Novartis AG

Good morning and good afternoon and welcome to the Novartis Q1 2026 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-ups. 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 Ms. Sloane Simpson, Head of Investor Relations.

Please go ahead, Madam. Thank you, Sharon. Good morning and good afternoon, and welcome to everyone to our Q1 2026 conference call. The information presented today contains forward-looking statements that involve known and unknown risks, uncertainties, and other factors. These may cause 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 20-F and its most recent quarterly results on Form 6-K that respectively were filed with and furnished to the U.S. Securities and Exchange Commission. Before we get started, I also want to echo Sharon. Please limit yourselves to one question at a time, and we will cycle through the queue as needed. And with that, I will hand across to Bas.

Thank you, Sloane, and thanks, everyone, for joining today's call. So if we go to slide four, as you saw this morning, we delivered a strong start to the year across our priority brands and launches, which is really where our focus is at the moment. These brands and launches are what's going to drive our mid- to long-term growth and where we believe now we have demonstrated that there's strong momentum behind these medicines. The sales for the quarter, you saw that those growth drivers were up 34% in constant currency. Our base business was largely stable, but we did see significant GX erosions as we've guided to. And Mukul will go through some of the dynamics for that over the course of the rest of the year. On core offing, we were down 14% driven by the sales decline, as well as the increased investments in R&D, which we also guided to. When you look at some of the pipeline highlights, a number of important highlights, including the continued progress for Rapsodo across a number of indications, Unalamab received a breakthrough therapy designation and priority review in Sjogren's disease, as well as a few other important milestones, which we'll go over over the course of the call. Importantly, we're maintaining our full-year sales and core operating guidance for the year. Now, moving to the next slide. When you look at those growth drivers in a little bit more detail, that 34% was driven in particular by very strong performance we saw in Cascali, Fluvicto, Casimta, Lekvio, driven by our strong launch overseas, particularly in China, and the continued performance of Semblok. So I'll look forward to going through now some of the dynamics for each of our key brands over the course of the remaining slides. Now moving to slide six, in quarter one, Kiskali grew 55%. And as you know, Kiskali now has a lot of momentum, both in early breast cancer and metastatic breast cancer. And given our global launches, we're starting to see a pickup in the ex-US markets. So focusing in on the US, you can see our NBRX share now in the early breast cancer setting is very strong, 65% plus 2% now versus prior quarter. In addition, in metastatic breast cancer, we have 47% NBRX and 41% TRX. So taken together, we're in a very strong position in metastatic and early breast cancer. And when we look at that data in more detail, we see that Kiskali has a strong position not only in the overlapping segment with our competitor in early breast cancer, but also in our unique segment, particularly the node one high risk and the node zero high risk patients. And going forward, our focus will be very much continuing to expand Kaskali's utilization in those early breast cancer populations. Now turning to the ex-US, I think one of the markets that we're keenly focused on is our performance in Germany, where we saw outstanding performance in quarter one. You can see in early breast cancer, our shares are approaching 80% now in Germany. Overall, we were growing 50% in constant currencies in the first quarter. We have continued metastatic breast cancer leadership across our key markets with 50% NBRX share. And we also see growth accelerating now as we have more EBC launches across a range of markets, 69 countries, and we're reimbursed now in 40 of those markets. Some of the other markets we were paying close attention to in the UK, we have 78% early breast cancer. And we have a strong early start in China where we do have now NRDL listing. So looking ahead, Kaskali is a brand we expect to have continued strong momentum over the course of this year. So turning to slide seven, Kasimta had also a solid quarter, 26% growth ahead of both the MS and B-cell markets. In the U.S., we saw a 21% TRX growth versus prior year. That was two points ahead of the market and 1.5 points B-cell class share increase versus prior year. Importantly, when we look at our NBRX market share, both in the overall market, we reached 17% and the B cell class, we reached 28%. So we're gaining our B cell class competitors as well as the older drugs that still nearly the majority of patients are taking in the US. Overall, we continue to see a significant runway for Kesimpta. I think a lot of that performance in the US is down to strong operational execution and We've gotten much better, I think, at targeting the right patient groups, the right physician groups, as well as honing our messaging around the unique benefits of Kesimpta as a self-administered monthly therapy. So excited about that. And we also continue to progress now our Q every two-month dose to Kesimpta, which we're looking forward to reading out next year. Now, in the ex-US setting, 31% constant currency growth, strong growth in Europe. We estimate one in six MS patients now are in Cosimta. We see 79% of patients that are coming on to Cosimta either as naive or first switch in the EU5. We also have continued NBRX leadership at nine out of 10 major markets. We do find in general outside of the US a strong interest in self-administered medicines that can get patients out of the hospital or out of needing ongoing visits for infusions. So, very amenable to the symptoms profile. And we see an opportunity for continued expansion with two-thirds of DMT-treated patients continuing to not be on a B cell therapy in our key market. Now, moving to slide eight, Fluvicto continued a strong rollout, particularly driven by the pre-taxing MCRPC setting. We saw strong demand, and we also saw good progress on our ex-US rollout. Starting with the US, we saw the US sales growth 76% in the quarter, with over 70% of that business now coming from the pre-taxing setting. And that's coming from a mix of urologists and community oncologists. Right now, we estimate about Over 60% of our NBRXs are coming from the community. I think that demonstrates we've not successfully made RLT a medicine that can be prescribed in the community setting for patients who prefer to access care in the community. Outside of the US, we saw 48% growth with NBRXs up 92%. This was driven by strong EU uptake, but also I think a notable solid start in Japan. where we're seeing very strong interest in Fluvicto, so we're excited about that, and the initial stages of a launch as well in China. As a reminder, we have manufacturing sites that are being built and getting up to speed now in Japan and China, which will allow us to serve the Asian market. So diving in a little bit deeper to think about some of those growth drivers, a key element of our story is driving depth in the existing sites. and expansion into urology that continues, and I think we're making good progress on that front. And then we also expect the hormone-sensitive approvals in the second half. There we expect the hormone-sensitive indication to increase the total patient pool available to Pluvicto by 75%, so a substantial expansion, and one that I think will enable us to get the next inflection of growth for Pluvicto. You can see here at the bottom of the slide some of the data on the number of sites, over 830 sites now prescribing in the U.S., 580 in the ex-U.S. I think that all just gives us confidence now we've been able to make RLT standard that's available now broadly in the communities that we serve and also sets us up well for the future radioligand therapy portfolio over the coming years. Moving to slide nine. Lyfio had a really strong quarter, and that was driven primarily by our performance outside of the U.S., with strong growth in China as well as in Europe and Japan. Now, first, let's start with the U.S., where we saw 31% growth in the quarter. We continue to outpace the advanced lipid lowering market, but I think in the U.S., the next inflection point we would expect is when we get the outcomes data in the first part of next year in the secondary prevention setting, and that will be an important milestone for us. Now, when you think about some of the other data, the highlights we're seeing, we're seeing that we are expanding in the Medicare Part B population up 11 points versus prior year. That's about two thirds of our current business. And we also see that our TRXs are consistently up 41 percent versus prior year. So I think all heading in the right direction, consistent, steady growth across the U.S. in the buy and build segment. Outside of the US, 106% constant currency growth. That was led by China. The NRDL listing unlocked significant demand. It is early days, so I think we'll have to see how the coming quarters evolve in China to really understand how much of this was a bolus versus a steady demand. But I think the early benchmarks that we're looking at suggest very strong demand in China and something that we're excited about for our future SIRNA portfolio. Now, lastly, in terms of evidence-based for Lectio, I mentioned the importance of the outcomes trials, but we also are advancing to where we received an FDA approval for adolescents in two specific rare disease indications, and that will be important as well from a long-term pediatric exclusivity standpoint. Lectio is included in the ACC and AHA guidelines, and I think many of you likely saw a that the guidelines highlight aggressive lipid management now, even at younger ages for patients. So I think that really points to not just statin use, but adding statin and PCFK9 use wherever possible. So I think that all points to a positive outlook for the medicine. Now moving to the next slide. Semblix was up 79%. I think really outstanding performance for this brand, both in the U.S. and ex-U.S. We see in the U.S. very strong performance in the frontline setting and outside the U.S., both second, third line and frontline now starting to pick up. Let's take each of those in sequence. So first in the U.S. now we've reached 31% first line NBRX share. You can see the steady climb upwards in the graph. So very excited about that. And hopefully soon we'll be consistently the leader in NBRX, NBRX new brand scripts in the United States. When you look at the, we're also leader across all lines now with 42% shares. I think that also demonstrates the breadth of interest in Semblix. Outside of the U.S., we grew 68%. That's driven primarily by our third line leadership, 73% share across our key markets. But we are seeing early line indications now starting, the indications starting to advance. We're approved in 63 countries. You can see in the chart here that the NBRX there in the first line in Japan, we've already reached 50%. In Germany, we're seeing early traction as well with 11% NBRX in the front line. And of course, for the long-term outlook for the rent, our goal is to make this the standard of care in the front line setting across all major geographies. And as you can see in the data, we're well on our way to deliver that goal. Now, moving to slide 11. Now, Cosentix had a broadly stable quarter, and we were impacted by some of the one-time effects that we had in the prior quarter in 2025. So when you net out those effects, we would estimate that our global sales growth was about 2%. In the U.S., we were roughly flat to 1% growth. So I think that indicates that we're stable, and I think set up well now as the new indications come online for Cosentix, and that's And that's going to be very, very important to ultimately achieve our peak sales goal. So when you look at some of the data, when you look at the hydradenitis superativa NBRX naive share, you can see here pretty consistently around 50%. We did see a slight dip in January because of the re-verification and the availability of biosimilars. But we see that now climbing back up. So we expect to be stable in that 50% range. Importantly, as well, for IV patient share, we see steady growth up to now 14%. And so both of these will continue to be important. We are hoping that the HS market continues to develop, not just for Cosentix, but as we'll address later, Remy Brutenev now will also have a readout later this year in HS. So we want to see this market expand so the patients who need better therapies are getting them. Outside of the U.S., we were up 3%. That's primarily driven by growth in Europe and emerging markets. We continue to see competitive pressures in China with multiple local NRDL entrants. And so there's a long list of competitors that we have. And we've had very strong share performance in China now over many years. But our goal will be to maintain now share and hopefully can stabilize as well as performance in China over the coming quarters. We continue to advance the new indications. Importantly, the PMR submission happened across geographies, and we expect the FDA approval in the second half. And we also received FDA approval for the pediatric HS indication, and we completed EMA submission as well. So all on track on that front. So moving to slide 12, I wanted to just say a few words on our renal portfolio by talking about each of the key brands. So first, let's talk about Fabhalta. Sales were up 103% in quarter one with NBRS leadership now, both in PNH and C3G. In PNH at the moment, we're seeing 50% NBRX share, as well as important and significant contributions from some of our key ex-US markets. In C3G, 56% NBRX share, and we're now approved in 46 countries. So both of those indications really are having solid and consistent performance. Now, importantly, in IGAN, I think we believe our uptake in US patients will continue to build with patients with persistent proteinuria. and glomerular inflammation. So here we're at later line therapy. But I think very important was the two-year phase three applause IGAN data, which was published in the New England Journal. It showed an impressive slowing in kidney function decline of 49% versus placebo and a reduction in progression to kidney failure by 43%. The FDA has granted us priority review for the traditional approval. So I think that just indicates the strength of the FAB-HALTA data in IGAN. For Venrafia, we see steady U.S. uptake and growth in a very competitive field, I think, as all of you know. That launch is ongoing. We have about 11% NBRX share. We see a significant market expansion opportunity with most patients still on supportive care. And as that market grows, we hope that Venrafia will ultimately benefit as a really effective and safe vascular agent, endothelial agent. And we do expect traditional FDA approval to drive future growth. You saw in the quarter we top-lined the aligned data, and we do expect to submit that data to FDA and EMA in the first half. We will present that data in full, and while we didn't reach statistical significance, we feel confident that the data is compelling and will allow that full approval to ultimately happen. Moving to slide 13. Now, Rapsodo CSU launched off to a strong start in the U.S., and we have the early steps now to begin the rollout as well outside of the U.S. And I think when you look at the profile we're building, pipeline and appeal potential, significant medicine here that could address a range of different dermatology and immunology indications. So starting with the CSU launch, the U.S. uptake, we see 3,000 prescribers to date. across allergists and dermatologists now prescribing the medicine. 6,000 patients start. So we're seeing very positive feedback on the speed of the onset of action. And we estimate an NBRX share now of 24%, which I think is very good in these early phases of launch. We are having early access wins, but I would say that access will build over the course of the year. So it will take us the full year to get to where we want to ultimately get to from an access standpoint. And that'll be important as well, because that's what allows us to bridge from free drugs to ultimately paid scripts. So that'll be a steady uptake over the course of the year, not a fast inflection. And then outside of the U.S., the China commercial launch and the European EC approval that we've received will enable us to hopefully have a solid launch to Rapsido in the second half of the year. We did also have the positive Sindhu readout, primary endpoint in chronic inducible urticaria. We saw significantly higher rates of complete responses versus placebo across all three Sindhu types the first time a medicine is delivered that well-tolerated with a favorable safety profile. We're on track now for the FDA approval in the first subtype of Sindhu and FDA submission of the other two types in the second half. Now, building on the overall profile for Rapsido, when you look at the next slide, slide 14, we did release as well the phase two results for remibrutinib in food allergy to support a fast-acting oral option for these patients. We also are on track now to initiate the phase three study. You can see here on the left the data that we read out. The 100 milligram dose provided 86.7% responders, which I think is a very impressive result. Our modeling indicates that the 75 milligram EID would be the appropriate dose for the patients moving forward. So that's the dose we've taken forward into the phase three study. Our focus will be a multi-allergen prevention study. So I think that's really exciting across a broad range of age, 12 years, all the way up to 65 years. And as I mentioned, anticipate initiation in the second half. This has the potential to address a significant unmet need, 3.5 million high-risk eligible patients across major markets. So very excited to add this to the indication list, hopefully, for Rapsodo. Then moving to slide 15. Also in the quarter, we completed the acquisition of Avidity, adding three late-stage medicines for neuromuscular disease. And I just wanted to highlight two data points from the quarter. We did release the one-year results for Delzota, our DMD Exon 44 skipping medicine, which was presented at the Muscular Dystrophy Association to a standing ovation, which I think shows the impact that this medicine could have for these patients. You can see here the creatine kinase declines, which are remarkable. And I think really experts have opined that it's really a revolution with this medicine. We're excited to also build after this. a range of additional exon skipping medicines for DMD. We are expecting the submission now in the first half as we've worked through some of the additional CMC topics to make sure that the file is fully submission ready. And then with Del Disseren, we had the final results for the Phase 1-2 study Marina trial published in the New England Journal. Those are results you all know well, but I think highlight the excellent profile that we've seen with this medicine. And we're on track for the Phase 3 readout for the Harbor study in the second half. moving to slide 16 i didn't want to say a word on the pipeline readouts for the rest of the year of the year we have quite a bit happening and we're excited about that so in the first half i already mentioned the rhapsody sindhu positive readout we did have unalamab readout and warm autoimmune hemolytic anemia which did not meet statistical significance so we won't be taking that forward but we don't expect that to be a read-through to itp where we already have positive second line data and we'll look forward to the first line data in the second half. We also have data in-house now for Vodafone Plan, which confirm our approach for the phase three study based on that data. We feel very comfortable taking the 10 milligram dose now forward into the pivotal phase three readout. We are in collaboration with our partner PTC now discussing the best next steps for that medicine, including further interactions as well with the FDA, and we'll keep everyone apprised as we continue to progress that medicine forward. We also are on track as well for the FSHD biomarker cohort readout as well. Our plan would be to ultimately disclose that data after we've had any discussions with FDA to understand better if the data meets the standard for an accelerated approval. We do not have that data in-house yet, but we do expect it over the course of the remainder of the first half. Other important readouts include, of course, the Pella-Carson readout, which I'm sure we can discuss, the remibrutinib MS readout, which will have two replicate studies, the Daldiseran DM1 study, which I also have mentioned. And then we've accelerated now the Rapsido HS program into the second half of this year. That study enrolled extremely quickly. So very excited because that will give us another first oral option for patients with HS. We also have our QCZ484 siRNA for hypertension phase two data reading out. And then lastly, VHB, our RILS TRM2 antibody reading out as well in the second half. So with that, I will hand it over to Mukul.

Thank you very much, Bas. And good morning, good afternoon, everyone. I will now take you through our financial results for the first quarter, which, as fast mentioned, were strong despite significant U.S. generic entries. As always, my comments refer to growth rates in constant currencies unless otherwise noted. Slide 18, please. Our Q1 results, as expected, were impacted by UXGX erosion, with sales down 5% and co-ropping down 14%. Worth noting is that we did have a positive gross net in our base from Q1 last year that also had a negative impact on the overall quarterly growth rate. Core margin in Q1 declined 4.1%. This was mainly due to higher R&D investments as well as the impact of generics on the gross margin. These results were fully in line with our internal expectations and how we see 2026 P&L phasing through the year panning out. Most importantly, our growth drivers continue to show very positive growth momentum, something that Vaas has shared earlier on in the presentation with growing at 34% in Q1. Slide 19, please. What's great to see is that our continued focus on free cash flow generation has paid off in Q1. The lower core are paying was compensated by favorable working capital movement. And this brought back the free cash flow broadly in line with previous year quarter one. A strong cash flow continues to support our reinvestment into our business, including Bolton, M&A, as well as gives us the opportunity to return capital to our shareholders through dividends and share buybacks. Slide 20, please. We remain committed to our balanced shareholder-friendly capital allocation strategy. Alongside an increased R&D, in the first quarter, we closed the average acquisition, and we also announced two early-stage deals to support our oncology and immunology disease franchises. On the other hand, for the return of capital to our shareholders' front, we did pay $9.1 billion in dividend in March and April, as previously announced. And in addition, we continue to progress with our up to $10 billion share buyback program. This program still has around $6.1 billion remaining, and it's targeted to complete end of 2027. Slide 21. With that, I'll move to the guidance piece. So with our Q1 results, we are now reaffirming our full year 2026 guidance. We continue to expect 2026 to have low single-digit sales growth, and low single-digit decline in core operating income. Worth noting is that this is the year we're growing the top line of the company through the largest LOE period that the company has seen. Core net financial expense will be around $1.7 billion, and core tax rate would be about 16.5%. And these two parameters are consistent with our previous estimates. Slide 22, please. We continue to expect 2026 to be a year of two halves. H1 growth will be impacted by a tough previous year base following U.S. generic increase for Interesto, Promarkta, and Tosigna mid last year. And with that in the base, we had guided H1 sales to decline low single digit and core opting to decline low double digits. With our Q1 results now in the bag, we are on track to meet that guidance. with Q2 sales expected to decline low single-digit and core-op expected to decline high single-digit to low double-digit. In half two, the impact of the U.S. generic entries in the base will start to minimize, and this will allow strong growth of our priority brands and launches to show through the overall P&L. And hence, we continue to expect H2 sales growth of mid-single-digit and core-op in growth of mid-to-high single-digit. And that brings us to our full year guidance. Next slide, please. If exchange rates remain at late April levels, we expect positive plus 2% impact on full year sales and positive 1% on full year core operating income. As a reminder, updated exchange rate assumptions are published monthly on our website. And then that concludes my remarks, and I'll hand it back to us.

Great. Thank you, Mukul, and welcome as well, Mukul, for his first quarter here as TFO is up to a tremendous start. So overall, we've delivered a strong start in 2026 across our priority brands and launches, and we remain fully confident with our mid to long-term growth outlook. We continue to advance our pipeline, completed the ability acquisition, and are well set up for multiple readouts in the second half. remain on track to deliver our full year guidance. And we'll also look forward to those readouts, which could enable us to raise our mid to long-term growth outlook. So with that, we can open the line for questions, Sharon.

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. Please limit yourself to one question and return to the queue for any follow-up. To withdraw your question, please press star 1 and 1. We will now go to our first question. And the first question today comes from the line of Peter Fedult from BNP Paribas. Please go ahead.

Yeah, thanks, Peter Fedult, BNP. Just one question, just a deep dive, please, Vaz, on HS. Could you perhaps, you talked about MBRX during the presentation, but could you talk about current volume price dynamics for Cosentix in HS, the target clinical profile for Rapsido in HS, and how, if the data is positive, you would intend to position both assets in the market? Thank you.

Yeah, Peter, absolutely. So overall, you know, with Cosentix, we've had stable, I'd say, gross to net across our indication suite this year. So I think we've been able to manage things pretty well. So overall, you know, with this is primarily, we saw very solid volume growth in the quarter with HS. More of the headwinds that we saw were with some of the older indications. But nothing notable in terms of increased gross to nets for Cosentix in the quarter. And when you think about remibrutinib, the phase two data indicated, I think, early but impressive results in disease management. I think we'll ultimately have to see how the phase three results play out. But the ambition would be to play, as we have remibrutinib in CSU and plan to do in Sindhu, is to hopefully have an oral option that could be placed ahead of biologics. And so clearly having two medicines would be helpful. We would have the oral option and ultimately the biologic option as well. But I think this is really dependent on the data set. This is a heterogeneous population, and we're going to have to see how the data looks before we can fully define the positioning. Next question.

Thank you. Your next question comes from the line of Satya and Jane from Bank of America. Please go ahead.

Hi there. I actually have a follow-on to the prior question on HS, if I may. So you sort of commented, Vav, but what's your target efficacy profile relative to existing biologics? Just given that Phase 2 was hard to interpret with the inverse dose response and varied placebo-adjusted rates. And then, in your mind, is HS or MS likely a bigger indication? Thank you.

Yeah, I mean, I think I don't know if I have the details such in that we may have to follow up with you on our expectations on the phase three study of the design in NHS. But I would still say it's all really going to depend in terms of your second part of your question, the overall data profile that we see. I think clearly if Remy and MS proves itself both in relapse rate and disability progression to be better than the anti-CD20s, then of course the opportunity here is massive. I think if it's in line or ultimately a little bit worse, then I think HS could be a similarly sized indication. We know the HS market is growing. We've guided it to be a 5 billion market growing. Certainly the potential is there to be much larger. And it might be that a safe and effective oral option would be really attractive. So I think it's really going to be dependent on that MS readout to understand the size of the MS opportunity. But I think it's exciting that we have two shots on goal with Remy to add to what's two already very compelling indications that we have going forward. But we'll get back to you on your question on HS. Next question.

Thank you. Your next question comes from the line of Richard Foster from J.P. Morgan. Please go ahead.

Hi, thanks for taking my question. A question about China. You referenced competition for placentics. But we also saw much lower growth in general in China across Q1, despite the strong start for LECVEO. So, you know, should we expect more slower international growth in Tresto, Cosentix going forward and slower overall China development? Or can LECVEO continue to drag China growth to double digits? And I have one quick linked question on LECVEO. You know, how much of the peak do you think can come from China given the strong start? Thanks very much.

Yeah, thanks for sure. So overall, the dynamics in China, we've seen a stabilization in the early part of this year. I don't think we're back to the pre 2025 growth levels, but we do see a stabilization overall in the market as well and in our key segments. And so we feel confident that our China business can be in that high single digit to low double digit growth range. So that's been that's been positive overall, I think. But there's no question it won't get back to the really high growth rates we saw a few years ago. We also see a higher number of competitors entering in in each in each segment as well, which is something we have to just be ready for when we do launch in China. Nonetheless, very large market, highly attractive. And I think you've seen the strong performance that we've had. You know, I think for Lectio, you know, we have guided that Entrusto can be a billion-dollar medicine across its indications, and certainly we have the aspiration to make Lectio as big or bigger than Entrusto over time. It's early days, I think, understanding the trajectory of how we get there, but I would say we see very solid demand for the medicine, and I think if we could make it in the range of Entrusto, that would be a success.

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

Thank you very much for taking my question, and I will stick to the one. Taking up on your offer, Vaz, could you give us your updated levels of confidence on the timing and outcome of the Pellicast and Horizon study? Thanks so much.

Yes, Simon. I don't think I have anything new to add, unfortunately, because we don't have any new information. But I think we, of course, continue to make sure that the study is on track, no change in our expected readout. We do expect a readout in the early part of the second half of the year, so no change with respect to that. I think if we get a positive result overall, regardless of the relative risk reduction, we'll find a way to ultimately launch the medicine. I think what we'll be really looking for is are there either the 90 milligram pre-specified subgroup or other subgroups where we can really demonstrate a significant benefit for patients that I think will help with the uptake. But we have no insight yet as to what that would be. We've modeled it extensively We continue to believe that we've done the right study and are fully powered for a 20% relative risk reduction in the 70 milligram per DL and higher patient population and a 25% relative risk reduction in the 90 milligram per DL patient population. As a reminder, the median level in the study is 108. So we definitely have enrolled the right patient group. And so we'll ultimately have to see. I think some of the other dynamics that will be important is cardiovascular versus stroke and how those different elements contribute to the primary outcome. We do have a MACE4 endpoint here, so we do include stroke. And I think some of the recent literature would suggest stroke is going to be an important element of the story for LP little a. So we'll see how that unfolds. So exciting, but we'll also have to see. I do want to highlight as well that as I've articulated in the past, this will be a slow building market simply because we need the testing rates to get much higher. So this will be, assuming it all plays out as we hope, multiple iterations. But our DII-235 is ready to go into phase three studies, which could be a once yearly LP little a injection. So we're quite excited about that as well to be ready. Lastly, I would note that ACC and AHA have now added that everybody in the United States should receive an LP little a test once in their life. And I think that's a milestone to hopefully get testing rates up and to start to build the market over time. So thanks for the question. Thanks so much.

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

Thank you. My question is about Rapsido. Vas, now that we're heading to EU approval, Rapsido is going to be one of the first pricing discussions for a multi-billion dollar product since MFN. So assuming that you've had some early discussions with European governments, are you seeing countries inclined to pay higher prices for innovation in Europe?

Yeah, thanks, Matthew. So first, it's important to note Rapsido only has an MFN impact for Medicaid because the approval happened before the signing of our MFN agreements. Our first launch that will have, I think, clear MFN-related implications across all segments in the U.S. would be Unalamab. So I think that's just one clarification. Nonetheless, I'll still answer the question in terms of the ongoing discussions with governments. We are engaging with governments across Europe as well as in Japan. to hopefully get to a better place. I think we're not seeing the progress that we had hoped to see at the pace that we had hoped to see. So I think there has to be some urgency here because I do expect across the industry, there will be difficult decisions companies will have to take in terms of how they launch or ultimately progress, you know, medicines. We're already in a situation where depending on how you look, 30 to 40% of medicines in Europe available in the U S don't ultimately come to Europe. You could have that number grow in general, significant delays for introduction of medicines into the European Union. So there's a lot of work to do. We certainly have, I think, proposals to all the key governments and most important in my mind are Japan and Germany. But we haven't seen the progress that we need to see. So this is something we'll have to continue to advocate for over the next year, because I think it's really a 2027 story. where you start to see the impact of MFN on launches in Europe. Next question.

Thank you. Your next question comes from the line of James Gordon from Barclays. Please go ahead.

Hello. I'm James Gordon from Barclays. Thanks for taking the question. The question was on hormonal breast cancer. So, Roche looks set to have pterodactyren that's US approval for adjuvant hormonal breast cancer. well before the year end because they've used a PRV. And they're suggesting this could be an $11 billion plus product across adjuvant and second line, but mostly in adjuvant. So that seems to assume big, broad uptake. I think the logic is that that could be used instead of someone using an aromatase and a CDK4 for some of the patients. So based on what you know about hormonal breast cancer, do you think that's plausible? Do you think even from the end of this year, you could see some pressure on CDK4 use because people instead would just do a CERN? So any thoughts on that, please?

Yeah, we don't see that in the same way. I mean, what we expect, continue to expect, is that physicians will want to use something to ultimately impact the hormonal access and then subsequently the cell cyclin-dependent kinase access, especially for patients that we're talking about here, which are patients that are node zero, node one, node two or more, and have other risk factors that indicate they have a higher risk of recurrence of breast cancer than So that's point one. That's all of our market research suggests that. And I think part of the reason the major oral SIRT companies are partnering with us to do combination studies is they ultimately see it in a similar way as well. I can't comment on patients who are very early or less high risk early breast cancer patients. We used to call them kind of stage one patients. I think that would be a separate topic that you can talk to our competitor about, but that's not something that we see. I would also say that it is not a straightforward thing to replace established therapies like aromatase inhibitors that have been used for decades. So I think this is something that will take time. I think when you look at the data in almost any class of drug, when you're trying to replace a very established therapy, it requires a lot of education and a lot of work, and that ramp will come up over time. So, you know, we don't view this as having an impact on the Kiskali outlook, particularly now that in the first line setting, it seems clear that CDK4-6 will remain the standard of care for the remainder of Kiskali's life cycle. Our focus very much is on CDK2, CDK2-4, CDK4 to make sure that we can life cycle. Kiskali, you saw us bring in Pickovation, which we think has the opportunity to be a pan-mutant PIK3CA that has the ability to avoid some of the toxicity profiles that we've seen with hyperglycemia and off-target toxicities. So that could be an exciting medicine that hopefully might be able to be used broadly in the approximately 50% of patients who have those mutations over time. And then developing the combination drug studies, which we continue to do with the oral cert companies.

Thank you. Thank you. Your next question comes from the line of Michael Leusten from Jefferies. Please go ahead.

Oh, thank you. Last question for you on avidity. So Dyn Therapeutics presented the achieved data recently with a splicing correction at month 3 to 11 at a higher rate than we've seen with Deldesarin. And they also showed positive trends in MDHI, where I think we haven't seen any data for Deldesiren. Can you elaborate on how this data fits with your decision to pursue a VST as opposed to other assets?

Yeah, absolutely. You know, I think, obviously, the way biomarker data, splicing correction data, ultimately correlates with function is to be determined. And I think this is obviously a complex topic, given that The target here is in the nucleus. And so it's definitely something where you're going to have different profiles for the different drugs, given that we're comparing here an siRNA versus an ASO versus other technologies that are being deployed. You know, when we look at the data set that ultimately was published in the New England Journal of Medicine, very clear that you saw compelling data with the hand opening time. We saw functional endpoints going in the right direction. And so we saw everything the way we would expect it. And we have the opportunity here with a fully enrolled, fully powered phase three study that's going to read out well ahead of the competition. And I think once that happens would make it harder for accelerated approval to ultimately happen in the field as historical precedents have shown. So I think being first to market with a key, first to market medicine with a key, with a compelling profile is going to be very attractive. And then I would also say that with the avidity acquisition, we have not only DM1, but we also have the opportunity to be the first medicine, even if we need to complete the phase three study in FSHD. So it would be first to market DM1, first to market FSHD. And now we're increasingly excited as well about the opportunity we're seeing in the pipeline to address more forms of DMD and as well as apply the technology of antibody oligonucleotides ties, whether SIRNAs or ASOs, to our own internal pipeline. So taken together, we think that was the right decision, and everything that we've seen since completing the acquisition continues to confirm that.

Thank you.

Next question.

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

Great, thanks for taking my questions. So on remabrutinib in MS, you've now had three trials read out with an Orbagio control arm, giving a pretty good view on the annualized relapse rate in that population. So to what extent can you compare that data to your blinded data in the remabrutinib phase three relapsing MS trials? And to the extent you can comment, does that give you any increased confidence in the ability to meet the endpoint? And also, could you just reconfirm that at this stage you're not seeing any drug-induced liver injury or high elevations of ALT in the blinded data? Thank you.

Yeah, thanks, Graham. So I don't have any comment on the ARR data. I'm not up to speed on any blinded views that we have or have not taken on the ARR data. But we do track the blinded safety data quite carefully. And I think all of the data that we've looked at and that I've also seen indicates that we don't see any Any contribution, if we assume that the historical rates that we've seen with teraflunomide in historical studies for liver, drug-induced liver injury, enzyme elevations, et cetera, there is no contribution from the remibrutinomab because all we see in the blinded data would be consistent with what one would see from having teraflunomide in the studies. That gives us a high degree of confidence given that all these patients now are well past three months where normally you would see any liver injuries showed up. So it gives us a high degree of confidence that the safety profile for remibrutinib is clean and consistent with what we've seen in CSU, in Sindhu, in the Phase II HS study, in the Phase II food allergy study. So now, you know, we have a pretty large portfolio of studies that have indicated the clean profile of remibrutinib. But no insights so far on ARR, and I think we'll obviously read out the studies this summer and we'll see where we are.

Thank you. Your next question comes from the line of Thibaut Botherin from Morgan Stanley. Please go ahead.

Thank you very much. So my question is just on Rapsido. The previous communication was that we should see limited sales in Q4 last year, Q1 this year, because of the free scripts before we see a step up in Q2. And actually, we saw quite decent sales in the first two quarters. So I guess the question is, how much stocking have we seen so far? And should we still expect a step up

uh in q2 as we bridge to paid script and in general if you could help us with the dynamic in terms of bridge for the rest of the year yeah absolutely i would say first on stocking we've seen stocking levels that are you know in line with what we've seen historically for brands so i don't think there's a significant uh anything that's out of out of what we would expect from a stocking perspective I think when you look at the early data, as I mentioned, 6,000 patient starts, 3,000 prescribers, about a quarter of the top CSU physicians prescribing the medicine. So that's all, I think, the right direction. We think that the early script data probably has to be interpreted carefully because we are using sampling and bridge programs. And as payer coverage expands, we will start to see the conversion from free to paid. But that's going to be a stepwise process over the course of the year. We have some early access wins, ESI, Cigna, Optum. And we have been able to secure first-line post-antihistamine coverage across those commercial plans. So I think overall, that gives us confidence. But I would expect it to be a steady increase in these initial months, not a hockey stick simply because it does take time to get all of that in place and then ultimately start bridging patients. We would expect then to see an acceleration in 2027 as we then have the payer coverage in place, and then we're well-suited to have a significant launch. It doesn't change our long-term outlook. As we've guided, we think this can be a very large medicine in CSU alone. And then when you add Sindhu on top, and then hopefully MS, hopefully HS, And then down the line, additional indications, food allergy, et cetera. We have a really exciting path ahead of us for the medicine.

Thank you. Thank you. Your next question comes from the line of James Quigley from Goldman Sachs. Please go ahead.

Great. Thank you for taking my questions. I've got one on Del Dizaran in DM1. So as we're heading into the data, what are you thinking would be a clinically meaningful impact on video hand-opening time? And to what extent are the secondary endpoints even more important here in interpreting the data into an overall benefit from a functionality perspective? And then also any comments you have on the recent early data from Sarepta in the same indication. So where do you think Del Dizaran will be differentiated relative to the emerging competitors? Thank you.

I think we would be in a position to kind of comment on a specific video at hand opening time, but we do believe it's a well-understood endpoint, and if we reach statistical significance, we think that would be an important milestone, and all of our physician discussions would suggest that would be sufficient to warrant, you know, broad use of the medicine. I think importantly as well, we're going to be looking at additional functional outcomes, such as the quantitative muscle testing, and patient-reported outcomes, as well as the 10-meter walk-and-run test. I think all of that will help us to further characterize the treatment effect. Now, when we look at some of the competitor data, I think it's important to note it's quite early. And as we know in these medicines that ultimately you need a relatively broad patient group because of the diversity of manifestations of the disease. So I wouldn't want to over-interpret what we're seeing. Certainly, it's exciting that there are many medicines coming forward to treat DM1 patients. But we feel like because of the large data set that we have now, over 100 patients treated across multiple disease states, 500 infusions, up to four years of multi-year exposure, that gives us a longitudinal data set that can really help us interpret the impact we're seeing. And I think most important for us is the muscle manifestations. I know there's been a lot of discussion as well about CNS, but I think in this particular disease, what really matters is muscle mobility and managing those muscle related manifestations. And that's very much our focus. So having, I think, 54-week follow-up long-term data on a large cohort of patients gives you a very robust read. And I think, you know, we feel confident that based on everything we've seen in the phase two study, that we're set up well, as well as we can be towards that phase three readout. Next question.

Thank you. Your next question comes from the line of Florence from OdoBHF. Please go ahead.

Good afternoon. Thank you very much for taking my questions. Francis Des from AutoBHS. A big picture question for Vas. On your last slide, you highlighted that there will be multiple readouts in H2 that could raise your mid-term to long-term growth outlook. Maybe, Vas, could you be a little bit more specific and give us a bit more color from where do you see the potential upside coming from? Thank you.

Yeah, thanks, Laura. When you look at what we guided to last fall, our focus was very much on what we had in hand and a probabilized view of our pipeline. And I think when then some of these medicines, if they ultimately come forward and we unprobabilize, that can lead to significant upsides versus where we are today. I think obviously the big readouts, not surprisingly, I think to all of you will certainly be know remy brudenib for the five-year term remy brudenib nms remy brudenib in hs del disran the dm1 we also believe you know unalamab and first line itb can be a billion dollar plus uh indication i think paula carson will be significant i think it will take longer to build over time and i think overall the combination of paula carson plus dii 235 will give us a very significant opportunity But in that kind of five-year term, I think that medicine will take time to build up. But, you know, I think those are the medicines where, you know, if we see some wins, it could allow us to, once we do the modeling, to reevaluate the 5% to 6% growth up to 2030 and hopefully drive additional upsides. So I think that's a great story. And I would say also in 2027, we have a number of readouts, important readouts as well. Avalastimab in stroke prevention. uh we will have uh as well the uh i'll uh no we'll have as well the cosimta uh data as well as some other phase two readouts as well as starting to read out as well our immune reset portfolio so i think a number of readouts coming that could uh could further bolster the long-term outlook of the company very clear thank you very much thank you your next question comes from the line of kerry holford from barenberg please go ahead

Thank you. A question for me on PluVicto, please. So following the recent European filing withdrawal in that pre-taxing setting, just keen to hear whether you plan to run any additional trials to address the EMA requirements. And if not, does the lack of pre-taxing approval in that region have any impact on your peak sales forecast for that drug?

Yeah, thanks, Kerry. So no impact on the peak sales forecast. We continue to expect $5 billion plus. We had assumed all along that navigating the European feedback on the comparator arm would be a challenge. We evaluated multiple ways to try to address it, and we tried to make the best arguments that we could. But ultimately, we thought it was prudent at that point to withdraw. We do see continued strong uptake in the vision population in Europe. It's important to note as well in Japan and in China, we are able to both have the PSMA4 and PSMA vision populations, which are critical, you know, long-term markets. And the next step now for Europe will be the hormone sensitive setting where we, because Pluvicto is used in combination with an ARPI versus an ARPI, there the comparator arm is what EMA would want. And I think would allow us then if we're to move forward now, we have the strong, as you know, RPFS data. We're waiting on the OS data. Once we have that OS data, we should be able to file in Europe and then expand the patient population there. So I think that was the best outcome we decided rather than running additional studies that would take many years to just withdraw the file and wait for the HSPC readout.

Lovely. Thank you.

Thank you. Your next question today comes from the line of Steve Scaler from TD Securities. Please go ahead.

Thank you so much. Some of your competitors are becoming increasingly vocal about extending big LOEs at the end of the decade. Novartis is the notable exception. It could be attributed to nothing more than communication practices. But if Novartis feels it has a good shot at delaying Cosentix LOE, then why not note that? And if this is an area of active pursuit, what is it that you're doing? Co-formulation, extended dosing, And related to all this, if Karen Hale is in the room, can she compare and contrast this to her experience at AbbVie? Thank you.

Yeah, thanks, Steve. So, you know, Karen Hale is in the room, but I'll spare her from having to compare her thoughts with AbbVie. I think that would be not the appropriate setting to do that, but we appreciate the question. I mean, of course, we have extensive efforts to defend our IP and then look at other ways to formulate our medicines. I mean, a good example is the Casimta two-month, which we do have now planned readout. We have additional efforts as well to lifecycle manage Casimta into longer intervals as well, which are still in the early phases of efforts. We'll see how that progresses. All of that would generate new IP, I think. And so that one is clear. I think with Cosentix, we have a number of cell line formulation and other patents that we continue to prosecute. We, as a practice, don't add those in as potential scenarios until we've gotten further along, I think, in the litigation phase to really understand where those trials ultimately fit. So I think with Casentix, with Casenta, many efforts. I think we've discussed extensively with Cascali the efforts around CDK2, CDK2-4, the picavation efforts as well. Harder with a small molecule, as you know, to come up with significant reformulation efforts, but something that we're certainly looking at. I would point out, even for medicines like Semblix, we're actively already working on ways to hopefully extend that franchise even further. You know, with Letheo, we moved from six months also to now go to 12 months and also to look at combinations of Letheo to target other siRNA targets within cardiovascular disease, things like HMG-CoA reductase amongst others. So I think, you know, we have quite a broad effort to always think about this, but we don't want to overpromise at this stage, sitting here in 2026, what may or may not happen five years from now. But rest assured, those efforts are ongoing. And as soon as we have something that we think is credible to put forward, we certainly will let the markets know.

Thank you. Your next question today comes from the line of Naresh Chauhan from Intron Health. Please go ahead.

Hi there. Thanks for taking my question. Just one thing on Cosentix. As we think about the margin impact of the Cosentix LOE, Is it fair to assume that you've already started optimizing the profitability of Cosentix as would be typical ahead of any other LOE? Thank you.

Thanks, Naresh. I'll give that to Mukul.

Yeah, Naresh, thanks for the question. Yeah, absolutely, I would confirm that. I think as we have previously indicated, I think we are, we've projected an LOE in the U.S. for Cosentix in 2029. There is also an IRA event in 2028 that we have factored into our numbers. And this is all baked into our back to 40% latest by 2029 guidance in the margin.

Thank you. Perfect. Thanks, Mukul.

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

This is Zach Dunn on behalf of Seamus Fernandez. Thank you for the questions. We're encouraged by the advancement of your IL-15, the GIA632 into vitiligo. Can you share your thoughts on how you think about the market size of biologic eligible vitiligo patients? And if you don't mind tying that into your thoughts on atopic dermatitis and the market opportunity there. Thank you.

Yeah, thanks. I mean, the IL-15 is something we did mention at the Meet the Management, and we are quite excited by the profile of this medicine. For those of you who are not aware, this is a medicine that we in-license. It's overexpressed in patients with atopic dermatitis, but we also see the opportunity to address a number of other diseases over time, including vitiligo. And so it's early days. I mean, these phase two studies are ongoing. The phase two A study in atopic dermatitis is now recruiting. The vitiligo study is set to begin. Obviously, if we can show meaningful improvements over the standard of care in atopic dermatitis or can obviously become a standard of care in vitiligo, these would be very large indications. I wouldn't be in a position to give you precise numbers, but obviously very large market opportunities. And we are actively looking at moving that IL-15 across multiple other immunology indications over time. So I think as we progress, we'll, of course, you know, keep you posted. Maybe I'll also note in atopic dermatitis, we also have the GHC program, which also IL-13, IL-18, which we're also, you know, on track.

Thank you. As a reminder, if you would like to ask a question, please press star 1 and 1 on your telephone and wait for your name to be announced. Please limit yourself to one question and return to the queue for any follow-up. We will now take the next question. And the question comes from the line of Matthew Weston from UBS. Please go ahead.

Thanks, Vas. It's a quick follow-up about my first question about Rapsido and XUS. And I was intrigued by your comment around you coming in for US approval before MFN. Just thinking about the CNS indication, which I think you've said previously is going to have a separate brand name, but obviously the same active ingredient at a different dose. Does that mean it would also be excluded from MFN considerations because of the original approval, or that's something that we'd have to think of in MS?

Yeah, so our current assumption, Matthew, it's a very good question. Our current assumption, working assumption, is that this is based on the chemical compound in question. So all, because remibrutinib has an approval that even with different brand names that all of the subsequent remibrutinib indications would be susceptible to the Medicaid element of the MFN story, but not the overall MFN across all segments of U.S. reimbursement environment. I would say that is our current working assumption. And if that changes, we'll let you know. But our current expectation is that would be how Remy Bruggen would be treated. as would be the case for other medicines such as zolgensma, where we have it bisma. But while the dose is changing, of course, the underlying gene therapy is the same. So that is our assumption for all of those medicines.

Cool. Many thanks.

Thank you. Your next question comes from the line of Michael Leuchten from Jefferies. Please go ahead.

Thank you for taking the follow-up. A question for Mokul, please. The gross margin is pressured by negative mixed effect, obviously. That is partly driven by the generic erosions and partly by the new products having payaways. Is there a scale factor in here that we should take into consideration as we think about the first half, second half of the year, or is the gross margin just plain and simple mixed driven?

Yeah. So I think there is, as you rightly said, I think there's two things at play here. If we look at Q1, the overall decrease in the margin is 4.1%. Three percentage points of that comes from R&D spend, and a percentage point comes from the GX impact on gross margin. Now, GX impact on gross margin, pretty much, I think if we take 2025 as a base, pretty much H2 base is what you guys should model going into this year, and that should be the base. And as far as R&D is concerned, I think we have to take into account not just the Avidity deal that we did, but we also did three other pretty significant deals in Tourmaline, Anthos, as well as Regulus. And I think they all came into the P&L from Q2 onwards. So in Q1, all of these three deals plus one month of avidity is incremental and going forward, I think part of it is already in the base. So the incremental R&D spend would start to run off the P&R.

Thank you. Next question.

Thank you. Your next question comes from the line of Thibaut Barthelin from Morgan Stanley. Please go ahead.

Yes, thank you. Just a question on your comments. on voter plan and the potential discussion with the FDA on the phase two. We had the phase two data some time ago. Have you seen anything new in the full data open label extension that makes you more confident on the potential for the FDA to accept a path for approval?

Yeah, I think, as I said, we feel like the results that we've seen confirm our planned design in phase three and also confirm that the 10 milligram dose is the right dose to take forward. I think at this point, we're still in discussions with our partner company on the right approach with PTC, on the right approach with any further engagement with FDA. And I think as soon as we have clarity on that, we'll, of course, continue. and have those discussions with FDA. We can keep the markets updated, but I think no further comment until those discussions are complete. Next question.

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

Okay, thanks for taking my follow-up. Just on casentics, actually, it would be useful if you could qualify the grace to net adjustments both in the base year and this year at the quarter. And previously, you talked about the U.S. growing mid-single-digit growth over the mid-term to an $8 billion peak on that asset. That was absent from the release and slide today. I just wonder if that still stands.

Thank you.

Yeah, so on the gross net and adjustments for Cosentex from quarter one last year.

Yeah, so I think if we exclude the gross net, impact on Cosentix. Cosentix moves into a positive growth territory for the U.S. I think to be exact, around 1%, 0% to 1%, closer to 1% for the quarter. We have to think of, and then I think if you think of an overall basis, we have two percentage points in our base for Grossnet in the U.S. in Q1 2025. I think we also have a positive impact this year. The net comes to about 1% on our overall P&R.

And then I think, you know, Graham, when you look going forward, yeah, we continue to expect to be in this mid single digit range globally. And I think that will be a mix of U.S. and ex-U.S. And we're going to have to, I think, see how the coming quarters evolve. But that's our current expectation is that we would be in that mid single digit range. Clearly, the Peak sales for Cosentix would most likely be in 2027, given the IRA event in 2028 would impact the overall pricing in Medicare, but also into the Medicaid best price in 2028. So all of those dynamics are unfolding alongside the PMR launch and the ongoing launch in IV.

Thank you.

Next question.

Your next question comes from the line of James Quigley from Goldman Sachs. Please go ahead.

Hello, thank you for taking my second question. So you're just following up on the remoributinib food allergy data from the phase two that are supporting the phase three trial. So what is it in the modeling that you saw that makes the 75 milligram the most appropriate dose given the data we've seen for the 100 milligram and the 25 milligram? Is there a bridge between where the efficacy is between the two or would the 75 milligram dose have the same target engagement as 100 milligrams?

That's a great question. So we modeled this really carefully based on the full data set that we have. And we do believe that at 75 milligrams, we do have full target engagement and we should be able to achieve efficacy that approaches the 100 milligram dose. And so we felt like this was a reasonable approach to take, particularly given that we want to move into the adolescent population and FDA would surely ask us to use the minimum required dose to achieve the efficacy required. So based on all our modeling, we believe we can get the necessary target engagement at 75 milligrams and then deliver the efficacy that you saw in the study, which, as you could see, was really very compelling. Next question.

Thank you. We will now take our last question for today. And the last question comes from the line of Steve Scaler from TD Securities. Please go ahead.

Oh, thank you so much for the follow-up. Slide 25 no longer mentions MFN, whereas the same slide in the Q4 deck did. I'm just curious why. I heard your earlier responses to Matthew's questions, but slide 25 suggests that Novartis is increasingly confident in its ability to deal with MFN, and I'm just wondering what has changed as we start 2026. Thank you.

Hold on one second, Steve. We're just trying to get slide 25 up. Okay. So I think no change in our perspective on MFN. I mean, we've fully factored in MFN into the guidance that we've given, both for this year and the five-year period. So that's fully factored in. If anything, I think we've gotten even better now at modeling the MFN impact. So we've made clear assumptions on the impact on the existing portfolio of medicines for the Medicaid effect, as well as on future launches, a set of assumptions on launch phasing for drugs that have a full MFN effect. And then we'll ultimately, of course, see how this all unfolds. We also have signed the agreements to allow us to not have an impact from tariffs with the commercial agreement that we've signed with the U.S. government, as well as scaling up, as you've seen, our manufacturing plants around the United States. to allow us to produce fully in the US for the US, such that we wouldn't expect any tariff impact. So all that to say, I guess at this point, we feel confident enough with MFN that we don't need to mention it anymore. Hence, that's why you're not seeing it on the slides. Thank you. I think that is all the questions. So thank you all very, very much for an engaging discussion. I know we have some follow-ups, but we'll get back to you. We appreciate your time as always, and we'll look forward to keeping you up to date in the months ahead. Have a great day.

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