諾和諾德 (NVO) 2023 Q1 法說會逐字稿

Actually, it's Pete Verdult from Citi. So welcome, everyone. On behalf of Citi, delighted to have Karsten Knudsen, Group CFO; and Martin Lange, Head of R&D; plus various members of the Novo [Nordisk] team in London for the Q1 roadshow. You all know the drill, short presentation and then straight into Q&A. A bit of housekeeping. There are microphones on each of the tables, which are on currently. So if you can all have your phones on silent and try and eat quietly and cluster less, that'll be fantastic.

實際上，是來自花旗銀行的 Pete Verdult。所以歡迎大家。代表花旗，很高興有 Karsten Knudsen 擔任集團首席財務官；和研發主管 Martin Lange；加上在倫敦參加 Q1 路演的 Novo [Nordisk] 團隊的各種成員。你們都知道演習、簡短的演示，然後直接進入問答環節。一點家政服務。目前，每張桌子上都有麥克風。因此，如果你們都可以將手機調成靜音，嘗試安靜地吃飯，減少聚集，那就太棒了。

So without further ado, Karsten Knudsen. Thank you.

因此，不用多說，Karsten Knudsen。謝謝。

Thanks, Pete, and thanks for the invitation and you're hosting our Novo Nordisk Q1 roadshow in the London lunch meeting in conjunction with Q1. We're bringing fantastic set of numbers. So it's great to be in London and see you all and also for the ones being available online.

謝謝皮特，感謝您的邀請，您將在倫敦午餐會上與第一季度一起舉辦我們的諾和諾德第一季度路演。我們帶來了一組很棒的數字。所以很高興能在倫敦見到你們所有人，也很高興能在網上看到你們。

So as Pete said, a few slides and then over to Q&A. And I'm sure we'll have some questions about the future and how the things are going to pan out. So -- and as you know, the future has a tendency to play out differently compared to what we expect based on today's knowledge. So that's the usual cautionary statement in terms of forward-looking commentary.

正如皮特所說，放幾張幻燈片，然後進入問答環節。而且我敢肯定，我們會對未來以及事情將如何發展提出一些疑問。所以——正如你所知，與我們基於今天的知識所期望的相比，未來的發展趨勢會有所不同。因此，這是前瞻性評論中通常的警告聲明。

When we look at our strategic aspirations, and you've all seen them before, this is how we hold ourselves accountable, especially you, in terms of our strategy execution as a company. And not going through all the details but just saying when we look at Purpose and Sustainability, ESG, if you will, we are progressing very nicely both in terms of our patient reach, our CO2 emissions as well as being a sustainable employer and the diversity targets we've set out there. [Pipeline margin], we'll get back to but very good progress across these areas. I think this is a very exciting year for Novo Nordisk in terms of readouts on a number of very exciting trials.

當我們審視我們的戰略抱負時，你們以前都見過它們，這就是我們在作為一家公司的戰略執行方面對自己負責的方式，尤其是你。並沒有詳細介紹所有細節，只是說當我們審視目的和可持續性、ESG 時，如果您願意的話，我們在患者覆蓋面、二氧化碳排放量以及成為可持續雇主和多樣性方面都取得了非常好的進展我們在那裡設定的目標。 [管道保證金]，我們會回到這些領域，但進展非常順利。就許多非常激動人心的試驗的讀數而言，我認為今年對於諾和諾德來說是非常激動人心的一年。

And then as to commercial execution, then we continue to be the global leader in diabetes with a global diabetes value market share of 32% now, growing by 1.7% over the last year. We are more than doubling our obesity franchise, of course, driven by the relaunch of Wegovy, mainly in the U.S. And then finally, our rare disease business is down 16%. We, unfortunately, had some very unfortunate production challenges on our rare endocrine side, which pulled down sales growth on rare disease.

然後在商業執行方面，我們繼續成為糖尿病領域的全球領導者，目前全球糖尿病價值市場份額為 32%，比去年增長 1.7%。當然，在重新推出 Wegovy 的推動下，我們的肥胖特許經營權增加了一倍多，主要是在美國。最後，我們的罕見病業務下降了 16%。不幸的是，我們在罕見的內分泌方面遇到了一些非常不幸的生產挑戰，這拉低了罕見疾病的銷售增長。

And all of that yields a top line growth for the quarter of 25% and operating profit of 28% and corresponding capital allocation to shareholders while we still continue to invest in our business CapEx, et cetera.

所有這些都為本季度帶來了 25% 的收入增長和 28% 的營業利潤以及相應的股東資本分配，同時我們仍然繼續投資於我們的業務資本支出等。

Going through our commercial performance for the quarter. I think what is really worth noting is a step-up in sales growth in North America, 41%, really being a key driver of the Novo business growth in the quarter, the 25%. I do note that we had some wholesale inventory fluctuation in the quarter, amplifying the North American and hence group results. However, when we look at the full year, I think we're still operating in the 20s in terms of top line growth.

回顧我們本季度的商業表現。我認為真正值得注意的是北美銷售額增長 41%，這確實是本季度 Novo 業務增長 25% 的主要推動力。我注意到我們在本季度有一些批發庫存波動，放大了北美和集團的業績。然而，當我們回顧全年時，我認為我們的收入增長仍在 20 多歲左右。

IO continuing to deliver double-digit growth driven by the different geographies. And one note on China being down 5% in the quarter, the good part about the 5% is, first of all, that this is the last quarter with impact from VBP on the growth rates. So now we'll have annualized it when we get into Q2. And secondly, when you look at our Chinese business results, then of course, we have been moving our resources towards Ozempic and Ryzodeg our growth opportunities in the market and showing very strong growth there. And hence, you should expect us coming back to growth already from the second quarter and almost in China.

在不同地區的推動下，IO 繼續實現兩位數的增長。關於中國在本季度下降 5% 的一個說明，關於 5% 的好處首先是，這是最後一個季度，VBP 對增長率產生了影響。所以現在我們將在進入第二季度時將其年化。其次，當你看一下我們在中國的業務成果時，當然，我們一直在將資源轉向 Ozempic 和 Ryzodeg 我們在市場上的增長機會，並在那裡顯示出非常強勁的增長。因此，您應該期望我們已經從第二季度開始恢復增長，而且幾乎在中國。

As to therapies, the 25% growth is really being driven by GLP-1 in diabetes, now constituting around 50% of group sales, so really delivering strong growth at 50% both IO and North America. (inaudible) 11%, that's VBP, China and it's U.S. pricing. And I think remarkable to note now GLP-1 in diabetes is profit to double the size of insulins in diabetes. So GLP-1 accounting 50% of group sales where insulins account 25% of sales in the quarter.

至於療法，25% 的增長實際上是由 GLP-1 在糖尿病領域推動的，目前約佔集團銷售額的 50%，因此 IO 和北美確實實現了 50% 的強勁增長。 （聽不清）11%，這是 VBP，中國和美國定價。我認為值得注意的是，現在糖尿病中的 GLP-1 可以使糖尿病中的胰島素量增加一倍。因此，GLP-1 佔集團銷售額的 50%，而胰島素佔本季度銷售額的 25%。

(inaudible), again, that (inaudible) we'll come back to and rare disease down 16% linked to the Norditropin manufacturing challenges.

（聽不清），再次，（聽不清）我們會回來，罕見疾病下降 16% 與 Norditropin 製造挑戰有關。

Talking about Wegovy, we brought this slide just to show the acceleration in group sales. Only a few years back, we were talking about incremental net sales year-on-year with, call it, DKK 1 billion or DKK 1.5 billion, and then we look at how we're stepping up now. So really a dramatic step-up. We're aiming to the TRx trajectory you see in the middle of the slide. So in round terms, when you look at added TRx on a year-to-date basis of Wegovy across doses in total, then incremental weekly added TRx [is 6,000]. And as a consequence, we have had to adjust the number of new patients being able to start on Wegovy. So we're reducing the initiation doses, the lower dose strengths, because we're simply scaling a biologic-based platform to a very, very significant level of sales growth.

談到 Wegovy，我們帶來這張幻燈片只是為了展示集團銷售的加速。就在幾年前，我們還在談論與去年同期相比增加的淨銷售額，稱之為 10 億丹麥克朗或 15 億丹麥克朗，然後我們看看我們現在是如何加強的。所以真的是一個戲劇性的提升。我們的目標是您在幻燈片中間看到的 TRx 軌跡。因此，從總體上看，當您查看 Wegovy 年初至今的總劑量增加的 TRx 時，每週增加的 TRx [是 6,000]。因此，我們不得不調整能夠開始使用 Wegovy 的新患者數量。所以我們正在減少起始劑量，降低劑量強度，因為我們只是將基於生物的平台擴展到非常非常顯著的銷售增長水平。

So you should expect perhaps not imminently but in the coming months, you should expect a step-down in terms of new patient starts as a consequence. And we do this to be responsible and have a sustainable beat business. So we're not creating a bigger pull in demand than what we can sustainably supply and patients type trading through those strings.

所以你應該期待也許不是迫在眉睫，但在接下來的幾個月裡，你應該期待在新患者開始方面的降級。我們這樣做是為了負責任並擁有可持續發展的業務。因此，我們並沒有創造比我們可以持續供應和患者通過這些字符串進行交易的更大的需求拉動。

And as a consequence, we are also pursuing a gradual rollout ex U.S. We would be very eager to launch in many, many markets. We have accrual, and we know the demand is there. But of course, we need to balance it with the supplies available. Sorry about that.

因此，我們也在尋求在美國以外的地區逐步推出。我們非常渴望在很多很多市場推出。我們有應計收入，我們知道需求在那裡。但當然，我們需要用可用的供應品來平衡它。對於那個很抱歉。

So let's hand it over to Martin Lange, our Head of Development, to go through the greatest (inaudible).

因此，讓我們將其交給我們的開發主管 Martin Lange 來完成最偉大的（聽不清）。

Thanks very much, Karsten. I think you talk about high doses of alternate both the space of diabetes and business. We talk about the need to show equivalence from an efficacy perspective, from a safety perspective but also from an exposure perspective as compared to (inaudible) 2.2 milligram in diabetes, but also compared to 2.4 milligram in Wegovy.

非常感謝，卡斯滕。我想你談論的是糖尿病和商業空間的高劑量交替。我們討論需要從療效的角度、安全的角度以及暴露的角度與糖尿病中的（聽不清）2.2 毫克相比，以及與 Wegovy 中的 2.4 毫克相比，顯示等效性。

We now read out the diabetes results. We're still waiting for the obesity results. Those will come within the next couple of months. But just looking at the diabetes results, we're obviously super happy. Trial was a [3-arm] trial designed to compare 14 milligrams of (inaudible) basically semaglutide to 25 and 50 milligrams, achieving basically all design outcomes in terms of or when it comes to tons as compared to 14 milligrams for both 25 and 50 milligrams and also a differential between 25 and 50 milligrams and the equivalent data set in (inaudible).

我們現在讀出糖尿病結果。我們仍在等待肥胖結果。這些將在接下來的幾個月內到來。但只要看看糖尿病的結果，我們顯然就超級高興了。試驗是一項 [3 臂] 試驗，旨在將 14 毫克（聽不清）基本上是 semaglutide 與 25 和 50 毫克進行比較，與 25 和 50 的 14 毫克相比，基本上實現了所有設計結果（以噸計）毫克以及 25 和 50 毫克之間的差異以及（聽不清）中的等效數據集。

At the same time, we see both weight loss and (inaudible) control comparable to that of 2 milligrams of Ozempic. So really achieving the data that we wanted to achieve. This both will obviously go for diabetes, but also data that we put the same one we still have not seen.

同時，我們看到體重減輕和（聽不清）控制與 2 毫克 Ozempic 相當。所以真正實現了我們想要實現的數據。這兩者顯然都適用於糖尿病，而且我們提供的數據與我們尚未看到的數據相同。

I think it's also important to call out that given the supply chain esters -- or rather the high demand that we've seen in other areas of the semaglutide franchises, we have to consider how we roll that out, thinking the broader supply and demand balance. And we will also have [to] when we have the best later to do the same consideration.

我認為考慮到供應鏈酯類——或者更確切地說，我們在 semaglutide 特許經營權的其他領域看到的高需求，我認為指出這一點也很重要，我們必須考慮我們如何推出它，考慮更廣泛的供需平衡。當我們以後有最好的時候，我們也將不得不 [to] 做同樣的考慮。

Broadly speaking, as Karsten alluded to 2023, first of all, has been but will also be in the next couple of months in terms of. We have Phase II or III poses ongoing in all of our paras, and we are excited to see the fruit of those investments. So maybe in the diabetes space obviously calling out into done a global regulatory space in U.S. and Europe and China. Securing that offset will be made available to patients for diabetes, and hopefully, not-too-distant future in both of them.

從廣義上講，正如 Karsten 所暗示的 2023 年，首先，已經但也將在未來幾個月內發生。我們所有的項目都在進行第二階段或第三階段的計劃，我們很高興看到這些投資的成果。因此，也許在糖尿病領域顯然呼籲在美國、歐洲和中國建立一個全球監管空間。確保糖尿病患者可以使用這種抵消，並希望在不久的將來他們都可以使用。

Also, I think important to call out, we saw really is from a very strong efficacy in basal only treatment spirit that of both bele and glasses, very good safety profile. And in the basal-bolus treatment clarity on efficacy parity on safety profile. And then obviously, convenience in our case is to have 313 days of injection in the basal only (inaudible). So really an attractive offering in type 2 diabetes.

另外，我認為重要的是要指出，我們確實看到了 Bele 和眼鏡的基礎治療精神非常強大的功效，非常好的安全性。並且在基礎推注治療中，安全性方面的療效均等的清晰度。然後很明顯，在我們的案例中，方便的是僅在基礎注射 313 天（聽不清）。所以真的是 2 型糖尿病的一個有吸引力的產品。

In type 1 diabetes, we did see more hypoglycemia. We still have a full diabetes filing, so both type 1 and type 2 diabetes part of the business profile, but we do expect more dialogue with the regulators on (inaudible). And just as a reminder, from a value perspective, type 1 diabetes is 7%, type 2 diabetes is 93%. So obviously, a big potential opt in this space.

在 1 型糖尿病中，我們確實看到了更多的低血糖症。我們仍有完整的糖尿病備案，因此 1 型和 2 型糖尿病都是業務概況的一部分，但我們確實希望與監管機構就（聽不清）進行更多對話。提醒一下，從價值的角度來看，1 型糖尿病是 7%，2 型糖尿病是 93%。很明顯，這個領域有很大的潛力。

I'll talk about the timing cost results, but maybe just calling out something that has caused a good deal of interest. We have reported on 2 studies and Phase II studies with fixed-dose combination with semaglutide and GLP analog and then a mono component co-agonist GLP-1/GLP co-agonist.

我將談論時間成本結果，但也許只是說出一些引起很大興趣的東西。我們已經報告了 2 項研究和 II 期研究，這些研究採用固定劑量組合與 semaglutide 和 GLP 類似物，然後是單組分共激動劑 GLP-1/GLP 共激動劑。

For the first one, we compared to semaglutide and the GLPs analog. And with some interest, we saw no impact of adding CIP through semaglutide on weight loss and most effect when adding GLP-1 analog semaglutide on plasma. Several different sort of interpretation of that, and you can maybe go into detail if you're interested (inaudible). But we did see a good and strong effective profile of the co-agonist in Phase I. We probably imagine that since we have also announced that so, we also saw some efficacy that financial. And therefore, we will progress the most promising of the 2 in the states of, obviously, diabetes, but potentially also it.

對於第一個，我們將 semaglutide 和 GLPs 類似物進行了比較。有趣的是，我們發現通過 semaglutide 添加 CIP 對減肥沒有影響，而在血漿中添加 GLP-1 類似物 semaglutide 時效果最大。對此有幾種不同的解釋，如果您有興趣（聽不清），您可以詳細了解一下。但我們確實在第一階段看到了共同激動劑的良好和強大的有效概況。我們可能會想像，既然我們也宣布了這一點，我們也看到了一些財務上的療效。因此，我們將在糖尿病狀態下取得 2 中最有前途的進展，但也可能是糖尿病。

(inaudible) I have to call out SELECT that's going to be incredibly exciting. We are in the process of closing down the SELECT (inaudible). You heard us talk to them. We will have the regard around the mid of this year. We are now more mature in terms of how we assess that. So we're not looking towards July, August, maybe closer to August. So June sort of not so much in gain anymore. And as you will recall, all of this degraded in nature of the fund. So we now get number we get to announce to start closing down and still conducting the remaining events during the first half.

（聽不清）我必須調用 SELECT，這將非常令人興奮。我們正在關閉 SELECT（聽不清）。你聽到我們和他們交談。我們將在今年年中左右得到尊重。就我們如何評估這一點而言，我們現在更加成熟。所以我們不期待 7 月、8 月，也許更接近 8 月。所以 6 月的收益不再那麼多了。你會記得，所有這些都降低了基金的性質。所以我們現在得到了我們要宣布開始關閉並在上半年繼續進行剩餘事件的數字。

Then maybe also talk about all and (inaudible) just very briefly, it's going to be incredibly exciting to see that with a very strong follow-on to Cagrisema. Similar profile basically times to both the amylin and GLP-1 receptors but in a unimolecular format to a core. We've obviously announced some flexibility, and we can have that either as an oral offering or is on, which is obviously (inaudible).

然後也許還可以非常簡短地談論所有和（聽不清），看到它與 Cagrisema 的非常強大的後續行動將會非常令人興奮。與胰島澱粉樣多肽和 GLP-1 受體基本上時間相似，但以單分子形式形成核心。我們顯然已經宣布了一些靈活性，我們可以將其作為口頭提供或進行，這顯然是（聽不清）。

In the rare disease space, you probably noticed the approval of concizumab in Canada and that almost at the same time, a complete response letter in the U.S. for concizumab, not related to the drug but most with the companion diagnostics that has to follow the drug so we can monitor consistently every patient. They requested more data, and we are working with them to drive these.

在罕見病領域，您可能注意到加拿大批准了 concizumab，幾乎與此同時，美國對 concizumab 的完整回复函，與該藥物無關，但大多數與必須遵循該藥物的伴隨診斷這樣我們就可以始終如一地監測每位患者。他們要求提供更多數據，我們正在與他們合作推動這些數據。

Sogroya was approved for both (inaudible), which is obviously press declining in once-daily -- sorry, once-weekly setting. And then maybe other sales chronic disease is just calling out through first human doses in heart failure and in Parkinson's disease for our cell-based therapies.

Sogroya 獲得了兩項（聽不清）的批准，這顯然是媒體在每天一次——抱歉，每週一次的設置中下降。然後也許其他銷售慢性疾病只是通過我們的細胞療法通過首次人體劑量治療心力衰竭和帕金森氏病。

And with that, back to you, Karsten.

然後，回到你身邊，Karsten。

Thank you, Martin. And now we are on the final stretch in terms of slide before Q&A, so you better warm up. So we released our guidance for the year linked to the second CMO coming online here almost 4 weeks ago. So now we're guiding a top line growth of between 24% and 30%, I'm just repeating, between 24% and 30% constant exchange rate sales growth. Really, really amazing growth, if you ask me. That translates into 28% to 34% operating profit growth, so getting a levels given the attitude of the sales growth.

謝謝你，馬丁。現在我們正處於問答前幻燈片的最後階段，所以你們最好熱身一下。因此，我們發布了與大約 4 週前在這裡上線的第二個 CMO 相關的年度指南。所以現在我們正在指導 24% 到 30% 的頂線增長，我只是重複，24% 到 30% 的固定匯率銷售增長。如果你問我的話，真的非常驚人的增長。這轉化為 28% 至 34% 的營業利潤增長，因此根據銷售增長的態度獲得一個水平。

And then, yes, we have currencies going against us this year linked to the weakening U.S. dollar to euro and some of the tight currencies or emerging market currencies. No changes to tax rate and free cash flow outcome linked to the growth of the business, so between DKK 66 billion and DKK 74 billion despite the fact that we're investing DKK 25 billion in CapEx this year to expand manufacturing capacity. And with this cash flow, we have been able to increase our share buyback program this year from DKK 28 billion to DKK 30 billion.

然後，是的，今年我們的貨幣對我們不利，這與美元兌歐元走弱以及一些緊縮貨幣或新興市場貨幣有關。與業務增長相關的稅率和自由現金流結果沒有變化，因此在 660 億至 740 億丹麥克朗之間，儘管我們今年在資本支出上投資 250 億丹麥克朗以擴大製造能力。有了這筆現金流，我們今年的股票回購計劃從 280 億丹麥克朗增加到 300 億丹麥克朗。

So that covers the outlook, and these are our strategic aspirations. And now we're ready to move into Q&A. And the host was the fastest. So we will start with Peter Verdult even though (inaudible) to get going. So Pete, first question for you.

所以這涵蓋了前景，這些是我們的戰略願望。現在我們準備進入問答環節。主人是最快的。因此，我們將從 Peter Verdult 開始，儘管（聽不清）開始。皮特，第一個問題問你。

Look, I'm sure we're going to discuss supply and SELECT and revenue seen late stream the meeting. So maybe we can start off on regulation, and I'll repeat the question I asked last week on pricing. So just on regulation, not in front of the Congress tomorrow. Any thoughts there? And also on the (inaudible), I mean you've talked about it over the years. Are you hearing anything in Washington about move towards getting Medicare reimbursement in obesity? So that's the regulation question.

看，我確定我們將討論供應和 SELECT 以及會議後期看到的收入。所以也許我們可以從監管開始，我會重複我上週提出的關於定價的問題。所以只是關於監管，而不是明天在國會面前。有什麼想法嗎？還有關於（聽不清），我的意思是你多年來一直在談論它。您是否在華盛頓聽到任何關於在肥胖方面獲得醫療保險報銷的消息？這就是監管問題。

And on pricing, I mean, (inaudible) Wegovy, different brands, different doses, different price points to get it. Mounjaro, same brand, same doses. Are we really going to see this separate price point between diabetes and obesity? Or are we -- are you expecting a rapid -- or should we say, narrowing or price erosion on GLP-1 obesity pricing?

關於定價，我的意思是，（聽不清）Wegovy，不同的品牌，不同的劑量，不同的價格點。 Mounjaro，相同品牌，相同劑量。我們真的會看到糖尿病和肥胖症之間的這個單獨的價格點嗎？或者我們 - 你是否期待快速 - 或者我們應該說，縮小或侵蝕 GLP-1 肥胖定價？

Yes. Thanks, Pete, and thank you for restraining shop to 2 questions. I think after last week's conference call, perhaps we get a better process of fair limiting all of us to 2 questions. And then we do move full rounds, if possible.

是的。謝謝，Pete，也謝謝你限制了 2 個問題。我認為在上週的電話會議之後，也許我們可以更好地公平地將我們所有人限制在 2 個問題上。然後，如果可能的話，我們會進行完整輪次。

So on regulations, yes, Lars will attempt the centering the Senate hearing tomorrow, together with the Lilly and Sanofi's CEOs, it's around insulin pricing. And I think rarely you see a lot of regulation coming out of Senate hearings directly, right? So I think it will be a hearing on insulin pricing, and it's something that I know Lars is looking very much forward to discussing.

因此，在法規方面，是的，Lars 將在明天與 Lilly 和 Sanofi 的首席執行官一起嘗試集中參議院聽證會，這是圍繞胰島素定價的。而且我認為您很少會直接從參議院聽證會中看到很多法規，對嗎？所以我認為這將是一次關於胰島素定價的聽證會，我知道 Lars 非常期待討論這個問題。

And we provided a lot of transparency on our U.S. insulin pricing in our annual report, and you've seen our insulin price going down consistently for now [most full] years in terms of -- especially our net pricing. So that's that part on regulation.

我們在年度報告中提供了很多關於我們美國胰島素定價的透明度，你已經看到我們的胰島素價格在目前 [最完整] 年中持續下降 - 特別是我們的淨定價。這就是監管的部分。

Tria, still TBD, so really no news there. Of course, we are encouraging as much as we can that it should be needed to reimburse the treatment for seniors in the U.S. And at the same time, we do know that more and more states have decided to cover the COVID for the Medicaid population in the States, so making it even more confounding why -- who should be covered for seniors. But that's a political decision that then, of course, we'll have to accept and live with them. The opportunity is decisive enough on its own merits.

Tria，仍待定，所以真的沒有消息。當然，我們盡可能地鼓勵它應該需要報銷美國老年人的治療同時，我們確實知道越來越多的州已經決定為美國的醫療補助人群覆蓋 COVID美國，所以更讓人困惑的是——誰應該為老年人提供保障。但這是一個政治決定，當然，我們將不得不接受並與他們共存。這個機會本身就足夠決定性了。

As to the single-brand versus dual-brand-type strategy, I think it -- ultimately, it's more to Lily to answer about that commercial strategy is -- we've noted the EU approval of -- on tirzepatide, whereas in the U.S., it is still TBD in terms of the leading commercial approach, whether it's a single- or dual-brand approach.

至於單一品牌與雙品牌類型的戰略，我認為——最終，Lily 更應該回答商業戰略是——我們注意到歐盟批准了——關於 tirzepatide，而在美國，就領先的商業方法而言，無論是單一品牌還是雙品牌方法，它仍然是待定的。

I would say, from our perspective, of course, the synergies running with one brand, but there are also benefits in terms of dual brand in terms of how to manage and navigate the market. I think most recently evidenced in terms of the COVID starter doses and so on. So I think, actually, given the nature of the (inaudible) market, I think there are clear benefits of running with a dual-brand strategy seen from a normal perspective. But of course, our competitors are free to make up their minds and decisions accordingly.

我想說，從我們的角度來看，當然是與一個品牌一起運行的協同效應，但就如何管理和駕馭市場而言，雙品牌也有好處。我認為最近在 COVID 起始劑量等方面得到了證明。所以我認為，實際上，鑑於（聽不清）市場的性質，我認為從正常角度來看，採用雙品牌戰略有明顯的好處。但當然，我們的競爭對手可以自由地做出相應的決定。

Thanks, Pete. And we go to Michael.

謝謝，皮特。我們去找邁克爾。

Michael Leuchten from UBS. Two questions, Karsten. One, despite the inventory in Q1, the value of the volume both for Ozempic and Wegovy sort of very different factory compared to Q4 and Q3. Just wondering how you -- what it could speak to channel mix. Is there anything in there that would be normal?

來自瑞銀的 Michael Leuchten。兩個問題，卡斯滕。第一，儘管第一季度有庫存，但與第四季度和第三季度相比，Ozempic 和 Wegovy 工廠的數量價值有很大不同。只是想知道你如何 - 它可以對渠道組合說些什麼。裡面有什麼東西是正常的嗎？

And then just going back to supply. As we think about the MTS being restricted, the way that ramps through the year, the moment that becomes really relevant is when your new plan should come online and you now have the new CDMO online already. So why restrict the new starter doses now as you go into that incremental supply come?

然後回到供應。當我們考慮 MTS 受到限制時，一年中逐漸增加的方式，變得真正相關的時刻是你的新計劃應該上線，你現在已經有新的 CDMO 上線了。那麼，為什麼在進入增量供應時現在限制新的起始劑量呢？

Yes. Thanks for those questions, Mike. And I'd say, as to value volume in the U.S. on Ozempic and Wegovy then I'd say, Wegovy is rather clean. So nothing is very special there. I think one note worth making is linked to my prior comment on increasing Medicaid access, so having some channel mix impact on pricing.

是的。謝謝你提出這些問題，邁克。我會說，至於美國在 Ozempic 和 Wegovy 上的價值量，那麼我會說，Wegovy 相當乾淨。所以那裡沒有什麼特別的。我認為值得一提的是我之前關於增加醫療補助計劃的評論，因此對定價有一些渠道組合影響。

But on a very positive background because it's more than [5 million] incrementalize we have from the Medicaid segment of (inaudible). So that's conscious decisions where we have been out negotiating with the state Medicaid agencies for this access. So that's Wegovy and for Ozempic volume value, let's say always be careful about overinterpreting on quarterly volume value because it doesn't take that big swing factors in terms of wholesaler inventory movements and so on, so throw the calculation off.

但在一個非常積極的背景下，因為我們從（聽不清）的醫療補助計劃中獲得了超過 [500 萬] 的增量。所以這是有意識的決定，我們一直在與州醫療補助機構就這種訪問權進行談判。這就是 Wegovy 和 Ozempic 的銷量價值，讓我們說總是要小心不要過度解釋季度銷量值，因為它不會在批發商庫存變動等方面考慮那麼大的波動因素，所以放棄計算。

So to boil it down in all simplicity, what we're seeing this year is similar to what we've seen in the past few years, so call it 10%, 15% net price decline linked to rebate enhancements and channel mix movements. So apart from that, there are some plus/minuses on inventory, and ROA is going the opposite way. But if you peel that away, no change compared to prior years.

因此，簡而言之，我們今年看到的情況與過去幾年看到的情況類似，所以稱其為 10%、15% 的淨價下降與返利增加和渠道組合變動有關。因此，除此之外，庫存還有一些優點/缺點，而 ROA 則相反。但如果你把它剝離，與往年相比沒有變化。

Then to the question about limiting the starter doses, this is really about safeguarding continuity of care for patients and allowing patients to step up through the doses and be able to deliver the right treatment experience for patients. We had assessed multiple options on how to manage the market linked to the very significant uptake in demand. So this is something we do while we scale at full speed supply chain-wise.

然後是關於限制起始劑量的問題，這實際上是關於保障患者護理的連續性並允許患者逐步增加劑量並能夠為患者提供正確的治療體驗。我們評估了多種選擇，以了解如何管理與需求量非常大相關的市場。因此，這是我們在全速供應鏈擴展時所做的事情。

So this is -- there are no real triggers linked to supply chain. This is just full speed on scaling, and then we adjust how can we put it in market uptake cost so we have a sustainable business gain, so to say.

所以這是 - 沒有與供應鏈相關的真正觸發因素。這只是全速擴展，然後我們調整如何將其放入市場吸收成本中，以便我們獲得可持續的業務收益，可以這麼說。

Yes. Then I'm a little bit down if I take this table first, because here, we have mics and then we can move around for the mic. So if I go this way, Richard, for you first. Richard Vosser?

是的。如果我先坐這張桌子，我會有點失望，因為在這裡，我們有麥克風，然後我們可以四處走動拿麥克風。所以，如果我這樣做，理查德，首先是為了你。理查德·沃瑟？

Perfect. Just on -- you've clearly got 3 plants this year, and we know that they're being scheduled and you've got 2 online. So how should we think about that next year in terms of additional lines coming on? Is it the same magnitude as this year in terms of 0 to 3? Or what should we think about that?

完美的。就在 - 你今年顯然有 3 個工廠，我們知道他們正在安排中，你有 2 個在線。那麼我們應該如何考慮明年新增的線路呢？ 0到3的幅度和今年一樣嗎？或者我們應該怎麼想？

And on the existing lines, how should we think about -- over the years, you've been able to scale capacity. And I think there's a chart from a Capital Markets Day where you -- the unit cost goes through the floor. How can you increase capacity at the existing lines as well? And then second question just on icodec. When the follow-up came through, the data seems to lose statistical significance. So how do the regulators view that?

在現有線路上，我們應該如何考慮——多年來，你已經能夠擴展容量。而且我認為有一張來自資本市場日的圖表，在那裡你 - 單位成本穿過地板。您如何增加現有生產線的產能？然後是關於 icodec 的第二個問題。當後續行動通過時，數據似乎失去了統計意義。那麼監管層是如何看待的呢？

Yes. Thank you, Richard. Yes, you're correct. And just (inaudible) the Wegovy single dose device supply chain in terms of filling: one, a smaller internal line; one CMO line up and running already from the beginning of the year; one CMO line up and running as per April this year, that was linked to our pre-release of full year outlook; and then the third CMO line coming online at the end of this year. So -- and then we have additional lines that we're contracting for in the years to come.

是的。謝謝你，理查德。是的，你是對的。就灌裝而言（聽不清）Wegovy 單劑量設備供應鏈：一個，更小的內部線；一個 CMO 從年初開始就已經在運行；今年 4 月，一位 CMO 排隊並正在運行，這與我們預發布的全年展望相關聯；然後第三條 CMO 線將在今年年底上線。所以 - 然後我們有額外的線路，我們將在未來幾年承包。

And in magnitude, I would say the lines are broadly of the same size, so just for you to size how much we're stepping up. So when we exit this year, our capacity will be almost around [factor 3] compared to when we exited 2 in terms of building capacity. So a very significant ramp up, and we'll continue to lay on additional lines in the years to come.

在規模上，我想說這些線的大小大致相同，所以只是為了讓您了解我們正在加強的程度。因此，當我們今年退出時，就建設能力而言，與我們退出 2 時相比，我們的能力將幾乎在 [因素 3] 左右。因此，這是一個非常顯著的增長，我們將在未來幾年繼續鋪設更多生產線。

I don't want to continue this about when is the next line, when is the next line. Just to say, expect the continued runway in terms of adding line capacity. And then a reminder that for Wegovy ex U.S., we also have our existing manufacturing platforms with (inaudible) and FlexTouch to utilize for ex U.S. Wegovy rollout. So we have a 2-string approach to supply chain-wise.

我不想繼續討論下一行是什麼時候，下一行是什麼時候。只是說，預計在增加線路容量方面會繼續跑道。然後提醒一下，對於美國以外的 Wegovy，我們也有我們現有的製造平台（聽不清）和 FlexTouch 可用於美國以外的 Wegovy 推出。所以我們有一個 2-string 方法來供應鏈。

Then Martin, on icodec?

然後是 Martin，在 icodec 上？

Absolutely. So I think it or to the call talk about almost close ONWARD 1, which obviously was one of our pivotal studies in the space. We did a 26-week extension. That's for regulatory reasons. We do that to secure top exposure and taste on this. So the primary focus of the extension part. And when you do that in open-label studies, you lose a little bit of (inaudible).

絕對地。所以我認為它或電話談論幾乎接近 ONWARD 1，這顯然是我們在該領域的關鍵研究之一。我們延長了 26 週。這是出於監管原因。我們這樣做是為了確保最高曝光率和品味。所以主要關注擴展部分。當你在開放標籤研究中這樣做時，你會失去一點（聽不清）。

We know that regulators know that our assumption is that from an efficacy perspective, also given that we now see the same results in ONWARDS 1, 2, 4 and 5, we would expect [of 3] but we would expect that, that sort of superiority that we've demonstrated in 4 studies will be reflected. But I also think that the extension data will be affected by the statement that this was a safe focus expansion for.

我們知道監管機構知道我們的假設是，從療效的角度來看，同時考慮到我們現在在 ONWARDS 1、2、4 和 5 中看到相同的結果，我們預計 [of 3] 但我們預計，那種我們在 4 項研究中展示的優勢將得到體現。但我也認為擴展數據將受到聲明的影響，這是一個安全的焦點擴展。

Thank you, Martin. And I think we'll move to Simon and then back to you.

謝謝你，馬丁。我想我們會轉到 Simon，然後再回到你身邊。

Simon Baker from Redburn. Two, please. Firstly, on capacity, but not the capacity of what else talking about. Understandably, we're focused on fill and finish for Wegovy. But can you share with us where you are in terms of oral capacity given the data you've seen with 50 mg, assuming some point that could be? And then the second one, Slide 5, you talk about broad commercial coverage. I just wonder if you could give us a little bit more detail about how things have changed for 2023.

來自雷德本的西蒙·貝克。兩個，請。首先，關於容量，而不是其他談論的容量。可以理解的是，我們專注於 Wegovy 的填充和完成。但是，根據您看到的 50 毫克的數據，您能否與我們分享您的口語能力，假設可能是某個點？然後是第二張幻燈片 5，你談到了廣泛的商業報導。我只是想知道您是否可以向我們提供更多有關 2023 年情況如何變化的詳細信息。

So oral supply, as you know, some 5 years back or so, we initiated a major expansion project in place on North Carolina, where we're producing semaglutide API. That factory is ramping up as we speak. So that's a significant step up in terms of sema API for -- especially for on the oral side.

所以口服供應，如你所知，大約 5 年前，我們在北卡羅來納州啟動了一個大型擴展項目，我們在那裡生產 semaglutide API。就在我們說話的時候，那家工廠正在加緊生產。因此，就 sema API 而言，這是一個重要的進步——尤其是在口語方面。

And then on top of that, we're currently in the process of constructing additional API facility in [Kalundborg]. And that will come online a few years down the road. So that's kind of the capacity scaling. And that's also why, given the viability of all, then we -- apart from CapEx, we're also looking at upgraded formulation solutions for the oil products because that will reduce the capacity stream supply chain-wise.

除此之外，我們目前正在 [Kalundborg] 中構建額外的 API 設施。這將在幾年後上線。這就是容量擴展。這也是為什麼，考慮到所有的可行性，那麼我們 - 除了資本支出之外，我們還在尋找石油產品的升級配方解決方案，因為這將減少供應鏈方面的產能流。

And then we have the portfolio playing so exactly to what patient populations and in what disease areas and in what dose strengths are we deploying our all products. And before we finally conclude on that, we would like to wait and see both ways as 1, but also as 4. And then we'll make portfolio decisions where we take the right choices between the capacity available and the clinical benefits and commercial attractiveness of the products.

然後我們的產品組合非常適合我們部署所有產品的患者人群、疾病領域和劑量強度。在我們最終得出結論之前，我們希望將兩種方式都視為 1，但也希望將其視為 4。然後我們將做出投資組合決策，在可用容量、臨床效益和商業吸引力之間做出正確的選擇的產品。

And so that's your first question, Simon. And the second one, in terms of broad access for Wegovy. So I assume that -- farmer Slide 5, but I assume it's under the Wegovy side. So that means that for formulary actions, we are around the 8% mark, but it's employed out in. So we have more than 40 million lives covered in the U.S., 40 million people with obesity covered. So in terms of runway and opportunity with 40 million covered and currently, the run rate for Wegovy is, call it, 200,000 per week or a little bit more than that. So 0.5 million patients on Wegovy, plus/minus, as we speak. So still a very, very significant runway. And do note we are continuing to build access as we speak.

所以這是你的第一個問題，西蒙。第二個，就 Wegovy 的廣泛訪問而言。所以我假設 - farmer Slide 5，但我假設它在 Wegovy 方面。這意味著對於公式化行動，我們大約在 8% 左右，但它已經用完了。所以我們在美國覆蓋了超過 4000 萬人的生命，覆蓋了 4000 萬肥胖患者。因此，就覆蓋 4000 萬的跑道和機會而言，目前 Wegovy 的運行率是每週 200,000 或稍多一點。在我們說話的時候，有 50 萬患者在使用 Wegovy，加/減。所以仍然是一條非常非常重要的跑道。請注意，我們正在繼續建立訪問權限。

Just to be clear, you said 40 million, that's commercial or commercial plus federal?

澄清一下，你說的是 4000 萬，這是商業還是商業加聯邦？

Commercial plus Medicaid.

商業加醫療補助。

So in total, more than 40 million.

所以總共超過4000萬。

I'm not sure I go here and then -- yes?

我不確定我去這裡然後 - 是嗎？

[Tony Male] from Morgan Stanley. So again to hear your thoughts on the positioning of high-dose injectable sema. So the step-up trial of the 7.2 mg, is that complete around the same time as REDEFINE one, which is obviously expected to produce a superior result? So is it before a future high-dose sema combination as sort of an insurance policy in case CagriSema doesn't work or as a backup in case of manufacturing issues for the more complicated products?

[Tony Male] 來自摩根士丹利。所以再次聽聽您對大劑量注射劑定位的看法。那麼 7.2 mg 的升級試驗是否與 REDEFINE 大約同時完成，這顯然有望產生更好的結果？那麼，它是在未來的高劑量 sema 組合之前作為一種保險政策，以防 CagriSema 不起作用，還是在更複雜的產品出現製造問題時作為備份？

I think it's obviously a very natural sort of potential lifetime extension also of CagriSema and the expansion of that opportunity. But it's also to -- while we still have a decade expire an opportunity to maximize value of semaglutide.

我認為這顯然是 CagriSema 的一種非常自然的潛在生命週期延長和機會的擴展。但這也是——雖然我們還有十年到期的機會來最大化 semaglutide 的價值。

And as we're having those data, should they be successful, we will have a step-up as compared to current doses of semaglutide probably be on a everything is that's currently out there. And then we'll have CagriSema, that would be a further step up to that.

當我們獲得這些數據時，如果它們成功的話，與目前的 semaglutide 劑量相比，我們將有一個升級，可能是目前存在的一切。然後我們將擁有 CagriSema，這將更進一步。

So our model is to bring 7.2 milligram in (inaudible) around the [10%] weight loss in CagriSema (inaudible). And having those opportunities also kicking into what Karsten was saying, not only having sort of resin, but also maybe from country-to-country opportunities to work with our portfolio is a really good place. So it's not to be considered as backup but actually maximizing semaglutide. That goes without saying that we see a new and that does [increase], we would also take that into semaglutide.

因此，我們的模型是在 CagriSema（聽不清）[10%] 的體重減輕附近帶來 7.2 毫克（聽不清）。擁有這些機會也符合 Karsten 所說的，不僅有某種樹脂，而且也許從國家到國家的機會與我們的投資組合合作是一個非常好的地方。因此，不應將其視為備用藥物，而應將其視為最大化 semaglutide。不用說，我們看到了一個新的並且確實[增加]，我們也會將其納入 semaglutide。

Yes. On a maximum level of weight loss, I mean, do you think there will be a maximum level that's safe and delight in the market eventually and that the debate will then shift to sort of consistency and quality? And sort of what level do you see that maximum at, I guess?

是的。關於最大程度的減肥，我的意思是，您是否認為最終會有一個在市場上安全和令人愉悅的最大程度，然後爭論將轉向某種程度的一致性和質量？我猜你認為最大的水平是什麼？

I don't want to speculate into maximum level. Right now, we are at semaglutide at around 25%. That's the both sales and benefit. And if you consider a patient with a BMI above 40, 25% weight loss will still lead you in this realm, and that basically means that potentially even higher weight losses.

我不想推測最高水平。現在，我們的 semaglutide 約為 25%。這就是銷售和收益。如果你考慮一個 BMI 超過 40 的患者，25% 的體重減輕仍然會讓你進入這個領域，這基本上意味著可能有更高的體重減輕。

Maybe we can achieve that oat. Maybe we need to have something else.

也許我們可以實現那燕麥。也許我們需要別的東西。

I think to your point, already now thinking about the rate of weight loss and maybe also the quality of weight loss becomes important. And this is why we have to accept safe weight loss. 25% or 30% weight loss for patients. But there will be a good proportion of patients, I think around 20% that had above the (inaudible). That's a substantial proportion of patients that may be more than 25% or 30%. We just have secured that (inaudible) weight.

我想你的觀點，現在已經在考慮減肥的速度，也許減肥的質量也變得很重要。這就是為什麼我們必須接受安全減肥。患者體重減輕 25% 或 30%。但是會有很大比例的患者，我認為大約有 20% 高於（聽不清）。這是相當大比例的患者，可能超過 25% 或 30%。我們剛剛確保了那個（聽不清）重量。

Peter, Jefferies. Two questions. So first one, just coming back again to the supply, sorry, just to understand this (inaudible). So should I might is the original Belgium facility right here, is that still operating sort of churning the same amount it was before? Is copromotes actually dwindling, if you like, not that going on here? Because we've obviously all read about a lot of problems that are going on there at the moment.

彼得，杰弗里斯。兩個問題。所以第一個，只是再次回到供應，抱歉，只是為了理解這一點（聽不清）。那麼我應該是原來的比利時工廠就在這裡，它的運轉量是否與以前一樣？ copromotes 實際上在減少嗎？因為我們顯然都讀過很多目前正在發生的問題。

And it just sounds a bit -- I guess, is it really at the moment, double what you had only 3 months ago? Or is the problem is we shouldn't be thinking about just double the at the moment, and there's a bit of a lag before it comes in and equally on the ex U.S. So I should understand in terms of given it's a kind pentane existing silicon, given the delayed ex-U.S. launches, is that constraint on sema that we're seeing here the actual APR because put fill finish shouldn't impact the ex U.S. Wegovy rollout? And then just some I mean...

這聽起來有點——我想，現在真的是三個月前的兩倍嗎？或者問題是我們現在不應該只考慮加倍，而且在它進入之前有一點滯後，同樣在前美國所以我應該理解它是一種戊烷現有矽，考慮到延遲的前美國。發射，我們在這裡看到的對 sema 的限制是否是實際的 APR，因為填充完成不應影響前美國 Wegovy 的推出？然後只是一些我的意思...

That's too many. So I count 2 already.

那太多了。所以我已經數到2了。

At as simple.

就這麼簡單。

I hope to get back to you in the next round. So on Wegovy and the limitation of the low-dose strengths, that's purely a reflection of the very aggressive demand uptick. It's not because of problems in manufacturing. So just to put that out. A lot of concerns are out there if this is reflected in about some of the recent clarifications from Catalent, and no, that's not the case. This is simply a question of demand outpacing supply. So our supply plans are intact for the year, just to be very clear about that.

我希望在下一輪迴到你身邊。因此，在 Wegovy 和低劑量強度的限制上，這純粹反映了非常激進的需求增長。這不是因為製造上的問題。所以只是把它說出來。如果這反映在 Catalent 最近的一些澄清中，就會引起很多擔憂，不，事實並非如此。這只是一個供不應求的問題。所以我們今年的供應計劃是完整的，只是非常清楚這一點。

As to ex U.S., Wegovy launches and the gradual approach, the gradual approach is a function of that Wegovy is sharing API with Ozempic, filling with Ozempic, Saxenda insulins, assembly with the same and packing also. So we have Wegovy on the FlexTrust platform is sharing a lot of capacities with other products. And as you've seen, for instance, on Ozempic, then we have drug shortage notifications in many markets ex U.S.

至於前美國，Wegovy 推出和漸進式方法，漸進式方法是 Wegovy 與 Ozempic 共享 API，填充 Ozempic，Saxenda 胰島素，組裝和包裝的功能。所以我們在 FlexTrust 平台上有 Wegovy 與其他產品共享很多功能。正如您在 Ozempic 上看到的那樣，我們在美國以外的許多市場都有藥品短缺通知。

So adding more pressure on to that entire supply platform is, of course, something that we do not do like, unless we have smart ways to do so. So I wouldn't want to get into individual bottlenecks and so on because we have a supply chain, which fits together and it's the whole supply chain we're lifting. So we are increasing our capacity across the supply chain from API to paving.

因此，給整個供應平台增加更多壓力當然是我們不喜歡的事情，除非我們有聰明的方法來做到這一點。所以我不想陷入個別的瓶頸等等，因為我們有一個供應鏈，它可以組合在一起，這是我們正在提升的整個供應鏈。因此，我們正在提高從 API 到鋪路的整個供應鏈的產能。

Yes. Then we move to -- I think we'll move to the tech for microphones. But you've been very patient in her back. You can move to that microphone then.

是的。然後我們轉向——我想我們將轉向麥克風技術。但你在她背後一直很有耐心。然後你可以移動到那個麥克風。

Emily Field from Barclays. One, how interlinked is a successful outcome with SELECT and movement forward of the Treat and Prevent Obesity Act? We get asked that a lot. Like is that something that could help move things through Congress?

巴克萊銀行的艾米麗·菲爾德。第一，SELECT 的成功結果與《治療和預防肥胖法》的推進之間有何關聯？我們經常被問到這個問題。就像這可以幫助通過國會推動事情一樣嗎？

And then secondly, while you're limiting supply of the starting dose that will go in the U.S., will you be scaling back promotional efforts as well? And then just any commentary you could provide on the compounding pharmacies out in the market. We get asked a lot, given the lack of FDA oversight on the production there, how -- if that could be a risk to the story overall.

其次，雖然你們限制了將在美國上市的起始劑量的供應，你們是否也會縮減促銷力度？然後，您可以就市場上的複方藥房提供任何評論。我們被問了很多，鑑於 FDA 對那裡的生產缺乏監督，如何——如果這可能對整個故事構成風險。

I'm sorry, Emily. I count 3 again. But I'm getting really good at the supply moment. So you supplied -- or demanded 3 questions and I'll supply 2. So we're practicing supply demand in this context also. So SELECT versus trial, unfortunately, science meeting politics, I think -- I would love to say yes, there is a (inaudible). In reality, no, it's not. So it would be another piece to the body of evidence why it's a good idea. I think it's already a good idea right now.

對不起，艾米麗。我又數了3。但我在供應時刻變得非常好。所以你提供了 - 或要求 3 個問題，我將提供 2 個。所以我們也在這種情況下練習供應需求。所以 SELECT 與試驗，不幸的是，科學遇到政治，我想——我很想說是的，有一個（聽不清）。實際上，不，不是。因此，這將是另一個證明為什麼這是個好主意的證據。我認為現在這已經是個好主意了。

And of course, we'll -- upon, knock on wood, a successful SELECT, we'll use that evidence as we use SELECT in other payer negotiations. Because SELECT will, of course, assuming the official play favorably into the quality and health economic assessments and hence, overarching payout discussions and negotiations.

當然，我們會——敲木頭，一個成功的 SELECT，我們將在其他付款人談判中使用 SELECT 時使用該證據。因為 SELECT 當然會假設官方對質量和健康經濟評估有利，因此會進行總體支出討論和談判。

As to commercial tactics on Wegovy in the U.S., there vis-à-vis reducing on the starter doses, then I would say, given the current situation, we're not going all in on all our commercial tactics. But of course, at the same time, we're building a new therapy area or value therapy area. And in the context, it's important that we inform and educate around the appropriate use and the benefits of obesity treatment with Wegovy. So don't expect radio silence, but also do know that we would have another gear in the gearbox at the appropriate point in time.

至於美國 Wegovy 的商業策略，相對於減少起始劑量，我想說，鑑於目前的情況，我們不會全力以赴地使用我們所有的商業策略。但當然，與此同時，我們正在建設一個新的治療區或價值治療區。在這種情況下，重要的是我們要就使用 Wegovy 治療肥胖症的適當用途和好處進行宣傳和教育。所以不要指望無線電靜默，但也要知道我們會在適當的時間點在變速箱中安裝另一個檔位。

Then we move to back table here.

然後我們轉到後桌。

Richard Parkes from BNP Paribas Exane. So a couple of questions. Firstly, I know this is partly asked on the call, but in terms of commercial plan coverage going into next year is something we're not going to go and notice the success you've had with Wegovy. So what risk is that you start to see plans looking to put in place restrictions to the eligibility criteria or treatment duration? Is there anything you see as being a risk good commercial coverage into next year? And then I'll come back with the second one, if that's all right.

來自 BNP Paribas Exane 的 Richard Parkes。所以有幾個問題。首先，我知道這部分是在電話中被問到的，但就明年的商業計劃覆蓋範圍而言，我們不會去注意你在 Wegovy 上取得的成功。那麼，您開始看到計劃對資格標准或治療持續時間施加限制的風險是什麼？您認為明年有什麼風險良好的商業報導嗎？然後我會帶著第二個回來，如果可以的話。

Sure. Absolutely. Then I only have to remember one. So first of all, market access in the U.S. on Wegovy is slightly different compared to some other disease categories in the sense that we have brought formulary coverage in commercial in the U.S. for Wegovy. And from there, it's very much an employer opt-in. So it's employers electing that they want to cover antigen medications. So it's a slightly different mechanism.

當然。絕對地。然後我只需要記住一個。因此，首先，與其他一些疾病類別相比，Wegovy 在美國的市場准入略有不同，因為我們在美國為 Wegovy 帶來了商業處方集覆蓋。從那裡開始，這在很大程度上是雇主的選擇加入。因此，雇主選擇他們想要承保抗原藥物治療。所以這是一個稍微不同的機制。

Could we see influence opting out when they see the cost associated with the obesity coverage? Yes. But at the same time, I think we are not at the end of the road in terms of building access with other employers and state Medicaid, et cetera. So that's something we navigate as we move forward.

當他們看到與肥胖覆蓋相關的成本時，我們能否看到他們選擇退出的影響力？是的。但與此同時，我認為在與其他雇主和州醫療補助計劃等建立聯繫方面，我們還沒有走到盡頭。所以這是我們前進的方向。

And at the same time, with some of the additional clinical data reading out, now we just discussed SELECT, of course, the stronger the evidence we can generate both from our clinical trials but also from just real-world evidence about the benefits of anti-obesity treatment, of course, a stronger position we would be in. So it's something where we will navigate over time. And I'd say right now, with the current supply-demand situation, it's not our primary concern in the near term going into next year. But of course, something we look carefully at.

同時，隨著一些額外的臨床數據的讀出，現在我們剛剛討論了 SELECT，當然，我們可以從我們的臨床試驗和真實世界的證據中產生的證據越強-肥胖治療，當然，我們將處於更有利的地位。因此，隨著時間的推移，我們將在這方面進行導航。我現在要說的是，在目前的供需形勢下，這不是我們在明年的短期內主要關注的問題。但是，當然，我們會仔細觀察。

And then second question is on margins are asked on the call. But you're obviously seeing more of a margin improvement this year than you'd originally anticipated. It was ramp up R&D as quickly. And I think you sort of mentioned it might be possibility of business development. There might be some step changes in terms of R&D.

然後第二個問題是關於利潤率的問題。但很明顯，您今年看到的利潤率改善比您原先預期的要多。它正在迅速增加研發。我想你有點提到這可能是業務發展的可能性。在研發方面可能會有一些階躍變化。

So how -- can you just talk about how you sort of going to think about balancing that and what's the priority be going forward? Would you commit to maintaining margins at current levels? Or would you be willing to absorb some contraction for attractive acquisitions?

那麼如何 - 你能談談你將如何考慮平衡這一點以及未來的優先事項是什麼嗎？您會承諾將利潤率維持在當前水平嗎？或者你願意為有吸引力的收購吸收一些收縮嗎？

Yes. So if I talk to Martins and then Martin can talk to a BD products because it's all about the pipeline and is part of the company. Then as to margins, when you look at our Q1 margin, it was 47%, right? So -- and we don't adjust it. So it's a clean operating margin. So at that level of margin, we create more value to shareholders if we invest in our business in terms of growth both the short, medium and long term.

是的。因此，如果我與 Martins 交談，那麼 Martin 可以與 BD 產品交談，因為這一切都與管道有關並且是公司的一部分。那麼關於利潤率，當你看我們第一季度的利潤率時，它是 47%，對嗎？所以 - 我們不調整它。所以這是一個乾淨的營業利潤率。因此，在這樣的利潤率水平上，如果我們在短期、中期和長期的增長方面投資於我們的業務，我們就會為股東創造更多價值。

So we don't have a margin strategy. We don't have a catch-up in terms of margin. We have an innovation-based growth strategy and very focused on driving that through investing in scaling supply, building the obesity market in terms of commercial build and infrastructure and then building and expanding our R&D pipeline to the extent rational within our therapy areas. So that's our strategic resource allocation principles.

所以我們沒有保證金策略。我們在保證金方面沒有追趕。我們有一個基於創新的增長戰略，並非常專注於通過投資擴大供應、在商業建設和基礎設施方面建立肥胖市場，然後在我們的治療領域內建立和擴大我們的研發管道到合理的程度來推動這一戰略。這就是我們的戰略資源分配原則。

And as I said at last week's call, then clearly, when growth rates come up as high as they are now, in the high 20s for this year, then naturally, there will be a margin benefit because in an organic type of growth setting -- but of course, if we end up buying something ties for inorganic in our string of growth strategy, then that, of course, can have kind of a negative impact on margins.

正如我在上週的電話會議上所說的那樣，很明顯，當增長率達到現在的水平時，今年達到 20 多歲，那麼自然會有利潤收益，因為在有機增長環境中 - - 但是，當然，如果我們最終在我們的一系列增長戰略中購買無機物，那麼這當然會對利潤率產生負面影響。

And as you saw with Dicerna just a few years back, then we accepted to take a dip on margins to get that technology platform in-house. And we're benefiting from that now. And actually, we've ended up recouping that margin impact. So that's just to say, we start from the innovative-based growth and then we're rational about the margin afterwards. So that's kind of the consulting.

正如你幾年前在 Dicerna 看到的那樣，我們接受了降低利潤率以在內部獲得該技術平台。我們現在正從中受益。實際上，我們最終收回了利潤率的影響。所以這只是說，我們從基於創新的增長開始，然後我們對之後的利潤率保持理性。這就是諮詢。

So Martin, BD?

那麼馬丁，BD？

Yes. Maybe just building on what Karsten said, I mean, we've never been in a situation where we've had to say no to a business development opportunity because of margin considerations. Clearly, take the approach that working within our strategic focus areas, both in terms of the areas, but also in terms of technology platforms, we do the right acquisitions and we do the collaboration.

是的。也許只是基於 Karsten 所說的，我的意思是，我們從來沒有遇到過出於利潤考慮而不得不拒絕業務發展機會的情況。顯然，採取在我們的戰略重點領域內工作的方法，無論是在領域方面，還是在技術平台方面，我們進行正確的收購併進行協作。

I think from a specific -- maybe also a technical perspective, we have a clear approach of, at this point in time, focusing on earlier assets. So same preclinical, early clinical assets where we can generate value rather than doing pickup later-stage acquisitions where, obviously, both margin but also venue generation some from the. Given our current point of time and current situation, we can allow ourself to do that. But careful of having sort of a dual standpoint in terms of strong internal innovation in all of our therapy areas but equally strong external focus in innovation.

我認為從一個具體的——也許也是一個技術角度來看，我們有一個明確的方法，在這個時間點，專注於早期的資產。同樣的臨床前、早期臨床資產，我們可以在這些資產中產生價值，而不是進行後期收購，顯然，既可以保證利潤，也可以從中產生一些場地。鑑於我們目前的時間點和現狀，我們可以允許自己這樣做。但要注意在我們所有治療領域的強大內部創新和同樣強大的外部創新焦點方面的雙重立場。

Yes?

是的？

It's Matthew Weston at Credit Suisse. Two for me as well, please. The first one follows on from Richard's question about costs and cost phasing. So you said yourself that it's normally organic within a pharma company. But obviously, now you have this exceptionally broad revenue guidance. I'd be really interested if there are any large chunks of OpEx that at some point in time you have to commit to or make a decision on and how you're going to go about making those or it's very simply an organic decision and waiting for the cost to catch up with the revenue.

我是瑞士信貸的馬修韋斯頓。請也給我兩個。第一個問題來自理查德關於成本和成本分階段的問題。所以你自己說它通常在製藥公司內是有機的。但很明顯，現在你有了這個非常廣泛的收入指導。如果有任何大塊的 OpEx 在某個時間點你必須承諾或做出決定，以及你將如何去做這些，或者這只是一個有機的決定和等待，我真的很感興趣為了成本趕上收入。

And then the second question to you, Martin, it's a bit bigger picture. We're looking at this market of obesity now, and everybody is debating Mounjaro versus Wegovy. Everyone is asking about stay time. If I look at any other big chronic therapeutic area, no one stays on a single drug, and there is no simple approach if you start with one and carry on going forever. There's always finesse. Whether it's a treatment phase and then a maintenance phase, you look at people moving different modes of action.

然後是第二個問題，馬丁，這是一個更大的圖景。我們現在正在關注這個肥胖市場，每個人都在爭論 Mounjaro 還是 Wegovy。每個人都在問停留時間。如果我看看任何其他大型慢性病治療領域，沒有人會停留在一種藥物上，如果你從一種藥物開始並一直持續下去，就沒有簡單的方法。總是有技巧。無論是治療階段還是維持階段，您都會看到人們採用不同的行動方式。

I'd be really interested as to your views as you kind of look through your crystal ball in obesity how you see it evolving and how you think you need to start looking at combination strategies or treat-and-maintain strategies to actually make this a 20-, 30-year market.

我真的很想知道你的觀點，因為你通過你的水晶球來看待肥胖症，你如何看待它的演變以及你認為你需要如何開始研究組合策略或治療和維持策略才能真正使它成為一個20、30年市場。

Yes. Thanks for that question, Matthew. And no, we don't have any singular major cost or OpEx step up or down. So this is a classic organic build. It comes down to employees and cost of running the business and, of course, the supply chain. So it's classic scalability. And that's why we have paid for good chunks of the infrastructure. So when growth reaches a certain magnitude, then we cannot scale R&D more in terms of organic scaling, and then we have a good flow through to the bottom line and to margin. So it's kind of a classic discipline in terms of financial management.

是的。謝謝你提出這個問題，馬修。不，我們沒有任何單一的主要成本或 OpEx 上升或下降。所以這是一個經典的有機構建。這歸結為員工和經營業務的成本，當然還有供應鏈。所以這是經典的可擴展性。這就是為什麼我們為大量的基礎設施付出了代價。因此，當增長達到一定幅度時，我們就無法在有機規模方面擴大研發規模，然後我們就有了很好的利潤和利潤率。因此，就財務管理而言，這是一門經典學科。

Yes. And a really good question with probably a little bit of a complex answer because clearly, we are at the very early stages of obesity treatment here. In my analysis is actually going back to the advent of Hasuda, you would recall it when you saw UKPDS [once a] treatment available, not a large sophistication in terms of understanding different patient needs an (inaudible) just pharmacies. We have several phenotypes. It's a progressive disease. And over the years, we've seen different modalities coming in and changing and optimizing the treatment airbag, but also offering more sophisticated treatment for infect patients.

是的。這是一個非常好的問題，答案可能有點複雜，因為很明顯，我們正處於肥胖治療的早期階段。在我的分析中，實際上可以追溯到 Hasuda 的出現，當你看到 UKPDS [一次] 治療可用時，你會記得它，在理解不同患者需要（聽不清）只是藥房方面並不是一個很大的複雜性。我們有幾種表型。這是一種進行性疾病。多年來，我們看到了不同的治療方式出現，改變和優化了治療氣囊，同時也為感染患者提供了更複雜的治療。

I think we'll see the same development in -- to your point, I mean, we have one -- in well or 15%-plus weight loss approved drug available right now. That doesn't call for a lot of sophisticated motion because yes, treating less than 1% of the obese population. What you will see, I think, in the coming years is a lot of focus on. I think that will drive a focus on just the action let-off in obese population.

我認為我們會看到同樣的發展 - 就你的觀點而言，我的意思是，我們有一個 - 現在可以使用或超過 15% 的減肥批准藥物。這並不需要很多複雜的動作，因為是的，治療不到 1% 的肥胖人群。我認為，在未來幾年，你會看到很多關注點。我認為這將推動人們關注肥胖人群的行動緩解。

But combination of treatment, to your point, will allow us to take weight loss for those who that may not be all, but also thinking the impact on combatant. That has been a major decision driver. I think that would also be the case in looking at the impact of weight loss on a (inaudible) on diabetes.

但是，就您的觀點而言，結合治療將使我們能夠為那些可能不是全部的人減輕體重，但也要考慮對戰鬥員的影響。這是一個主要的決策驅動因素。我認為在研究減肥對（聽不清）糖尿病的影響時也是如此。

And then to your point, maintenance of treatment. I currently -- and obviously, I'm biased and it's still early days. I'm currently seeing obesity as qualities with need for quality treatment. When people are going off treatment today, they start to increase and/or regain weight. To me, that means chronic treatment. But we have to look at different modalities, either stay on treatment, reduced dose. We maybe do it to maintain the accrued weight loss. All of that provides a lot of knowledge insight and innovation. And we'll see research but also innovations in that space in the years to come. I think at the strongest post clinical, but also preclinical pipeline clears.

然後到你的地步，維持治療。我目前 - 顯然，我有偏見，現在還為時尚早。我目前將肥胖視為需要優質治療的品質。當人們今天停止治療時，他們開始增加和/或恢復體重。對我來說，這意味著長期治療。但是我們必須考慮不同的方式，要么繼續治療，要么減少劑量。我們可能這樣做是為了維持累積的減肥效果。所有這些都提供了大量的知識洞察力和創新。我們將在未來幾年看到該領域的研究和創新。我認為在最強的臨床後，但也清除了臨床前管道。

Thanks, Matthew. We'll stay with this table before we move forward. Any answer questions? Rajan?

謝謝，馬修。在我們繼續之前，我們將留在這張桌子上。任何回答問題？拉詹？

A quick one. Have you done any modeling on the higher dose of summer with category on where you can get that 25% higher? Have you got numbers on that?

一個快速的。你有沒有對夏季的高劑量進行任何建模，並確定在哪裡可以提高 25%？你有這方面的數字嗎？

So yes and no in the sense that we've done the modeling. And if 7.2 pans out in sort of real life, I would be confident to taste right now. I want to clinical data substitute support model. I think it's reasonable to assume that a 7.2 milligrams of semaglutide is providing additional benefit. That will also be an interesting consideration in U.K. since.

所以從我們已經完成建模的意義上說是和否。如果 7.2 在現實生活中出現，我現在就有信心品嚐。我要臨床數據替代支持模型。我認為可以合理地假設 7.2 毫克的 semaglutide 會提供額外的益處。從那以後，這在英國也將是一個有趣的考慮因素。

Then move back to Michael Leuchten.

然後回到 Michael Leuchten。

Just going back to CagriSema manufacturing and the oral alternative in Phase I. Given your capacity on CagriSema is hardly limited, will you wait to see some of that clinical data or the alternative to decide how much CapEx is behind it? Or are those 2 independent from each other?

回到第一階段的 CagriSema 製造和口服替代方案。鑑於您在 CagriSema 上的能力幾乎沒有限制，您會等到看到一些臨床數據或替代方案來決定它背後有多少資本支出嗎？或者這兩個是相互獨立的？

Which one, sorry?

哪一個，抱歉？

The semaglutide, the...

索馬魯肽...

Oh, the oral and CagriSema?

哦，口服和CagriSema？

Yes.

是的。

That's an easy answer because no, we are -- we're scaling and catering to both. So part of the step-up in our CapEx that we announced beginning of this year, DKK 25 billion this year and, say, being in the 10% to 15% CapEx to sales ratio in the coming years, that is catering to both scaling API capacities as well as fill finish.

這是一個簡單的答案，因為不，我們是——我們正在擴展和迎合兩者。因此，我們今年年初宣布的資本支出增加的一部分，今年 250 億丹麥克朗，比如說，未來幾年資本支出佔銷售額的比例在 10% 到 15% 之間，這既滿足了規模化需求API 容量以及填充完成。

So the currently ongoing API facility that we're currently building in Calamba in Denmark is what you would call a multipurpose facility for peptides. So as a consequence, we'll be able to deploy that across a number of different assets on the API side.

因此，我們目前正在丹麥卡蘭巴建造的目前正在進行的 API 設施就是您所說的多肽多用途設施。因此，我們將能夠在 API 端的許多不同資產中部署它。

Simon and then Pete.

西蒙，然後是皮特。

Just going back to the question of target weight loss. If I pass on back a long time, I remember on some of the early bid studies, the weight loss is plus 5% to minus [40%]. I'm on a set, obviously, quite extreme. But it goes to the point that the point estimates that we see here are the average is quite a distribution. And I just wondered if you give the current doses, what is the range response which would go? If you push it to 25%, when would you see that range go? Because if that gun example is relevant for the class, then you could have some fairly extreme weight loss you're targeting 25%.

回到目標減肥的問題。如果我回傳很長一段時間，我記得在一些早期投標研究中，體重減輕了 5% 到負 [40%]。很明顯，我很極端。但是，我們在這裡看到的點估計是平均值，這是一個相當分佈的點。我只是想知道如果你給出當前劑量，那麼範圍反應是什麼？如果你把它推到 25%，你什麼時候會看到這個範圍？因為如果那個槍的例子與班級相關，那麼你可能會有一些相當極端的減肥，你的目標是 25%。

So just listening to the numbers that you say. I mean, the range for semaglutide current dose is more than (inaudible). So we have also paid to up to 40% of their body weight. I'd say the vast majority, 95%-plus, lose weight and more than [5%] of their body weight. So I don't think we have any gain weight, but it's more or less the same wins. And that to me, without actually having the full inline, suggests that there is maybe a natural limit to the range. I think we'll see what CagriSema way, weight loss being driven towards 25% but still within a range that doesn't exceed something that will be. Obviously, an, but that would be my comment.

所以只聽你說的數字。我的意思是，semaglutide 當前劑量的範圍超過（聽不清）。所以我們也付出了高達他們體重40%的代價。我想說的是，絕大多數人（95% 以上）的體重都減輕了 [5%] 以上。所以我不認為我們有任何體重增加，但或多或少是相同的勝利。對我來說，如果沒有真正的完整內聯，這表明範圍可能存在自然限制。我想我們會看到 CagriSema 的方式，將減肥推向 25%，但仍在不超過將要達到的水平的範圍內。顯然，這是我的意見。

Pete?

皮特？

It's for Martin. On SELECT, we will know the parasumption just to repeat what everyone's already dead about the ranges. But 2 questions. In terms of what we see on the press release, will it be solely related to the primary endpoint? Or can you discuss about what you would reveal or not? Would there be any potential not the secondary endpoint, but we see that headline press release. And that's part one.

是給馬丁的。在 SELECT 上，我們將知道參數只是為了重複每個人已經對范圍不了解的內容。但是2個問題。就我們在新聞稿中看到的內容而言，它是否僅與主要終點相關？或者你能討論一下你會透露什麼或不透露什麼嗎？有沒有可能不是次要終點，但我們看到了標題新聞稿。這是第一部分。

And part two of the question is that sees clearly your doctor, you see us now at the low end of the range is. But in numbers in its treat but [a second] strike there is 100-plus patients. One might say rand. That does come up with discussions with some KOLs can we discuss the.

問題的第二部分是清楚地看到你的醫生，你現在看到我們處於範圍的低端。但在治療但 [第二次] 罷工的人數上，有 100 多名患者。有人可能會說蘭特。確實提出了與一些 KOL 的討論，我們可以討論嗎？

Yes. Absolutely. So on the press release, I think you will see us on the something limited, either positively or otherwise, comes up, we'll stint to a statement on the primary end point and on the spot profit. Then we'll have to sort of await further information expect comes.

是的。絕對地。所以在新聞稿中，我想你會看到我們在一些有限的事情上，無論是積極的還是其他的，都會出現，我們會限制對主要終點和當場利潤的聲明。然後我們將不得不等待更多信息的到來。

I think from a clinical perspective, and you as you also see that from more diabetes rat, we have (inaudible) reporting on to, I would say, 50% apart from semaglutide, that is at 25%. 11% to 15% risk reduction in mix. That is specific in and obviously have been a statistic and something that both prescribers patients and payers are considering growth.

我認為從臨床角度來看，你也從更多的糖尿病大鼠身上看到，我們（聽不清）報告說，除了 semaglutide 之外還有 50%，即 25%。混合風險降低 11% 至 15%。這是具體的，並且顯然是一個統計數據，開處方的患者和付款人都在考慮增長。

Clinically speaking, if I see [10%] reduction when it comes to CV deaths, stroke or myocardial infarction, I think that is well. But I'd like to see something more, of course. From a statistical perspective, we guide project to continue to come down around the [10%, 11%]. I think it's important to consider. I mean we still believe in [around 10%]. That's our base assumption. That would be not only clinically relevant but also actually statistic. But it should not be seen in isolation. There will be a number of other kind of baseline points that will be important to look at from the SELECT. But there will also be a number of comorbidities or process peripheral disease in diabetes that will allow us to have a iodine on also the economic case for this net.

從臨床上講，如果我看到 CV 死亡、中風或心肌梗塞減少 [10%]，我認為這很好。但我當然想看到更多東西。從統計的角度，我們引導項目在[10%、11%]左右繼續回落。我認為重要的是要考慮。我的意思是我們仍然相信 [大約 10%]。這是我們的基本假設。這不僅具有臨床相關性，而且實際上具有統計意義。但不應孤立地看待它。從 SELECT 中將有許多其他類型的基線點很重要。但是糖尿病中也會有一些合併症或過程外周疾病，這將使我們能夠在這個網絡的經濟案例上也有碘。

Yes. When we move to the sale to the left. I think we need to find -- get you close to a microphone so the online audience can hear.

是的。當我們移動到左側的銷售時。我認為我們需要找到 - 讓您靠近麥克風，以便在線觀眾可以聽到。

I have a -- in the U.K., we pulled up on import and marketing impact. I just wanted to check whether that as of any reassessment of how you approach this.

我有一個——在英國，我們提高了進口和營銷的影響力。我只是想檢查是否重新評估了您的處理方式。

Yes. Yes. Thank you for that question. And it's correct. That's been a case around our business ethics practices in the U.K. and the assessment by the industry association, APPI, in that context. The starting point and the objective on our side was to educate and inform medical doctors and pharmacists around the appropriate use of obesity medications. So that is our go intention, which we believe is important in a new disease area like obesity treatment.

是的。是的。謝謝你提出這個問題。這是正確的。這就是我們在英國的商業道德實踐以及行業協會 APPI 在這方面的評估的案例。我們的出發點和目標是就肥胖藥物的適當使用對醫生和藥劑師進行教育和告知。這就是我們的目標，我們認為這在肥胖治療等新疾病領域很重要。

And in that context, some mistakes from it, and we deal with the consequences. We've been transparent about our dialogue and clarifications about what and why, and now we take the consequences and learn from it. So we've put in place a number of additional initiatives to strengthen that we don't face similar issues elsewhere or in the U.K. So very unfortunate. And of course, we adhere to all regulations in this context.

在這種情況下，出現一些錯誤，我們會處理後果。我們一直對我們的對話和澄清是什麼和為什麼保持透明，現在我們承擔後果並從中吸取教訓。因此，我們已經採取了一些額外的舉措來加強我們在其他地方或英國不會遇到類似的問題。非常不幸。當然，我們遵守這方面的所有規定。

Just insulin, if you look at your chart, you've got a global chart in volumes, look so actually in now almost a majority of markets now, insulin volumes are actually going down. Is that some of the fact is transitory? Or is it -- because it doesn't intuitively seem like an obvious dynamics on what's going on in the world and anything else here.

只是胰島素，如果你看一下你的圖表，你就會得到一個全球銷量圖表，實際上現在幾乎大多數市場看起來，胰島素銷量實際上都在下降。有些事實是暫時的嗎？或者是——因為它在直覺上看起來不像是關於世界上正在發生的事情和這裡的任何其他事情的明顯動態。

And does that mean from your planning point of view, are you planning now basically your interest in case of the efficiency going up and up, you price yourself that all time. Is that been investments in instant because actually, you do think you've reached sort of steady state when you move into?

這是否意味著從你的計劃的角度來看，你現在是否基本上計劃你的興趣，以防效率不斷上升，你一直在為自己定價。那是即時投資嗎，因為實際上，當你搬進來時，你確實認為你已經達到了某種穩定狀態？

Yes. So on insulin, you're right, global volumes are slightly down after looking at the infill market for many, many years now. And it is a really, really sticky, really, really slow-moving markets right? So -- and I'd say our historic learnings in this context has been that every time we thought that whatever bile volumes -- balance risk volumes are going down and the best we end up realizing that, no, they're not. So just speaking to the effects around the thickness of the market.

是的。所以在胰島素方面，你是對的，在觀察填充市場很多年之後，全球銷量略有下降。這是一個非常、非常粘、非常、非常緩慢的市場，對吧？所以——我想說我們在這方面的歷史經驗是，每次我們認為無論膽汁量如何——平衡風險量都在下降，而我們最終意識到，不，它們不是。所以只談市場厚度的影響。

And again, this is chronic therapy, and we are growing populations. So even if we have better treatments like GLP-1s that might take some of the insulin utilization away, then overall, the macro dynamics will keep the global insulin volumes reasonably flat.

再一次，這是慢性治療，我們正在增加人口。因此，即使我們有更好的治療方法，如 GLP-1，可能會減少一些胰島素的利用，但總體而言，宏觀動態將使全球胰島素量保持合理的持平。

So pricing-wise, what does that mean? That means that, of course, it's not insulin driving the big CapEx volumes. But when we build our facilities, we build platforms that can be utilized also for insulins. So the CapEx I was just alluding to before to Michael Leuchten's question, that API facility will also be fitted to produce into an API. And for some of our fill finish capacities we're building, they will also be more teas and hence, be able to fill insulin products.

那麼在定價方面，這意味著什麼？這意味著，當然，驅動大資本支出的不是胰島素。但是當我們建造我們的設施時，我們建造的平台也可以用於胰島素。因此，我之前提到的 CapEx 只是針對 Michael Leuchten 的問題，即 API 設施也將用於生產 API。對於我們正在建設的一些填充完成能力，它們也將是更多的茶，因此能夠填充胰島素產品。

So then we have one last question, which comes from the back table here.

那麼我們有最後一個問題，來自這裡的後台。

Stuart from Citi. Just going on the BD, and you're talking about looking at maintenance strategy, thinking that maintenance long term. And everyone's concerned that some have is around the target adipose tissue and muscle mass. So to what extent is looking at strategies that really shows hating an a tissue ROE going to be needed to have a mental gear?

來自花旗的斯圖爾特。就在 BD 上，你在談論著眼於維護策略，認為維護是長期的。每個人都關心的是目標周圍的脂肪組織和肌肉質量。那麼，在多大程度上研究真正表明討厭組織 ROE 的策略需要有心理裝備？

That is clearly a priority and a focus area, in particular when we go into the bigger weight losses. That's not our only focus area but clearly something that we are very focused on because we also hear those concerns. And right now, with the (inaudible) base, I think it's balanced. But moving beyond this has to be something that we would want.

這顯然是一個優先事項和重點領域，尤其是當我們進行更大規模的減肥時。這不是我們唯一關注的領域，但顯然是我們非常關注的領域，因為我們也聽到了這些擔憂。現在，有了（聽不清）基礎，我認為它是平衡的。但超越這一點必須是我們想要的。

Thank you for that question. And unfortunately, I have to close the call now. So thanks a lot to Peter and Citi for hosting. And we'll continue our rounds with our Q1 results. It's a historic year for Novo Nordisk, delivering between 24% and 30% top line growth, and as a consequence, investing a lot of resources in scaling accordingly. So really, really fantastic growth for Novo Nordisk. So thank you for listening in, and thank you for attending here, [Philippe].

謝謝你提出這個問題。不幸的是，我現在必須結束通話。非常感謝 Peter 和 Citi 的主持。我們將繼續我們的第一季度結果。對於諾和諾德來說，這是具有歷史意義的一年，實現了 24% 至 30% 的收入增長，因此投入了大量資源進行相應的擴展。諾和諾德的增長真的非常非常棒。 [Philippe]，感謝您的收聽，也感謝您出席這裡。

Thank you.

謝謝。

Thank you very much.

非常感謝。