諾和諾德 (NVO) 2023 Q2 法說會逐字稿

Okay. Everyone, should we get kicked off. Thank you very much. So thanks very much everyone. It's Sachin Jain here from the European Pharma team at BofA. Thank you very much to everyone for coming. It's a real pleasure to be hosting Novo post their results. And obviously, we have a fuller room than anticipated, obviously, Tuesday was a very good day and so demand build. So apologies were tightened here. We have an hour and 15, we have the entire C-suite. I think we have half an hour of presentation and for questions.

好的。大家，我們應該被踢掉嗎？非常感謝。非常感謝大家。我是美國銀行歐洲製藥團隊的 Sachin Jain。非常感謝大家的到來。很高興能夠主持 Novo 發布他們的結果。顯然，我們的房間比預期的更滿，顯然，週二是非常好的一天，因此需求增加。所以這裡的道歉更加嚴格了。我們有 1 小時 15 個小時，我們有整個 C 級管理層。我想我們有半個小時的演示和提問時間。

So Lars, with that further over to you. Thanks very much.

拉斯，這件事就交給你了。非常感謝。

Thank you, Sachin. And thank you, Bank of America for hosting us. Indeed, it is a great week for us. We're very excited. It's great to be on the road and talk about where the company is. We will go through the slides relatively quickly, so we can get into the Q&A. I have to advise you that we'll be making some forward-looking statements. And obviously, things can turn out in a different way. So please pay attention to these comments.

謝謝你，薩欽。感謝美國銀行接待我們。事實上，這對我們來說是美好的一周。我們非常興奮。能夠在路上談論公司的情況真是太好了。我們將相對快速地瀏覽幻燈片，以便我們可以進入問答環節。我必須告訴您，我們將做出一些前瞻性陳述。顯然，事情可能會以不同的方式發展。所以請注意這些評論。

So from an overall strategic aspiration point of view, we feel really good about how we're tracking both on our purpose and sustainability. But obviously, really, really strong commercial execution, the 30% growth we had in the first half of this year and the raised guidance underpins both how we are executing commercially but also how we're confident in building capacity to be able to supply to a high and higher degree to this amazing growth opportunity.

因此，從整體戰略願景的角度來看，我們對如何跟踪我們的目標和可持續性感到非常滿意。但顯然，非常非常強大的商業執行力，今年上半年我們實現了 30% 的增長，以及提高的指導既支撐了我們的商業執行方式，也支撐了我們對建設產能以供應給客戶的信心。對這個驚人的增長機會的高度越來越高。

We had a major readout this quarter in R&D, not least this week with the SELECT data, very, very comforting for the longer-term prospects of semaglutide in obesity. But it's really a molecule that keeps giving. We have also seen the HFpEF data really leading data in heart failure space and maybe something that goes a bit below the radar. There's been an individual trial for a new molecule, I think, would have attracted even more attention. So really, really encouraging to see how we're broadening out the potential indications for semaglutide and also the all data.

本季度我們在研發方面發布了重要數據，尤其是本週的 SELECT 數據，這對索馬魯肽治療肥胖症的長期前景非常非常令人欣慰。但它確實是一個不斷給予的分子。我們還看到 HFpEF 數據在心力衰竭領域確實處於領先地位，也許有些東西有點低於雷達。我認為，對一種新分子的單獨試驗會引起更多關注。看到我們如何擴大索馬魯肽的潛在適應症以及所有數據，真的非常令人鼓舞。

And in the financial quadrant that will also explain a bit more about in the slides, really, really strong growth. We see that we can turn the higher growth momentum into higher operating profit and here also an increased outlook. So really, really strong first half year for Novo Nordisk. We encouraged about our outlook.

在金融象限中，幻燈片中還將進一步解釋真正非常強勁的增長。我們看到，我們可以將更高的增長動力轉化為更高的營業利潤，並提高前景。對於諾和諾德來說，上半年真的非常非常強勁。我們對我們的前景感到鼓舞。

And with that, I'll hand over to Camilla for a few more details on the commercial performance.

接下來，我將向卡米拉詢問有關商業表演的更多細節。

Thank you, Lars. And when we look at our 30% sales growth, you just see here how it is constituted -- I'm just moving in front of the microphone, sorry. Sales growth of 30%, driven by both of our operating units. You see North America 44% growth, IO 17% growth, but also other regions are driving double-digit growth. When we segment the growth into the therapy areas, as you see GLP-1 growth of 50%. You see insulin of minus 7% and then obesity care of 157% and rare D of minus 18%. So basically, more than 100% of our growth is driven by diabetes and obesity.

謝謝你，拉爾斯。當我們看到 30% 的銷售額增長時，您會看到它是如何構成的 - 抱歉，我只是走到麥克風前面。在我們兩個運營部門的推動下，銷售額增長了 30%。您會看到北美增長了 44%，IO 增長了 17%，但其他地區也在推動兩位數的增長。當我們將增長細分到治療領域時，您會看到 GLP-1 增長了 50%。您會看到胰島素為負 7%，然後肥胖治療為 157%，罕見 D 為負 18%。所以基本上，我們 100% 以上的增長都是由糖尿病和肥胖推動的。

The growth is driven 71% by North America in terms of share growth and 55% of our sales is now in North America. So that, of course, to a large extent, also is constituted of obesity sales growth. So I'll just dig into that a little bit more on this slide where you see the 150% sales growth in the first half mainly driven by the U.S.

就份額增長而言，北美地區推動了 71% 的增長，目前我們 55% 的銷售額來自北美。當然，這在很大程度上也是由肥胖症銷量的增長構成的。因此，我將在這張幻燈片上進一步深入探討這一點，您可以看到上半年 150% 的銷售額增長主要是由美國推動的。

You also know that we have done commercial launches in the U.S., in Denmark, in Norway and most recently in Germany of Wegovy, and we have broad commercial access in the U.S. with more than 80% coverage. And we are, of course, continuing to build supply to cater for this market and these patients. And we are also continuing to make sure that we support continuity of care for patients so that they can keep those who are starting on the product and keep staying on the product. And I'm sure we'll talk much more about the obesity in the Q&A section also.

您還知道，我們已經在美國、丹麥、挪威以及最近在德國的 Wegovy 進行了商業發布，並且我們在美國擁有廣泛的商業准入，覆蓋率超過 80%。當然，我們正在繼續增加供應以滿足這個市場和這些患者的需求。我們還將繼續確保支持患者的連續性護理，以便他們能夠留住那些開始使用該產品並繼續使用該產品的人。我相信我們也會在問答部分更多地討論肥胖問題。

So I'll hand over now to Martin to talk little bit more about obesity also.

現在我將讓馬丁進一步談談肥胖問題。

Thank you very much, Camilla. So I was also asked by Daniel, to be brief. And I think when it comes to select, that's reasonably easy. You asked us a lot of questions over the last couple of years about SELECT, and that's been interesting. It's really all about 1 number, 20%. You've probably seen the data. We are only disclosing the primary endpoint at this point. And obviously, to see a 20% risk reduction in MACE in the population as we investigated in SELECT. It's no less than stellar from our perspective. It's going to change the way that we see, the way we treat obesity. And obviously, with the safety profile that again confirms the safe approach that we have to the treatment of obesity with semaglutide, we are really, really happy with the data that we've seen.

非常感謝你，卡米拉。所以丹尼爾也要求我簡短地說。我認為當談到選擇時，這相當容易。在過去的幾年裡，您向我們詢問了很多有關 SELECT 的問題，這很有趣。這實際上都是關於 1 個數字，20%。您可能已經看過這些數據。目前我們僅披露主要終點。顯然，正如我們在 SELECT 中所調查的那樣，人群中 MACE 的風險降低了 20%。從我們的角度來看，它不亞於恆星。它將改變我們看待事物的方式以及治療肥胖的方式。顯然，安全性再次證實了我們用索馬魯肽治療肥胖症的安全方法，我們對所看到的數據非常非常滿意。

Next steps, and I've received a lot of questions already about secondary endpoints, about more details about some of the things that all of us both from a clinical, but also from a payer perspective are interested in. You'll have wait a couple of months until the American Heart Association will release more data, both at the actual congress, but also through publications.

下一步，我已經收到了很多關於次要終點的問題，關於我們所有人從臨床角度以及從付款人角度都感興趣的一些事情的更多細節。您需要等待幾個月後，美國心臟協會將在實際大會上以及通過出版物發布更多數據。

And then obviously, we are working hard towards release -- sorry, the regulatory submission of the data in Europe and in U.S. to start. In other R&D news, obviously, we are focusing a lot on oral semaglutide in both diabetes and obesity in the sense that we are planning for U.S. submission in third quarter of this year for both diabetes and obesity 25 and 50-milligram in diabetes, 50-milligram in obesity and then in Europe in Q4, again for both diabetes and -- in CagriSema, we are initiating our Phase III program for Type 2 diabetes. The reason why you don't see CagriSema basically because Phase II has in terms of recruitment being finalized for REDEFINE 2 and 3. And that basically means that we are in the treatment phase, and we are awaiting results.

顯然，我們正在努力發布——抱歉，首先是在歐洲和美國向監管機構提交數據。在其他研發新聞中，顯然，我們非常關注糖尿病和肥胖症的口服索馬魯肽，因為我們計劃今年第三季度在美國提交治療糖尿病和肥胖症的 25 毫克和 50 毫克糖尿病的藥物，50 - 毫克治療肥胖症，然後在第四季度在歐洲，同樣治療糖尿病- 在CagriSema，我們正在啟動針對2 型糖尿病的III 期計劃。你看不到 CagriSema 的原因基本上是因為第二階段的 REDEFINE 2 和 3 的招募工作已經完成。這基本上意味著我們處於治療階段，我們正在等待結果。

As a good marker, obviously, you tend to see that it's easier to recruit when patients -- physicians are interested in the drug. And even with 5,000 patients almost being recruited in the CagriSema program, we actually finalized recruitments well ahead of time as compared to our pets. Already talked about SELECT. And I think it's important to also cut as lasted STEP HFpEF trial where we saw Phase III results increasing really, really strong and interesting data on functionality of semaglutide in heart failure with preserved ejection pack.

顯然，作為一個好的標記，您往往會發現，當患者（醫生）對該藥物感興趣時，招募起來更容易。即使 CagriSema 計劃幾乎招募了 5,000 名患者，但與我們的寵物相比，我們實際上提前完成了招募。已經談到了 SELECT。我認為重要的是要削減最後的 STEP HFpEF 試驗，我們看到 III 期結果增加了關於索馬魯肽在保留射出包的心力衰竭中的功能的非常、非常強大和有趣的數據。

I think it's also important to call out that these measures of functionality can actually be correlated to outcomes, which is why it's from a regulatory perspective, it's also interesting -- and we can actually expect to see a label update when we combine with the type 2 diabetes results showing the benefits of semaglutide with patients suffering from heart failure.

我認為指出這些功能衡量標準實際上可以與結果相關也很重要，這就是為什麼從監管角度來看，這也很有趣——當我們與類型結合時，我們實際上可以期望看到標籤更新2 糖尿病結果顯示索馬魯肽對心力衰竭患者的益處。

We terminated a PYY agonist program earlier this year basically based on not sufficient efficacy results, not leading to a differentiated profile. And as you know, we have a very strong opinion on not progressing, not differentiated assets. And then maybe in rare disease, obviously, remind you that somapacitan has been approved in both Europe and Japan for treatment of children with growth hormone deficiency. And as some of you also have noticed, we've announced that we've initiated a Phase III program for ziltivekimab. It's actually an outcomes trial in heart failure with preserved detection.

我們今年早些時候終止了 PYY 激動劑項目，主要是因為療效結果不充分，沒有產生差異化的結果。如您所知，我們對不進步、不差異化資產有非常強烈的看法。然後，也許在罕見疾病中，顯然，提醒您索馬帕坦已在歐洲和日本被批准用於治療生長激素缺乏症的兒童。正如你們中的一些人也注意到的，我們宣布我們已經啟動了 ziltivekimab 的 III 期計劃。這實際上是一項保留檢測的心力衰竭結果試驗。

And with that, over to Karsten.

接下來，交給卡斯滕。

Thank you, Martin, for a brief and selective presentation. So first half results, 30% growth, but of course, looking at the quarters, I would be remittent if not saying 36% growth in the second quarter, probably the strongest growth in the history of the company, for sure, it is in absolute terms. So really a staggering growth level delivered through our portfolio as Camilla presented.

謝謝馬丁的簡短而有選擇性的介紹。因此，上半年業績增長了 30％，但當然，看看季度，如果不是說第二季度增長了 36％，我會感到寬慰，這可能是公司歷史上最強勁的增長，當然，這是在絕對條款。正如卡米拉所介紹的那樣，我們的投資組合確實實現了驚人的增長水平。

Through that growth, we're investing in the company, first of all, in our supply chain. So we're building our supply chain. We invest in building the obesity market and, of course, invest in building an attractive and competitive pipeline in both the medium and long term. And still, we are able to return operating profit growth of 32% and an earnings per share growth for the first half of 44%.

通過這種增長，我們正在對公司進行投資，首先是我們的供應鏈。所以我們正在建立我們的供應鏈。我們投資建設肥胖市場，當然，我們也投資建設具有吸引力和競爭力的中長期管道。儘管如此，我們上半年的營業利潤增長了 32%，每股收益增長了 44%。

Outlook for the year, we raised both sales and OP outlook by 3 percentage points that's not even the most impressive part of it because in reality, our outlook for the year mimics the growth rate we saw in the first half. So we deliver 30% in the first half midpoint for the full year is a 30% growth, 3-0 percent growth. So really impressive growth in an industry which is perhaps growing to the tune of low to mid-single digits. Same for operating profit growth even higher in the sense that we get some gearing, of course, linked to our sales growth.

對於今年的展望，我們將銷售額和運營前景展望提高了3 個百分點，這甚至不是其中最令人印象深刻的部分，因為實際上，我們對今年的展望模仿了我們上半年看到的增長率。所以我們上半年實現了30%的增長，全年中點是30%的增長，3-0%的增長。這個行業的增長確實令人印象深刻，可能會增長到中低個位數。營業利潤增長也是如此，甚至更高，因為我們獲得了一些與銷售增長相關的槓桿。

So a guidance now of between 31% and 37% operating profit growth. Currency is unchanged compared to last and a slight downgrade on our free cash flow. And this is purely because our free cash flow definition includes cash flow going to business development activities. As we disclosed, we have done the BIOCORP acquisition on connected devices, and we have the Inversago acquisition. So adjusting for that, then we're actually increasing our free cash flow in line with the strengthening business outlook.

因此，目前的營業利潤增長指導值為 31% 至 37%。與上次相比，貨幣沒有變化，我們的自由現金流略有下調。這純粹是因為我們的自由現金流量定義包括用於業務開發活動的現金流量。正如我們所披露的，我們已經在互聯設備上完成了 BIOCORP 收購，並且我們還收購了 Inversago。因此，對此進行調整後，我們實際上會根據不斷增強的業務前景來增加自由現金流。

So much for the outlook and then Lars on strategic aspirations.

展望就這麼多，然後是拉斯的戰略願景。

Yes. I alluded a bit to it in the beginning. We feel comfortable in how we are progressing on our strategic aspirations, an amazing demand for our CB1-based product portfolio. And I think we're executing quite well in taking that opportunity and converting that into sales. And I think you should also rest assured that we're investing what is needed for us to scale capacities to continuously grow and aim to meet that demand. Pipeline progress is equally important for us. I think we have a very long underpinned growth opportunity with semaglutide based on the SELECT data. In parallel, we're building late and early-stage pipeline. And we are quite comfortable that we can add that on top of the growth prospect that semaglutide provides.

是的。我一開始就提到過一點。我們對我們在實現戰略願景方面取得的進展感到滿意，這對我們基於 CB1 的產品組合有著驚人的需求。我認為我們在抓住這個機會並將其轉化為銷售方面表現得很好。我認為您也應該放心，我們正在投資擴大產能以持續增長並旨在滿足這一需求所需的資金。管道進展對我們來說同樣重要。我認為，根據 SELECT 數據，我們在索馬魯肽方面有一個非常長期的增長機會。與此同時，我們正在建設後期和早期管道。我們很高興我們可以在索馬魯肽提供的增長前景之上添加這一點。

So I'll leave with that, and we should then go to the Q&A session, which Daniel will moderate. And maybe we should all come up here and stand so we can easily go to the podium.

我就這樣離開，然後我們應該進入問答環節，丹尼爾將主持該環節。也許我們都應該到這里站起來，這樣我們就可以輕鬆地走上講台。

Yes. Thank you, Lars. So I will moderate the Q&A session. Please clearly state your name and institution. And let's go for one question per person, and then we can take different rounds if time allows. And as always, I think we should give the first question to our host, Sachin Jain.

是的。謝謝你，拉爾斯。所以我將主持問答環節。請清楚地註明您的姓名和機構。讓我們每人回答一個問題，然後如果時間允許的話我們可以進行不同的輪次。和往常一樣，我認為我們應該向主持人 Sachin Jain 提出第一個問題。

Great. Sachin Jain. Going to be challenge for me to have one. So I'm going to have 1 in 2 parts, if that's all right. I'm going to do sema heart failure for me. You've mentioned a couple of times you believe it's underappreciated. So one for Martin, if you can talk about the correlation of this function outcomes to hard outcomes when we see data at ASC in a few weeks, you get hard outcomes data that gets across the 10% to 15% threshold of people. Cardiologists typically think clinically relevant, Camilla, any simple thing if you could just outline the commercial opportunities as an add-on to standard of care.

偉大的。薩欽·賈恩.擁有一個對我來說是一個挑戰。如果可以的話，我將製作兩部分中的一部分。我要為我做sema心力衰竭。您曾多次提到您認為它沒有得到充分重視。因此，對於Martin 來說，當我們幾週後在ASC 上看到數據時，如果你能談論這個功能結果與硬結果的相關性，你就會得到跨越10% 到15% 人群閾值的硬結果數據。卡米拉，心髒病專家通常認為與臨床相關，只要你能概述商業機會作為護理標準的附加內容，任何簡單的事情都可以。

So both the KCCQ and the 6 minute walking test can be correlated to outcomes. Obviously, it's always a little bit difficult to quantify that correlation. But it is to a level and it's so well established that from a regulatory perspective, it's actually possible to get both the 6-minute walking test and KCCQ to a label. I think it's important for us to call out that -- and again, we can't disclose the data, but we will obviously be looking at also SELECT where we had at baseline 25% of patients having stable heart failure. And therefore, there's a big opportunity to leak into the SELECT data as a secondary endpoint and evaluate this may have impact on heart failure. That will allow us to potentially not only get the functionality assessment into the label, but also maybe even harder endpoints, depending on, obviously, the data and our interactions with the regulators.

因此，KCCQ 和 6 分鐘步行測試都可以與結果相關。顯然，量化這種相關性總是有點困難。但它已經達到了一定水平，而且已經非常完善，從監管角度來看，實際上可以將 6 分鐘步行測試和 KCCQ 都貼上標籤。我認為對我們來說重要的是要指出這一點 - 再說一次，我們不能透露數據，但我們顯然也會關注 SELECT，我們在基線時有 25% 的患者患有穩定型心力衰竭。因此，有很大的機會洩漏到 SELECT 數據作為次要終點，並評估這可能對心力衰竭產生影響。這將使我們不僅能夠將功能評估納入標籤中，而且還可能獲得更難的終點，這顯然取決於數據以及我們與監管機構的互動。

Okay. Thank you, Martin. And in terms of potential, we estimate that approximately 25 million to 30 million people living with HFpEF, of course, a big, big part of them are living with obesity also. So in principle, one could say that Wegovy label almost cover that, if you say a BMI above 27% and obesity-related comorbidities, but it will be very important for us to actually get it in the label so that we're able to promote that. And with that, of course, we are able to establish a differentiator with Wegovy compared to other treatments.

好的。謝謝你，馬丁。就潛力而言，我們估計大約有 2500 萬到 3000 萬 HFpEF 患者，當然，其中很大一部分也患有肥胖症。因此，原則上，人們可以說Wegovy 標籤幾乎涵蓋了這一點，如果你說BMI 高於27% 以及與肥胖相關的合併症，但對我們來說，將其真正納入標籤中非常重要，這樣我們就能夠促進這一點。當然，與其他治療方法相比，我們能夠通過 Wegovy 建立差異化優勢。

Thank you, Martin. Thanks, Camilla. So we're ready for the next, and I will give it to Emily.

謝謝你，馬丁。謝謝，卡米拉。所以我們已經為下一個做好了準備，我會把它交給艾米麗。

Emily Field from Barclays. I wanted to follow up on one of Doug Langa's answers yesterday about SELECT maybe having the potential to change the attitude of Medicare? Just how would that work is that you need to have that added to the label first and then Medicare could have those discussions? And then also if there was -- I believe the treatment prevent obesity was reintroduced into the Senate this summer. So any updates on the progression of that legislation?

巴克萊銀行的艾米麗·菲爾德。我想跟進 Doug Langa 昨天關於 SELECT 可能有潛力改變 Medicare 態度的回答之一？您需要先將其添加到標籤中，然後醫療保險才能進行這些討論，這將如何運作？然後，如果有的話——我相信預防肥胖的治療方法今年夏天被重新引入參議院。那麼該立法的進展有什麼更新嗎？

Thanks Emily. Lars, will you take that?

謝謝艾米麗。拉爾斯，你願意接受嗎？

Yes. So it's a political process, obviously, and it's hard to predict around that. I feel confident that we'll end up having a courage in Medicare. Exactly when it will happen is hard for us to imagine. You're right that there is now -- it seems like there's bipartisan support of that. But I also know there's a lot of other health care discussions going on. So how this priority is hard to say. You can imagine then when a population has been on obesity treatment in, say, in the workforce and being active taxpayers and eventually retire.

是的。因此，顯然這是一個政治過程，很難對此進行預測。我相信我們最終會在醫療保險方面擁有勇氣。究竟什麼時候會發生我們很難想像。你說得對，現在似乎得到了兩黨的支持。但我也知道還有很多其他醫療保健討論正在進行。所以這個優先級如何很難說。你可以想像一下，當一群人在工作中接受肥胖治療並成為積極的納稅人並最終退休時。

You would also expect to have support for such an intervention there. So I think we'll get there. Short term, it's not something that's rate-limiting for our ability to drive growth because we have maybe 0.5 million patients on treatment, and we have access to 45 million patients. So there's ample of patients for us to source from short term as we build this broad access.

您還希望在那裡獲得對此類干預的支持。所以我想我們會到達那裡。短期來看，這不會限制我們推動增長的能力，因為我們可能有 50 萬患者正在接受治療，並且我們可以接觸到 4500 萬患者。因此，當我們建立廣泛的渠道時，我們可以在短期內找到大量患者。

Thank you. We are ready for the next question. I'll give it to Mark Purcell.

謝謝。我們準備好回答下一個問題了。我會把它交給馬克·珀塞爾。

Thank you, Daniel. It's Mark Purcell from Morgan Stanley. A question for Martin. Martin, when you look back at outcome trials, including SUSTAIN 6, PIONEER 6 you look at the STEP program, you look at the NASH studies. Could you help us understand what percentage of the cardiovascular benefit you believe is weight related? And what percentage is non-weight-related? And maybe then to Camilla, how will you educate and promote the message that the quality of weight loss might be different with sema versus competing incretins?

謝謝你，丹尼爾。我是摩根士丹利的馬克·珀塞爾。問馬丁一個問題。馬丁，當你回顧結果試驗時，包括 SUSTAIN 6、PIONEER 6，你會看到 STEP 計劃，你會看到 NASH 研究。您能否幫助我們了解您認為與體重相關的心血管益處的百分比是多少？與體重無關的百分比是多少？也許卡米拉，您將如何教育和宣傳這樣的信息：sema 與競爭性腸促胰島素的減肥質量可能不同？

Thanks very much for what I think is a very important question. Obviously, we can see across the board maybe take a step back. When we look at the effect of, for example, semaglutide on cardiovascular benefit, we can look at different variables and their attribution to that effect. And we do that through what we call a mediation analysis. And in that, we can look at various different parameters.

非常感謝您提出我認為非常重要的問題。顯然，我們可以全面看到可能會退一步。例如，當我們研究索馬魯肽對心血管益處的影響時，我們可以查看不同的變量及其對該影響的歸因。我們通過所謂的中介分析來做到這一點。在此，我們可以查看各種不同的參數。

It's relevant, for example, for semaglutide to look at weight loss to look at glycemic control, to look at blood pressure, to look at lipid lowering and potentially also to look at inflammation and other factors. And we know already from diabetes that -- it's not a loss. It's not just a glycemic control. In all of our stories, the anti-inflammatory effects of semaglutide has popped up as being quite important, almost out there with the weight loss and the glycemic control.

例如，索馬魯肽與減肥、血糖控制、血壓、降脂以及可能還與炎症和其他因素相關。我們已經從糖尿病中知道——這不是損失。這不僅僅是血糖控制。在我們所有的故事中，索馬魯肽的抗炎作用都顯得非常重要，幾乎與減肥和血糖控制一樣。

I can't disclose the data from SELECT but obviously, we will do mediation analysis here also to explain how -- what is driving the 20% MACE benefit that we see with semaglutide. And my assumption will be that just like we see it in diabetes, it will be in part weight loss, but it will also be the anti-inflammatory effects, but probably also some glycemic control and the other parameters. So I think it's important to take a holistic approach to this. It's not just about the weight loss. It's not just about utilizing control, but it's the bigger picture of benefits that we see with semaglutide.

我不能透露來自 SELECT 的數據，但顯然，我們將在這裡進行中介分析，以解釋是什麼推動了我們在索馬魯肽中看到的 20% MACE 益處。我的假設是，就像我們在糖尿病中看到的那樣，它會部分減輕體重，但也會有抗炎作用，但也可能有一些血糖控制和其他參數。所以我認為採取整體方法來解決這個問題很重要。這不僅僅是減肥的問題。這不僅僅是利用控制，而是我們看到索馬魯肽帶來的更大的好處。

Thanks, Martin. And a quick comment from you, Camilla.

謝謝，馬丁。還有你的簡短評論，卡米拉。

Yes. So exactly as a follow-up to what Martin is saying, with Wegovy, that is the only product that so far has proven the cardiovascular outcomes reduction in terms of MACE benefit. And when we will disclose a little bit more about the elements of that, then that is, of course, also a clear differentiator for us in terms of how we will promote the products going forward. And you will hear much more about that when we publish more details. But what we can promote always depends on what Martin can deliver. So that's how things are constructed.

是的。因此，正如 Martin 所說的那樣，Wegovy 是迄今為止唯一能證明 MACE 益處可降低心血管結局的產品。當我們披露更多有關其中要素的信息時，當然，這對於我們未來如何推廣產品而言也是一個明顯的差異化因素。當我們發布更多細節時，您會聽到更多相關信息。但我們能推廣什麼始終取決於馬丁能提供什麼。這就是事物的構造方式。

Thanks, Camilla. We'll move down here to Pete.

謝謝，卡米拉。我們將搬到皮特這裡。

Peter Verdult, Citi. One question, Martin again. Rewind and sustain, if I recall, the event rate was around 9% to 12%, and I realize that's a different population, they were diabetics. But I'm not asking you to disclose the data SELECT, but can you just help us -- I'm assuming that this population, the assumed event rate was much lower. Is that a fair assumption? Or can you at least tell us going into the study? I don't want to know the data but what you were assuming the event rate would be in this population.

彼得·韋爾杜，花旗銀行。還有一個問題，馬丁。回過頭來，如果我沒記錯的話，事件發生率約為 9% 到 12%，我意識到這是一個不同的人群，他們是糖尿病患者。但我並不是要求你透露 SELECT 數據，而是你能幫助我們嗎？我假設這個人群的假設事件發生率要低得多。這是一個公平的假設嗎？或者您至少可以告訴我們如何進行這項研究嗎？我不想知道數據，但想知道您假設該人群中的事件發生率是多少。

Thanks, Pete. And Martin, Pete doesn't want to know the data, but you still had a question.

謝謝，皮特。馬丁、皮特不想知道數據，但你仍然有一個問題。

So you're exactly right. Our assumptions were that typically, we hear on a maybe a little more per year with SELECT we assumed approximately half of that. And I think it's fair to say, without disclosing any data, we were not that far off, slightly above 2.

所以你是完全正確的。我們的假設是，通常情況下，我們每年聽到的 SELECT 消息可能會多一點，我們假設大約是一半。我認為可以公平地說，在不透露任何數據的情況下，我們離這個目標並不遙遠，略高於 2。

Thanks, Martin. We'll move to Simon here.

謝謝，馬丁。我們將搬到西蒙這裡。

Simon Baker from Redburn. I'll kick this one a bit more general because we've been asked this a lot this week. And a question is on margins and the outlook for margins. There are 2 schools of thought that given your growth, there is inevitably significant operational leverage in the business and margins will rise significantly over time. There are others saying that you have a lot of investment in R&D going forward as you broaden your therapeutic base.

來自雷德本的西蒙·貝克。我會更籠統地討論這個問題，因為本週我們被問到了很多。還有一個問題是關於利潤率和利潤率的前景。有兩種觀點認為，鑑於您的增長，業務中不可避免地會存在巨大的運營槓桿，並且利潤率將隨著時間的推移而顯著上升。還有人說，隨著您擴大治療基礎，您將在研發方面進行大量投資。

And there are others saying there's only so far you can let margins rise before it becomes an issue with payers. So the question is not such a guidance, but how do we think about that in terms of how far margins could rise and how far margins should rise over time?

還有人表示，在這成為付款人的問題之前，你只能讓利潤率上升。因此，問題不是這樣的指導，而是我們如何考慮利潤率可以上升多少以及隨著時間的推移利潤率應該上升多少？

Karsten, I think that's for you.

卡斯滕，我想那是給你的。

That's well selected, Daniel. So in terms of margin, as we commented on before, our starting point being north of 40% in terms of operating margin is top quartile industry. We're not adjusting for anything, as you know. So a really competitive starting point. So our strategy as a company in terms of resource allocation is not driven by margin leverage. It's driven by top line growth. Top line growth is really our top priority then investing in the business in a rational way. And so at the last Capital Markets Day, we indicated it will be broadly flat given different puts and takes, especially investing in R&D.

這是精心挑選的，丹尼爾。因此，就利潤率而言，正如我們之前評論的那樣，我們的起點是營業利潤率超過 40%，屬於行業前四分之一。如您所知，我們不會針對任何事情進行調整。這是一個真正有競爭力的起點。因此，我們作為一家公司在資源配置方面的戰略並不是由利潤槓桿驅動的。它是由營收增長推動的。營收增長確實是我們的首要任務，然後才是以理性的方式投資業務。因此，在上一個資本市場日，我們表示，考慮到不同的看跌期權，尤其是研發投資，它將大致持平。

And -- but what we didn't fully foresee at the last CMD is quarters like we just passed with 36% growth. And as I said at Q1, when we grow at this pace, then there will be margin leverage. The magnitude of margin leverage is, of course, depending on the investment opportunity. So if I just go through some of the main puts and takes, then for our gross margin, then given the product mix of what's driving top line growth, then that creates a margin -- a gross margin expansion opportunity. Of course, it's partially being offset by some pricing/mix.

但我們在上一屆 CMD 中沒有完全預見到我們剛剛過去的季度增長率為 36%。正如我在第一季度所說，當我們以這種速度增長時，就會出現保證金槓桿。當然，保證金槓桿的大小取決於投資機會。因此，如果我只考慮一些主要的看跌期權，那麼我們的毛利率，然後考慮到推動營收增長的產品組合，那麼這就創造了利潤——毛利率擴張的機會。當然，它部分地被一些定價/組合所抵消。

And secondly, it's also being impacted by our significant CapEx program because part of our CapEx program even though most goes to the balance sheet, there are certain parts that goes into the P&L. But net-net, slightly improving gross margin. It's already at a high level, as you know, at 85. SG&A, there we'll have leverage since we have the infrastructure more or less in place. There will be investments in driving and delivering on the growth opportunities we have.

其次，它也受到我們重要的資本支出計劃的影響，因為我們的資本支出計劃的一部分即使大部分進入資產負債表，但也有某些部分進入損益表。但淨利潤淨增，毛利率略有改善。如您所知，它已經處於較高水平，SG&A 為 85。我們將擁有槓桿作用，因為我們或多或少擁有適當的基礎設施。我們將進行投資來推動和實現我們擁有的增長機會。

But of course, when we are rate limited on certain products, then of course, we don't put more money behind it. That would be a distraction. And then finally, in R&D, this really comes back to the opportunity. So we see -- when you look at our R&D ratio, then below industry -- and of course, with the growth rate we have, we also need to replenish our pipeline to build our company for the longer term. And that's where we're stepping up both in our anti -- and when you look at this year Inversago, I'm not adjusting for anything linked to BD, right? So that's part of the 3 percentage point guidance upgrade this year. That covers whatever trial running cost related to Inversago as an example, and BIOCORP.

但是，當然，當我們對某些產品進行費率限制時，我們當然不會投入更多資金。那會分散注意力。最後，在研發方面，這真正回到了機會。所以我們看到——當你看看我們的研發比率時，然後低於行業——當然，隨著我們的增長率，我們還需要補充我們的管道，以建立我們公司的長期發展。這就是我們加強反對的地方——當你看看今年的 Inversago 時，我不會調整任何與 BD 相關的內容，對嗎？這是今年指導值上調 3 個百分點的一部分。這涵蓋了與 Inversago 和 BIOCORP 相關的任何試運行成本。

So I expect R&D ratio to go up over time. And net-net, this year, around 30% sales growth that will deliver margin expansion. And then we'll come back to more specifically in the years to come when we come on top line guidance. To what extent that opens up for margin expansion.

所以我預計研發比率會隨著時間的推移而上升。今年的淨銷售額增長約 30%，這將帶來利潤率的擴張。然後，當我們在未來幾年提出頂線指導時，我們將更具體地回過頭來討論。在多大程度上可以擴大利潤率。

Thanks, Karsten. So we are ready for the next.

謝謝，卡斯滕。所以我們已經為下一步做好了準備。

Jo Walton at Credit Suisse. I'm going to follow on from Simon, I think. And just look at pricing going forward. So it's all very well having a drug that you sold to 0.5 million people. But if you sell it to 45 million people, society isn't going to pay anywhere near the same price. And I would imagine that at the moment because everybody, yourselves and Lilly, both in diabetes and obesity are capacity constrained. You're actually okay on pricing. But if I look going forward, I wonder how competitive that might be and how low the prices might go.

瑞士信貸銀行的喬·沃爾頓。我想我會繼續西蒙的做法。看看未來的定價。因此，將一種藥物出售給 50 萬人，這一切都很好。但如果你把它賣給 4500 萬人，社會將不會支付接近相同的價格。我想，目前，因為每個人，包括你們自己和禮來公司，在糖尿病和肥胖方面的能力都受到限制。其實你的定價沒問題。但如果我展望未來，我想知道它的競爭力如何以及價格可能會低到什麼程度。

I note, for example, that Kaiser Permanente is removed Ozempic and Trulicity and gone 100% Mounjaro for their Medicare plan, at least that's what it says on the website. So that's just giving you an idea that there are payers out there who could just go 1 way or the other. So I was wondering how you felt we should be looking at pricing because we're very good at assuming that there's massive increase in penetration, and we're not always as good at assuming that the price comes down to match.

例如，我注意到 Kaiser Permanente 刪除了 Ozempic 和 Trulicity，並在其 Medicare 計劃中採用了 100% Mounjaro，至少網站上是這麼說的。所以這只是讓你知道有些付款人可以選擇一種方式或另一種方式。所以我想知道你覺得我們應該如何看待定價，因為我們非常擅長假設滲透率大幅增加，但我們並不總是擅長假設價格會下降以匹配。

Thanks, Jo. Karsten or Lars, I don't know who want to go.

謝謝，喬。卡斯滕或拉爾斯，我不知道誰想去。

So in our obesity price point, that is somehow say, historically determined because there was, say, an anchor point in the diabetes indication for Victoza in the market. And then because of linearity, we ended up at the price point we are at now. And then you can say, what is the payer reaction so far, that is actually a willingness to pay that. And that also goes when the payer is an individual person that has tried a lot of different attempts to lose weight.

因此，在我們的肥胖價格點上，這在某種程度上是由歷史決定的，因為市場上 Victoza 的糖尿病適應症有一個錨點。然後由於線性，我們最終達到了現在的價格點。然後你可以說，到目前為止付款人的反應是什麼，實際上是願意付款。當付款人是一個嘗試過很多不同減肥嘗試的個人時，情況也是如此。

So I actually think there is an attractive value case. And that value case is just getting better because many of those patients, as alluded to by Camilla and Martin are living with a number of diseases. And now we have a product like Wegovy that's about to be unfold in the number of indications that is actually supporting and many patients would benefit from all of these indications.

所以我實際上認為有一個有吸引力的價值案例。這個價值案例正在變得更好，因為正如卡米拉和馬丁提到的那樣，許多患者都患有多種疾病。現在我們有了像 Wegovy 這樣的產品，即將在實際支持的適應症中展開，許多患者將從所有這些適應症中受益。

We also know that depending on which market we're talking about, that we typically launch at the highest price and then rebate takes it down over time despite the fact that we actually add more and more value to the product. If you look in the single payer territory like what we have in Europe, I think payers are trying to figure out how can we open up for obesity medicine. And we're also trying to look at how can we actually make sure that -- when you get to markets, we actually collaborate with single payers in making sure that those who are structuring the most, that is a psychonomic element to obesity also that those who would not be able to pay out of pocket themselves that we actually work with health care systems to make sure that they are addressed, acknowledging that no health care systems would actually be able to cater for the patients.

我們還知道，根據我們所討論的市場，我們通常會以最高價格推出產品，然後隨著時間的推移，折扣會降低價格，儘管事實上我們實際上為產品增加了越來越多的價值。如果你看看我們在歐洲的單一付款人領域，我認為付款人正在試圖弄清楚我們如何才能開放肥胖醫學。我們還試圖研究如何真正確保——當你進入市場時，我們實際上與單一付款人合作，確保那些結構最多的人，這是肥胖的心理因素那些無法自掏腰包的人，我們實際上與醫療保健系統合作，以確保他們的問題得到解決，並承認沒有任何醫療保健系統實際上能夠滿足患者的需求。

And then there will be out-of-pocket segments. So I think we'll see different payer channels or structures, so to say, in different markets where we have an opportunity of getting to actually creating a societal impact that's recognized and that the payers will be willing to pay for, whether that's a health care system or individuals. And I think we'll have an immense impact on health at a population level by this intervention that I think will be recognized and appreciated.

然後會有自付費用部分。因此，我認為我們會在不同的市場中看到不同的付款渠道或結構，在這些市場中，我們有機會真正創造出公認的社會影響，並且付款人願意為此付費，無論這是否是健康問題。護理系統或個人。我認為，通過這種干預措施，我們將對人口健康產生巨大影響，我認為這種影響將會得到認可和讚賞。

So we'll go here to Richard.

那麼我們就去找理查德吧。

Richard Parkes from BNP Paribas Exane. Just on SELECT, so in theory, if you get a secondary prevention label from the FDA, that could allow for Medicare reimbursement. So I'm just wondering how confident you are that might be the case? And what number of patients or individuals that could unlock? I think it feels like it could be 10 million to 15 million lives in the U.S. So just wondering if you could talk about that.

法國巴黎銀行的理查德·帕克斯 (Richard Parkes)。就 SELECT 而言，理論上來說，如果您獲得 FDA 的二級預防標籤，就可以獲得醫療保險報銷。所以我只是想知道你對這種情況有多大信心？可以解鎖多少患者或個人？我認為美國可能有 1000 萬到 1500 萬人的生命，所以我想知道你是否可以談談這個問題。

Karsten, will you take that?

卡斯滕，你願意接受嗎？

So thanks for that question. And I think it puts a little bit on what we discussed before. So getting it on label, of course, strengthens our position, vis-a-vis, that is obese medication should be available for all people with obesity in the U.S. When we look at the magnitude, as Lars covered before, if you look at it today, call it, 100 million adults with obesity in the U.S., almost half of those with insurance coverage and 1% of those with insurance coverage on nonalcoholic medication today, 1%.

謝謝你提出這個問題。我認為這對我們之前討論的內容有所幫助。因此，將其貼在標籤上當然會加強我們的立場，即肥胖藥物應該為美國所有肥胖患者提供。當我們考慮其嚴重程度時，正如拉斯之前提到的，如果你看一下今天，美國有1 億成年人患有肥胖症，其中幾乎一半有保險，而今天有1% 的人有非酒精藥物保險，1%。

So the runway on what we have currently is fantastic. But -- and then with the Medicare coming on, it's a political process. So there's no simple causality between clinical trial outcomes even though we would like it and then legislation because it requires a list of change. That's a political process. It will come, we think, but it's politics. Let's see when it comes.

所以我們目前擁有的跑道非常棒。但是，隨著醫療保險的推出，這是一個政治過程。因此，臨床試驗結果之間不存在簡單的因果關係，即使我們希望它和立法，因為它需要一系列的改變。這是一個政治過程。我們認為它會到來，但這是政治。讓我們看看它什麼時候到來。

I suppose my question was could allow for reimbursement by Medicare with outlets and for the secondary endpoint....

我想我的問題是可以允許醫療保險通過網點和次要終點進行報銷......

So it is a potential, but that's something we're looking into whether -- but it would not being necessarily slammed on to get a broader approach to Medicare Part D through the CV benefit or the heart failure trial. But there could be some opening, vis-a-vis, reimbursement, but it's not something that is fully clarified at this point, what would the process be in terms of, you could say, if not the STEP at it, but the paper work to get to that reimbursement. So that's not clarified at this point. Sorry for not being clear.

所以這是一種潛力，但這是我們正在研究的事情，但不一定會通過CV福利或心力衰竭試驗來獲得更廣泛的醫療保險D部分方法。但是，相對於報銷，可能存在一些開放性，但目前還沒有完全澄清，您可以說，如果不是步驟，而是文件，那麼該過程是什麼？努力獲得補償。所以目前還沒有澄清。抱歉沒說清楚。

Thanks, Karsten. So we'll move over here.

謝謝，卡斯滕。所以我們就搬到這裡來吧。

Rajesh Kumar from HSBC. Just -- thank you very much for indicating that you're putting up R&D. You would invest more. When you think of capital allocation over the next 3 to 5 years, which -- would it be more towards organic R&D or acquisitions? And if so, how do you -- what are the thresholds you put internally? So in that context, if you could help us unpack the latest valuation you paid for the acquisition, what was the thinking behind it? What was the logic? And cannabinoid receptor, a lot of get worried when we hear about that. But you found DKK 1 billion-plus valuation for that. So it would really help if you could unpack that.

來自匯豐銀行的拉傑什·庫馬爾。只是——非常感謝您表明您正在投入研發。你會投資更多。當您考慮未來 3 到 5 年的資本配置時，哪個會更傾向於有機研發還是收購？如果是這樣，你如何——你在內部設定的門檻是什麼？因此，在這種情況下，如果您能幫助我們了解您為此次收購支付的最新估值，其背後的想法是什麼？邏輯是什麼？還有大麻素受體，當我們聽到這個消息時，很多人都會感到擔心。但你發現它的估值超過 10 億丹麥克朗。所以如果你能解開它，那真的會有幫助。

I don't know, Martin, if you will start by giving the rationale from your perspective and then others can chip in.

我不知道，馬丁，你是否會首先從你的角度給出理由，然後其他人可以加入進來。

I wanted to chip in here. But I think when we look at in versus external innovation, it's very, very clear. You will not be successful with external innovation if you don't have very strong internal innovation. So without putting a number, it's very, very clear, we have an ambition in all of our disease areas to have strong internal innovation, but then complement our internal innovation with what we can acquire from the external. We also have a very clear approach where we go externally. We are not going for late-staged assays. We are going to look at assays that are in late clinical, early clinical, so we can deliver the value and build on those opportunities. .

我想在這裡湊個熱鬧。但我認為，當我們審視內部創新與外部創新時，情況就非常非常清楚了。如果沒有很強的內部創新能力，外部創新就不會成功。因此，無需給出具體數字，就非常非常清楚，我們的雄心是在所有疾病領域擁有強大的內部創新，然後用我們可以從外部獲得的東西來補充我們的內部創新。我們對外也有非常明確的方針。我們不會進行後期分析。我們將研究處於臨床晚期和早期臨床的檢測方法，以便我們能夠提供價值並利用這些機會。 。

Obviously, there's a little bit of a high risk, but there's also more value creation by taking this approach. Specifically for the Inversago, I don't think you should be worried because you're absolutely right with the CB1 antagonism that there have been historically problems. But these are molecules that have primarily worked in the central part of the body, so in the brain, where they obviously introduced some efficacy in terms of wait loss, but also some quite serious side effects.

顯然，存在一點高風險，但採用這種方法也可以創造更多價值。特別是對於 Inversago，我認為你不應該擔心，因為你對 CB1 的對抗性認為歷史上存在問題是完全正確的。但這些分子主要在身體的中央部分起作用，因此在大腦中，它們顯然在等待損失方面帶來了一些功效，但也帶來了一些相當嚴重的副作用。

With the INV202, we have a CB1 inverse agonist that primarily works in the peripheral tissue. That actually calls for a really good efficacy but also calling for minimization of the historical adverse effects because the impact on the brain is minimized. And that also means that when we look at clinical data, it was very, very clear in the historical trials, it was present in 30% of the patients. So it's pretty easy to spot. And it occurred within 2 to 3 weeks after treatment initiation.

INV202 是一種主要作用於外周組織的 CB1 反向激動劑。這實際上需要非常好的療效，但也需要盡量減少歷史上的不利影響，因為對大腦的影響已經最小化。這也意味著當我們查看臨床數據時，在歷史試驗中非常非常清楚，30% 的患者存在這種情況。所以很容易發現。它發生在治療開始後 2 至 3 週內。

So we can actually allow ourselves to look at the clinical data even if it's Phase I/II data that we're looking at -- and we'll get some confidence that say that they had actually managed to derisk this through a peripheral mode of action and not a central mode of action. So then we take a very deliberate approach to how we do excel innovation and investment. And I don't think you should be too concerned about the CLAVO acquisition.

因此，我們實際上可以讓自己查看臨床數據，即使我們正在查看的是 I/II 期數據，而且我們會獲得一些信心，表明他們實際上已經設法通過外圍模式消除了這種風險。行動而不是中心行動模式。因此，我們採取了非常審慎的方法來推動創新和投資。我認為你不應該太擔心 CLAVO 的收購。

And for clarification, Karsten on evaluation?

為了澄清一下，卡斯滕的評估？

Yes. Very briefly, the DKK 1 billion you alluded to, that's a biotech dollars. So we didn't pay DKK 1 billion upfront, just to be clear about that. And the way we think about it is basically, we do an asset valuation like we do on our internal projects, including upfront and whatever subsequent liabilities. And compare that to the risk of the project and the potential future value opportunity in the space.

是的。簡而言之，您提到的 10 億丹麥克朗，是生物技術領域的美元。因此，我們沒有預先支付 10 億丹麥克朗，只是為了澄清這一點。我們的思考方式基本上是，我們像內部項目一樣進行資產評估，包括前期和任何後續負債。並將其與項目的風險和該領域潛在的未來價值機會進行比較。

And I think this one is actually from a -- and then we do deriskings on top of that. So pretty straightforward as any other asset acquisition. And on this one specifically, I think it works out nicely between the upfront and the risk and the market opportunity. And then we front-load, the derisking of the assets. So from a financial point of view, the CFO is having.

我認為這實際上是來自——然後我們在此基礎上進行去風險處理。與任何其他資產收購一樣非常簡單。具體來說，我認為在前期、風險和市場機會之間效果很好。然後我們預先加載，降低資產的風險。所以從財務角度來看，CFO 是有的。

That's good to know, Karsten. And David, we'll move to you.

很高興知道，卡斯滕。大衛，我們搬到你那裡去。

Dave Evans from Kepler Cheuvreux. So just a question on the SELECT study population. So as I understand this is kind of a subset of ASCVD patients basically, so probably less than 10% of the overall obesity population, if that's fair. I mean, can we extrapolate the results to the broader population and patients who are just CV risk. I mean, especially given what we saw in Leader in SUSTAIN 6 that there was a big difference between efficacy in patients with preexisting CV disease, not really not much of a trend in patients without. So is it actually a different debate around whether you get coverage in ASCVD patients versus the broader population? Or will payers look at this somehow the same population or read across?

來自 Kepler Cheuvreux 的戴夫·埃文斯 (Dave Evans)。這只是關於 SELECT 研究人群的問題。據我了解，這基本上是 ASCVD 患者的一個子集，所以如果公平的話，可能不到總體肥胖人群的 10%。我的意思是，我們能否將結果推斷到更廣泛的人群和有心血管風險的患者。我的意思是，特別是考慮到我們在SUSTAIN 6 的Leader 中看到的情況，即患有先前存在的CV 疾病的患者之間的療效存在很大差異，而對於沒有患有CV 疾病的患者來說，這種趨勢並不是沒有太大的趨勢。那麼，關於 ASCVD 患者與更廣泛人群是否獲得承保的爭論實際上是不同的嗎？或者付款人會以某種方式看待相同的人群或閱讀不同的內容嗎？

I think, Martin, you can start.

我想，馬丁，你可以開始了。

Maybe also Camilla wants to chip in. But we have to distinguish between secondary prevention and primary prevention. What we've done with SELECT is secondary prevention. So we have investigated in patients with overweight obesity and a combination of either prior myocardial price drop and peripheral artery disease. It's actually a fairly large shop population, if you will, in the obesity space. And to coming to this point, if there's 750 million people out there, even 10% would be a quite sizable. I actually think it's slightly above 10%.

也許卡米拉也想參與其中。但我們必須區分二級預防和一級預防。我們對 SELECT 所做的就是二級預防。因此，我們對超重肥胖且既往心肌價格下降和外周動脈疾病相結合的患者進行了調查。如果你願意的話，在肥胖領域，實際上有相當大的商店人口。就這一點來說，如果有7.5億人，即使是10%也已經是相當大的數字了。事實上我認為略高於10%。

I don't want to speculate whether payers will extrapolate to primary prevention. We have seen actually in the diabetes space that are examples that if you show secondary prevention, you will likely also show primary prevention. We ourselves are looking into primary prevention within diabetes. I think it's fair to say that we will also discuss whether we need to do that with the obesity. At this point in time, I don't think from a commercial perspective, it's required. But I think it would be interesting to know that from a clinical perspective, so we can continue to guide our prescribing physicians.

我不想猜測付款人是否會推斷出初級預防。實際上，我們在糖尿病領域已經看到了一些例子，如果您採取二級預防措施，那麼您也可能會採取一級預防措施。我們自己正在研究糖尿病的一級預防。我認為可以公平地說，我們還將討論是否需要針對肥胖問題這樣做。目前，我認為從商業角度來看，這不是必需的。但我認為從臨床角度了解這一點會很有趣，這樣我們就可以繼續指導我們的處方醫生。

Thanks, Martin. Camilla, a quick follow-up.

謝謝，馬丁。卡米拉，快速跟進。

Yes, just very shortly to say that 2 out of 3 people living with obesity die from cardiovascular disease, and we know that they incur 2 to 3x higher cost in the health care system. So of course, with the SELECT data as likely to be a high interest from payers to understand how we can bring down those costs.

是的，很快就可以說，三分之二的肥胖者死於心血管疾病，而且我們知道他們在醫療保健系統中承擔的費用高出 2 到 3 倍。當然，付款人可能會對 SELECT 數據非常感興趣，以了解我們如何降低這些成本。

Thank you, Camilla. I'll give the mic to Ben.

謝謝你，卡米拉。我會把麥克風給本。

It's Ben Yeoh at RBC Asset Management. I had a question guys on human capital and organizational resilience. Would you say your execution is average or above average or maybe even below? And you guys are hiring probably at the fastest rate you have ever hired and that obviously causes a lot of friction.

我是加拿大皇家銀行資產管理公司的 Ben Yeoh。我有一個關於人力資本和組織彈性的問題。您認為您的執行力是平均水平還是高於平均水平，或者甚至低於平均水平？你們的招聘速度可能是有史以來最快的，這顯然會造成很多摩擦。

Do you feel that this hiring and the resilience is going well? Do you have enough good people to execute because obviously, a bit supply constrained now, but you're going to need thousands of good people to do this. So I'd be interested on some comments on the human capital side.

您覺得這次招聘和彈性工作進展順利嗎？你是否有足夠的優秀人才來執行，因為顯然，現在供應有點緊張，但你將需要數千名優秀人才來做到這一點。所以我對人力資本方面的一些評論感興趣。

I'll give the word to you, Lars.

我會轉告你的，拉斯。

Thank you. So I think it's a great question. We are a people business. It is people at the end of the day that turns the facilities into products, R&D, et cetera. And the very good point, we have recruited some 8,500 people over a year. So if you talk about, say, whether that's working, you say the HR department is working because they have actually recruited these people the majority of them goes into manufacturing. And when you work in manufacturing, obviously, you need to work in compliance. So there's a significant onboarding task and training task going on.

謝謝。所以我認為這是一個很好的問題。我們是一家以人為本的企業。最終是人們將設施轉化為產品、研發等。非常好的一點是，我們一年多以來就招募了大約 8,500 名員工。因此，如果你談論這是否有效，你會說人力資源部門正在工作，因為他們實際上已經招募了這些人，其中大多數人進入了製造業。顯然，當您從事製造業工作時，您需要合規工作。因此，正在進行一項重要的入職任務和培訓任務。

And when we talk about ramping up capacity and supplies, that's of course, a function of that, that it takes time to train people. I believe, and I have to make the disclaimer that I'm biased because I've been with the company for 32 years. I believe we have a unique culture, what we call the Novo Nordisk way, based on a set of personal values that we actually assess leaders on whether they walk work each and every day and the consequences of not doing that.

當我們談論提高產能和供應量時，這當然是一個原因，因為培訓人員需要時間。我相信，而且我必須聲明我有偏見，因為我已經在這家公司工作了 32 年。我相信我們有一種獨特的文化，我們稱之為諾和諾德方式，它基於一套個人價值觀，我們實際上根據領導者是否每天步行工作以及不這樣做的後果來評估他們。

So I spent quite some time in understanding from newcomers how they assess joining Novo Nordisk. And the first comment I typically get is one in relation to the culture and the consistency between what we actually say we do and what we do. And apparently, that's a unique feature. And I don't know because I've never tried other places than Novo Nordisk. So it's something we really work hard on. And we're right now rolling out say, a double down on Novo Nordisk way onboarding and education because among those 8,500 new colleagues are also leaders. So it's really, really important for me, my colleagues and each and everyone work to talk in terms of culture. I think that's the best guarantee for turning that investment in people into assets that helps patients at the end of the day.

所以我花了相當多的時間來了解新人對加入諾和諾德的評價。我通常得到的第一條評論與文化以及我們實際所說的和我們所做的之間的一致性有關。顯然，這是一個獨特的功能。我不知道，因為除了諾和諾德之外，我從未嘗試過其他地方。所以這是我們真正努力的事情。我們現在正在推出雙倍的諾和諾德入職和教育方式，因為在這 8,500 名新同事中也是領導者。因此，對我、我的同事以及每個人來說，談論文化真的非常非常重要。我認為這是將對人員的投資轉化為最終幫助患者的資產的最佳保證。

Thanks, Lars. We have one here.

謝謝，拉爾斯。我們這裡有一個。

Harry Gillis from Berenberg. So just a quick question on oral Wegovy and whether you can give any indication when you may look to assuming approval when you may launch this product? I'm just trying to understand a sense of how viable a large-scale launch would be given the sort of higher API requirements? And so do you feel confident that maybe in the sort of medium term, you'll be able to meet those requirements? And if I may also ask, just -- I know you may not sort of give any details, but at a high level how you may think about pricing the sort of oral version versus the injectable?

來自貝倫貝格的哈利·吉利斯。那麼，我想問一個關於口頭 Wegovy 的簡單問題，以及您是否可以給出任何指示，表明您何時可能希望獲得批准，何時可以推出該產品？我只是想了解一下，在更高的 API 要求下，大規模發布的可行性如何？那麼您是否有信心在中期內能夠滿足這些要求？如果我也可以問，只是 - 我知道您可能不會提供任何細節，但從高水平來看，您會如何考慮口服版本與註射劑的定價？

Thanks for that question. Camilla?

謝謝你提出這個問題。卡米拉？

Yes. So while I cannot comment on pricing at this point in time, I can comment on the perspective of 50-milligram semaglutide, oral semaglutide. Of course, we are very happy with the result that shows similar efficacy to Wegovy is 2.4 milligram. When we are looking at time to launch, we first need to, of course, this approved. And after approval, we will be considering how we can scale this depending of course, on demand, and capacity.

是的。因此，雖然我目前無法評論定價，但我可以評論 50 毫克索馬魯肽口服索馬魯肽的觀點。當然，我們對結果感到非常滿意，它顯示出與 Wegovy 類似的功效，即 2.4 毫克。當我們考慮啟動時間時，當然，我們首先需要獲得批准。獲得批准後，我們​​將考慮如何根據需求和容量來擴展這一規模。

I'm saying that because, of course, you all know that an oral version requires more APIs than an injectable version. So this rollout, of course, is likely to be depending on how things are developing at that point in time in terms of demand and supply, knowing that we want to make sure we can cater for as many patients as possible. And the demand right now seems to be, of course, very high. And therefore, those are the considerations we have. But much more about that when it's all approved.

我這麼說是因為，當然，你們都知道口服版本比注射版本需要更多的 API。因此，當然，這次推出可能取決於當時需求和供應方面的情況發展，因為我們知道我們希望確保能夠滿足盡可能多的患者的需求。當然，現在的需求似乎非常高。因此，這些就是我們的考慮因素。但當一切都獲得批准後，還會有更多的事情發生。

Thank you so much, Camilla. So we have time for a few more questions. I think we're back at our host.

非常感謝你，卡米拉。所以我們還有時間再問幾個問題。我想我們回到了我們的主人身邊。

Sachin Jain, Bank of America, again. One for Martin and then one big picture. Would it really discuss GGG much at ADA, and you had a similar mechanism internally that you sort of preferred category for just any perspectives on how you believe you'll follow on compared to Lilly's follow-on. And I guess if you could just comment on your perspective on safety and then diabetes profile because I don't think they started with Phase III in diabetes.

再次是美國銀行的 Sachin Jain。一張是給馬丁的，然後是一張大照片。它真的會在 ADA 中大量討論 GGG嗎？你們內部也有一個類似的機制，您認為與 Lilly 的後續行動相比，您認為自己將如何跟進的任何觀點都傾向於選擇類別。我想您是否可以評論一下您對安全性和糖尿病概況的看法，因為我認為他們不是從糖尿病的第三階段開始的。

And then a big picture for Lars. This is a question I get a fair bit, and I'm not sure it's a straightforward answer. GLP-1 consensus at peak cross Novo in Lilly is in the DKK 80 million to DKK 100 million range now. And a question I frequently get even post SELECT is how can the system digest a number much bigger than that. So I wonder if you can touch on that from a couple of aspects in terms of indication breadth, how you think about cash pay of the market? Will the payers digest a much bigger percentage of the pie being a single molecule drug class?

然後是拉斯的大局觀。這是我經常遇到的一個問題，我不確定這是一個簡單的答案。禮來公司 Novo 的 GLP-1 共識目前處於 8000 萬丹麥克朗至 1 億丹麥克朗的範圍內。甚至在 SELECT 之後我經常遇到的一個問題是系統如何消化比這個大得多的數字。所以我想知道您是否可以從指示廣度的幾個方面談一下這個問題，您如何看待市場的現金支付？付款人會消化更大比例的單分子藥物類別嗎？

Thanks, Sachin. We'll start with you, Martin, followed by Lars.

謝謝，薩欽。我們將從你開始，馬丁，然後是拉爾斯。

So I'll not do direct comparisons between our pipeline and our competitors. But I think I can do maybe an indirect in the sense that we also had a GGG in our pipeline a couple of years ago. And we obviously also did a clinical assessment of that. In that, we obviously found it works. It gives a good weight loss, and it could potentially also have a good impact in NASH. But it was more difficult in the diabetes space. There is some inherent challenges in that with glucagon. And maybe the combination and the ratios can rectify that a little bit.

因此，我不會在我們的管道和競爭對手之間進行直接比較。但我想我也許可以做一個間接的，因為幾年前我們的管道中也有一個 GGG。我們顯然也對此進行了臨床評估。在那方面，我們顯然發現它有效。它具有良好的減肥效果，並且還可能對 NASH 產生良好的影響。但在糖尿病領域，情況更加困難。胰高血糖素存在一些固有的挑戰。也許組合和比率可以稍微糾正這一點。

But we also saw other safety issues in the cardiovascular space and had some concerns about the broad in metabolism and effects of glucagon as well. Given that we had agreed we had CagriSema and we have a GGG in our pipeline and we actually saw better efficacy with CagriSema and a more clean safety profile. From a pipeline perspective, that was an easy choice.

但我們也看到了心血管領域的其他安全問題，並對胰高血糖素的廣泛代謝和影響也存在一些擔憂。鑑於我們已經同意我們有 CagriSema 並且我們的管道中有 GGG，我們實際上看到了 CagriSema 更好的功效和更乾淨的安全性。從管道的角度來看，這是一個簡單的選擇。

And therefore, I don't want to speculate what others are doing. I wish them best of luck. I think from an efficacy perspective, we'll see it works. But obviously, again, we are very confident with the efficacy of CagriSema both in diabetes and in obesity. And we're also very confident of the safety profile of CagriSema in diabetes and obesity.

因此，我不想猜測其他人在做什麼。我祝他們好運。我認為從功效的角度來看，我們會看到它有效。但顯然，我們對 CagriSema 在糖尿病和肥胖症方面的功效再次充滿信心。我們對 CagriSema 在糖尿病和肥胖症方面的安全性也非常有信心。

Thanks, Martin. And Lars?

謝謝，馬丁。拉斯呢？

So I think there's no doubt that the GLP-1 opportunity is a very, very sizable one. And your guess about how large this become is as good as ours. I think it's important to dissect this into a number of health benefits. We started looking at type 2 diabetes. We added CV benefit to that. We're now looking at obesity, adding CV benefit to that. We spoke about the HFpEF data in the SELECT study. We started a number of other outcomes. So I think to really assess how big is this drug class and what does it mean for payers. We actually need to start segmenting the value story from a medical benefit position.

所以我認為毫無疑問 GLP-1 的機會是一個非常非常大的機會。你對這個規模有多大的猜測和我們的一樣好。我認為將其分解為許多健康益處很重要。我們開始研究 2 型糖尿病。我們為此添加了 CV 福利。我們現在正在研究肥胖問題，並在此基礎上增加心血管益處。我們討論了 SELECT 研究中的 HFpEF 數據。我們開始了一些其他成果。因此，我認為要真正評估這一類藥物的規模有多大以及它對付款人意味著什麼。我們實際上需要開始從醫療福利的角度來細分價值故事。

And the population we serve, living with, say, broad cardiometabolic disorders. They would otherwise end up on, say, a handful or 2 handfuls of different individual medicines to deal with these medical conditions. And I think it's really attractive is there's one mechanism that can do it all. And I think it creates flexibility in actually how we can -- you can define the value story for payers because they can chip in different values depending on which population they look at. And I think that's a really, really attractive case for us to be engaged here.

我們服務的人群患有廣泛的心臟代謝疾病。否則，他們最終可能會服用一把或兩把不同的藥物來治療這些疾病。我認為真正有吸引力的是有一種機制可以完成這一切。我認為它實際上為我們如何做創造了靈活性——你可以為付款人定義價值故事，因為他們可以根據他們所關注的人群輸入不同的價值。我認為這對我們來說是一個非常非常有吸引力的案例。

Yes. We'll take one final question before we wrap up, but there will still be time for networking.

是的。在結束之前我們將回答最後一個問題，但仍然有時間進行交流。

Mark Purcell from Morgan Stanley. Martin, could you give us your latest thoughts on oral approaches for obesity. So small molecules versus peptides. I guess, covered in this SemaDapa, the decision or to move forward there. Was that a technical reason why you're not moving forward? Can you combine small molecules with the stack technology? Or is there something that you can't do that?

摩根士丹利的馬克·珀塞爾。馬丁，您能給我們介紹一下您對口服肥胖治療方法的最新想法嗎？所以小分子與肽。我想，在這個 SemaDapa 中，決定還是要向前邁進。這是你沒有繼續前進的技術原因嗎？能否將小分子與堆棧技術結合起來？或者有什麼是你不能做的嗎？

And then it's a question of now having done the Inversago deal, and you've talked about combinations. Are you looking at plus small molecule combinations? Or can you combine peptide and small molecules together.

然後問題是現在已經完成了 Inversago 交易，並且您已經談到了組合。您正在尋找加小分子組合嗎？或者你可以將肽和小分子結合在一起。

Thanks, Mark. Martin?

謝謝，馬克。馬丁？

I think both in the incretin space, but also moving across the incretin space, it's always relevant to look at different modalities that obviously comes also to small molecule versus peptide based. From our perspective, what we've seen with the OASIS program with the PIONEER PLUS program, I think if we just look at GLP-1, it's going to be from an efficacy and safety perspective, it will be difficult to show even better efficacy or safety as compared to that.

我認為，無論是在腸促胰島素領域，還是在腸促胰島素領域，研究不同的模式總是相關的，這些模式顯然也涉及小分子與基於肽的。從我們的角度來看，我們在 OASIS 計劃和 PIONEER PLUS 計劃中看到的情況，我認為如果我們只看 GLP-1，從功效和安全性的角度來看，很難表現出更好的功效或與之相比的安全性。

And obviously, that's why we're excited with the PIONEER PLUS and the OASIS data. I think, broadly speaking, if we move them beyond, for example, to Inversago combination, is interesting. I think we see that with our own CagriSema. We see that also from some of our competitors in order to increase efficacy but without having to compromise on safety. We can do that in loose combination combining a subcutaneous and on all, but we could potentially also be looking at combining potential small molecules with small molecules.

顯然，這就是我們對 PIONEER PLUS 和 OASIS 數據感到興奮的原因。我認為，從廣義上講，如果我們將它們超越，例如 Inversago 組合，就會很有趣。我認為我們通過自己的 CagriSema 看到了這一點。我們也從一些競爭對手那裡看到了這一點，目的是提高功效，但又不必犧牲安全性。我們可以通過皮下注射和全身注射的鬆散組合來做到這一點，但我們也可能會考慮將潛在的小分子與小分子結合起來。

Specifically on SemaDapa, you're absolutely right. We terminated that on technical reasons basically because was not really a differentiated profile we saw and showing superiority to the mono components is requiring a really big development program. It was maybe not really warranted in this space.

特別是在 SemaDapa 上，你是絕對正確的。我們出於技術原因終止了這一計劃，主要是因為我們看到的並不是真正的差異化配置，要顯示出對單聲道組件的優越性需要一個非常大的開發計劃。在這個領域可能並沒有真正的保證。

Thank you, Martin. So that concludes our Q&A session. We'll still have a bit of time for networking and opportunity to talk with management. But before we close, finally, Lars any final words from you?

謝謝你，馬丁。我們的問答環節就到此結束。我們仍然有一些時間進行交流並有機會與管理層交談。但最後，在我們結束之前，拉爾斯，您還有什麼想說的嗎？

I'd just like to take this opportunity to thank Sachin and Bank of America for hosting us for all of you coming and the good questions and also you participating on the live stream. As you can hopefully hear, we're hugely excited about the momentum in Novo Nordisk right now. We're equally excited about both the short and the medium and long-term growth prospects of the portfolio of products we have and what we have in our pipeline. So we look forward to report back to you in the coming quarters on this progress. Thank you.

我想藉此機會感謝 Sachin 和美國銀行接待我們，感謝你們所有人的到來、提出的好問題以及你們參與直播。正如您希望聽到的那樣，我們對諾和諾德目前的發展勢頭感到非常興奮。我們對我們擁有的產品組合以及我們正在開發的產品的短期和中長期增長前景同樣感到興奮。因此，我們期待在未來幾個季度向您報告這一進展。謝謝。