Axsome Therapeutics vs. Viking Therapeutics: Which Healthcare Stock Is a Better Buy in 2026?

Is it better to own a company already selling drugs or one with a potential blockbuster in testing? Investors are weighing Axsome Therapeutics (NASDAQ:AXSM) against Viking Therapeutics (NASDAQ:VKTX) to decide.

Axsome focuses on commercializing treatments for depression and sleep disorders, showing significant revenue growth. Viking is a clinical-stage developer targeting the massive obesity market but has no products on the market yet. Both represent different stages of growth within the biotech world, making them popular choices for healthcare-minded portfolios.

The case for Axsome Therapeutics

Axsome develops and sells treatments for central nervous system conditions such as depression, migraines, and narcolepsy. It is a prominent name among biotech stocks, with a portfolio that includes Auvelity, Sunosi, and Symbravo. The company recently entered a settlement that grants license rights to five generic manufacturers for Sunosi starting in 2040, providing long-term clarity on its patent life and market position. In its latest annual report, filed in early 2026, the company noted it had over 900 full-time employees to support its commercial reach.

In FY 2025, revenue reached nearly $638.5 million, marking growth of close to 65.5% compared to the prior year. This increase was driven by the continued expansion of its key central nervous system treatments into new geographic markets. The company reported a net loss of approximately $183.2 million, resulting in a negative net margin, which is the percentage of revenue left after all expenses are paid, of roughly 28.7%. Some investors focus on the P/S ratio to value the business relative to this growing revenue.

As of December 2025, the debt-to-equity ratio was nearly 2.7x, meaning the company uses significant debt relative to its equity. The current ratio of approximately 1.6x indicates it has $1.60 in assets for every $1.00 in liabilities due within a year. Free cash flow, or cash from operations minus capital spending, was nearly negative $93.9 million as the company continues to invest in its commercial pipeline. This spending is intended to support the long-term growth of its approved products and the development of new candidates.

The case for Viking Therapeutics

Viking is a clinical-stage business that develops therapies for obesity and metabolic diseases. It currently has no products on the market, as its primary candidates like VK2735 are still undergoing clinical testing for weight loss. The company relies on a master license agreement with Ligand Pharmaceuticals (NASDAQ:LGND) to access the core technology used in its drug development programs. Viking manages its operations with a lean staff of about 53 full-time employees, according to its latest annual report filed in early 2026.

For FY 2025, Viking reported revenue of $0.0, which is standard for a biotech firm in the development phase. The business reported a net loss of approximately $359.6 million as it accelerated investment in its clinical trials to move its obesity treatments toward regulatory review. Investors generally view these losses as the necessary cost of targeting massive future markets, which factors into the Forward P/E. While there are no sales to measure, the clinical data remains the primary driver of the company value.

As of December 2025, the debt-to-equity ratio was 0.0x, indicating the company carries no debt relative to its equity. Its current ratio was roughly 9.3x, meaning its liquid assets far exceed its upcoming bills and provide a significant cash runway for research. Free cash flow was nearly negative $278.7 million, representing the cash used to support its ongoing research and operational needs. This spending level is expected for a company in the high-stakes world of drug development where clinical success is paramount.

Risk profile comparison

Axsome faces risks from its heavy reliance on only a few approved products, as any commercial or regulatory setback would be harmful to the business. It also carries significant debt from a loan agreement that includes restrictive rules on how much cash it must keep on hand. The company competes against giants like Pfizer (NYSE:PFE), and it faces potential conflicts from licensing technology from an entity owned by its own chief executive.

Viking faces the risk that its drug candidates might fail in clinical trials or not receive the necessary regulatory approval to reach the market. Because it has no revenue, the company must eventually raise more capital, which could lead to shareholder dilution. It also faces competition from other developers like Altimmune (NASDAQ:ALT) and depends entirely on its license with Ligand, which would cripple the company if it were terminated.

Which stock would I buy in 2026?

I'd go with Viking Therapeutics, though Axsome makes this closer than some may expect. Axsome is a commercial-stage company with drugs already on the market and growing fast. Its lead drug just received a new FDA approval for Alzheimer's agitation, revenue grew strongly year over year, and the company believes its cash runway extends into profitability. For investors who prefer owning a company already generating revenue, Axsome has a credible story.

But revenue missed estimates in the most recent quarter, losses are widening as selling costs surge, and the path to profitability requires everything to keep going right commercially.

Viking is playing in one of the largest healthcare markets ever created. Its obesity drug, VK2735, is showing strong results in both injectable and oral formulations, with a phase 3 program underway. The competitive landscape includes giants like Eli Lilly and Novo Nordisk, but if Viking's drug succeeds, the upside dwarfs anything Axsome is building toward.

For a long-term investor comfortable with clinical risk, Viking's opportunity is simply larger. That's why it's my pick today.

Sara Appino has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends Axsome Therapeutics, Eli Lilly, Novo Nordisk, and Pfizer. The Motley Fool recommends Viking Therapeutics. The Motley Fool has a disclosure policy.