The big question for D&D: can a small Korean biotech compete in a space where Novo Nordisk, Eli Lilly, and Madrigal are already throwing billions at the problem?

The Road Ahead

D&D has FDA Fast Track designation for zabopegdutide in MASH, which helps with regulatory interactions but doesn't guarantee approval. No Phase 3 trial has been announced yet, and that's the critical next step. The company has also signed a licensing deal with Shenzhen Salubris for certain territories, suggesting it may look to partners rather than go it alone globally.

For investors and industry watchers, the takeaway is nuanced. D&D's data validates the dual agonist approach in MASH and adds to the growing mountain of evidence that GLP-1-class drugs can reverse liver scarring, not just slow it down. But the trial is too small to change clinical practice, and the competitive moat is basically nonexistent.

The MASH market is a massive opportunity that's barely been tapped. Right now, it's a land grab. D&D just planted a flag, but planting a flag and holding territory are two very different things.