嬌生 (JNJ) 2023 Q4 法說會逐字稿

Good morning, and welcome to Johnson & Johnson's Fourth Quarter 2023 Earnings Conference Call. (Operator Instructions) This call is being recorded. If anyone has any objections, you may disconnect at this time. (Operator Instructions) I would now like to turn the conference call over to Johnson & Johnson. You may begin.

早安，歡迎參加強生 2023 年第四季財報電話會議。 （操作員說明）此通話正在錄音。如果有人有任何異議，您可以此時斷開連接。 （操作員指示）我現在想將電話會議轉給強生公司。你可以開始了。

Good morning. This is Jessica Moore, Vice President of Investor Relations for Johnson & Johnson. Welcome to our company's review of business results for the fourth quarter and full year 2023 and our financial outlook for 2024. Joining me on today's call are Joaquin Duato, Chairman and Chief Executive Officer; and Joe Wolk, Executive Vice President, Chief Financial Officer.

早安.我是潔西卡摩爾，強生公司投資人關係副總裁。歡迎參加我們公司對2023 年第四季度和全年業務業績的回顧以及我們對2024 年的財務展望。與我一起參加今天電話會議的是董事長兼首席執行官華金·杜阿托(Joaquin Duato )；執行副總裁兼財務長 Joe Wolk。

As a reminder, you can find additional materials, including today's presentation and associated schedules, on the Investor Relations section of the Johnson & Johnson website at investor.jnj.com.

請注意，您可以在強生公司網站 Investor.jnj.com 的投資者關係部分找到更多資料，包括今天的簡報和相關時間表。

Please note that this presentation contains forward-looking statements regarding, among other things, the company's future operating and financial performance, market position and business strategy. You are cautioned not to rely on these forward-looking statements, which are based on current expectations of future events using the information available as of the date of this recording and are subject to certain risks and uncertainties that may cause the company's actual results to differ materially from those projected. A description of these risks, uncertainties and other factors can be found in our SEC filings, including our 2022 Form 10-K, which is available at investor.jnj.com and on the SEC's website. Additionally, several of the products and compounds discussed today are being developed in collaboration with strategic partners or licensed from other companies. This slide acknowledges those relationships.

請注意，本簡報包含有關公司未來營運和財務績效、市場地位和業務策略等的前瞻性陳述。請注意，不要依賴這些前瞻性陳述，這些陳述基於使用截至本記錄之日的可用資訊對未來事件的當前預期，並受到某些風險和不確定性的影響，可能導致公司的實際結果有所不同實質上來自那些預計的。有關這些風險、不確定性和其他因素的描述可以在我們向 SEC 提交的文件中找到，包括我們的 2022 年 10-K 表格，該表格可在 Investor.jnj.com 和 SEC 網站上取得。此外，今天討論的幾種產品和化合物正在與策略合作夥伴合作開發或從其他公司獲得許可。這張投影片承認了這些關係。

Moving to today's agenda. Joaquin will open with a few comments on our 2023 performance and key milestones as well as highlights from our enterprise business review. I will then review the fourth quarter sales and P&L results as well as full year 2023 results for the enterprise. Joe will then close by sharing an overview of our cash position, capital allocation priorities and guidance for 2024. The remaining time will be available for your questions. To ensure we provide enough time to address your questions, we anticipate the webcast will last a little over 60 minutes.

轉到今天的議程。 Joaquin 將首先對我們 2023 年的業績和關鍵里程碑以及我們企業業務回顧的亮點發表一些評論。然後我將回顧該企業第四季的銷售和損益結果以及 2023 年全年業績。最後，Joe 將概述我們的現金狀況、資本配置優先事項和 2024 年指導。剩下的時間將用於回答您的問題。為了確保我們有足夠的時間來解決您的問題，我們預計網路廣播將持續 60 分鐘多一點。

I am now pleased to turn the call over to Joaquin.

我現在很高興將電話轉給華金。

Thank you, Jess, and good morning, everyone. 2023 was a remarkable year for Johnson & Johnson. In becoming a 2-sector company focused on Innovative Medicine and MedTech, we strengthened our position as an innovation powerhouse.

謝謝你，傑西，大家早安。 2023 年對強生公司來說是非凡的一年。在成為一家專注於創新醫學和醫療科技的兩大產業公司的過程中，我們鞏固了作為創新強國的地位。

With breakthrough science and transformative technology, we innovate across the entire patient pathway in ways no other company can. And as we shared at our enterprise business review, we have a stronger growth and margin profile and are more focused and agile than ever before, which is what you see with today's results.

憑藉突破性的科學和變革性技術，我們在整個患者路徑上進行創新，這是其他公司無法做到的。正如我們在企業業務回顧中所分享的那樣，我們擁有更強勁的成長和利潤狀況，並且比以往任何時候都更加專注和敏捷，這就是您在今天的結果中看到的。

I'm particularly proud of our Q4 results with Innovative Medicine operational sales, excluding the COVID-19 vaccine, growing by 9.5%, a metric adjusted operational sales growing by an impressive 9.1%. For the full year, we delivered strong and sustained performance with 9% operational sales growth, excluding the COVID-19 vaccine, and 10.8% adjusted operational earnings per share growth. These results reflect the breadth and competitiveness of our portfolio. And when I look at the milestones we achieved in 2023 and the promise of our pipeline, I have confidence in our guidance for 2024 and beyond. So let's take a deeper look at the business and what we achieved last year.

我對我們第四季度的創新醫學營運銷售業績（不包括 COVID-19 疫苗）成長 9.5% 感到特別自豪，這項指標調整後的營運銷售成長了令人印象深刻的 9.1%。全年業績強勁且持續，營運銷售額成長 9%（不包括 COVID-19 疫苗），調整後每股營運收益成長 10.8%。這些結果反映了我們產品組合的廣度和競爭力。當我看到我們在 2023 年實現的里程碑以及我們的管道的承諾時，我對我們對 2024 年及以後的指導充滿信心。因此，讓我們更深入地了解我們的業務以及我們去年的成就。

Starting with Innovative Medicine for the full year, we delivered above-market operational sales growth of 7.2%, excluding the COVID-19 vaccine. Our Innovative Medicine business continues to be fueled by growth from key brands and the acceleration of sales of new products. Our multiple myeloma portfolio is a good example with significant contribution from recently launched products, including CARVYKTI, TECVAYLI and TALVEY.

從全年創新醫學開始，我們的營運銷售額成長了 7.2%，高於市場水平（不包括 COVID-19 疫苗）。我們的創新藥物業務繼續受到主要品牌的成長和新產品銷售加速的推動。我們的多發性骨髓瘤產品組合就是一個很好的例子，最近推出的產品（包括 CARVYKTI、TECVAYLI 和 TALVEY）做出了重大貢獻。

Turning to clinical trials. Key results from the year included positive Phase III readouts for more than 10 of our in-line and pipeline medicines, including CARVYKTI in 1 to 3 prior lines of therapy in multiple myeloma; DARZALEX in frontline multiple myeloma transplant-eligible patients; RYBREVANT in combination with chemotherapy and RYBREVANT plus lazertinib in nonsmall cell lung cancer; and finally, TREMFYA monotherapy in ulcerative colitis.

轉向臨床試驗。今年的主要結果包括我們超過 10 種線上和管道藥物的 III 期試驗結果呈陽性，其中包括 CARVYKTI 在多發性骨髓瘤先前治療中的 1 至 3 個系列； DARZALEX 用於第一線多發性骨髓瘤移植合格患者； RYBREVANT 合併化療和 RYBREVANT 加拉澤替尼治療非小細胞肺癌；最後，TREMFYA 單藥治療潰瘍性結腸炎。

In addition, we saw positive Phase I and Phase II readouts for nipocalimab and TAR-200 and TAR-210. And we initiated our Phase III clinical development programs for milvexian and our targeted oral peptide JNJ-2113. Beyond that, we received FDA breakthrough designation for TAR-200 for the treatment of bladder cancer and fast track designations for milvexian in atrial fibrillation, stroke and acute coronary syndrome. And with 19 U.S. and EU filings across our Innovative Medicine business in 2023, we have high expectations for the year ahead. Our recent announcement of a definitive agreement to acquire Ambrx to develop next-generation antibody drug conjugates further strengthens our Oncology pipeline.

此外，我們也看到 nipocalimab、TAR-200 和 TAR-210 的 I 期和 II 期結果呈現陽性。我們啟動了 milvexian 和我們的標靶口服勝肽 JNJ-2113 的 III 期臨床開發計畫。除此之外，我們還獲得了 FDA 對 TAR-200 用於治療膀胱癌的突破性指定，以及 Milvexian 用於治療心房顫動、中風和急性冠狀動脈綜合徵的快速通道指定。 2023 年，我們的創新藥物業務在美國和歐盟收到了 19 份申請，我們對未來一年抱有很高的期望。我們最近宣布達成收購 Ambrx 以開發下一代抗體藥物偶聯物的最終協議，進一步加強了我們的腫瘤產品線。

Now moving to MedTech. In 2023, we delivered full year operational sales growth of 12.4% and full year adjusted operational sales growth of 7.8%. For the first time, our MedTech team delivered more than $30 billion in sales as we continue to build a best-in-class business. We are accelerating growth through commercial execution, differentiated innovation and moving into higher-growth markets as you saw with our successful integration of Abiomed and our recent acquisition of Laminar, which focused on eliminating the left atrial appendage in patients with nonvalvular atrial fibrillation.

現在轉向醫療科技。 2023 年，我們全年營運銷售額成長 12.4%，全年調整後營運銷售額成長 7.8%。隨著我們繼續打造一流的業務，我們的醫療技術團隊銷售額首次超過 300 億美元。我們正在透過商業執行、差異化創新和進入更高成長的市場來加速成長，正如您所看到的，我們成功整合了Abiomed 並最近收購了Laminar，後者專注於消除非瓣膜性心房顫動患者的左心耳。

And at the same time, we are making strong progress in our pipeline, including advancing our Ottava surgical robot, MONARCH approval in China for bronchoscopy and continued market expansion for VELYS, our robotic-assisted solution for total knee replacement with CE Mark approval in 2023.

同時，我們的產品線正在取得重大進展，包括推進我們的Ottava 手術機器人、MONARCH 在中國批准支氣管鏡檢查，以及繼續拓展VELYS 的市場，VELYS 是我們的機器人輔助全膝關節置換解決方案，將於2023 年獲得CE 標誌批准。

In electrophysiology. We have a lot of momentum in our post-field ablation portfolio. We announced regulatory approval a few weeks ago for the VARIPULSE PFA platform in Japan and have submitted for CE Mark approval in the EU. The (inaudible) generator has received approval in the EU. And we received first and only approval from the U.S. FDA for a zero fluoroscopy workflow for cardiac ablation.

在電生理學中。我們的後場消融產品組合勢頭強勁。幾週前，我們宣布 VARIPULSE PFA 平台在日本獲得監管機構批准，並已提交歐盟 CE 標誌批准。 （聽不清楚）發電機已獲得歐盟的批准。我們第一個也是唯一一個獲得美國 FDA 批准的心臟消融的零透視工作流程。

And in the fourth quarter, findings from our Q DOT micro catheter Q efficiency study showed that very high power, short duration ablations improved quality of life and reduced health care utilization for atrial fibrillation patients. In Vision, we are driving strong performance across our TECNIS IOLs and OASYS 1-Day family of contact lenses, including our most premium lens, ACUVUE OASYS MAX 1-Day, which has proven superiority in comfort and clarity than the competition.

在第四季度，我們的 Q DOT 微導管 Q 效率研究結果表明，功率非常高、持續時間短的消融可以改善心房顫動患者的生活品質並減少醫療保健利用率。在Vision 方面，我們正在推動TECNIS IOL 和OASYS 1-Day 系列隱形眼鏡的強勁性能，其中包括我們最優質的鏡片ACUVUE OASYS MAX 1-Day，事實證明，該鏡片在舒適度和清晰度方面優於競爭對手。

Turning to Abiomed. We recently completed our Impella ECP pivotal clinical trial. In Q4, we also enrolled our first patient in the Abiomed Recover IV randomized, controlled trial. As we look ahead, I have never been more excited about the future of our business. At our enterprise business review, we shared that we expect our Innovative Medicine business to grow 5% to 7% from 2025 to 2030 with our industry-leading pipeline and portfolio delivering more than 10 assets that have the potential to generate over $5 billion in peak year sales by 2030.

轉向阿比奧梅德。我們最近完成了 Impella ECP 關鍵臨床試驗。在第四季度，我們也在 Abiomed Recover IV 隨機對照試驗中招募了第一位患者。展望未來，我對我們業務的未來感到前所未有的興奮。在我們的企業業務回顧中，我們預計我們的創新藥物業務從2025 年到2030 年將增長5% 到7%，我們行業領先的產品線和產品組合將提供超過10 種資產，這些資產高峰時有可能產生超過50 億美元的收入到 2030 年銷售額。

We also expect a further 15 assets to have the potential for $1 billion to $5 billion in peak year sales. In 2024, we expect data readouts for many of these assets, including Phase III trials for TREMFYA in IBD, ERLEADA in heavy stage prostate cancer, our targeted oral peptide, JNJ-2113 in psoriasis, nipocalimab in myasthenia gravis as well as aticaprant and seltorexant in major depressive disorder.

我們也預計另外 15 項資產在高峰年的銷售額將達到 10 億至 50 億美元。到2024 年，我們預計其中許多資產的數據將公佈，包括治療IBD 的TREMFYA、治療重度前列腺癌的ERLEADA、我們的靶向口服肽、治療牛皮癬的JNJ-2113、治療重症肌無力的尼泊卡利單抗以及阿替卡蘭和seltorexant 的III 期試驗患有重度憂鬱症。

We also expect Phase II readouts for our combination therapy, guselkumab and golimumab, JNJ-4804 in psoriatic arthritis, nipocalimab in Sjogren's disease and TAR-200 in nonmuscle invasive bladder cancer. In MedTech, we shared that we expect to grow at the upper range of our markets, which are anticipated to grow by 5% to 7% between 2022 and 2027. And that by 2027, we expect 1/3 of our revenue to be generated by new products.

我們也預期我們的聯合療法古塞奇尤單抗和戈利木單抗、治療銀屑病關節炎的JNJ-4804、治療乾燥症的尼泊卡利單抗和治療非肌肉浸潤性膀胱癌的TAR-200 的II 期結果。在醫療科技領域，我們預計高端市場將實現成長，預計 2022 年至 2027 年將成長 5% 至 7%。到 2027 年，我們預計 1/3 的營收將來自於透過新產品。

In 2024, we see strong progress towards these goals in electrophysiology that includes the full U.S. market release of Q DOT my catheter. And we are expecting CE Mark approval for our post-field ablation catheter VARIPULSE in Europe in the first half of 2024. We plan to submit an investigational device exemption to the FDA for Ottava in the second half of 2024.

2024 年，我們看到電生理學領域在實現這些目標方面取得了巨大進展，其中包括 Q DOT my 導管在美國市場的全面發布。我們預計我們的現場後消融導管 VARIPULSE 將於 2024 年上半年在歐洲獲得 CE 標誌批准。我們計劃於 2024 年下半年向 FDA 提交 Ottava 的研究設備豁免。

And in Abiomed, we expect U.S. commercial launch of Impella RP Flex with smart assist and an Impella ECP submission in 2024. As you can see, our pipeline is advancing. Our business is transforming.

在 Abiomed 中，我們預計具有智慧輔助功能的 Impella RP Flex 將於 2024 年在美國商業推出，並提交 Impella ECP。如您所見，我們的產品線正在推進。我們的業務正在轉型。

Before I turn the call to Jess and Joe, I want to thank our teams around the world for everything they do help our patients. We have entered 2024 from a position of strength, and I'm confident in our ability to lead the next wave of health innovation.

在打電話給 Jess 和 Joe 之前，我要感謝我們世界各地的團隊為幫助我們的患者所做的一切。進入 2024 年，我們處於強勢地位，我對我們引領下一波健康創新浪潮的能力充滿信心。

With that, I'll turn the call over to Jess.

這樣，我就把電話轉給傑西。

Thanks, Joaquin. Unless otherwise stated, the financial results and guidance highlighted reflects the continuing operations of Johnson & Johnson. We will report the Consumer Health financial results as discontinued operations. Furthermore, the percentages quoted represent operational results and therefore, exclude the impact of currency translation.

謝謝，華金。除非另有說明，否則強調的財務表現和指導反映了強生公司的持續經營。我們將把消費者健康業務的財務表現報告為已終止業務。此外，所引用的百分比代表營運結果，因此排除了貨幣換算的影響。

Starting with Q4 2023 sales results. Worldwide sales were $21.4 billion for the fourth quarter of 2023. Sales increased 7.2%, with 11% in the U.S. and 2.7% outside of the U.S. Excluding the net impact of acquisitions and divestitures, adjusted operational sales growth was 5.7% worldwide, 8.8% in the U.S. and 2.1% outside the U.S. It is important to note that sales in Europe were negatively impacted by the COVID-19 vaccine and loss of exclusivity of ZYTIGA by approximately 1,500 basis points operationally.

從 2023 年第四季的銷售結果開始。 2023 年第四季全球銷售額為214 億美元。銷售額成長7.2%，其中美國成長11%，美國以外成長2.7%。排除收購和資產剝離的淨影響，調整後的全球營運銷售額成長分別為5.7%、8.8% 美國和美國以外地區的銷售額分別為2.1% 和2.1%。值得注意的是，歐洲的銷售受到COVID-19 疫苗和ZYTIGA 獨家經營權喪失的負面影響，營運上下降了約1,500個基點。

Turning now to earnings. For the quarter, net earnings were $4.1 billion, and diluted earnings per share was $1.70 versus diluted earnings per share of $1.22 a year ago. Excluding after-tax intangible asset amortization expense and special items for both periods, adjusted net earnings for the quarter were $5.6 billion. And the diluted earnings per share was $2.29, representing increases of 2.4% and 11.7%, respectively, compared to the fourth quarter of 2022. On an operational basis, adjusted diluted earnings per share increased 11.2%.

現在轉向收益。該季度淨利潤為 41 億美元，稀釋後每股收益為 1.70 美元，而一年前稀釋後每股收益為 1.22 美元。不計兩個時期的稅後無形資產攤銷費用和特殊項目，季度調整後淨利為 56 億美元。稀釋每股收益為2.29美元，較2022年第四季分別成長2.4%和11.7%。在營運基礎上，調整後稀釋每股收益成長11.2%。

For the full year 2023, sales were $85.2 billion. Sales grew 7.4%, with 10.6% in the U.S. and 3.8% outside of the U.S. Excluding the net impact of acquisitions and divestitures, adjusted operational sales growth was 5.9% worldwide, 8.2% in the U.S. and 3.4% outside the U.S. Sales in Europe were negatively impacted by the COVID-19 vaccine and loss of exclusivity of ZYTIGA by approximately 1,000 basis points operationally.

2023 年全年銷售額為 852 億美元。銷售額成長7.4%，其中美國成長10.6%，美國以外地區成長3.8%。排除收購及資產剝離的淨影響，全球調整後營運銷售額成長5.9%，美國成長8.2%，美國以外地區成長3.4%。歐洲銷售額受到 COVID-19 疫苗和 ZYTIGA 獨家經營權喪失的負面影響約 1,000 個基點。

Net earnings for the full year 2023 were $13.3 billion. And diluted earnings per share was $5.20 versus diluted earnings per share of $6.14 a year ago. Full year 2023 adjusted net earnings were $25.4 billion, and adjusted diluted earnings per share was $9.92, representing increases of 6.8% and 11.1%, respectively, versus full year 2022. On an operational basis, adjusted diluted earnings per share increased by 10.8%.

2023 年全年淨利為 133 億美元。稀釋後每股收益為 5.20 美元，而一年前稀釋後每股收益為 6.14 美元。 2023 年全年調整後淨利為254 億美元，調整後稀釋每股盈餘為9.92 美元，較2022 年全年分別成長6.8% 及11.1%。在營運基礎上，調整後稀釋每股盈餘成長10.8% 。

I will now comment on business sales performance in the quarter. Beginning with Innovative Medicine. Worldwide Innovative Medicine sales of $13.7 billion increased 4% with growth of 9.5% in the U.S. and a decline of 3.1% outside of the U.S. Excluding COVID-19 vaccine sales, worldwide and U.S. sales growth was 9.5%, and growth outside of the U.S. was 9.4%. Sales outside the U.S., excluding the COVID-19 vaccine, were negatively impacted by approximately 120 basis points due to the loss of exclusivity of ZYTIGA in Europe.

我現在將評論本季的業務銷售業績。從創新醫學開始。全球創新藥物銷售額為 137 億美元，成長 4%，其中美國成長 9.5%，美國以外地區下降 3.1%。不包括 COVID-19 疫苗銷售額，全球和美國銷售額成長 9.5%，美國以外地區成長。為9.4%。由於 ZYTIGA 失去在歐洲的獨家經營權，美國境外的銷售（不包括 COVID-19 疫苗）受到約 120 個基點的負面影響。

Innovative Medicine growth was driven by our key brands and continued uptake from recently launched products, with 9 assets delivering double-digit growth. We continue to drive strong sales growth for both DARZALEX and ERLEADA, with increases of 22.2% and 19%, respectively.

創新醫學的成長是由我們的主要品牌和最近推出的產品的持續吸收所推動的，其中 9 項資產實現了兩位數的成長。我們繼續推動 DARZALEX 和 ERLEADA 的銷售強勁成長，分別成長 22.2% 和 19%。

Within immunology. We saw sales growth in both STELARA and TREMFYA, with increases of 14.5% and 20.5%, respectively. This growth was driven by market growth and share gains as well as favorable patient mix in TREMFYA. Growth of 17.4% in pulmonary hypertension was driven by favorable patient mix, share gains and market growth.

在免疫學範圍內。我們看到 STELARA 和 TREMFYA 的銷售額均出現成長，增幅分別為 14.5% 和 20.5%。這一增長是由市場增長和份額增長以及 TREMFYA 有利的患者組合推動的。有利的患者組合、份額成長和市場成長推動了肺動脈高壓治療成長 17.4%。

Turning to newly launched products. We continue to make progress on our launches of CARVYKTI and SPRAVATO. We are also encouraged by the early success of our launches of TECVAYLI and TALVEY, sales of which are driving the growth in Other Oncology. As a reminder, we expect to begin disclosing TECNIS sales in Q1 2024. Total Innovative Medicine sales growth was partially offset by unfavorable patient mix in XARELTO, a decrease in IMBRUVICA sales due to competitive pressures and a loss of exclusivity of ZYTIGA, REMICADE and Prezista.

轉向新推出的產品。我們在 CARVYKTI 和 SPRAVATO 的推出方面繼續取得進展。我們也對 TECVAYLI 和 TALVEY 的早期成功感到鼓舞，這兩種藥物的銷售正在推動其他腫瘤學的成長。提醒一下，我們預計在2024 年第一季開始揭露TECNIS 銷售額。創新藥物總銷售額的成長被XARELTO 不利的患者組合、競爭壓力導致的IMBRUVICA 銷售額下降以及ZYTIGA、REMICADE 和Prezista 失去獨家經營權所部分抵消。 。

I'll now turn your attention to MedTech. Worldwide MedTech sales of $7.7 billion increased 13.4% with Abiomed contributing 4.5% to growth. Growth in the U.S. was 14.1% and 12.8% outside of the U.S. Excluding the impact of acquisitions and divestitures, worldwide adjusted operational sales growth was 9.1%.

現在我將把你們的注意力轉向醫療科技。全球醫療技術銷售額達 77 億美元，成長 13.4%，其中 Abiomed 貢獻了 4.5% 的成長。美國的成長為 14.1%，美國以外的成長為 12.8%。排除收購和資產剝離的影響，全球調整後的營運銷售成長為 9.1%。

MedTech was negatively impacted by international sanctions in Russia worth approximately 50 basis points, primarily in Advanced Surgery and Vision. Electrophysiology delivered double-digit growth of 25.2% with strong growth in all regions, including Europe. This growth was driven by our global market-leading portfolio, including the most recently launched QDOT RF ablation and OCTARAY catheters.

醫療科技受到俄羅斯國際制裁的負面影響約 50 個基點，主要是在高級外科和視力領域。電生理學實現了 25.2% 的兩位數成長，在包括歐洲在內的所有地區均實現強勁成長。這一成長是由我們全球市場領先的產品組合推動的，包括最近推出的 QDOT 射頻消融和 OCTARAY 導管。

Abiomed contributed $340 million in sales within the quarter driven by continued strong adoption of Impella 5.5 technology. Growth of 6.4% in surgery was driven primarily by procedure recovery and strength of our biosurgery and wound closure portfolios. Growth was partially offset by volume-based procurement in China, primarily in endocutters.

在 Impella 5.5 技術持續強勁採用的推動下，Abiomed 在本季貢獻了 3.4 億美元的銷售額。外科手術成長 6.4% 主要是由於手術恢復以及我們生物外科和傷口閉合產品組合的實力。成長被中國的大量採購（主要是內切機）部分抵消。

Orthopaedics growth of 5% reflects procedure growth, success of recently launched products such as the global expansion of our VELYS digital solutions and expansion in ambulatory surgical centers as well as lapping of prior year (inaudible) VBP price concessions in spine.

骨科成長 5% 反映了手術的成長、最近推出的產品的成功，例如我們 VELYS 數位解決方案的全球擴張和門診手術中心的擴張，以及脊椎領域的研磨（聽不清楚）VBP 價格優惠。

Growth of 6.6% in Vision was driven by price actions in contact lenses as well as strength of new products including ACUVUE OASYS 1-Day family of products and contact lenses and TECNIS Eyehance, our monofocal intraocular lens and surgical vision. Growth of contact lenses was partially offset by U.S. stocking dynamics. Global Vision growth was negatively impacted by 140 basis points due to the Blink divestiture in Q3.

視力成長 6.6% 的推動因素是隱形眼鏡的價格走勢以及新產品的實力，包括 ACUVUE OASYS 1-Day 系列產品和隱形眼鏡以及 TECNIS Eyehance（我們的單焦點人工水晶體和手術視力）。隱形眼鏡的成長被美國庫存動態部分抵銷。由於第三季 Blink 剝離，Global Vision 的成長受到了 140 個基點的負面影響。

Now turning to our consolidated statement of earnings for the fourth quarter of 2023. I'd like to highlight a few noteworthy items that have changed compared to the same quarter of last year. Cost of products sold margin deleveraged by 130 basis points due to commodity inflation and unfavorable product mix in MedTech, partially offset by favorable patient mix and lower COVID-19 vaccine supply network-related exit cost in Innovative Medicine. We continue to invest strategically in research and development at competitive levels, [investing] $4.5 billion or 20.9% of sales this quarter. We invested $3.4 billion or 24.5% of sales in Innovative Medicine with the increase in investment being driven by higher milestones, partially off by portfolio prioritization.

現在轉向我們 2023 年第四季的合併損益表。我想強調一些與去年同期相比發生變化的值得注意的項目。由於大宗商品通膨和醫療科技領域不利的產品結構，產品銷售成本利潤率去槓桿化了130 個基點，但部分被創新醫學領域有利的患者結構和較低的COVID-19 疫苗供應網絡相關退出成本所抵消。我們繼續在具競爭力的水平上對研發進行策略性投資，[投資] 45 億美元，佔本季銷售額的 20.9%。我們在創新醫學上投資了 34 億美元，佔銷售額的 24.5%，投資的增加是由更高的里程碑推動的，部分是由於投資組合的優先順序。

In MedTech, R&D investment was $1.1 billion or 14.6% of sales with the increase in investment primarily driven by the Laminar acquisition. Interest income was $212 million in the fourth quarter of 2023 as compared to $77 million of income in the fourth quarter of 2022. The increase in income was driven by higher interest rates earned on cash balances and a lower average debt balance. The other income and expense line was income of $421 million in the fourth quarter of 2023 compared to an expense of $795 million in the fourth quarter of 2022. This was primarily driven by higher unrealized gains on securities and [lower] COVID-19 vaccine-related exit costs.

在 MedTech 領域，研發投資為 11 億美元，佔銷售額的 14.6%，投資增加主要是由 Laminar 收購推動的。 2023 年第四季的利息收入為 2.12 億美元，而 2022 年第四季的收入為 7,700 萬美元。收入成長是由於現金餘額賺取的利率上升和平均債務餘額下降所推動的。其他收入和支出項目是2023 年第四季的收入為4.21 億美元，而2022 年第四季的支出為7.95 億美元。這主要是由於證券未實現收益增加和COVID-19 疫苗[較低]所致。相關的退出成本。

Regarding taxes in the quarter, our effective tax rate was 14.4% versus 16% in the same period last year. This decrease was primarily driven by the net decrease of tax liabilities, including the settlement of the 2013 through 2016 U.S. audit. Excluding special items, the effective tax rate was 10.8% versus 16.2% in the same period last year. I encourage you to review our upcoming 2023 10-K filing for additional details on specific tax-related matters.

關於本季的稅收，我們的有效稅率為 14.4%，而去年同期為 16%。這一下降主要是由於稅收負債淨減少所致，包括 2013 年至 2016 年美國審計的結算。不計特殊項目，實際稅率為10.8%，去年同期為16.2%。我鼓勵您查看我們即將提交的 2023 年 10-K 申報文件，以了解有關特定稅務相關事項的更多詳細資訊。

Lastly, I will direct your attention to the box section of the slide, where we have also provided our income before tax, net earnings and earnings per share adjusted to exclude the impact of intangible amortization expense and special items.

最後，我將引導您注意幻燈片的方框部分，其中我們還提供了調整後的稅前收入、淨利潤和每股收益，以排除無形攤銷費用和特殊項目的影響。

Now let's look at adjusted income before tax by segment. In the fourth quarter of 2023, our adjusted income before tax for the enterprise as a percentage of sales decreased from 32.5% to 29.2%. Innovative Medicine margins declined from 37.7% to 37.4%, primarily driven by higher R&D milestones, partially offset by favorable patient mix and leveraging and selling and marketing expense.

現在讓我們按部門查看調整後的稅前收入。 2023年第四季度，我們調整後的企業稅前收入佔銷售額的百分比從32.5%下降至29.2%。創新醫學利潤率從 37.7% 下降至 37.4%，主要是由於更高的研發里程碑推動的，但部分被有利的患者組合以及槓桿、銷售和行銷費用所抵消。

MedTech margins declined from 24.5% to 15.5%, primarily driven by in-process research and development expense from the Laminar acquisition, commodity inflation and unfavorable product mix, partially offset by selling and marketing expense leverage. This concludes the sale and earnings portion of the call.

MedTech 利潤率從 24.5% 下降至 15.5%，主要是由於收購 Laminar 產生的研發費用、大宗商品通膨和不利的產品組合，但部分被銷售和行銷費用槓桿所抵消。電話會議的銷售和收益部分到此結束。

I'm now pleased to turn it over to Joe.

我現在很高興把它交給喬。

Thank you, Jessica, and thanks, everyone, for joining us today. As Joaquin and Jessica commented, 2023 was a strong year for Johnson & Johnson evidenced by notable top and bottom line performance beats relative to what we guided to 2023 at this time last year.

謝謝傑西卡，也謝謝大家今天加入我們。正如Joaquin 和Jessica 評論的那樣，2023 年對於強生公司來說是強勁的一年，與我們去年此時對2023 年的指導相比，其頂線和底線業績均顯著優於我們，這證明了這一點。

We are particularly proud of the innovation we advanced to strengthen our development pipelines, the continued expansion of our portfolio and investments made for future success. All of this provides us with a strong foundation as we enter 2024.

我們為加強開發管道而推進的創新、不斷擴大的產品組合以及為未來成功而進行的投資感到特別自豪。所有這些都為我們進入 2024 年奠定了堅實的基礎。

Thus far during the call, you've heard about sales and income performance in 2023. So now let's dive into some detail on capital allocation highlights. We generated free cash flow of more than $18 billion in 2023. At the end of the year, we had approximately $23 billion of cash and marketable securities and approximately $29 billion of debt for a net debt position of $6 billion. We maintained a healthy balance sheet and robust credit rating, underscoring the strength of Johnson & Johnson's financial position, which enables us to strategically invest and deploy capital to unlock value.

到目前為止，在電話會議期間，您已經了解了 2023 年的銷售和收入表現。現在讓我們深入了解有關資本配置亮點的一些細節。 2023 年，我們產生了超過 180 億美元的自由現金流。截至年底，我們擁有約 230 億美元的現金和有價證券，以及約 290 億美元的債務，淨債務部位為 60 億美元。我們維持了健康的資產負債表和穩健的信用評級，凸顯了強生公司的財務狀況實力，這使我們能夠策略性地投資和部署資本以釋放價值。

To that end, we executed against all of our capital allocation priorities in 2023. For starters, we invested more than $15 billion in research and development, or 17.7% of sales, an all-time high for the company as we remain one of the top investors in R&D across all industries. Jessica provided R&D investment by business segment, information we will continue to provide on a quarterly basis moving forward.

為此，我們在2023 年執行了所有資本配置優先事項。首先，我們在研發方面投資超過150 億美元，佔銷售額的17.7%，這是公司的歷史最高水平，因為我們仍然是全球領先的公司之一。所有行業研發領域的頂級投資者。傑西卡提供了按業務部門劃分的研發投資，我們將繼續按季度提供資訊。

As far as dividends, 2023 marked the 61st consecutive year in which we increased our dividend. We know this use of capital is a priority for our investors, and we plan to continue to increase our dividend annually. We also deployed, announced or committed over $3 billion in strategic value-creating inorganic growth opportunities in the last 12 months. This amount includes the recent Ambrx and Laminar transactions as well as more than 50 smaller early-stage licensing deals and partnerships that complement our current Innovative Medicine and MedTech pipelines.

就股利而言，2023 年是我們連續 61 年增加股利。我們知道資本的使用是我們投資者的首要任務，我們計劃繼續每年增加股利。在過去 12 個月裡，我們還部署、宣布或承諾了超過 30 億美元的戰略價值創造無機成長機會。這筆金額包括最近的 Ambrx 和 Laminar 交易，以及 50 多個較小的早期許可交易和合作夥伴關係，這些交易和合作夥伴關係補充了我們當前的創新醫學和醫療技術管道。

Finally, share repurchases. In early 2023, we completed the $5 billion share repurchase program initiated in late 2022 and in combination with our dividend, returned over $14 billion to shareholders last year. Through the Kenvue separation, we further reduced the Johnson & Johnson's outstanding share count by 191 million shares, or approximately 7%, without the use of cash and in a tax-free manner. Looking ahead to 2024, Johnson & Johnson's robust free cash flow generation should continue to solidify our already strong financial foundation and fuel further investment leading to growth for our business or returns to shareholders.

最後，股票回購。 2023 年初，我們完成了 2022 年底啟動的 50 億美元股票回購計劃，加上我們的股息，去年向股東返還了超過 140 億美元。透過 Kenvue 分拆，我們在不使用現金且以免稅方式的情況下，進一步減少了強生公司的流通股數量 1.91 億股，即約 7%。展望 2024 年，強生公司強勁的自由現金流生成應會繼續鞏固我們業已雄厚的財務基礎，並推動進一步投資，從而實現我們的業務成長或股東回報。

Now turning to our full year 2024 guidance. Today, we are confirming the 2024 guidance for those items previewed at our enterprise business review in early December by filling in some of the details. We expect operational sales growth for the full year to be in the range of 5% to 6% or $88.2 billion to $89 billion. As a reminder, our sales guidance continues to exclude any impact from COVID-19 vaccine sales.

現在轉向我們的 2024 年全年指導。今天，我們透過填寫一些細節來確認 12 月初企業業務回顧中預覽的那些項目的 2024 年指導。我們預計全年營運銷售額成長將在 5% 至 6% 之間，即 882 億美元至 890 億美元之間。提醒一下，我們的銷售指南繼續排除 COVID-19 疫苗銷售的任何影響。

In Innovative Medicine, we expect 2024 to deliver a 13th consecutive year of above-market growth, driven by market share gains from key brands such as DARZALEX, TREMFYA and ERLEADA, as well as continued adoption of recently launched newer products such as CARVYKTI, TECVAYLI, TALVEY and SPRAVATO. In MedTech, we remain focused on executing our key value drivers: first, advancing our differentiated pipeline such as programs in pulse field ablation, Abiomed and surgical robotics, further shifting our portfolio into high-growth markets. Second, expanding our reach and scale around the world. And third, building operational resilience across our portfolio.

在創新醫學領域，我們預計 2024 年將連續 13 年實現高於市場的成長，這得益於 DARZALEX、TREMFYA 和 ERLEADA 等主要品牌的市佔率成長，以及 CARVYKTI、TECVAYLI 等最近推出的新產品的持續採用、塔維和斯普拉瓦托。在醫療科技領域，我們仍然專注於執行我們的關鍵價值驅動因素：首先，推進我們的差異化產品線，例如脈衝場消融、Abiomed 和手術機器人項目，進一步將我們的投資組合轉向高成長市場。其次，擴大我們在全球的影響力和規模。第三，在我們的投資組合中建立營運彈性。

We don't speculate on future currency movements. But utilizing the euro spot rate relative to the U.S. dollar as of last week at $1.09 as well as other major currencies, we estimate there would be a slight unfavorable impact of $400 million or a negative 0.5% on reported sales growth for the year.

我們不會猜測未來的貨幣走勢。但根據上週歐元兌美元及其他主要貨幣的即期匯率為 1.09 美元，我們估計今年報告的銷售成長將受到 4 億美元的輕微不利影響，即負 0.5%。

Turning to other items on our P&L. We expect our 2024 adjusted pretax operating margin to improve by approximately 50 basis points, driven primarily by a continuation of efficiency programs across the organization. We expect this to be partially offset by anticipated STELARA biosimilar entrants in Europe in the second half of this year and some lingering inflation impact in MedTech inventory that will flow through 2024's P&L. This margin improvement encompasses dilution of additional investment associated with our planned acquisition of Ambrx, which will be treated as a business combination. Now we do acknowledge that the 50 basis point improvement simply gets us back to what your models expected, given the elevated Q4 2023 R&D investment for new pipeline assets.

轉向我們損益表中的其他項目。我們預計 2024 年調整後的稅前營業利潤率將提高約 50 個基點，這主要是由於整個組織持續實施效率計畫。我們預計，預計今年下半年 STELARA 生物仿製藥進入歐洲，以及醫療技術庫存中一些揮之不去的通膨影響將部分抵消這一影響，這些影響將貫穿 2024 年的損益表。這一利潤率的提高包括稀釋與我們計劃收購 Ambrx 相關的額外投資，該收購將被視為業務合併。現在我們確實承認，鑑於 2023 年第四季度新管道資產的研發投資增加，50 個基點的改進只是讓我們回到了模型的預期。

Regarding other income and expense. We anticipate income to be $1.2 billion to $1.4 billion for 2024. This is less than the 2023 amount, driven by the impact of actuarial assumptions on certain employee benefit programs such as lower discount rates. We are comfortable with new modeling net interest income between $450 million and $550 million, consistent with 2023 levels.

關於其他收入和支出。我們預計 2024 年的收入將為 12 億至 14 億美元。這低於 2023 年的金額，這是由於精算假設對某些員工福利計劃（例如較低的貼現率）的影響所致。我們對新模型的淨利息收入在 4.5 億至 5.5 億美元之間感到滿意，與 2023 年的水平一致。

Finally, we are projecting an effective tax rate for 2024 in the range of 16% to 17% based on current tax laws and anticipated geographic income mix across our businesses. This tax rate takes into account an increase of approximately 1.5% or 150 basis points relative to the recently enacted Pillar 2 legislation. We continue to believe the U.S. Treasury's current perspective on Pillar 2 is harmful, reducing U.S. incentives for innovation and resulting in U.S.-based multinational companies paying more tax revenue to foreign governments.

最後，根據現行稅法和我們業務的預期地理收入組合，我們預期 2024 年的有效稅率將在 16% 至 17% 之間。該稅率考慮到相對於最近頒布的第二支柱立法增加約 1.5% 或 150 個基點。我們仍然認為，美國財政部目前對第二支柱的看法是有害的，它會減少美國對創新的激勵，並導緻美國跨國公司向外國政府繳納更多稅收。

Our full year share count calculation for adjusted earnings per share in 2024 will include the remaining benefit equal to approximately 120 million shares from the approximately 191 million net share reduction in outstanding J&J shares following the Kenvue exchange offer. Given all these factors, we expect adjusted operational earnings per share to grow 7.4% at the midpoint for a range of $10.55 to $10.75. Based on the euro spot rate of 1.09 from last week, we do not estimate any currency impact on earnings per share.

我們對 2024 年調整後每股盈餘的全年股數計算將包括 Kenvue 交換要約後強生流通股淨減約 1.91 億股中約 1.2 億股的剩餘收益。考慮到所有這些因素，我們預計調整後每股營運收益中位數將成長 7.4%，範圍為 10.55 美元至 10.75 美元。根據上週歐元即期匯率 1.09，我們預期貨幣對每股盈餘不會產生任何影響。

I'll now provide some qualitative considerations on quarterly phasing for your models. We expect Innovative Medicine sales growth to be slightly stronger in the first half of the year compared to the second half, given the anticipated entry of STELARA biosimilars in Europe towards the middle of the year. This headwind will be partially offset by continued uptake from our recently launched products.

我現在將提供一些有關模型季度分階段的定性考慮因素。鑑於 STELARA 生物相似藥預計將於年中進入歐洲，我們預計上半年創新藥物銷售成長將略強於下半年。我們最近推出的產品的持續吸收將部分抵消這一不利因素。

We project MedTech operational sales growth to be relatively consistent throughout the year, expecting procedures in 2024 to remain above pre-COVID levels. The first half of the year will continue to have modest impact from Russia sanctions as our licenses are approved. We anticipate China VBP pricing for surgical IOLs and orthopedic sports to begin in 2024 with impacts from 2023 VBP in electrophysiology, endocutters, energy, spine and trauma to begin to anniversary throughout 2024.

我們預計全年 MedTech 營運銷售成長將相對穩定，預計 2024 年的流程將保持在新冠疫情前的水平之上。隨著我們的許可證獲得批准，今年上半年俄羅斯制裁將繼續產生適度的影響。我們預計中國外科 IOL 和骨科運動的 VBP 定價將於 2024 年開始，從 2023 年起 VBP 對電生理學、內切刀、能源、脊椎和創傷的影響將在 2024 年開始週年。

Regarding EPS phasing. It is important to highlight that the first half of the year will benefit from the full 191 million net share reduction following the Kenvue exchange offer, with only a partial comparative benefit in the third quarter versus Q3 2023, and the fourth quarter being neutral versus Q4 2023. So based on the foundation strengthened in 2023 and numerous catalysts that Joaquin outlined across our business in 2024, we are confident in our ability to achieve both near- and long-term financial targets.

關於 EPS 階段。需要強調的是，今年上半年將受惠於Kenvue 換股要約後的1.91 億股淨減持，第三季與2023 年第三季相比僅獲得部分相對收益，第四季與第四季相比呈中性2023 年。因此，基於 2023 年加強的基礎以及華金在 2024 年概述的眾多業務催化劑，我們對實現近期和長期財務目標的能力充滿信心。

I'd like to close by thanking our colleagues for their dedication and commitment to benefit patients around the world. It is their effort that enables Johnson & Johnson to deliver innovative therapies and solutions that address serious unmet medical needs and creates long-term sustainable value for shareholders.

最後，我要感謝我們的同事為造福世界各地的病人所做的奉獻和承諾。正是他們的努力使強生公司能夠提供創新的療法和解決方案，解決嚴重的未滿足的醫療需求，並為股東創造長期可持續的價值。

With that, I am now pleased to turn the call over to Kevin to begin the Q&A portion of the call.

至此，我現在很高興將電話轉給凱文，開始電話的問答部分。

(Operator Instructions) Our first question today is coming from Joanne Wuensch from Citi.

（操作員說明）我們今天的第一個問題來自花旗銀行的 Joanne Wuensch。

With my one question, I'm curious why you're looking for 2024 procedure volumes to remain above pre-COVID levels and your expectations for how long that will last?

我的一個問題是，我很好奇為什麼您希望 2024 年的手術量保持在新冠疫情前的水平之上，以及您對這種情況會持續多久的預期？

Thank you, Joanne, and good morning, everyone. First, let me remark the strong close of our MedTech business in 2023. We delivered annually more than $30 billion in sales, which is -- were all-time high in our company history with operational -- adjusted operational growth in the fourth quarter of 9.1. So very strong results across the board in electrophysiology, in recovery, in surgery, in orthopedics and in vision. So when we think about our results in 2023, we think it's going to be aligned with our competitor composite for the year but ahead of our competitor composite in the fourth quarter. Now certainly, COVID-19 impacts have stabilized globally. While we continue to see some challenges, macro challenges from the point of view of inflation, hospital staffing and the like, there is a bolus of patients coming out into the market after COVID-19, which has made 2023 market growth faster than historical averages.

謝謝喬安妮，大家早安。首先，讓我談談我們的醫療技術業務在 2023 年的強勁收官。我們的年度銷售額超過 300 億美元，這是我們公司歷史上的歷史最高水平，調整後的第四季度運營增長9.1.在電生理學、復健、外科、骨科和視力方面都取得了非常強勁的成果。因此，當我們考慮 2023 年的業績時，我們認為它將與我們競爭對手當年的綜合業績保持一致，但領先於競爭對手第四季度的綜合業績。當然，現在 COVID-19 的影響在全球範圍內已經趨於穩定。雖然我們繼續看到一些挑戰，從通貨膨脹、醫院人員配備等角度來看的宏觀挑戰，但在 COVID-19 之後，大量患者湧入市場，這使得 2023 年市場增長速度快於歷史平均水平。

And we see that trend continuing into a good part of 2024. And therefore, being a tailwind into 2024. There's a lot of factors playing into that. But overall, we see the amended procedures continuing into, at least, the first half of 2024. Now we also have a number of tailwinds on our side, other than the procedures that make me optimistic about 2024. We have the trajectory of Abiomed in heart recovery, which is very strong with the adoption of Impella 5.5. We filed already for our Impella ECP, which is the smaller version of Impella CP.

我們看到這種趨勢將持續到 2024 年的大部分時間。因此，這將成為 2024 年的順風車。有很多因素在起作用。但總體而言，我們認為修訂後的程序至少會持續到 2024 年上半年。除了讓我對 2024 年持樂觀態度的程序之外，現在我們還有許多有利因素。我們看到 Abiomed 的發展軌跡心臟恢復，採用Impella 5.5 後恢復非常強勁。我們已經申請了 Impella ECP，它是 Impella CP 的較小版本。

In orthopedics, we continue to move into higher-growth markets with the expansion of our VELYS Robotic-Assisted Solution. We obtained CE Mark in Europe. In surgery, we continue to launch innovations across our surgery business with the ENSEAL X1 Curved Jaw Tissue Sealer in energy and ECHELON 3000 as a Stapler. And we continue to see good expansion of our Plus Sutures, too. In our Vision business, we are expanding our TECNIS family into the premium segment of IOLs. And finally, and I know this is an area of interest to you. In electrophysiology, we continue to expand our PFA portfolio of catheters.

在骨科領域，我們透過擴展 VELYS 機器人輔助解決方案繼續進軍更高成長的市場。我們在歐洲獲得了 CE 標誌。在外科手術方面，我們繼續在整個外科手術業務中推出創新，包括能量型 ENSEAL X1 曲線下顎組織封閉器和作為吻合器的 ECHELON 3000。我們也繼續看到 Plus Sutures 的良好擴張。在我們的視覺業務中，我們正在將 TECNIS 系列擴展到 IOL 的高端領域。最後，我知道這是您感興趣的領域。在電生理學領域，我們繼續擴大 PFA 導管產品組合。

We obtained approval for our VARIPULSE, loop catheter, PFA loop catheter in Japan at the beginning of this year. And we continue to roll out the global launch of QDOT Micro, our newest radiofrequency ablation catheter. So overall, a number of catalysts and tailwinds into our MedTech business into 2024. As we discussed in our enterprise business review, we continue to see our MedTech business growing at the upper end of our markets and becoming a best-in-class competitor in MedTech.

今年年初，我們的 VARIPULSE、環形導管、PFA 環形導管在日本獲得批准。我們繼續在全球推出 QDOT Micro，這是我們最新的射頻消融導管。因此，總體而言，到2024 年，我們的醫療科技業務將面臨許多催化劑和順風車。正如我們在企業業務回顧中所討論的那樣，我們繼續看到我們的醫療科技業務在高端市場不斷增長，並成為該領域的一流競爭對手。醫療技術。

Next question is coming from Terence Flynn from Morgan Stanley.

下一個問題來自摩根士丹利的特倫斯·弗林。

Great. Maybe 2 parts for me on CARVYKTI. I noticed an ODAC panel was just announced to review the CARTITUDE-4 data. I was just wondering if you can talk about the focus of that upcoming meeting and your confidence in an on-time label expansion for CARTITUDE-4. And then the second part of the question is I know in manufacturing, you've been ramping up in Belgium. And I believe that facility is now up and running. So how should we think about supply for 2024 broadly for CARVYKTI?

偉大的。也許我在 CARVYKTI 上有 2 個部分。我注意到 ODAC 小組剛剛宣布審查 CARTITUDE-4 資料。我只是想知道您是否可以談談即將舉行的會議的重點以及您對 CARTITUDE-4 按時標籤擴展的信心。問題的第二部分是我知道在製造業，你們一直在比利時發展。我相信該設施現已啟動並運行。那我們應該如何考慮 2024 年 CARVYKTI 的整體供應量呢？

Thank you, Terence. So with more than 2,000 patients treated, CARVYKTI, it's really the fastest launch CAR-T in the market overall. And we are pleased to continue to see quarter-over-quarter sequential growth in CARVYKTI. And overall, we remain confident in 2 things, both the risk benefit of CARVYKTI in the indication that it is being studied, and at the same on the potential of CARVYKTI to be $5 billion-plus asset at peak year sales. Regarding the ODAC that you commented. We are very confident on the data of our Phase III CARTITUDE-4 study that support the efficacy and safety of CARVYKTI in 1 to 3 prior lines in the treatment of patients with relapsed/refractory multiple myeloma.

謝謝你，特倫斯。因此，CARVYKTI 已治療了 2,000 多名患者，它確實是整個市場上推出最快的 CAR-T。我們很高興繼續看到 CARVYKTI 的環比增長。總體而言，我們對兩件事仍然充滿信心，一是 CARVYKTI 的風險收益表明它正在接受研究，二是 CARVYKTI 在銷售高峰年成為 50 億美元以上資產的潛力。關於您評論的 ODAC。我們對 III 期 CARTITUDE-4 研究的數據非常有信心，這些數據支持 CARVYKTI 在 1 至 3 個先前線治療復發/難治性多發性骨髓瘤患者中的有效性和安全性。

We presented the results at ASCO, as you know. And we also published those results in the New England Journal of Medicine. And we very much look forward to review the updated survival and safety data with the FDA ODAC in the future. We are committed to work with the FDA in the continued development of CARVYKTI. And we continue to have the focus on bringing this immunotherapy to multiple myeloma patients in early lines of therapy. We are working with the FDA towards a PDUFA date for our CARTITUDE-4 indication in April 5 and with EMEA towards an anticipated CHMP opinion in the first quarter of 2024. So overall, we feel confident about the risk-benefit profile in this indication and about the future of CARVYKTI.

如您所知，我們在 ASCO 上公佈了結果。我們也在《新英格蘭醫學雜誌》上發表了這些結果。我們非常期待將來與 FDA ODAC 一起審查更新的生存和安全數據。我們致力於與 FDA 合作，持續開發 CARVYKTI。我們繼續致力於將這種免疫療法應用於早期治療的多發性骨髓瘤患者。我們正在與FDA 合作，爭取在4 月5 日確定CARTITUDE-4 適應症的PDUFA 日期，並與EMEA 合作，爭取在2024 年第一季獲得CHMP 的預期意見。因此，總的來說，我們對該適應症的風險效益狀況充滿信心，並且關於 CARVYKTI 的未來。

Regarding your manufacturing question. We've done a significant progress in our manufacturing capacity, which is a major driver in the continuous growth of CARVYKTI. On the cell processing side, we have doubled our cell processing capacity in our Raritan facility. Since 2023, we are making progress to your point, Terence, in our European cell processing facilities. We are already manufacturing the first batches of CARVYKTI for clinical use this month of January. And we also have contracted additional capacity, external capacity to scale up production and increase our ability moving forward, that will start mid this year.

關於你的製造問題。我們的製造能力取得了重大進步，這是CARVYKTI持續成長的主要動力。在細胞處理方面，我們將 Raritan 工廠的細胞處理能力提高了一倍。自 2023 年以來，我們的歐洲細胞加工設施正在朝著您的觀點取得進展，Terence。我們已經在一月生產第一批用於臨床的 CARVYKTI。我們還簽訂了額外產能、外部產能合同，以擴大生產規模並提高我們未來的能力，這將在今年年中開始。

On the other hand, we have also made significant progress in the internalization and scale-up of our lentivirus production. We have increased capacity in Switzerland, in our Switzerland side. And at the same time, we continue to progress with new U.S. capacity and addition sites in the Netherlands to produce our lentivirus. Late December, we received approval to expand our lentivirus capacity from 20-liter tanks to 50-liter tanks of lentivirus production in our U.S. facility. So overall, we feel good that we are progressing with CARVYKTI, that we will continue to deliver quarter-over-quarter growth in 2024. And we are working towards building this $5 billion-plus product and continue to transform the treatment paradigm in multiple myeloma. As we have discussed in the past, moving from treating-to-progression to treating-to-cure as we move CARVYKTI into earlier lines of therapy.

另一方面，我們在慢病毒生產的國際化和規模化方面也取得了重大進展。我們增加了瑞士境內的產能。同時，我們繼續在美國的新產能和荷蘭的新工廠上取得進展，以生產我們的慢病毒。 12 月底，我們獲得批准將美國工廠的慢病毒生產能力從 20 公升罐擴大到 50 公升罐。因此，總的來說，我們對 CARVYKTI 的進展感到滿意，我們將在 2024 年繼續實現季度環比增長。我們正在努力開發這款價值超過 50 億美元的產品，並繼續改變多發性骨髓瘤的治療模式。正如我們過去所討論的，當我們將 CARVYKTI 轉移到早期治療線時，從治療到進展轉變為治療到治癒。

Your next question is coming from Larry Biegelsen from Wells Fargo.

你們的下一個問題來自富國銀行的拉里·比格爾森。

Congrats to a nice finish to the year here. Joe or Joaquin, I'd love to hear just a general update on your M&A appetite and expand on your recent comments about Abiomed being a gateway in cardiovascular devices, which you, Joaquin, commented on earlier this month.

恭喜您今年圓滿成功。 Joe 或 Joaquin，我很想聽聽您關於併購意願的一般更新，並詳細闡述您最近關於 Abiomed 成為心血管設備領域門戶的評論，Joaquin 您本月早些時候對此發表了評論。

Yes. So Larry, let me start, and then I can turn it over to Joaquin. So we are very well positioned to continue to entertain many types of deals. As you know, we have the parameters of making sure that they are a strategic fit so that we've got scientific expertise and insights. A familiarity with the space has proven to be our most successful platforms.

是的。拉里，讓我開始，然後我可以把它交給華金。因此，我們處於有利位置，可以繼續進行多種類型的交易。如您所知，我們有確保它們符合策略的參數，以便我們擁有科學專業知識和見解。事實證明，對該領域的熟悉是我們最成功的平台。

We want to make sure that we're earning a fair return to compensate shareholders for the risk that we're bearing on their behalf. It was only 13 months ago, we were able to deploy $17 billion in capital for Abiomed. We're very pleased with that acquisition. Not only has it beat our internal deal models, but it also is performing better than what the Street had called for that business prior to the announcement of the acquisition. So it's been a really nice fit.

我們希望確保我們獲得公平的回報，以補償股東我們代表他們承擔的風險。僅 13 個月前，我們就為 Abiomed 部署了 170 億美元的資本。我們對此次收購感到非常滿意。它不僅擊敗了我們的內部交易模型，而且其表現也比華爾街在宣布收購之前對該業務的要求要好。所以這是一個非常適合的選擇。

What I would say is we also deployed or announced, as I said in my prepared remarks, over $3 billion in capital for more than 50 smaller licensing partnerships or deals. And while those have not made headlines, they usually are headlines when they become products for patients. And so that when you think about our history of DARZALEX, IMBRUVICA, CARVYKTI for one, it's been -- that's kind of our track record. Our appetite is still, I would say, interested in moving into spaces that complement our existing portfolio, whether that be for the near or long term.

我想說的是，正如我在準備好的演講中所說，我們還為 50 多個較小的許可合作夥伴關係或交易部署或宣布了超過 30 億美元的資本。雖然這些產品還沒有成為頭條新聞，但當它們成為患者產品時通常會成為頭條新聞。因此，當您思考我們 DARZALEX、IMBRUVICA、CARVYKTI 的歷史時，您會發現，這就是我們的業績記錄。我想說，我們的興趣仍然是有興趣進入補充我們現有投資組合的空間，無論是短期還是長期。

Thank you. And look, talking about that, Larry. Let me say we are agnostic to sector and agnostic to size. And as Joe commented, our preference is clearly to be in areas in which we have internal capabilities and know-how and also to go into products that represent a significant progress from the point of view of improving the current standard of care and that are first-in-class and best-in-class.

謝謝。聽著，談論這個，拉里。我想說的是，我們對產業和規模不可知。正如喬所評論的那樣，我們顯然更傾向於在我們擁有內部能力和專業知識的領域，以及從提高當前護理標準的角度來看代表重大進步的產品，並且首先- 一流和一流。

To illustrate that, the 2 deals that we completed this year, Laminar and Ambrx would be in that direction. So for example, Laminar is a deal in an area we know well, which is atrial fibrillation, and we believe could be first-in-class to be a device that can eliminate the left atrial appendage. When it comes to Ambrx, it's a deal in an area that we have a strong legacy like prostate cancer with a number of products marketed already. And this could be a first-in-class antibody drug conjugate, in order to address a significant medical need in metastatic castration-resistant prostate cancer in patients that have failed under gene therapy.

為了說明這一點，我們今年完成的兩筆交易 Laminar 和 Ambrx 就是朝這個方向發展的。舉例來說，Laminar 是我們熟知的心房顫動領域的一項交易，我們相信它可能是一流的消除左心耳的設備。就 Ambrx 而言，這是一項我們在前列腺癌等領域擁有悠久歷史的交易，並且已經有許多產品上市。這可能是一種一流的抗體藥物偶聯物，可以滿足基因治療失敗的轉移性去勢抵抗性前列腺癌患者的重大醫療需求。

So very much so and in that context, we continue to see also opportunities when it comes to Innovative Medicines in neuroscience and in immunology. And when it comes to MedTech, to your point, in other cardiology areas based on the strength that we have now with Biosense Webster and Abiomed, and not excluding also the potential for other areas like robotic surgery or segments of orthopedics that are growing faster and also areas of vision. So overall, that's our approach. We try to put this strategic, scientific and to Joe's point, scientific lens, in order to be able to deliver value for patients and also value for our shareholders.

因此，在這種背景下，我們繼續在神經科學和免疫學領域的創新藥物方面看到機會。當涉及醫療技術時，就您的觀點而言，基於我們現在與Biosense Webster 和Abiomed 的實力，在其他心臟病學領域，也不排除其他領域的潛力，例如機器人手術或骨科領域，這些領域增長更快，還有視野範圍。總的來說，這就是我們的方法。我們嘗試採用這種策略性、科學性以及喬的觀點，科學性的視角，以便能夠為患者創造價值，也為我們的股東創造價值。

Next question is coming from Chris Schott from JPMorgan.

下一個問題來自摩根大通的克里斯·肖特。

Just, Joe, a question for you. How should we think about gross margins in 2024 and beyond? I know you've talked about operating margins, but it did seem like adjusted gross margins came down in 4Q. And I'm just wondering if that's a one-off result or a longer-term trend when you think about -- as we think about kind of the cadence of your P&L over the next few years.

只是，喬，問你一個問題。我們該如何看待 2024 年及以後的毛利率？我知道您談到了營業利潤率，但第四季度調整後的毛利率似乎確實有所下降。我只是想知道，當您考慮未來幾年損益表的節奏時，這是否是一次性結果或長期趨勢。

Chris, thanks for the question. I think as you look at that specifically for the fourth quarter, what you have in our operating margins is obviously the Laminar transaction that was part of that mix. So on our slide that details IBT, you likely saw a quarterly reduction in MedTech, specifically of about 9 points, about 2 points for the full year. I would say 2/3 of that is represented by the Laminar transaction. You also then have, I would say, in the fourth quarter specific some mix as orthopedics performed probably a little bit better than it had in previous quarters. And then you have the inflationary impact, obviously, with higher levels of inventory on our balance sheet that flow through the P&L, that is occurring throughout 2023. And we expect it to occur throughout at least the first half of 2024. We're not seeing any incremental inflation in, I'll call it, current activity. So it's not being additive to inventory, but it's also not subsiding either. So we're kind of at a new, I'd say water level, if you will, that should be going forward but not hurting as we look out beyond the second half of 2024.

克里斯，謝謝你的提問。我認為，當您專門考慮第四季度時，我們的營業利潤率顯然是屬於該組合的一部分的層流交易。因此，在我們詳細介紹 IBT 的幻燈片中，您可能會看到 MedTech 季度下降，具體來說下降了約 9 個百分點，全年下降了約 2 個百分點。我想說其中 2/3 是由層流交易代表的。我想說，在第四季度，您也進行了一些特定的組合，因為骨科的表現可能比前幾季要好一些。然後，很明顯，我們的資產負債表上流經損益表的庫存水準會更高，從而產生通貨膨脹影響，這種情況在2023 年全年都會發生。我們預計這種情況至少會在2024 年上半年發生。看到任何增量通貨膨脹，我稱之為當前活動。因此，它並沒有增加庫存，但也沒有減少。因此，我們處於一個新的水位，如果你願意的話，這應該會繼續發展，但不會造成傷害，因為我們展望 2024 年下半年之後。

Next question is coming from Shagun Singh from RBC Capital Markets.

下一個問題來自加拿大皇家銀行資本市場的 Shagun Singh。

I was just wondering if we could get your latest thoughts on the potential impact of Novo's osteoarthritis data on orthopedic utilization, given the focus on WOMAC or pain scores. I believe the presentation could be here soon. Just curious to hear your thoughts and also what kind of scores could or may not have a potential impact.

我只是想知道，考慮到 WOMAC 或疼痛評分，我們是否可以了解您對 Novo 骨關節炎數據對骨科利用率潛在影響的最新想法。我相信演示很快就會到來。只是想聽聽您的想法以及什麼樣的分數可能或可能不會產生潛在影響。

So overall, look, that is a contributor to knee surgery. Sometimes I'm asked about osteoarthritis in the context of the GLP-1s, and weight is not a factor in osteoarthritis. We continue to look at this data, and it's early for us to give you an answer there. Now what we can tell you is that we continue to see an increased volume of procedures in orthopedics based on coming out of COVID. And we don't see any change in that neither in the hips or in the knee area or in any of the segments that we compete. So we are optimistic about our orthopedics trajectory. Specifically we are optimistic about how we are progressing with our VELYS Robotic System for total knee replacement. We have already have 30,000 procedures with very positive feedback from the surgeons, especially in the ambulatory surgical centers.

總的來說，看，這是膝蓋手術的因素。有時我被問到 GLP-1 背景下的骨關節炎，體重不是骨關節炎的因素。我們將繼續關注這些數據，現在給您答案還為時過早。現在我們可以告訴您的是，隨著新冠疫情的爆發，我們繼續看到骨科手術量不斷增加。我們沒有看到任何變化，無論是在臀部、膝蓋區域還是在我們比賽的任何部位。因此，我們對我們的骨科發展軌跡持樂觀態度。具體來說，我們對 VELYS 機器人系統全膝關節置換術的進展感到樂觀。我們已經進行了 30,000 例手術，並得到了外科醫生非常積極的回饋，特別是在門診手術中心。

We are working to submit our 510(k) for our VELYS unique knee application. And we are seeing a strong recovery also in our hip business with a combination of new products like ACTIS, KINCISE and VELYS hip navigation. So we feel good about our orthopedics business as we continue to see global procedure recovery in most markets. We continue to succeed with our new products, and we love also part of the headwind that we had in China during this year. So very positive outlook moving forward for our orthopedics business.

我們正在努力為 VELYS 獨特的膝蓋申請提交 510(k)。透過 ACTIS、KINCISE 和 VELYS 髖關節導航等新產品的組合，我們的髖關節業務也出現了強勁復甦。因此，隨著我們繼續看到大多數市場的全球手術恢復，我們對我們的骨科業務感到滿意。我們的新產品持續成功，我們也喜歡今年在中國遇到的逆風。我們的骨科業務前景非常樂觀。

It's also important to maybe provide us a reminder what we commented to last quarter, and that's -- we're looking very hard at improving the profitability of the orthopedics unit. So being very selective as to what geographies we play in and what SKUs are actually going to be offered. So not only will you see some of the strength in the top line, as Joaquin outlined, but you should see an improved margin profile for that business as well.

同樣重要的是，也許可以提醒我們我們對上個季度的評論，那就是——我們正在努力提高骨科部門的獲利能力。因此，我們對我們的遊戲地區以及實際提供的 SKU 非常有選擇性。因此，正如華金所概述的那樣，您不僅會看到收入的一些優勢，而且還應該看到該業務的利潤狀況有所改善。

Our next question is coming from Vamil Divan from Guggenheim Securities.

我們的下一個問題來自古根漢證券公司的瓦米爾·迪萬。

So just maybe an area we don't spend as much time on is on the respiratory side, PAH. But just sort of a 2-part question, but that franchise of yours continue to sort of outperform expectations. So curious if you can talk about sort of what's driving success there. There's also an area where you don't have a lot of sort of longer-term investment. So going back to sort of the business development question, I'm just curious in your interest in sort of PAH or respiratory more generally as an area, further focus given your key franchises are going to be going away but you do have the infrastructure there already.

因此，我們可能沒有花太多時間關注的一個領域是呼吸系統，即多環芳烴。但這只是一個由兩部分組成的問題，但您的特許經營權繼續超出預期。很好奇您能否談談推動成功的因素。還有一個領域沒有大量的長期投資。回到業務發展問題，我只是好奇您對 PAH 或呼吸系統作為一個領域更廣泛的興趣，考慮到您的關鍵特許經營權即將消失，但您確實擁有那裡的基礎設施，因此進一步關注已經。

So first, let me underline the great results of our PAH franchise in 2023. We had growth in the high teens driven by improved patient mix, market growth coming out of COVID, too. This was an area that was heavily impacted by COVID as pulmonologists were working at COVID and not diagnosing new patients. So overall, it's been a very positive trajectory of our PAH business, and we remain confident about the short-term future of this business into 2024.

首先，讓我強調我們的 PAH 特許經營權在 2023 年取得的巨大成果。由於患者結構改善以及新冠疫情帶來的市場成長，我們在青少年群體中實現了成長。這是一個受到新冠疫情嚴重影響的領域，因為肺科醫師正在研究新冠病毒，而不是診斷新患者。總體而言，我們的 PAH 業務發展軌跡非常積極，我們對該業務到 2024 年的短期前景仍然充滿信心。

We are working towards the combination of macitentan, OPSUMIT with Tadalafil, which the trademark would be OPSYNVI. And that would be another option for patients there to enhance compliance. And in my talks with physicians treating pulmonary hypertension, they seem very positive about it, and we expect an approval of that combination in 2024. So that's the outlook for our pulmonary franchise. Are we looking at other areas there? There, we are looking at the space and see if there are potential opportunities to be able to improve the standard of care. And we continue to look to see how we can continue to extend success of our pulmonary franchise into the future. But overall, we're very happy with the trajectory of our pulmonary franchise in 2023. And we expect a similar trajectory as macitentan, OPSUMIT and UPTRAVI become standard of care clearly established in this area.

我們正在努力將馬西騰坦、OPSUMIT 和他達拉非結合起來，商標為 OPSYNVI。這將是患者提高依從性的另一種選擇。當我與治療肺動脈高壓的醫生交談時，他們似乎對此非常積極，我們預計該組合將在 2024 年獲得批准。這就是我們肺動脈高壓專營權的前景。我們是否也在關注其他領域？在那裡，我們正在觀察這個空間，看看是否有潛在的機會可以提高護理標準。我們將繼續尋找如何在未來繼續擴大我們肺部特許經營業務的成功。但總體而言，我們對 2023 年肺部特許經營業務的發展軌跡感到非常滿意。我們預計與馬西替坦、OPSUMIT 和 UPTRAVI 類似的發展軌跡將成為該領域明確建立的護理標準。

Your next question today is coming from Louise Chen from Cantor Fitzgerald.

今天你們的下一個問題來自 Cantor Fitzgerald 的 Louise Chen。

I just wanted to ask you with respect to your oncology franchise. Do you have any thoughts on CAR-Ts for autoimmune disease at all? And then secondly, radiopharmaceutical?

我只是想問您有關腫瘤專營權的問題。您對 CAR-T 治療自體免疫疾病有什麼想法嗎？其次，放射性藥物？

So thank you, Louise. And we have a strong oncology franchise in different areas. I commented that here in prostate cancer with ERLEADA that I discussed before. We'll see data in high-risk localized prostate cancer in 2024 with the addition of Ambrx now, an antibody drug conjugate in this area. We are very, very excited about RYBREVANT and the combination of RYBREVANT plus lazertinib. We have Phase III studies completed. We expect -- we have filed all the 3 indications, and we expect approval of that in 2024.

謝謝你，路易絲。我們在不同領域擁有強大的腫瘤學專營權。我在之前討論過的 ERLEADA 的前列腺癌中對此進行了評論。 2024 年，我們將看到高風險局限性前列腺癌的數據，現在添加了 Ambrx，這是該領域的抗體藥物偶聯物。我們對 RYBREVANT 以及 RYBREVANT 與 lazertinib 的組合感到非常非常興奮。我們已經完成了第三階段研究。我們預計——我們已經提交了所有 3 個適應症，並預計在 2024 年獲得批准。

So we are very excited about RYBREVANT and the combination of RYBREVANT plus lazertinib in EGFR-mutated nonsmall cell lung cancer in first line. Moving into bladder cancer. You also will see data with TARIS-200, and TARIS-210 in nonmuscle invasive localized bladder cancer. And we received FDA breakthrough designation for TARIS-200 in 2023. And then we continue our progress in our multiple myeloma franchise. We talk about CARVYKTI, but it's important to recognize how well TECVAYLI and TALVEY, our 2 bispecific antibodies, are performing in the marketplace and the continued growth of DARZALEX with the impressive per sales data that we presented in first-line in newly diagnosed transplant-eligible multiple myeloma patients.

因此，我們對 RYBREVANT 以及 RYBREVANT 合併 lazertinib 一線治療 EGFR 突變非小細胞肺癌感到非常興奮。進入膀胱癌。您還將看到 TARIS-200 和 TARIS-210 在非肌肉層浸潤性局限性膀胱癌中的數據。我們的 TARIS-200 於 2023 年獲得 FDA 突破性指定。然後我們在多發性骨髓瘤特許經營方面繼續取得進展。我們談論CARVYKTI，但重要的是要認識到我們的2 個雙特異性抗體TECVAYLI 和TALVEY 在市場上的表現如何，以及DARZALEX 的持續增長，我們在新診斷的移植一線中提供了令人印象深刻的銷售數據 -符合資格的多發性骨髓瘤患者。

So we are looking at CAR-T in autoimmune diseases to your question, yes. But it's early data. As you know, we did a deal earlier in 2023 to partner 2 CAR-Ts, a CD19 and a CD19/CD20 BiCAR. So we are looking at that, and it's early data. It looks promising. We are interested in radiopharmaceuticals. We believe that the avenue that we are doing with antibody drug conjugates, it's an important therapeutic option. And when it comes to radiopharmaceuticals, we did a deal earlier this year with Nanobiotix for a radio enhancer that they still been developing head and neck cancer.

所以我們正在研究 CAR-T 在自體免疫疾病中的應用，回答你的問題，是的。但這是早期數據。如您所知，我們在 2023 年初達成了一項協議，合作合作 2 個 CAR-T，一個 CD19 和一個 CD19/CD20 BiCAR。所以我們正在研究這一點，這是早期數據。看起來很有希望。我們對放射性藥物感興趣。我們相信，我們正在研究的抗體藥物偶聯物是一種重要的治療選擇。說到放射性藥物，我們今年稍早與 Nanobiotix 達成了一項無線電增強劑協議，他們仍在開發頭頸癌。

We expanded our rights at the end of the year. And this could be another avenue to be there for us in which we could combine our expertise in medical devices, in medical technology and pharmaceuticals. And we plan to do a broader development plan of our radio enhancer, and we'll provide you more information about it as we continue to move. So overall, we are very pleased with the progress that we see in our oncology franchise, both in solid tumors and in hematology. And it remains a core strength of our Innovative Medicine group.

我們在年底擴大了我們的權利。這可能是我們的另一條途徑，我們可以將我們在醫療設備、醫療技術和製藥方面的專業知識結合起來。我們計劃為我們的無線電增強器製定更廣泛的開發計劃，隨著我們的繼續發展，我們將向您提供更多有關它的資訊。總的來說，我們對腫瘤學領域（實體腫瘤和血液學）所取得的進展感到非常滿意。它仍然是我們創新醫學團隊的核心優勢。

Next question is coming from Matt Miksic from Barclays.

下一個問題來自巴克萊銀行的馬特·米克西奇。

I wanted to follow up on some of the comments you made about MedTech trends and margins. And I think you mentioned some of the headwinds there were patient mix. Would love to get an idea of maybe kind of in the middle of the P&L and the operating line, in terms of margin progression throughout the year. Which ones of those of your business lines there are kind of more reflecting that negative mix that you described and how that progresses during the year?

我想跟進您對醫療技術趨勢和利潤率的一些評論。我想你提到了一些來自耐心混合的阻力。我很想了解損益表和營業線中間的情況，也就是全年的獲利成長情況。您的哪些業務線更能反映您所描述的負面組合以及這種情況在這一年中的進展？

Yes, Matt, I apologize, but it was a little bit tough to hear your question entirely. I think it was around margins, specifically in MedTech and how that may progress through the year. So as I stated earlier, I would say that the margin profile is going to be impacted by inflationary pressures that were incurred really in 2022, sit on our balance sheet as inventory and then kind of flow through the P&L throughout the corresponding 2023 and probably a good piece of 2024.

是的，馬特，我很抱歉，但完整地聽到你的問題有點困難。我認為這與利潤率有關，特別是在醫療科技領域，以及這一年的進展。因此，正如我之前所說，我想說，利潤率狀況將受到2022 年真正發生的通膨壓力的影響，作為庫存存在於我們的資產負債表上，然後在相應的2023 年期間流經損益表，並且可能會在2024 年的好作品。

That being said, Tim and the team are doing magnificent work in terms of finding efficiencies across the business. I highlighted one of the earlier ones with respect to orthopedics. But we're, quite frankly, doing that across the entire MedTech portfolio at this point in time, looking for opportunities whether it be aided by artificial intelligence or just infrastructure overall as to how we can further improve the MedTech profitability profile. Right now, we stand a little bit above the middle of the pack in terms of our peer set on margin. And we're looking to get towards the upper end of that peer set.

話雖這麼說，蒂姆和團隊在提高整個企業的效率方面做得非常出色。我強調了早期有關骨科的一項內容。但坦白說，我們目前正在整個醫療科技投資組合中這樣做，尋找機會，無論是人工智慧還是整體基礎設施的幫助，以進一步提高醫療科技的獲利能力。目前，就我們的同行設定的利潤率而言，我們的水平略高於中間水平。我們希望能夠躋身同類產品的高階。

Our next question today is coming from Geoff Meacham from Bank of America.

今天我們的下一個問題來自美國銀行的 Geoff Meacham。

Great. I just wanted to ask you about the XARELTO patient mix that you guys called out. Just help us with kind of current dynamics and maybe looking forward whether this trend you expect to continue.

偉大的。我只是想問你們提到的 XARELTO 患者組合。請幫助我們了解當前的動態，並展望您希望這種趨勢是否持續下去。

Yes, Geoff, I can answer that one. So specifically on XARELTO in the quarter. We would say there's 2 items. It's patient mix, but there is also a onetime entry. Moving forward in 2024, we do expect that there will be a decline but not to the extent that you saw in Q4.

是的，傑夫，我可以回答這個問題。特別是本季的 XARELTO。我們會說有 2 個項目。這是耐心的組合，但也有一次性的條目。展望 2024 年，我們確實預期會出現下降，但不會達到第四季的程度。

Your next question is coming from Danielle Antalffy from UBS.

您的下一個問題來自瑞銀 (UBS) 的丹妮爾·安塔菲 (Danielle Antalffy)。

Joe, sorry to harp on the MedTech margin side of things. I appreciate everything you're saying for going forward. But just as we look at Q4 specifically, even adding back Laminar, we're still getting to sort of down 400 basis points year-over-year in the quarter. And I was just hoping maybe you could bridge us a little bit more. Is there any component of that is sort of price increases taken in late '22 into '23 rolling off? Or anything that you would highlight there.

喬，很抱歉在醫療技術利潤方面喋喋不休。我感謝你所說的一切，讓我繼續前進。但正如我們具體觀察第四季度一樣，即使重新添加層流，我們仍然會在該季度同比下降 400 個基點。我只是希望你能為我們之間架起更多的橋樑。其中是否有任何一部分是從 22 世紀末到 23 世紀期間出現的價格上漲？或您要在那裡強調的任何內容。

No, Danielle. I think it's really the inflationary impact. So out of the 9% drop that you saw in Q4, 5 points are really Laminar. The other -- the balance of 4 points, I would chalk up to the inflationary impact that I spoke of earlier and then the mix component, whereby orthopedics, which is our lowest margin portfolio within the MedTech portfolio overall, performed a little bit better.

不，丹妮爾。我認為這確實是通貨膨脹的影響。因此，在您看到的第四季度 9% 的下降中，有 5 個點確實是層流下降。另一個——4分的平衡，我將其歸因於我之前談到的通貨膨脹影響，然後是混合成分，其中骨科，這是我們整體醫療科技投資組合中利潤率最低的投資組合，表現稍好一些。

So there's really nothing magical behind it other than the explanations that were already given on the call. Again, we are looking at cost improvement initiatives, specifically in orthopedics, but across the entire portfolio as we move through 2024. But there's nothing that happened -- maybe this is the best way to state it. There's nothing that happened in Q4 that has us concerned about our outlook or calls around margin profile or EPS for the balance of this upcoming year.

因此，除了電話會議中已經給出的解釋之外，這背後確實沒有什麼神奇之處。同樣，我們正在考慮成本改進舉措，特別是在骨科領域，但在我們進入 2024 年時，整個產品組合都在考慮。但什麼也沒發生——也許這是最好的表述方式。第四季沒有發生任何事情讓我們擔心我們的前景或對來年餘額的利潤率或每股盈餘的預測。

Our next question is coming from David Risinger from Leerink Partners.

我們的下一個問題來自 Leerink Partners 的 David Risinger。

So notwithstanding the recently announced Ambrx acquisition, in recent years, J&J has executed more MedTech M&A than pharma M&A. And I don't mean to belabor the point. I know that you got some specific therapeutic area questions. But could you just comment at a high level on what has held J&J back in pharma M&A in recent years? And whether we should expect greater cash deployment to accelerate long-term pharma revenue growth going forward?

因此，儘管最近宣布了 Ambrx 收購，但近年來強生執行的醫療科技併購多於製藥併購。我並不是想詳細說明這一點。我知道您有一些特定治療領域的問題。但您能否從高層角度評論近年來強生在製藥併購方面的阻礙因素？我們是否應該預期更多的現金配置來加速未來製藥收入的長期成長？

So thank you, David. And M&A has been -- M&A and external innovation has been a core of our pharma portfolio growth and transformation. As I said initially, we are agnostic to sector. In the case of pharma, our preferred mode has been trying to go to assets that were around proof-of-concept. So generally speaking, from a size perspective, it's been about deals that have been either of a smaller size or have been different modalities like client senses or partnerships.

謝謝你，大衛。併購和外部創新一直是我們製藥產品組合成長和轉型的核心。正如我最初所說，我們對產業不可知。就製藥業而言，我們的首選模式一直是嘗試使用圍繞概念驗證的資產。因此，一般來說，從規模角度來看，交易要么規模較小，要么是不同模式（例如客戶感知或合作夥伴關係）。

Just last year, we completed overall, at Johnson & Johnson, more than 50 deals. The thing is that the headlines are only made by the ones that are M&A. So we've done multiple deals in our pharmaceutical side in order to be able to enhance our existing portfolio. And our bias is to go for transactions that are going to enable us to create more value by leveraging our clinical development strength, our manufacturing capabilities and our commercial reach.

就在去年，強生公司總共完成了 50 多筆交易。問題是，只有那些併購的公司才會成為頭條新聞。因此，我們在製藥方面進行了多項交易，以便能夠增強我們現有的產品組合。我們的偏見是進行那些能讓我們利用我們的臨床開發實力、製造能力和商業影響力創造更多價值的交易。

So hence, why the majority of the deals that you see in our pharmaceutical side are at an earlier stage. Are we looking broader than that? Yes, we do. But mainly, we find more opportunities to create value at an earlier stage. For example, this year, we did a number of deals that went less publicized. We did, as I commented before, a deal with CBMG now called AbelZeta, in CAR-T with CD19 and CD20, which we believe could be a best-in-class CAR-T in this area that could launch in this decade or at the end of the year. We also did another deal in antibody drug conjugates with a Korean company called LegoChem, which was underreported.

因此，為什麼您在我們的製藥領域看到的大多數交易都處於早期階段。我們的眼光是否比這更廣？是的，我們願意。但主要是，我們在早期階段發現了更多創造價值的機會。例如，今年，我們做了一些不太公開的交易。正如我之前評論的那樣，我們與 CBMG 達成了一項協議，現在稱為 AbelZeta，涉及 CD19 和 CD20 的 CAR-T，我們相信這可能是該領域最好的 CAR-T，可能在本十年或年底。我們還與一家名為 LegoChem 的韓國公司達成了另一筆抗體藥物偶聯物交易，但該交易並未充分報告。

But we continue to work in identifying deals in our pharmaceutical space that enables us to be able to put all our capabilities to work in the clinical development side, in manufacturing and in commercial. And that's been the source of very significant value creation in products that all of you know, like DARZALEX or CARVYKTI, that come from that type of approach of going earlier on into the development process.

但我們繼續致力於在製藥領域尋找交易，使我們能夠將我們所有的能力運用到臨床開發、製造和商業方面。這是大家都知道的 DARZALEX 或 CARVYKTI 等產品創造非常重要價值的源泉，這些產品來自於早期進入開發過程的方法。

Our final question today is coming from Rick Wise from Stifel.

我們今天的最後一個問題來自 Stifel 的 Rick Wise。

Maybe you could expand a little bit more on your electrophysiology comments. You had an extraordinary quarter. I'm guessing the new products helped. Maybe you could give us a little more color on maybe quantify the impact -- the negative impact from China VBP. And looking ahead, we've got not -- we've got one PFA device approved in the U.S. Another one seemingly coming in the next month or 3 maybe. How should we think about the EP franchise as we look ahead to '24? What are you incorporating in your thinking?

也許您可以進一步擴展您的電生理學評論。你度過了一個非凡的季度。我猜新產品有幫助。也許你可以給我們更多的資訊來量化影響——中國 VBP 的負面影響。展望未來，我們還沒有——我們已經在美國批准了一種 PFA 設備，另一種可能會在下個月或三個月內推出。當我們展望 24 世紀時，我們該如何看待 EP 系列？你的想法融入了什麼？

So thank you for the question. Great and strong results of our EP franchise in 2023. And you should think about our EP franchise in 2024 as also a strong year, another year of growth, a strong growth for our EP franchise. If I look at the -- to your point that the drivers of growth in 2023, it was across the board. I mean it was in Asia Pacific, in the U.S. and EMEA. It was driven by the procedure recovery but also by the new product performance and some offset also, a slight offset of value-based procurement in China.

謝謝你的提問。我們的EP 特許經營權在2023 年取得了巨大而強勁的業績。您應該將我們的EP 特許經營權2024 年視為強勁的一年，又是增長的一年，我們的EP 特許經營權的強勁增長。如果我看一下——就你的觀點而言，2023 年的成長驅動因素是全面的。我的意思是在亞太地區、美國和歐洲、中東和非洲地區。這是由程序恢復推動的，也是新產品性能的推動，還有一些抵消，即中國基於價值的採購的輕微抵消。

The new products that we introduced this year are the engine generator, our mapping catheters, OCTARAY and OPTRELL. And also, importantly, our QDOT MICRO Catheter in radiofrequency ablation that has efficacy results higher than any PFA catheter. And that together with our strong commercial execution and broad clinical support across the board has driven this result in electrophysiology that in the fourth quarter was 25% growth globally, 22% growth in the U.S. and 29% outside of the U.S. So very strong results.

我們今年推出的新產品是引擎發電機、測繪導管、OCTARAY 和 OPTRELL。而且，重要的是，我們的 QDOT 微導管在射頻消融方面的療效高於任何 PFA 導管。再加上我們強大的商業執行力和廣泛的臨床支持，推動了電生理學領域的這一成果，第四季度全球增長 25%，美國增長 22%，美國以外增長 29%，非常強勁的結果。

So we have a strong leadership in electrophysiology and 20 years of understanding this field. And when it comes to our strategy in cardiac ablation, we have multiple strategies, but one core strategy is our CARTO mapping system. That is a fundamental pillar of our strategy in cardiac ablation that supports procedural efficiency and very importantly, now low to zero fluoroscopy workflow.

因此，我們在電生理學領域擁有強大的領導地位，並且在該領域擁有 20 年的了解。當談到我們的心臟消融策略時，我們有多種策略，但核心策略之一是我們的 CARTO 繪圖系統。這是我們心臟消融策略的基本支柱，支持手術效率，非常重要的是，現在透視工作流程低至零。

For the electrophysiologist, it's very important to know where they are and what are they doing to the heart anatomy. Otherwise, they are flying blind if they don't have a mapping system. And the CARTO system, it's providing the electrophysiologist real-time feedback and very important parameters like tissue proximity, contact force measurement and ablation indexes that give them an idea of how durable deletion is going to be and what are going to be the outcomes of the procedures. So that's key for us to be able to have a workflow that enables the type of progress that electrophysiologists have been already used to with radio frequency ablation. And hence, all our suite of catheters, it's is going to be from Day 1, fully integrated in our mapping system.

對於電生理學家來說，了解他們在哪裡以及他們對心臟解剖結構做了什麼非常重要。否則，如果他們沒有地圖系統，他們就會盲目地飛行。 CARTO 系統為電生理學家提供即時回饋和非常重要的參數，例如組織接近度、接觸力測量和消融指數，使他們了解刪除的持久性以及刪除的結果。程式。因此，對我們來說，關鍵在於能夠擁有一個工作流程，能夠實現電生理學家已經習慣的射頻消融進展類型。因此，我們所有的導管套件將從第一天開始就完全整合到我們的繪圖系統中。

We have 5,000 CARTO systems already deployed globally and an extensive network of mappers to support the electrophysiologist. When it comes to our catheters, we are developing a full portfolio of options. You commented on VARIPULSE, our multi-electrode catheter that was approved in Japan. We are developing a focal and a large focal catheter and also a single shot one. So electrophysiologists are going to be able to choose the catheter that is more appropriate for their anatomy and for the workflow that they are selecting. We have 5 clinical trials active, 3 of them have completed. And we have submitted our VARIPULSE catheter for CE Mark, and we plan submitting the VARIPULSE catheter to the U.S. FDA in 2024.

我們已在全球部署了 5,000 個 CARTO 系統，並擁有廣泛的製圖網絡來為電生理學家提供支援。對於我們的導管，我們正在開發一整套的選擇。您對我們在日本獲得批准的多電極導管 VARIPULSE 發表了評論。我們正在開發一種焦點導管、一種大焦點導管以及單發導管。因此，電生理學家將能夠選擇更適合他們的解剖結構和他們選擇的工作流程的導管。我們有 5 項正在進行的臨床試驗，其中 3 項已經完成。我們已經向 VARIPULSE 導管提交了 CE 標誌，並計劃於 2024 年向美國 FDA 提交 VARIPULSE 導管。

Ultimately, PFA is an important option, but RF is also here to stay. That's why we believe that having the workflow and the procedure efficiency that CARTO gives you plus the option of having a catheter, like our dual energy catheter that would enable electrophysiologists to simply change depending on the anatomy of deletion from PFA to RFA, it's going to be important for the future. And it's going to help them adopting PFA as this is the most widely used catheter in the world. So very positive about our growth in 2024 based on the strength that we have in this area. I'm positive about the outlook of our ablation business moving forward.

最終，PFA 是一個重要的選擇，但 RF 也將繼續存在。這就是為什麼我們相信，擁有CARTO 為您提供的工作流程和程序效率，再加上導管的選擇，例如我們的雙能量導管，使電生理學家能夠根據刪除的解剖結構簡單地從PFA 更改為RFA，這將對未來很重要。這將有助於他們採用 PFA，因為這是世界上使用最廣泛的導管。基於我們在這一領域的實力，我們對 2024 年的成長非常樂觀。我對我們消融業務的未來前景持樂觀態度。

As we have commented in multiple occasions, atrial fibrillation. It's an area that is still undertreated. And the outcomes of radio frequency ablation and most likely, the outcomes of PFA have shown significant improvement even compared to medical therapy. So very positive about the outlook of our -- and the strength of our atrial fibrillation business.

正如我們多次評論的那樣，心房顫動。這是一個仍未被充分處理的地區。與藥物治療相比，射頻消融的結果以及最有可能的 PFA 的結果已經顯示出顯著的改善。我們對我們的前景以及房顫業務的實力非常樂觀。

Thank you, Rick, and thanks to everyone for your questions and your continued interest in our company. We apologize to those we couldn't get to because of time, but don't hesitate to reach out to the Investor Relations team with any remaining questions you may have. I will now turn the call back over to Joaquin for some brief closing remarks.

謝謝你，瑞克，謝謝大家提出的問題以及對我們公司的持續關注。對於因時間因素無法聯繫的人，我們深表歉意，但如果您還有任何疑問，請隨時聯繫投資者關係團隊。現在我將把電話轉回給華金，讓其發表一些簡短的結論。

Thank you, Jess. The strong performance we delivered in '23 gives me great confidence in the trajectory of our business. As I said earlier, we are entering 2024 from a position of strength, and we have multiple catalysts for growth. No other company is as well positioned as Johnson & Johnson to lead the next wave of health care innovation. And we look forward to sharing our progress in the year ahead. Thank you.

謝謝你，傑西。我們在 23 年取得的強勁業績讓我對我們業務的發展軌跡充滿信心。正如我之前所說，我們正以強勢地位進入 2024 年，並且我們擁有多種成長催化劑。沒有任何一家公司能夠像強生公司那樣引領下一波醫療保健創新浪潮。我們期待分享來年的進展。謝謝。

Thank you. This concludes today's Johnson & Johnson's Fourth Quarter 2023 Earnings Conference Call. You may now disconnect.

謝謝。今天強生公司 2023 年第四季財報電話會議到此結束。您現在可以斷開連線。