Novartis AG

Good morning and good afternoon and welcome to the Novartis Q4 2023 Results Release Conference Call and Live Webcast. Please note that during the presentation, all participants will be in a listen-only mode and the conference is being recorded. After the presentation, there'll be an opportunity to ask questions by pressing star 1 and 1 at any time during the conference. Please limit yourselves to one question and return to the queue for any follow-up. A recording of the conference call, including the Q&A session, will be available on our website shortly after the call ends. With that, I would like to hand over to Mr. Samir Shah, Global Head of Investor Relations. Please go ahead, sir.

Thank you very much, and good morning and good afternoon, everybody. Thank you again for listening to our full year results and Q4 results. The information presented today contains forward-looking statements that involve known and unknown risk uncertainties, and other factors. These may cause the actual results to be materially different from any future results, performance, or achievements expressed or implied by such statements. For a description of some of these factors, please refer to the company's Form 20F and its most recent quarterly results on Form 6K that, respectively, were filed with and furnished to the U.S. Securities and Exchange Commission. And with that, I'll hand it across to Val.

Thank you, Samir, and thanks everyone for joining today's call. I know it's a busy day with many companies reading out, but we hope to provide you some insights into our Q4 2023 results and also some perspectives on the outlook for Novartis in 2024 and beyond. If we move to the first slide, slide four. As you saw in our earnings release this morning, we delivered a strong full-year performance with margin expansion and strong innovation momentum with 10 positive Phase 3 readouts over the course of 2023. As a reminder, our full-year guidance at the start of the year was quite a bit lower than where we ended up, and we had multiple earnings upgrades over the course of the year, demonstrating, I think, the strong business momentum we have as a company. Q4 sales up 10%, core operating income was up 13%. And on the full year, we were up 10% on sales and core operating income up 18% all in constant currencies. And Harry will go through this in more detail in a few moments. We also had the successful spinoff of Sandoz as a really value creating event for Novartis and our shareholders. We provided our updated 2024 guidance where we expect to grow mid single digit and core opting expected to grow high single digit. And we've chosen to be prudent with this guidance at this point in time. And then looking to our midterm guidance, which I'll also go through in more detail, we've extended our midterm guidance of 5% constant currency CAGR growth to 2023 to 2028 and continue to hold to our core operating income margin guidance of 40% plus by 2027. So moving to slide five, this year was a really critical year for the company because we completed the transformation of Novartis. We believe really laying a strong foundation for our future growth. Since 2014, we have spun off both Alcon and Sandoz in shareholder-friendly ways. We have exited our OTC stake, also in a shareholder-friendly approach, and exiting, creating a new OTC company with GSK. And also importantly, exited our Roche stake, completing a $15 billion share buyback, and then continuing $15 billion share buyback, which is ongoing currently, and we expect to complete by mid-2025. That leaves us as a pure play innovative medicines company with a margin of 36% on its way to the 40% plus, strong free cash flow, and a strong innovation engine, which we think positions us well for the long run. So moving to slide six, when you look at Q4, most importantly with the underlying growth of our key growth drivers, which grew 40% overall on the quarter, and that growth rate we expect to continue. That underlying growth is what gives us confidence that we can grow mid-single digit in the coming years and then continue that growth in 2028 and beyond in the mid-single digit plus range. A combination of these growth drivers as well as strong pipeline productivity puts us, I think, in a strong position to be a consistent grower over the next decade. And moving to slide seven. And I want to just walk through each of the brands to give you some perspectives and then look forward to taking your questions. So first, Entresso delivered 31% growth with sales reaching $6 billion and we're well on track to reach our peak sales goal of $7 billion. Plus, this growth was both in the U.S. and ex-U.S. geographies. You can see on our weekly TRX, we continue to reach record highs. We had constant currency growth of 27% and 26% in U.S. and ex-U.S. and China and Japan contributed strongly with strong performance with their ongoing hypertension launches. So looking forward, we expect continued growth for this brand. We maintain our guidance for forecasting purposes that an Entresto LOE would not occur until 2025, and we also maintain our guidance on EU regulatory data protection to November 2026. So moving to slide eight. Now, Cosentix reached $5 billion in 2023, and we expect to see at least mid- to high-single-digit growth in 2024 on our way to our guidance of $7 billion peak sales. Going a little deeper into this performance, we saw 17% growth in the U.S. and 26% outside the U.S. This was in part in the U.S. due to revenue deduction adjustments we had in the prior year leading to a lower base. But we are seeing very good momentum on our IV and hydradenitis launches in the U.S. and in hydradenitis in Europe, which gives us confidence that Cosentix can be a dynamic grower over the coming years. We'll continue to keep you updated on how these launches progress over the coming quarters. And then we also will keep you updated as well on the three ongoing phase three studies we have are progressing in giant cell arteritis, PMR, and rotator cuff tendinopathy. So moving to slide nine, Cosimta sales in the full year doubled to $2.2 billion. We remain on track to reach our $4 billion peak sales guidance. Strong growth in the U.S., but also now increasing growth in Europe and in the ex-U.S. markets. We currently see 85,000 patients treated with Kesimpta to date. Our U.S. growth is 48% in constant currencies, ex-U.S. at 193%. And we have NBRX leadership now in 7 out of 10 major markets outside of the United States. I think everyone knows well the compelling profile we have in terms of efficacy and convenience, as well as the easy-to-use sensor-ready pen that patients can benefit from with Casimta. We have five years of efficacy, safety, and tolerability, and we'll look forward to continuing to expand this brand, both in terms of the growth of the B-cell class in MS, but also increasing our NBRX share within the B-cell class as a key growth driver. Moving to slide 10. cascali reached 2.1 billion in the metastatic breast cancer setting we maintain our 4 billion dollar peak sales guidance in the metastatic breast cancer setting alone you can see this growth again was driven by both the us and our international business our rolling nbrx share and the metastatic setting is now up to 46 and we see continued strong growth in the metastatic setting This is driven by the statistically significant OS we have now across three pivotal studies, the NCCN Category 1 designation, and the median OS of five years we've demonstrated across those three pivotal trials. We can confirm that we have filed in the EU, US, and China the adjuvant indication across intermediate and high-risk breast cancer, and we'll look forward to keeping you up to speed as we progress towards hopefully those approvals and launches over the course of this year. moving to slide 11. fluvicto a full year sales closed out a near blockbuster status at 980 million importantly now we see unconstrained supply for this brand we maintain our multi-million dollar peak sales guidance for the current indication and i can say we see very strong demand signals and growth dynamics in january consistent with our expectations But as we cleared the supply constraints and some of the challenges we saw in quarter four, we would get back to strong, robust growth in quarter one 2024. And what we would expect is robust quarter on quarter growth over the course of this year. Some more details in terms of treatment sites. We have over 300 US sites now that are active and regularly ordering fully unconstrained supply. We're 99.9% now doses injected on the planned day. with a capacity of 250,000 radioligo therapy doses expected in 2024, with the approval now of our Indianapolis site. We have a network expansion ongoing to prepare for launches in Asia with announced investments in both China and Japan. And as I already noted, we expect robust quarter-on-quarter growth over the course of 2024. Our PSMA-4 expected US submission is second half 2024, and we'll keep you updated as We progress towards that and we also remain on track on our both our PSMA addition and PSMA localized oligometastatic disease trials to move Flavico into earlier lines of therapy. Now moving to slide 12. Semblix had a strong year and strong quarter moving up now to 125 million in quarter four 2023. This is in the third-line setting where we have leading third-line market share, NBRX share of 43%, TRX share of 22%. I think, as you all well know, there's high unmet need in the third-line setting, and over 50% of hematologists really want improvements in quality of life and better management of side effects. Insemblix really delivers that. Now we have four years of follow-up that really demonstrate its differentiated profile in terms of efficacy as well as a very clear and strong safety profile. So the global rollout in the third line setting is ongoing. We have approval in over 60 markets. We have access granted now in over 25 markets and very positive feedback from payers on the clinical benefit. Now moving to slide 13. We read out earlier this month the Ask for First trial, which met both its primary endpoints with clinically meaningful and statistically significant results in the frontline setting for Semblix. As a reminder, this study had Semblix compared to investigator-choice TKI. We estimate 50% of the patients were on imatinib and 50% of the patients were on second-gen TKIs, nilatinib or disatinib or busutinib. Both primary endpoints were met. We showed superior major molecular response rates at week 48 for standard of care, and we also had a very favorable safety and tolerability profile with fewer AEs, treatment discontinuations, and no new safety signals observed. So we're very excited about this data. Importantly, MMR is a good predictor, a reasonable predictor of important endpoints such as PFS, OS, and EFS. So this data will be presented at an upcoming medical congress. We're moving rapidly towards a submission in the first half of 2024, and we'll look forward to sharing this full data set and really providing our conviction that Semblix can be a multibillion-dollar medicine for Novartis. Now moving to slide 14. Now, Lectio continued its steady expansion in the US as well as across regions. You can see here we delivered $123 million on the quarter. growth in both our international and our US business. On the US side, we have 3,500 facilities now ordering Lectio, which is a 13% growth versus Q3. 55% of that business now is coming from in-office buy and build. And we expect to continue to drive growth on this brand by driving depth in our key accounts, as well as expanding the buy and build acquisition channel. Ex-U.S., our rollout also continues well with 29 countries with public reimbursement, 39 countries with private coverage. And we see very positive, solid early signals in China in the self-pay market, which we expect to continue over the course of 2024 ahead of a proposed NRDL listing in 2025. In terms of the outcome trials, we remain on track for our secondary prevention outcome studies in 2026. And we also continue to enroll our primary prevention studies as well. And moving to slide 15, Fabhalta now is launched in the United States. And we see, I think, very positive early launch signals. But we do expect a modest ramp for this brand, given the dynamics within the PNH market. As a reminder, we have very compelling data for this medicine, including improvements in hemoglobin transfusion avoidance. IVH, intravascular and extravascular hemolysis control, and a very clean safety profile. Our populations in our label are adults with PNH, both naive and switch patients, which was our target label for this medicine. And as an oral therapy, we think we really provide a unique offering for patients with PNH. There is a REMS requirement, but this is similar to other complement inhibitors. Right now, as we look at our launch, our focus very much is coming out of ASH, getting patients up on our patient support program, getting our REMS up and running. Our first patients have already been initiated. And what we're hearing is positive HCP sentiment, interest from patients and pair groups. And our goal will be initially to focus on newly diagnosed patients as well as patients who are not currently under full control for their hemolysis with their existing therapies. Over time, we would want to certainly expand this market. We estimate half of patients with PNH are currently not on therapy. And with an oral agent, we have the possibility, we hope, over time to get more patients on therapy to avoid any of the subsequent sequelae associated with PNH. And moving to slide 16. You know, as noted, in 2023, we had 10 positive Phase III readouts with significant sales potential. You see them listed here. A lot of this data will be presented over the course of 2024, so you'll have a better understanding of the potential of these medicines, whether it's medicines like Remibrutinib. We've already seen the Lutathera Netter2 data, which I think is really outstanding, and hopefully some of you saw that potential now for Lutathera on the frontline setting. Of course, the data for Atrasentin and Aptacopan and the SumList data, which I've already mentioned. So moving to slide 17, I just want to say a word of some of the top line readouts we had in quarter four. Eptaclopan had another, it's a third phase three readout with a positive, positive phase three readout with clinically meaningful and statistically significant pronuria reduction in patients with C3G, lemurial nephropathy. You see here on the left, the phase two data, which we've previously disclosed. In phase three, we had a study design versus placebo looking at month six before patients crossed over to Iptaclopan on both arms. We saw this really important proteinuria reduction and safety profile consistent with what we've seen in previous data, and we're currently engaged with regulatory agencies with a goal for submissions in 2024. And moving to slide 18, over the course of the year, we had positive readouts both on imtaclopan and our newly acquired atrasentan in IgA nephropathy, clinically meaningful results here as well. Both of these programs have been reviewed with the FDA and we're on track for submissions of these medicines that would really allow us to have, I think, a robust portfolio of medicines to bring to nephrologists in IgA nephropathy and then in the future, D3G as we continue to try to build out a nephrology presence around the world. Zygacibart, our anti-april antibody also acquired in the Chinook acquisition, is also on track in its phase three study. So moving to slide 19. Now we expect our innovation momentum to continue in 2024. This will be a year of data readouts, full data readouts and submissions primarily for the company. We expect a few phase restarts, but importantly, as I mentioned, key data readouts and submissions will keep you posted on as we progress. And when you look at slide 20, this is why we have confidence as well that we'll have a steady stream of innovation to drive the company's growth beyond 2028 with the number of exciting, I think, assets we have, 24, 25, as well as the 26, 28 timeframe. This will create a steady flow of replacement power and innovation, enabling us to drive that mid single digit growth rate beyond. Now moving to slide 21. Over the course of the year, we also signed 15 strategic deals, exits, as well as acquisitions totaling over $6 billion. I do want to emphasize our core approach in M&A remains as bolt-on acquisitions in the sub $5 billion space. Deals such as Chinook but also many smaller deals you can see across the full landscape you're very much focused on technologies like XRNA gene therapy and RLT as well as our key therapeutic areas like such as Chinook Amongst others. We also continue to invest in artificial intelligence on top of our collaborations with Microsoft and Palantir we've also signed agreement now with an agreement now with isomorphic labs of Google's DeepMind and which really allows us, I think, to be partnered with some of the most preeminent AI researchers in the world to speed up our drug discovery and drug development. And moving to slide 22, we did also today extend and update our midterm guidance. You'll remember at R&D day, we had noted 22 to 27, 5% CAGR. And today, given the momentum we're seeing on our growth drivers and the strong pipeline, performance we're seeing, we're extending that 5% growth guidance to 23 to 28. Now, of course, up until 28, we do have some GX impact, which I'm sure we can discuss further in the Q&A. But the momentum we're seeing in our in-market growth drivers across our base business, across each of the brands, which I've already discussed, as well as the positive data we've seen in PopHalta, Semblix, Remy Brutonib, and Atrasentin, gives us confidence now that we can continue that 5% growth up to 28, and we've already guided mid-single digits beyond that. So moving to slide 23, I want to close with just a word on ESG, which remains very much a part of the Novartis strategy and Novartis approach. We focus on innovation and access to medicine, human capital in terms of our work on DEI culture, as well as ensuring that we're amongst the leaders in environmental sustainability and ethical standards. When you look at our performance now, we're number one in sustainability in the leaders group in MSDI and also amongst the leaders in important other benchmarks such as access to medicine and GDP. We plan to continue that, of course, in 2024. And so with that, on slide 24, I'll hand it over to Harry.

Yeah, thank you very much, Vas. Good morning and good afternoon, everybody. I'm now going to walk you through some of the financials for the fourth quarter and full year, as well as provide you with our 2024 guidance. As always, my comments refer to growth rates and currencies, unless I would otherwise note that. Also, throughout the presentation, I'm only going to talk about continuing operations. And just as a reminder that continuing operations include retained business activities of Novartis, comprising of our innovative medicines business and the continued corporate activities. Discontinued operations include Zandos and selected portions of corporate activities attributable to the Zandos business, as well as certain expenses related to the spinoff. Next slide, please. This chart shows you the restated comparable numbers post the Zandos spinoff. History doesn't tell the future, but track record is important. And as you can see, since 2018, top line sales growth has been 7% in average. Bottom line, even 14% CAGR. And this has resulted in a core margin increase of 990 basis points in constant currency to 36%. So very clear path also from a margin standpoint. toward 40% in 2027. This strong performance has continued in 23, where we met or even slightly exceeded our upgraded full-year guidance. On the next slide, just a little comparison here. On the 23, it shows a top-line growth of 10%. We guide it to grow basically high single digits, last one, but we upgraded three times through the year and we started with low to mid single digit. Really a testimony to the excellence business momentum that even strengthened throughout the year. And then co-operating income at 18% and again here we were able to upgrade three times and could even slightly exceed the guidance we gave in October of mid to high teens. On slide 27, a bit more detail about the 2023 performance, which we will go through by quarter and full year. On the quarter, top line growth was 10%, cooperating income through 13%. As outlooked in October, quarter four of 22 was a very high profit quarter to be compared to. given that we were in the middle of our restructuring then, and that's why we guided to full year to where we were, already assuming that quarter four bottom line growth would be a little bit less than the nine-month bottom line growth. But still, residing in a marginal improvement of one percentage point and core EPS at $1.53, and so a good quarter. For full year, top line grew 10%. And for cooperating income, we delivered 18%, leading to a 2.4% points margin increase. Core EPS was $6.47. And the full-year cash flow was even more than $13 billion, another significant growth also on the cash flow side. As Outlook, you know, therefore, we were over our guidance and strong full-year results with also a strong quarter and absolute, but of course, comparable base was a bit higher. Now, slide 28. So we continue to create significant and sustainable shareholder value. As you know, we are highly cash generated business and our strong cash flow allows us to optimize both investing in the business as well as returning capital to shareholders. In terms of investing in the business, of course, R&D is the key focus. in addition to launch and pre-launch investments. And from a business development M&A perspective, it is value-creative bolt-ons in our core therapeutic areas. In terms of returning capital to our shareholders, the focus has been on a consistent, growing annual dividend in Swiss francs, which has not been rebased post the Alcon nor the Sandoz spinoff. And with regards to share buybacks, we continue, of course, our most recent share buyback of up to $15 billion announced in July 2023, with up to $12.7 billion to be executed still by the end of 2025. Now, we got some questions as we paused share buyback for a few weeks in January, as we had to adjust our trading plan, just to ensure everybody is clear we will restart during the next days and with our full intention to complete that share buyback as mentioned by the end of 2025. Besides all of that, we have of course also created shareholder value through numerous strategic actions like divesting the consumer healthcare joint venture stake, spinning off Alcon and divesting the Roche stake at 356 Swiss francs and, of course, importantly and most recently, the successful completion of the spin-off Sandoz on October 4th last year. If you go to the next slide, please. Now, talking about the successful spin-off of Sandoz, on the day of the spin-off, subsequently, both Novartis as well as Sandoz share price and the implied market capitalization have increased quite significantly. Since the day of the spin-off, October 4th, until yesterday, just to have the exact numbers from last night's closing, Novartis market cap has increased by over 11% and Sandoz over 28%. So in total, as a result of the spin-off and of course subsequent market movements, a combined value of over 28 billion has been created for Novartis. shareholders continuing to hold Novartis and Sandoz share. Again, as a reminder, we are not rebasing our dividend post the Sandoz spin. Speaking of the dividend, let's go to the next page. Yes, we are pleased to propose the 27th consecutive dividend increase to 3.30 francs per share in U.S. dollars, even $3.92, and This is based on the 320 francs last year. So an increase of 3% in Swiss francs and 12% in US dollars with a dividend yield reaching close to 4%. And it's fully in line with our policy of increasing our dividend every year in Swiss francs per share without rebasing it post-decentral spin. Now moving to 2024. Our full year guidance is for sales to grow mid single digit and core operating income to grow high single digit. In terms of the drivers of Co-op Inc. for 2024, pushes and pulls are similar to 2023 and we fully expect our positive business momentum to continue. However, this prudent guidance assumes that there will be a higher generic impact in 2024 versus 2023. I'm sure we will discuss this later on in the Q&A. For forecasting purposes, we assume no US interest in generic entry in 2024. And to complete our full year 2024 guidance, please note that we expect core net financial expenses to be around 0.6 to 0.7 billion, and the core tax rate to be around 16 to 16.5%. Now on to my final slide. There we go. currencies yes so we have outlined some details regarding the currency impact and as you can see currencies had a negative two points impact on net sales in both quarter four and the full year as well as negative eight points impact on cooperating income for the quarter four and negative seven points for the full year driven by the strong swiss franc there was a special effect on Coop Inc in quarter four at about two points due to the mid-December Argentina devaluation. And then we had to catch up basically to hyperinflation accounting instructions, IFRS guidelines, the full effect in quarter four. That's two points worsening due to the Argentina in quarter four. If late January rates prevail for 2024, we expect the full year impact of currencies to be less than 23. And on top line would be a negative 1%, and on the bottom line would be a negative 3% point currency impact. And as a reminder, we do update this every month on our website, as it is hard to forecast from the outside, but you get a monthly update on it. And with that, I head back to Bas.

Great. Thank you, Harry. So in conclusion, if we go to slide 34, we had a very strong 2023 multiple guidance increases, double digit growth for sales and core opting. I think really reflecting that our focus strategy as a pure play innovative medicines company is the right one and really delivering strong operational performance. We met or exceeded our strategic operational and innovation targets, including the successful San Diego spinoff, 10 positive phase three readouts, all with significant sales potential. And we're confident for 2024 and in the midterm, where we now guide to 5% constant currency sales, 23 to 28, and a 40% plus margin in 2027, all building, of course, on the longer-term goal to maintain that mid single-digit sales growth, 28 and beyond. So with that, we can open the line for questions. As the operator mentioned, we'll limit to one question per analyst, and then we'll come back through the list again. Thank you very much.

Thank you. To ask a question, you will need to press star 1 and 1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1 and 1 again. We will now go to our first question. And your first question comes from the line of Matthew Weston, UBS. Please go ahead.

Thank you very much. It's Matt Weston from UBS. My one question is around the growth in SG&A that we saw in 4Q. and what it means for 2024 guidance. So, there was a significant step up in commercial spending. Vas, you mentioned in your opening remarks that you felt that 2024 guidance was prudent. Is the 4Q step up bringing forward or front-loading launch spend, given the exciting opportunities you have in 2024, or is that level a good indicator of the cost acceleration we should expect for the full year? Any help gratefully received.

Thanks, Matthew. I'll hand it over to Harry. Harry?

Hello, Matthew. Good to have you around. Hey, I think, you know, quarter four came exactly in as we forecasted for the year and outlined our full year guidance in October. So I think we have to keep this a bit in perspective and not overreact to short term, you know, consensus thinking, because in the end, we increased our function costs the full year like three percent in constant currencies with a growth of 10 on the top line i um tried to explain maybe i was not very successful in october that quarter four of 22 was a very low spent quarter because we're in the middle of a big restructuring now quarter four spent is as a usual seasonality of higher spend levels for versus the first three quarters in 22 that was a bit muted we are back to that normal pattern. So you should have no worries about our cost development for 24. Our guidance of continued margin improvement is absolutely bulletproof because of our top line growth, as well as our productivity programs. And everything in 23 came in as planned.

Thank you. Many thanks indeed. Thank you, Matthew. Next question, operator.

Thank you. Your next question comes from the line of Andrew Baum from Citi. Please go ahead.

Hi. I'm not sure if Dave's on the call, but someone might like to take this question relating to your cardiovascular outcome trials. I've previously asked about why not unblind the Orion IV, particularly given the pressures from the IRA and the nine years prior to price negotiation. I'd ask the same question about Horizon. These are very high-risk secondary prevention patients. We know that it's a highly atherogenic particle, and again, you've got the same issue for nine years. So is there any possibility of either of these trials being unblinded before the publicly stated dates? And maybe you could also opine on whether the bipartisan efforts to try and reclassify advanced therapies for 13 years rather than nine-year exclusivity is going to start to move. It's obviously very relevant to you, given... Lacteo, Pelicas, and Previcta, etc. Many thanks.

Yeah, thank you, Andrew. So right now, there's no plans to adjust our thought process on waiting for these studies to run to completion. I think as Dave outlined in the R&D day, we continue to believe by having a longer follow-up, we're more likely to deliver very differentiated cardiovascular risk reduction in Orion 4.0. And I think with respect to Horizon, you know, our powering calculations and the approach that we've taken, both with very high-risk LP little a patients, as well as the kind of medium-risk patients, requires us to follow these patients out through 2025. That said, we're very cognizant of your points, and we do debate and discuss them, especially in light of the IRA. I think a few things we're doing. First, on the policy front, there is bipartisan support for an amendment on, I think, the 9 to 13 on so-called genetically targeted therapies. However, I think it will still be some time and likely not during this year, given it's an election year, for that to really move forward. But we're hopeful that we can progress that over the coming years to enable that to move to 9 to 13, along with our broader policy goal as an industry to move 9 to 13 across all small molecules. We also continue to invest in lifecycle management for our entire siRNA portfolio. We've struck at least a few deals now that really target annual dosing for siRNAs, most recently with a company called Atlantic Therapeutics. And there we have multiple targets now that we're pursuing to try to move to annual dosing and or combinations with other targets that would allow us to lifecycle manage in the event that we need to ahead of that nine-year timeframe. So those are the approaches we're taking, but we obviously take your feedback seriously and we'll continue to evaluate accordingly. Next question, operator.

Thank you. Your next question comes from the line of Florence Espedes from Societe Generale. Please go ahead.

Good afternoon. Thank you very much for taking my question. A quick one on your mid-term guidance. You have updated this guidance, but now starting from a higher base from 2023. I was just wondering if there is anything new versus the last update last year. And if you see, let's say, new drivers that would help to achieve this mid-term guidance. Thank you.

Yeah, thank you, Florent. I think a few things. So first, in terms of the growth drivers and what we overall saw in the quarter, in quarter four and on the full year, you see very dynamic growth for Kissimta for Kissgalli, I think Strongroad for Lutathera, Semblik. And we also saw the return of, as I mentioned, strong demand signals for Pluvicto, all of which gave us confidence in those brands outlook towards our peak sales guidance. In addition, we have now the approval of Aptacopan and the Aptacopan positive, or Fabhalta positive data across PNH, C3G, and IGAN, which gives us more conviction that this medicine will be a multibillion-dollar medicine as well. So that, I think, all was on the positive side from an inline brand. And then importantly, with the Semblix first-line data, where we saw, I think, really what we believe will be potentially practice-changing data, this has an opportunity now as well to be a multibillion-dollar medicine. So taking all of that together, that growth momentum for our inline brands and strong pipeline performance, gave us more conviction in that long-term guide. I would also note, of course, Giscali now has also filed for medium and high-risk women with early breast cancer. So I think all gives us positive signals and momentum to continue that 5% plus guidance to 28.

Thank you very much. Next question, operator.

Thank you. Your next question comes from the line of Graham Parry, Bank of America. Please go ahead.

Thanks for taking my question. So it's on Plavicto. So the number in the quarter was a drop off quarter on quarter. I think in Q3 that you've actually seen about a 50% increase in patient starts. But also there was an offsetting factor here of sicker patients not getting the sort of the last two doses. So that would just help us with the dynamics of why that increase in patients you saw in Q3 didn't translate into a higher sales number in Q4. And then on sites, I think you said 300. So how many are you targeting for 2024? And given your supply unconstrained, is this actually now the rate-limiting step to getting to the multibillion number that you've talked about for the vision indication? Thank you.

Yeah, thanks, Graham. So on Plovicto in quarter four, we saw a steady rebuild, but I think we did not see yet the full replenishment of the base of patients, given that we still had supply constraints. into the August, well, July, August timeline. And so over the course of quarter four, we saw more patients getting on therapy, which then of course gives us the four to six doses on those patients, which we build that base. I would also say during the holiday period, we did see less as we were expecting in the Christmas period and Thanksgiving period, these patients tend not to want to have the therapy given the radiation can lead to, it does lead to a restriction on being around children and other loved ones. So I think those dynamics did play a role. But we did see growth in new patient starts in Q4 versus Q3. But the growth was not, you know, I think as strong as maybe what the external world predicted. We had tried to guide in quarter three to the expectation that we would be to a rounded billion, which is exactly where we are at the 980 million mark. But perhaps we should have been more clear on our outlook and expectation. All of that said, we, of course, contract this on a daily basis, and we see strong growth in demand, strong overall dynamics, and we continue to expect to see robust quarter-on-quarter growth for PluVicto over the course of this year, getting us back towards that multibillion-dollar outlook that we've guided to in the vision population.

Incentives?

Center. Sorry, Graham. Yes. So our goal is to get to 500 plus centers and we're expanding now rapidly. I think centers are probably one constraint. And then I think the other in terms of the growth. And so we expect to have the ad centers of a steady clip over the course of this year. And then we also are encouraging physicians now that supply is unconstrained to treat earlier, so therefore the average number of patients moves more towards six doses per patient, which will certainly be our goal over the course of the year. I think both of those dynamics will fuel growth for this brand over the course of 2024.

Thank you. Next question, operator.

Thank you. Your next question comes from the line of John Priestner from JP Morgan, please go ahead.

Hi, thanks very much for taking my question. So you said that the 2024 guidance includes the impact of generics, which we assume is for kind of Promactor and also to Singer. So what are your thinking behind the actual timings of those

generic entries and also you also said that the 2024 guidance could be somewhat prudent so what are some of the key kind of levers that you could execute on to kind of exceed that guidance thank you yeah thanks John so there's three three generic entries we would expect over the course of the year but we're not in a position I think to provide specific guidance on when these entries would happen given the the I think unpredictability both in terms of our own goals to defend our IP, as well as supply for some of these parties. The three would be from ACTA and to Cigna, as you noted, as well as a standard satin LAR, where there is now an approved generic, but no product in the market. We, of course, would provide updates when these would enter over the course of this year. But I think this is our current forecast, and we'll see, of course, how things evolve Now, in terms of our full year performance, Harry, in terms of the prudent guidance.

Yeah, John, thank you very much. I mean, we will not say when we assume, right, this is all for financial forecast assumptions. Of course, we do appropriately defend our IP when possible. Of course, on ZandoStat and LAR, there is no IP anymore. That's more about the ability of the generic producer to produce. It's a very difficult to produce product. On the other hand, we have basically distributed these three potential entries for forecast purposes over the quarters. There's a bit of a generic portfolio play, if you will. And now if all of them come a bit later, then we may have an upside to our guidance. So that's what we meant with that. And of course, overall, we do assume that our key growth drivers continue to perform very well. But it's a bit difficult with these three different generics to make assumptions. And so we do them in a prudent way. And there could be changes to this if either one competitor cannot produce or we have some upside on the LOE and patent defense, if you will, on the other two.

Thank you. Next question operator.

Thank you. Your next question comes from the line of Tim Anderson, Wolf Research. Please go ahead.

Thank you. On Cosentix, a question on pricing and market access dynamics in 24 just in the U.S. with multi-source about similar from here on the market now, albeit only for six to seven months. Are you seeing any access tightening in 24 such as more step edits given indication overlap? And if not in 24, then do you think it might tighten in 2025? And then also on this topic, just the level of U.S. net price erosion in 24 relative to what it was last year.

Yeah, thanks, Tim. In terms of Cosentix, we actually feel pretty good about overall the access environment for 2024. We've had modest gross to net shifts overall for the brand, and we have a broader access in some of the major accounts versus what we've had in the past. We haven't seen any, let's call it, increased impact from biosimilar adalimumab. We think this is mostly because we were contracting within the IL-17A class, and given our track record in the class and large position, that's enabling us to manage the overall access environment successfully. Have not seen, to my knowledge, any increase in step edits either with respect to Cosentix access. Now, I think looking forward, obviously always difficult to predict. I think some of the tailwinds we have going for us is the new indications in hydradenitis, which, of course, at least for now, we're only one of a few medicines that have that indication, which gives us strength in terms of formulary negotiation. Hopefully, some of the other indications come through as well. Separate from that as well, with Cosentix, we've launched in the IV setting as well, and that's also another, I think, important growth driver for this medicine over the coming years. So overall, I think, pretty stable position for Cosentix, at least for 2024. And of course, as we understand better, 2025 and beyond will keep everybody updated.

Moving to the next question. Thanks, Tim.

Thank you. Your next question comes from the line of Simon Baker, Redburn. Please go ahead.

Thank you for taking my question, and it's another one on Cosentix. I wonder if you could give us your thoughts on the expectation of the uptake for Cosentix in HS. I've had some clients suggesting it's slower than expected given the quality of the profile and the paucity of the competition. How do you see the potential and the uptake there over the course of the next year also? Thanks so much.

Yeah, I think so. I mean, I think it's early days. So I think, you know, I don't want to, I think, get too far ahead. But so far, we've heard positive feedback overall from clinicians. I mean, Cosentix has an outstanding long-term safety profile. I think that's been well established now over many, many years. It doesn't have some of the safety topics that some of our competitors may have. And so I think that allows us to have a very strong comfort level with dermatologists for treating these patients. And as well, overall, the efficacy, I think, is solid and with the opportunity to give these patients a safe, efficacious option. And as you know, the big challenge in HS is really getting patients to come in to be treated, given that it's been so long since there have been new medicines that have been launched since the TNFs were indicated for this condition. So I think solid early start, and we'll certainly see how the quarters unfold. But I think the safety profile and the overall comfort level in dermatologists gives us a very good position for this launch.

Great. Thank you. Thank you. Your next question comes from the line of Kerry Holford from Barenburg. Please go ahead.

Oh, thank you. A couple of questions for me, please. Firstly, Kiskali. When do you expect that drug to become eligible for price negotiation under IRA? And given we're moving towards, I think, a patent expiry 2031, can you talk to the lifecycle management options available to you here? When I look at the Novartis pipeline, I see few breast cancer-specific assets, but perhaps I'm wrong in any feedback you could give there, any areas of interest there. would be gratefully received. And then business development, clearly you've been somewhat busy over the last 12 months. What's your appetite for deals moving into 2024? Size, everybody can't agree. Is RLT still an area of focus for M&A business development? Many thanks.

Thanks, Gerrit. So first on Cascalia, as you know, it's not a precise science to predict IRA for these patients. I'd also notice in the early breast cancer population, these patients are younger and tend not to be in the Medicare population. So I'd say we really see this being a topic for Cascalia towards the end of the decade, but importantly would only affect the portion of our sales that are in the Medicare population. And we'll, of course, as we learn more and understand better how the program will unfold, we'll keep you all updated. But we think we have a very good runway now for this medicine for the coming years, both in metastatic and assuming approval in the early breast cancer space. In terms of life cycle management in breast cancer, of course, the You know, one opportunity is other CDK targets, which we are pursuing in-house. And that's something that we are looking at within our research labs, as well as potential for combinations. And that's another topic for us as well. We also continue to advance early stage programs with RLTs in breast cancer as well. Not specifically, you know, life cycle management in Kaskali, but give us the opportunity to bring forward radioligand therapies in the breast cancer space. And that's an area of high focus for us at the moment. So I think a combination of novel targets in small molecules, as well as radioligand therapies in the breast cancer, overall in the breast cancer space. So in terms of business development, as outlined in the slide, our strategy is very much to focus on our four core therapeutic areas and our three key technology platforms. So those technology platforms are cell therapy slash immune reset, cell and gene therapy slash immune reset, RLT, and RNA therapeutics. And I think that's well known. And in terms of size of deal, no change to our overall approach, smaller than $5 billion bolt-on acquisitions, with the vast majority of those deals being sub $1 billion deals, and no change to our approach there from what we've previously stated. So moving next.

Thank you. Your next question comes from the line of Seamus Fernandez from Guggenheim Securities. Please go ahead.

Thanks very much. So I just wanted to ask one particular question in terms of the sort of business development strategy. I know, Vaz, you've already talked about this, but I wanted to get a little bit more clarity on specifics around the sort of threshold that you've talked about publicly, you know, is that sort of $5 billion and below threshold really still kind of the target range or given the success that you are seeing in some of the other areas of development, is there the opportunity to potentially go, you know, larger in terms of the potential transactions? Just wanted to get a better sense of if you feel there's more flexibility given the phase three, solid phase three hit rate that you've had, or if you're kind of sticking to your guns or to your knitting in the $5 billion and south range.

Yeah, thanks, Seamus. So really nothing, I think, to add beyond what I've already stated. Of course, look at the full range, as you would expect a company of our size, a full range of potential opportunities within business development. But what we consistently see is the opportunities we have, whether it's the most significant opportunity for value creation, as well as a differentiated view versus the market, is on the lower end of the range of deal values. I think that's why when you look at the 15 plus deals that we did last year, vast majority are under a billion or even under 500 million. We did Chinook at 3.1 billion. And I think that's where we see the best opportunities for us as a company. I will never exclude that we would do anything if it makes sense for our shareholders and makes sense for the long-term profile of Novartis. But our focus is very much on that bolt-on sub-5, sub-2, $1 billion range programs. And that's where I think we'll be

So moving to the next question. Thanks, Seamus.

Thank you. Your next question comes from the line of Emily Field, Barclays. Please go ahead.

Hi, thanks for taking my question. Just a question on remibirtonib. How far along are you in the recruitment of the MS trials, just given we've seen another partial clinical hold in the space? And then if you could just remind us how your molecule was differentiated given the, you know, we did see that phase three failure after your R&D day. Thank you.

Yeah, thanks, Emily. So, you know, on Remy Brew, let me start with why we think our molecule is differentiated. When you look at the structures, and if you go back to some of our slides in R&D Day, you'll see that our molecule, as a different overall chemo-type structure than some of the other peers, we believe that the liver signals that have been seen thus far in this group of medicines have to do with off-target toxicities related to the structure of the molecule. So we have a highly potent covalent BTK inhibitor that we think is unique and it's at least so far in the clinical and preclinical work profile in terms of having any of those off-target toxicities. So we of course already have read out two positive phase three studies in CSU and plan to file with the 52-week data in the second half of this year. We continue to pursue as well remibrutinib in other immunology indications where we think there is an opportunity given a safe profile. And importantly, at that dose range, 25 milligrams BID, we saw no liver signals in those dermatology studies. In terms of the MS trials, we continue to recruit on track. However, we don't expect a filing before 2026, if I'm not mistaken. And we did have a futility analysis looking at futility for non-inferiority to our comparator, and we passed that futility analysis, so the program will continue. So we don't see any safety signals. We've passed a futility analysis, which we put in place given some of the data that some of our peers have read out, and we'll continue then to progress the study in multiple sclerosis as well. We do believe remubrutinib has the opportunity to be a significant medicine across a range of indications, particularly as the safety profile continues to hold up because of the structure of the medicine. So thanks, Emily.

Next question, operator.

Thank you. Your next question comes from the line of Peter Welford from Jefferies. Please go ahead.

Hi, thanks for taking my question. Just curious, I want to come back to Fab Hauser at Takapan. You sort of had some more cautious commentary, perhaps, than you might expect for a new launch. I wonder if you could just talk a little bit about, does this, as you say, relate very specifically to the PNH market? And perhaps, you know, why are you perhaps more confident that you potentially can't get into some of those currently untreated patients sooner? Or does it reflect the REMS and the initial program and perhaps impediments you're seeing getting this in front of doctors and through the process then perhaps you envisage and i guess how does that and the profile of the drug if at all read into the potential rollout for the larger igan indication potentially in the future thank you yeah thanks peter so first on pna it did very much uh the uptake very much has to do with the rems as well as some of the other elements that need to be placed particularly vaccinations and so this takes time

to put in place for this medicine, as well as our organization getting the infrastructure fully up and running. We estimate 7,000 to 8,000 patients with PNH in the United States, roughly 3,000 to 4,000 of them being treated today. And so in such an ultra-rare patient population as well, you have a relatively high dispersion of physicians who are treating one or two patients. It also takes time to reach all of these physicians. It doesn't change our long-term belief that this is can become the medicine of choice for these patients, given it's a twice a day safe oral medicine with high efficacy and I think a reasonable safety profile overall. And that will just take time as we get physicians up to speed. Either patients in the position where they need to switch because they're uncontrolled over time, even controlled patients, we would argue, would want to be switched and then new starts as well. And then we do make efforts already to try to reach that half of the estimated half of the patient population, which is currently untreated. So we just want to set reasonable expectations for the first year, and then we hope to ramp up thereafter. We do think that given our positioning in C3G and IgAIN, C3G already also being an ultra-rare disease, IgAIN, we target refractory patients. Again, given that we're targeting a very select patient population, we think we can absolutely manage the patient start process for those patients and then ensure a very strong uptake for the medicine. And then if you look at the future indications for Fabhalta, largely also in the ultra-rare space, which will then, I think, as we build that capability, we should be able to get patients on therapy sustainably over time. Thanks, Peter.

Next question, operator.

Thank you. Your next question comes from the line of Richard Parks from BNP Paribas. Please go ahead.

Hi. Thank you for taking my question. It's just following up on business development strategy. I mean, it's been quite clear the last 18 months you're now very confident about growth through upcoming LOEs for the business overall. But you still will have to absorb LOEs in specific therapeutic categories. We're obviously thinking about Entresso. So when you look at your cardiovascular franchise, given that let's suppose maybe they've been a bit slower and a cast on this clinical risk, are you comfortable you've got enough coming through to maintain a healthy franchise and not have any kind of negative leverage post that? Or is that an area where you would look to maybe be more active in terms of business development to bring in later stage products? Thank you.

Yeah, thanks, Richard. We feel very confident with what we have in-house in cardiovascular disease. When you look at it, we have Lecvio in secondary prevention and then moving to primary prevention as well. We have Pelocarsin, the LP little a program. We have a program called XXB, which we are currently moving forward in mid-stage studies in hypertension and heart failure, as well as an oral version of XXB as well, NPR1 agonist that we're also bringing forward. And as I've noted, we have an extensive in-house siRNA effort targeting a range of lipid-lowering and cardiovascular targets, as well as external collaborations that we've also now brought on board, which we think allows us to cover most of the key targets which would be of interest for siRNAs. And our goal is, one, to move to new targets, two, to move to combinations, and three, also to get to annual dosing. which we think is the right strategy in cardiovascular disease in the long run. Of course, other companies are pursuing orals and fully understand that, but we believe that in this space, given the compliance challenge over the long run that's been demonstrated over decades, having infrequently administered siRNAs on validated targets is the right strategy. So given all of that and the efforts that we have ongoing, we feel very comfortable with our internal cardiovascular portfolio and pipeline. Next question, operator.

Thank you. As a reminder, if you would like to ask a question, please press star 1 and 1 on your telephone keypad. Your next question comes from the line of Mark Purcell from Morgan Stanley. Please go ahead.

Yeah, thanks for taking my question. On Cosimta, Faz, hopefully you can help us understand the growth dynamics here and what MBX leadership means, especially in light of the XUS acceleration. So When you think about B-cell MBRX share, how does the XUS share compare to the U.S., where we get data from Roche? And then when I looked at the MBRX leadership footnote in 7 out of 10 markets, it just said data on file. So could you help us understand, I guess, where infusions are more of a barrier to treatment in some XUS markets versus U.S., where your share stands relative to the alternative infused therapy in this space? And then just the housekeeping on Kiskali and the Natalie filing, did you include no negative patients in that filing? Thanks very much.

Yes, thanks, Mark. So Kiskali, yes, no negative patients were included. On Kesimpta, so first on the ex-US dynamics, I think first it's important to note outside of the US, you don't have the same structure as Part B for providing an infused medicine. And in many of these healthcare systems, there's a preference to move patients out of the medical centers and medical homes and more having at-home therapies. So in those key markets, we really see a dynamic. I don't know the specific shares offhand, but we see a dynamic where we are being a favored class of medicines in some of the large ex-US markets. We have very strong performance in markets like Germany, very strong performance in markets like Japan. And so I think that's really just a reflection of different dynamics in those markets where there's a preference for neurologists to provide patients a medicine that's easy for at-home use. And we hope over time, as we now move Cosimta more broadly across Europe and Asia, we have the opportunity to drive significant growth ex-US. In the US, there is different dynamics. Right now, we estimate that The B cell class share of NBRX is in the mid 50% range, 55%. And over time, we expect that to continue to grow. Cosimta's share within the B cell class is in the high 20s, 27% to 30%, depending on when you look. And we right now are growing with the B cell class overall. But very much our goal over time is to grow our share of the B cell class. And that's something we're very much focused on. That will take, I think, time for us to achieve, but that's going to be important if we want to get well beyond the $4 billion guidance we've already given. We think we can get to the $4 billion just by the March of the B-cell class, but if we want to do better, we need to improve our B-cell class share in the U.S., and that's something we're definitely focused on. Thank you.

Next question, operator.

Thank you. Your next question comes from the line of Stephen Scala from TD Cowan. Please go ahead.

Thank you very much. I'm curious what happens with Entresto IRA price negotiation in 2026 when generics can launch in 2025. It would seem that if there were an Entresto generic, then Entresto would not be eligible for price negotiation. Is that how you see it? And has that come up in price negotiations so far? If yes, then the best case it would seem for Novartis is would be limited generic competition, maybe even an authorized, which could turn out to be a plus for interest or revenue. Thank you.

Yeah, thanks, Steve. So it is a valid point. And our position would be if there is a generic that's launched that a medicine in our portfolio per the current guidance of the IRA would not be eligible at that point in time. So that would be our view. But I think As you know, there's many things that are still unfolding with respect to the IRA negotiation. I obviously can't comment on our approach to the various generic entrants and our approach on how to manage that. I would say that, you know, look for Entresto even beyond in the U.S. We guide to this 2025, mid-2025 LOE and a IRA. If we were to move, not have a generic enter in 2025, we would be ira eligible in early 2026 so one way or another we are going to have entrusto being impacted in this period of time what is important to note is we guide to 5 plus 20 to 23 to 28 growth even with entrusto coming out in the us and also coming out in europe given the the timeline of our rdp in europe So I think we feel confident we can grow well beyond the Entrusto LOE or IRA, however it ultimately happens in that period.

Next question, operator.

Thank you. Your next question comes from the line of Matthew Weston, UBS. Please go ahead.

Thank you very much. Thanks for taking the follow-up. It's a follow-up on Plavicto. Vas, I think at JP Morgan and at the R&D Day, you highlighted PSMA-4 filing in 2024. Now it's the second half of 2024. So can you give us an update? Has anything changed? And also, can you just give us an update on your discussions with regulators? I know there's been a lot of discussion about the modeled control arm, given the significant crossover. Can you give investors comfort that you're still confident but it will be acceptable to FDA and regulators around the world.

Yeah, thanks, Matthew. So we don't have any updates as the trial, you know, continues to accrue events. I mean, based on our current estimates, we think a second half 2024 filing is the right timeline to provide at this point in time. But of course, you know, this will evolve as the events accrue. In terms of our confidence level, nothing has changed. When you look at the overall data set that you saw last year, you saw very impressive gains In our PFS, you saw impressive gains in ORR. You saw a high quality of life improvement, a relatively clean safety profile, even versus ARPI comparator arms. So I think a positive safety profile overall. So we think we have a very compelling case. We think it's really a matter of getting to the higher resolution, both in terms of the adjusted analysis where we're already below a hazard ratio of one, as well as a tighter radius around the all-comers analysis as well for the OS. And so this will be, of course, a topic of discussion with the FDA, but we think we can make a very clear and compelling case that this medicine should be offered to patients in the pre-taxane setting. And then we also are continuing, as I mentioned, to move forward rapidly on PSMA addition, as well as Pluvicto in the oligometastatic setting, so we can cover all of our bases. I do think overall, as an industry, we'll learn more with some of the upcoming adcoms from other competitor medicines on how the FDA is thinking about OS crossover and how to manage this. And I'm hopeful that overall patient benefit is what ultimately rules out over some of the pure statistical considerations, given that we are encouraged to utilize crossover in our studies to be patient-friendly in an appropriate way, I think it's very important we start to be looking at the adjusted analyses. Otherwise, this puts overall the industry in a very challenging position. Next question, operator.

Thank you. Your next question comes from the line of Graham Perry, Bank of America. Please go ahead.

Okay. Thanks for taking the follow-up. I just wanted to dig into some of the moving parts for the guide on generics. I made some sort of high-level comments there, but in terms of the ability to manufacture, I assume that's Sanderstatt in LAR, I think, to have gotten approval December. But is that a restriction, a legal one? So is there any litigation around manufacturing, even if there isn't around the approval, or is that a tech ops consideration? And then on Promacta, I believe there's no litigation outstanding. You have a SALT pattern in 2026, so... What are the moving parts for timing of the launch there? And is a 2025 or 26 launch on Promactor even also still a possibility? Thank you.

Yeah, thanks, Graham. On Sandestatin, there is no litigation ongoing, I think, and I can't comment on other companies' manufacturing capabilities. I think what we did observe in Europe with the launch of Generics is there was limited supply available for those launches given the complexity of the manufacturing process. And we believe that that's a complexity as well that would still be the case in the US. This is a very difficult medicine to consistently make and characterize and release. But obviously that's for the approved generic to ultimately determine. So we'll be monitoring to see how and when that product comes to market and in what volumes. And in the meantime as well, I mean, we very much are focused on our Lutathera frontline data where we, I think, presented really compelling uh data to make ludathera the medicine frontline medicine of choice it's already on label we're already promoting that to to physicians making sure physicians understand the data set that we've now generated with the net or two that gives us an opportunity as well to maintain our neuroendocrine tumor business um with respect uh to promacta not much more i can i can add we of course um continue to defend our IP and will do so and try to maintain the medicine's protection for as long as possible. But at this point in time, I can't provide any further details or guidance on Promacta. For forecasting purposes, we're saying a generic entry in 2024, but as always, we defend our IP to the fullest extent possible. Moving to the last question, operator.

Thank you. Your last question for today comes from the line of Tim Anderson, Wolf Research. Please go ahead.

Thank you so much. Obesity, I think you've been asked this before, but quite possibly the biggest therapeutic category. You guys have a big presence in cardiometabolic. How high of a priority is it to enter this space? There are acquirable assets in clinical development. They fall into that sub $5 billion range. Why not move on one of them? Can't late entrant products still capture revenues? Or are no vulnerabilities too far ahead to justify the cost of a competitive development program?

Yeah, thanks, Tim. So look, when we think about the obesity market, we very much look at it in the lens of our presence in cardiovascular disease and wanting to ensure we have a presence that enables future cardiovascular drugs we have in our pipeline to either be combinable or available to patients. with the full range of cardiovascular disease so certainly something we're evaluating and looking at our current view is that given the number of companies already pursuing injectable and oral glp gip top assets that we should be focused on differentiated assets that have novel targets or novel approaches novel profiles which is what we look at in research But of course, we evaluate all the opportunities that are currently out there, given the size of this market and the importance for cardiovascular health. So obviously, if we find something of interest, we'll pursue it. But at the moment, I can't really say anything specific about anything we're looking at. Perfect. Thanks, everyone, for joining. We look forward to keeping you updated over the course of the year and wish everyone a great 2024.

Thank you. This concludes today's conference call. Thank you for participating. You may now disconnect.