諾和諾德 (NVO) 2023 Q4 法說會逐字稿

My name is Mark Purcell from Morgan Stanley. It gives me great pleasure to introduce you to the Novo Nordisk management team here at the London Full Year Results Investor Presentation. We have everybody here I think.

我叫馬克‧珀塞爾，來自摩根士丹利。我很高興在倫敦全年業績投資者介紹會上向您介紹諾和諾德管理團隊。我想我們每個人都在這裡。

And Lars, I'll hand over to you to start the presentation.

Lars，我將讓你開始示範。

Thank you, Mark, and thank you to Morgan Stanley for hosting us today. We are glad to be here and we'll do a quick presentation upfront and then get into Q&A. I have to warn you that we'll be talking about the future so please take due notice to the forward-looking disclaimer on this slide. So overall on performance, we're really pleased with how we exited 2023. We're making good progress on our strategic aspirations. 2023 was a year where we stepped up the number of patients by 5 million and just in context we are now serving in total some 42 million. So 5 million more is a very sizable volume in a scaling perspective. We did that without emitting more CO2 emission. We actually kept logging that also despite the growth. So from a sustainability point of view, we're quite pleased around that. I would also say that from a commercial execution point of view, we have reached 2 of the aspirations we have set for 2025 in terms of diabetes market share and reaching more than DKK 25 billion in obesity sales.

謝謝馬克，也謝謝摩根士丹利今天接待我們。我們很高興來到這裡，我們將預先進行快速演示，然後進行問答。我必須警告您，我們將討論未來，因此請適當注意這張投影片上的前瞻性免責聲明。整體而言，就業績而言，我們對 2023 年的表現感到非常滿意。我們在實現策略目標方面取得了良好進展。 2023 年，我們的患者數量增加了 500 萬，就目前情況而言，我們目前服務的患者總數約為 4,200 萬。因此，從擴展的角度來看，另外 500 萬是一個非常大的數量。我們在沒有排放更多二氧化碳的情況下做到了這一點。儘管有所增長，但我們實際上仍在繼續記錄這一點。因此，從永續發展的角度來看，我們對此感到非常滿意。我還想說，從商業執行的角度來看，我們已經實現了 2025 年設定的 2 個目標：糖尿病市佔率和肥胖症銷售額超過 250 億丹麥克朗。

We keep plowing forward despite the fact we have achieved the targets. We were less fortunate in our rare disease business linked to some specific manufacturing issues on growth hormone. That is being remediated and we hope that we can gradually get back during this year. On the pipeline, we're very pleased with some very strong outcomes data, but we're also pleased that we are making progress both with our organic pipeline and you can see that increasingly Novo Nordisk is also tapping into external innovation. So we'll get a bit more back to the details on that. And the strong execution from a commercial point of view obviously leads to a set of very strong financials and that has also set us up to guide I think in a very nice solid way for 2024 and we'll also get a bit more into that. So very strong year for Novo Nordisk and we are equally excited about 2024 and sustained growth for our business and also some exciting pipeline news to come.

儘管我們已經實現了目標，但我們仍繼續努力前進。我們在與生長激素的一些特定製造問題相關的罕見疾病業務方面就不那麼幸運了。這個問題正在修復中，我們希望能夠在今年內逐步恢復。在管道方面，我們對一些非常強勁的成果數據感到非常滿意，但我們也很高興我們在有機管道方面取得了進展，而且您可以看到諾和諾德也越來越多地利用外部創新。因此，我們將進一步討論這方面的細節。從商業角度來看，強大的執行力顯然會帶來一系列非常強勁的財務狀況，這也讓我們能夠以非常可靠的方式為 2024 年提供指導，我們還將對此進行更多研究。對於諾和諾德來說，這是非常強勁的一年，我們對 2024 年以及我們業務的持續增長以及即將到來的一些令人興奮的管道消息同樣感到興奮。

With that, I'll hand over to Camilla for an update on commercial.

接下來，我將把廣告的最新情況交給卡米拉。

Thank you, Lars. We'll start with an overview of the sales per region and sales in -- we wanted just to give this one, sorry, the sales per region and the sales per therapy area. As you see, 36% sales growth driven by both operating units. North America growing 54% and IO growing 60%. In IO growth is driven by all regions as you see on the slide also. From a therapy area point of view, you see strong growth primarily in GLP-1 in diabetes, but also in obesity. And our primary brands are Ozempic, Wegovy and Rybelsus driving the vast majority of our growth. You also see in obesity care, growth of 154% for the full franchise.

謝謝你，拉爾斯。我們將從每個地區的銷售額和每個治療領域的銷售額的概述開始——我們只想給出這個，抱歉，每個地區的銷售額和每個治療領域的銷售額。如您所見，兩個營運部門推動了 36% 的銷售額成長。北美成長 54%，IO 成長 60%。正如您在幻燈片中看到的那樣，IO 成長是由所有地區推動的。從治療領域的角度來看，您會看到主要是 GLP-1 在糖尿病中的強勁增長，但在肥胖症中也有強勁增長。我們的主要品牌是 Ozempic、Wegovy 和 Rybelsus，推動了我們的成長。您還可以看到，在肥胖護理領域，整個特許經營業務成長了 154%。

In rare disease, we have negative growth primarily driven by production issues in the Norditropin space, but altogether it's 36% growth across all the franchises and operating units. If we zoom in on the 154% growth in obesity, you see here that it primarily consists of Wegovy in the U.S.. But we have now launched Wegovy in 9 countries, including the U.S. And of course in the U.S., we have now also resumed the supply of the starter doses and we continue outside the U.S. with launches in an adaptive fashion with a more restricted supply to make sure that we can continue patients who start on the treatment to also continue on the treatment. We might get back to talk more about obesity later.

在罕見疾病方面，我們的負成長主要是由 Norditropin 領域的生產問題所驅動的，但所有特許經營和營運單位的整體成長為 36%。如果我們放大154%的肥胖成長，你會發現它主要由美國的Wegovy組成。但我們現在已經在包括美國在內的9個國家推出了Wegovy。當然在美國，我們現在也恢復了Wegovy起始劑量的供應，我們繼續在美國境外以適應性方式推出，供應更加有限，以確保我們能夠繼續讓開始接受治療的患者也繼續接受治療。我們稍後可能會回來更多地討論肥胖問題。

So for now, I'll just hand over to Martin to give you an update on R&D.

所以現在，我將把研發工作的最新情況交給 Martin 為您提供。

Thank you very much, Camilla. I'll start with a deep dive into IcoSema I think. So as you know, we've announced the first piece of data for IcoSema. IcoSema is a combination drug between icodec, which is a once weekly insulin and semaglutide, which is obviously our once weekly GLP-1. The IcoSema development program is consisting of 3 studies for the regulatory filing. The first 2 studies are primarily regulatory studies demonstrating that IcoSema is superior to the mono components, the [semaglutide] and insulin icodec in terms of glycemic control, in terms of weight loss and so on. The third study that we have actually and that's a little bit of a paradox reported on first is comparing IcoSema to what we call insulin basal bolus treatment. You'll probably recall that 2/3 of type 2 diabetes patients are on insulin starting with basal insulin, but progressing and this will go for a big proportion of type 2 patients, progressing to what is basal bolus insulin.

非常感謝你，卡米拉。我想我將從深入研究 IcoSema 開始。如您所知，我們已經公佈了 IcoSema 的第一個數據。 IcoSema 是 icodec（每週一次的胰島素）和 semaglutide（顯然是我們每週一次的 GLP-1）之間的組合藥物。 IcoSema 開發計劃由 3 項監管備案研究組成。前兩項研究主要是監管研究，證明 IcoSema 在血糖控制、體重減輕等方面優於單一成分、[索馬魯肽]和胰島素 icodec。我們實際上進行的第三項研究（第一個報告有點矛盾）是將 IcoSema 與我們所謂的胰島素基礎推注治療進行比較。您可能還記得，2/3 的 2 型糖尿病患者從基礎胰島素開始使用胰島素，但會不斷進展，這將適用於很大一部分 2 型糖尿病患者，進展為基礎推注胰島素。

That's 1 basal injection per day plus up to 4 mealtimes injection per day. The average patient takes approximately 3 bolus injections per day. So for simplicity, we'll allow ourselves to say 4 injections per day compared to once weekly injection. That's obviously a tremendous convenience upside to patients if this pans out. And what we did was comparing once weekly IcoSema to 4 daily injections of insulin 52 weeks and in a setting where patients were recruited based on having type 2 diabetes and being on basal insulin only, but in full control. So the results you have already seen, they are quite staggering. So we get hypoglycemia control, which is currently the gold standard in treatment of late stage type 2 diabetes namely the basal bolus treatment. Actually it's numerically a little bit better. At the same time, we see a weight loss with IcoSema where the insulin treated patients get a weight gain.

即每天 1 次基礎注射加上每天最多 4 次用餐時間注射。平均患者每天約進行 3 次推注。因此，為簡單起見，我們允許自己說每天注射 4 次，而不是每週注射一次。如果成功的話，這顯然會為患者帶來巨大的便利。我們所做的是將每週一次的 IcoSema 與 52 週內每天注射 4 次胰島素進行比較，並且在招募患者時，患者患有 2 型糖尿病，並且僅使用基礎胰島素，但病情完全得到控制。所以你已經看到的結果是相當驚人的。這樣我們就能控制低血糖，這是目前治療晚期第2型糖尿病的黃金標準，即基礎推注治療。事實上，從數字上看，它要好一些。同時，我們看到 IcoSema 的體重減輕，而接受胰島素治療的患者體重卻增加。

The net difference was almost 7 kilograms and obviously a substantial benefit to the IcoSema treated patients. Equally significant, we saw a factor of 10x lower risk of hypoglycemia. In the IcoSema arm, we saw around 0.2 events per patient exposed. But in the insulin treatment arm, we saw 10x as more events per patient exposed. All of this obviously means better clinical benefit for the patients; good glycemic control, good weight management and really, really strong hypoglycemia data in terms of a 10x lower risk of hypoglycemia. At the same time, the IcoSema patients could look at 52 injections per year whereas the insulin treated patients on average had 1,450 injections per year. That is a dramatic increase. And normally we don't sort of do a lot in the convenience space because we look primarily at the efficacy and safety.

淨體重差近 7 公斤，顯然對 IcoSema 治療的患者有很大好處。同樣重要的是，我們發現低血糖風險降低了 10 倍。在 IcoSema 組中，我們發現每位暴露患者發生約 0.2 個事件。但在胰島素治療組中，我們發現每位患者暴露的事件數量增加了 10 倍。所有這些顯然都意味著為患者帶來更好的臨床益處；良好的血糖控制、良好的體重管理以及非常非常強的低血糖數據，低血糖風險降低了 10 倍。同時，IcoSema 患者每年可以注射 52 次，而接受胰島素治療的患者每年平均注射 1,450 次。這是一個巨大的成長。通常我們不會在便利領域做太多事情，因為我們主要關注的是功效和安全性。

But I think even we had to say going from 1,450 injections per year to 52, that is something that is incredibly meaningful for patients, for treating physicians and caregivers and it's actually also really, really good for the environment because we can save a lot of devices in that space. So so far, we are super excited about what IcoSema has shown us. We'll continue that journey and the next 2 studies, and these are the pivotal regulatory studies from the IcoSema program, will read out during the first half of this year. If I take sort of the helicopter view, broadly speaking we see really, really strong progress across both our research, but also our development pipeline in all of our therapy areas. We are really, really happy with that progress. And maybe if I allow myself to start just looking at a little bit back to Q4. Obviously we're very excited about the STEP HFpEF results. We now have readout from both STEP HFpEF in obesity and in diabetes.

但我認為，即使我們不得不說，從每年1,450 次注射增加到52 次，這對患者、治療醫生和護理人員來說都非常有意義，而且實際上對環境也非常非常有益，因為我們可以節省大量資金。該空間中的設備。到目前為止，我們對 IcoSema 向我們展示的內容感到非常興奮。我們將繼續這趟旅程，接下來的兩項研究是 IcoSema 計畫的關鍵監管研究，將於今年上半年公佈。如果我採取某種直升機視角，那麼從廣義上講，我們在我們的研究以及所有治療領域的開發管線中都看到了非常非常強勁的進展。我們對這項進展感到非常非常高興。也許如果我允許自己開始稍微回顧一下第四季。顯然，我們對 STEP HFpEF 結果感到非常興奮。我們現在已經獲得了肥胖和糖尿病的 STEP HFpEF 讀數。

Very consistent data showing that we can actually make a difference in a patient population that has a significant unmet need and is severely underserved. We have seen the readout from the osteoarthritis study and obviously we've seen readout, and this has caused some attention, from the oral amycretin study. Looking into what's going to happen next. We are going to see very important readout from the Phase III program for Mim8 in the not so distant future. We're going to see the actual data from the FLOW study that we terminated mid-2023. We're going to see the readout from SOUL, which is big cardiovascular outcome studies looking at the effect of Rybelsus in type 2 diabetes. And finally, we're going to see around the end of this year the readout from the pivotal CagriSema trial. So while these are just some highlights, we're looking into a super interesting R&D year and obviously really, really something to look forward to.

非常一致的數據表明，我們實際上可以為那些需求未被滿足且服務嚴重不足的患者群體帶來改變。我們已經看到了骨關節炎研究的讀數，顯然我們已經看到了口服香蜜素研究的讀數，這引起了一些關注。看看接下來會發生什麼。在不久的將來，我們將看到 Mim8 第三階段計劃的非常重要的結果。我們將看到我們在 2023 年中期終止的 FLOW 研究的實際數據。我們將看到 SOUL 的讀數，這是一項大型心血管結果研究，旨在研究 Rybelsus 對第 2 型糖尿病的影響。最後，我們將在今年年底看到關鍵的 CagriSema 試驗的結果。因此，雖然這些只是一些亮點，但我們正在尋找一個超級有趣的研發年，顯然真的非常非常值得期待。

Thank you, Martin. Now over to financials. Good afternoon all. So some of you might have seen this Yahoo Finance. I know it's more American, but there was a quote yesterday that my American colleague sent me, I'm not sure if even my colleagues saw it. But they took a quote from an interview where they said that numbers like this will keep the CFO smiling for a long time. So 36% sales growth is just truly, truly spectacular and it's historic in the Novo Nordisk context both in relative size, but also in magnitude. So at constant exchange rates, we added more than DKK 60 billion year-on-year. So when Lars talked about scalability, I think the ultimate measure of scalability is of course the top line growth and I think these numbers really testify to that. So 36% top line growth translates into 44% operating profit growth of course since we have paid for the infrastructure.

謝謝你，馬丁。現在轉向財務。大家下午好。你們有些人可能看過這部雅虎財經。我知道這更美國化，但是昨天我的美國同事發給我一句話，我不確定我的同事是否也看到了。但他們引用了一次訪談中的話，說這樣的數字會讓財務長長時間微笑。因此，36% 的銷售額成長確實非常驚人，無論是相對規模還是規模，對諾和諾德來說都是歷史性的。因此，以固定匯率計算，我們比去年同期增加了超過 600 億丹麥克朗。因此，當 Lars 談到可擴展性時，我認為可擴展性的最終衡量標準當然是營收成長，我認為這些數字確實證明了這一點。因此，36% 的營收成長當然會轉化為 44% 的營業利潤成長，因為我們已經支付了基礎設施的費用。

So while we grow so much, we are actually also able to invest significantly into supply chain. So we are really putting a lot of money into getting max out of our supply chain footprint that operates today. We are investing in R&D. You see how busy Martin is these days in terms of initiations and readouts and it's also borne by the numbers, 37% growth at CER for R&D investments last year. So that pretty much marks a doubling of R&D investments over only like a 3, 4-year period investing DKK 45 billion. If we include BD in this number, DKK 45 billion of R&D investments in 2023. So really significant step-up in investments into the future of the company. And then of course all in all, 52% growth on our earnings per share, which is then being returned to shareholders through a corresponding step-up in dividend per share as we announced.

因此，儘管我們成長如此之大，但我們實際上也能夠對供應鏈進行大量投資。因此，我們確實投入了大量資金，以最大限度地利用目前營運的供應鏈足跡。我們正在投資研發。您可以看到 Martin 這些天在啟動和發布方面有多忙，這也得益於數字，去年研發投資的 CER 成長了 37%。因此，這幾乎標誌著研發投資在 3、4 年內翻了一番，投資金額為 450 億丹麥克朗。如果我們將 BD 納入這個數字，到 2023 年，研發投資將達到 450 億丹麥克朗。因此，對公司未來的投資確實顯著增加。當然，總而言之，我們的每股收益成長了 52%，然後我們將透過相應提高每股股息將其返還給股東。

Then just 1 note on CapEx. So last year we announced CapEx project initiations to the tune of DKK 75 billion. We spent last year measured at cash flow of DKK 26 billion, which is a doubling from the year before and now we're guiding DKK 45 billion in CapEx spend for 2024. So this is of course a huge investment into the future of the company also and really making us competitive in the cardiometabolic market and really scaling our capacity both in diabetes, obesity and adjacent areas. And of course our investments there are going both into API. The picture you see up here, it's a few months old. But this is one of the up and coming big API facilities in Kalundborg, Denmark and I could have brought a lot more pictures and videos. So many efforts going into CapEx scaling. And how does that then look for 2024 in terms of our financial outlook?

然後只是關於資本支出的 1 個說明。因此，去年我們宣布啟動資本支出項目，金額達 750 億丹麥克朗。去年我們的現金流為 260 億丹麥克朗，比前一年翻了一番，現在我們指導 2024 年的資本支出為 450 億丹麥克朗。因此，這當然是對公司未來的一項巨額投資也確實使我們在心臟代謝市場具有競爭力，並真正擴大了我們在糖尿病、肥胖和鄰近領域的能力。當然，我們的投資都將投入 API。你在這裡看到的照片是幾個月前的。但這是丹麥卡倫堡新興的大型 API 設施之一，我本可以帶來更多的圖片和影片。為擴大資本支出付出瞭如此多的努力。那麼，我們對 2024 年的財務前景有何看法？

We are guiding for the full year between 18% and 26% top line growth, which you should basically see as a continuation of the growth momentum we delivered in 2023. It's the same drivers in terms of geographies and products. And then we continue to invest into R&D, into supply scaling and into building our obesity commercial infrastructure. But even though we are leaning in on those investments, we still managed to get leverage and hence the bottom line guidance of between 21% and 29% CER growth. And then I covered the CapEx and of course with the elevated CapEx, then free cash flow is impacted by that. But we still managed to deliver share buyback also in 2024 this year to the tune of DKK 20 billion. So a very attractive financial profile really focused on driving growth and investing in R&D and growth for the future. So that concludes the financial part and then I'll just get back to this.

我們預計全年營收成長 18% 至 26%，您基本上應該將其視為我們在 2023 年實現的成長勢頭的延續。在地理位置和產品方面，驅動因素相同。然後我們繼續投資研發、擴大供應規模和建造我們的肥胖商業基礎設施。但即使我們依靠這些投資，我們仍然設法獲得槓桿，因此獲得了 21% 至 29% CER 成長的底線指導。然後我討論了資本支出，當然還有資本支出的增加，然後自由現金流就會受到影響。但今年我們仍設法在 2024 年實現了價值 200 億丹麥克朗的股票回購。因此，非常有吸引力的財務狀況確實專注於推動成長以及投資於研發和未來的成長。財務部分就這樣結束了，然後我再回到這一點。

And then we have asked Daniel Bohsen, our Head of Investor Relations, to be the master of Q&A. So I'm sure he'll do extremely well.

然後我們請投資者關係主管 Daniel Bohsen 擔任問答大師。所以我確信他會做得非常好。

I'll do my best. Thank you, Karsten. And as always, please state your name and institution and let's start with 1 question per person and then we'll maybe do several rounds. And we'll start with Mark Purcell from Morgan Stanley.

我將盡我所能。謝謝你，卡斯滕。像往常一樣，請說明您的姓名和機構，我們從每人 1 個問題開始，然後我們可能會進行幾輪。我們將從摩根士丹利的馬克·珀塞爾開始。

A big picture question maybe for you, Lars, just to begin with. Could you sort of help frame the sort of scale of the investment, the DKK 75 billion CapEx investment, you're making and help us translate that maybe into product volumes or patient volumes or whichever metric you believe will be helpful for us to understand the sort of scale of the investment?

拉爾斯，首先，這對你來說可能是一個大問題。您能否協助確定您正在進行的 750 億丹麥克朗資本支出投資的投資規模，並幫助我們將其轉化為產品數量或患者數量或您認為有助於我們理解的任何指標投資規模如何？

I started by mentioning that we have added 5 million patients during 1 year, which is a significant step-up. If you look at the guidance we have made for '24, it's a similar step-up. So it's actually quite massive added volumes of patients and to do that, we obviously first need to ramp up the API. That's where we started. So we had a large API facility coming in line in the U.S. a couple of years back. We started one of the factories in Kalundborg in '17 that will kick in with API in a couple of years and we already started the next. So very significant step-up in API capacity. And we do fermentation based API with continuous harvesting. So we believe we can produce cheaper than anyone else when it comes to API. And then what we're focusing on now is the fill/finish because with much more API coming in, obviously we need to either make that into tablets or to do fill/finish.

我首先提到，我們在一年內增加了 500 萬名患者，這是一個重大進步。如果您查看我們為 24 年制定的指南，您會發現這是一個類似的升級。因此，患者數量實際上增加了相當多，而要做到這一點，我們顯然首先需要增加 API。這就是我們開始的地方。因此，幾年前我們在美國建立了一個大型 API 設施。我們於 17 年在卡倫堡開設了一家工廠，該工廠將在幾年內開始使用 API，並且我們已經開始了下一個工廠。 API 能力的顯著提升。我們透過持續收穫進行基於發酵的 API。因此，我們相信在 API 方面我們可以比其他任何人生產更便宜的產品。然後我們現在關注的是填充/完成，因為隨著越來越多的 API 進來，顯然我們需要將其製成片劑或進行填充/完成。

So you saw that in Chartres France, we announced a large project to expand fill/finish. And we have a global network of some 5 strategic sites where you can imagine that we'll be adding fill/finish capacity. In addition to that, we also work with the contract manufacturing organizations. So now it's really the focus on getting the fill/finish up to match that API. So we don't guide in terms of number of patients or business volume on long term. But the pull nature we see for our products right now and the ability to scale 5 million patients on a yearly basis, then you can start adding up where that gets us in terms of really having huge societal impact in treating many more patients and obviously there's a very significant commercial opportunity in that.

所以你看到，在法國沙特爾，我們宣布了一個擴大填充/完成的大型專案。我們擁有由約 5 個戰略站點組成的全球網絡，您可以想像我們將在其中增加填充/完成能力。除此之外，我們也與合約製造組織合作。所以現在真正的重點是讓填充/完成來匹配該 API。因此，我們不會根據患者數量或業務量進行長期指導。但是我們現在看到的產品的拉力性質以及每年擴大 500 萬患者的能力，那麼您可以開始計算這對我們在治療更多患者方面真正產生巨大社會影響的影響，顯然有這是一個非常重要的商業機會。

So we're ready for the next question. I think we take Emily and then we move down this way.

我們準備好回答下一個問題了。我想我們帶著艾米麗，然後沿著這條路走下去。

Emily Field from Barclays. A financial question. So we've seen operating margin sort of steadily expand over the last few years in a supply constrained environment. So maybe if you could just give us some high level thoughts on margin progression over time given that as supply comes online, that top line will be growing at pace.

巴克萊銀行的艾米麗·菲爾德。一個財務問題。因此，我們看到過去幾年在供應緊張的環境下營業利潤率穩步擴大。因此，也許您能給我們一些關於隨著時間的推移利潤增長的高層次想法，因為隨著供應的增加，收入將會快速增長。

So first of all, the classic structure is of course the faster company grows, the more opportunity for margin expansion. That's what we see already in '23 with margin expansion and that's what you see in '24 also. But it's important to note that margin expansion is not a target on its own merit in Novo Nordisk. It was in the old days when we were subpar compared to the industry. But now being around 45% in margin, we do believe that we create much more value by investing in driving top line, scalability in manufacturing and building pipeline in R&D. So yes, at high growth rates, there will be margin expansion everything else equal. But the margin expansion is kind of the residual, it's not the primary objective if that makes sense.

首先，經典的結構當然是公司發展越快，利潤擴張的機會就越多。這就是我們在 23 年看到的利潤率擴張的情況，這也是您在 24 年看到的情況。但值得注意的是，利潤率擴張本身並不是諾和諾德的目標。在過去，我們與產業相比仍處於劣勢。但現在利潤率約為 45%，我們確實相信，透過投資推動營收、製造可擴展性和研發管道建設，我們可以創造更多價值。所以，是的，在其他條件相同的情況下，在高成長率下，利潤率將會擴大。但利潤率擴張是一種剩餘，如果有意義的話，它不是主要目標。

So let's go to Kerry here.

那我們就去凱裡吧。

Kerry Holford, Berenberg. Another question for you, Karsten. Capital allocation, thinking about really very strong top line growth again predicted for this year, margin expansion, but yet planning to return less in terms of share buybacks than you did last year. So can you just talk us through how you come to that number? Should we therefore take away that this is a year that you will pursue more external investment and blissfully using your cash outside rather than inside the company? Just your thoughts on capital allocation will be really useful.

凱莉·霍爾福德，貝倫貝格。卡斯滕，還有一個問題想問你。資本配置，考慮到今年再次預測的非常強勁的營收成長、利潤率擴張，但計劃在股票回購方面的回報比去年要少。那麼您能告訴我們您是如何得出這個數字的嗎？因此，我們是否應該認為今年您將尋求更多的外部投資，並幸福地在外部而不是公司內部使用您的現金？您對資本配置的想法將非常有用。

Thank you for that question. So first of all, when we look at -- and we just at our Board meeting this week, we had a review of our capital allocation strategy and I don't think it differs a lot from other pharmaceutical companies. So priority #1 is assuming attractive investment cases we want to invest in in the company. So that's priority #1, organic investments in the company. Then of course the next priority is we also expect it to deliver a return to our shareholders. So that's why we're very consistent in delivering a payout ratio around 50%. Now our dividend per share is up 52% over last year, which marks our 28th consecutive year of increasing the dividend per share. And then from there, we are of course also looking at what can we buy from the outside within our therapeutic categories that complements our own internal pipeline. So licensing primarily of early-stage assets within our therapeutic categories.

謝謝你提出這個問題。因此，首先，當我們看時——我們剛剛在本週的董事會會議上，我們對我們的資本配置策略進行了審查，我認為它與其他製藥公司沒有太大不同。因此，第一要務是假設我們想要投資該公司的有吸引力的投資案例。因此，這是第一要務，即對公司的有機投資。當然，下一個優先事項是我們也希望它能為我們的股東帶來回報。這就是為什麼我們始終如一地提供 50% 左右的派息率。現在我們的每股股息比去年增長了52%，這標誌著我們連續28年增加每股股息。然後，從那裡開始，我們當然也在考慮我們可以在我們的治療類別中從外部購買什麼來補充我們自己的內部管道。因此，主要對我們的治療類別內的早期資產進行許可。

And then at the very end comes our share buyback program and between our share buyback program and the cash we carry on our balance sheet, that's defined by so-called financial reserve requirements, which we agree with our Board of Directors. What's the financial reserve requirement in terms of how much cash and financial reserves should we have in the company to ensure resilience in the company in adverse situations? So that's the overarching logic. And then more specifically, why is share buyback down from DKK 30 billion in '23 to DKK 20 billion this year? It's a super simple question. It's higher operating cash flow more than offset by CapEx stepping up by DKK 19 billion. So if you take the delta there, then you get exactly to the DKK 20 billion of share buyback. So beyond that, no signaling vis-a-vis priorities for BD et cetera.

最後是我們的股票回購計劃，以及我們的股票回購計劃和我們資產負債表上的現金之間的關係，這是由所謂的財務準備金要求定義的，我們與董事會達成協議。財務儲備要求是多少，也就是我們應該在公司擁有多少現金和財務儲備，以確保公司在不利情況下的彈性？這就是總體邏輯。更具體地說，為什麼股票回購從 2023 年的 300 億丹麥克朗減少到今年的 200 億丹麥克朗？這是一個超級簡單的問題。增加的 190 億丹麥克朗的資本支出足以抵銷較高的營運現金流。因此，如果您採用 Delta 值，那麼您將獲得 200 億丹麥克朗的股票回購。除此之外，沒有關於 BD 等優先事項的訊號。

So we are ready for the next question. We have 1 there.

我們準備好回答下一個問題了。我們那裡有 1 個。

It's Ben Jackson from Jefferies. Perhaps more of a specific question with regards to thoughts around the oral obesity and diabetes space. Have you had any change in thoughts in how you're thinking about the peptide versus small molecule area in there? And then more specifically, whether there's any update with timing to Oasis 4 and the high dose oral filings?

我是來自 Jefferies 的本傑克遜。也許更多的是關於口腔肥胖和糖尿病領域的想法的具體問題。您對其中的勝肽與小分子區域的看法有什麼變化嗎？更具體地說，Oasis 4 和高劑量口服申請的時間表是否有任何更新？

So maybe Lars, you take it strategically and then Martin, I don't know if you have any comments on Oasis 4?

所以也許Lars，你會從戰略上看待它，然後Martin，我不知道你對綠洲4有什麼評論嗎？

Yes. So you can address the oral versus injectable in different ways. You can look at convenience scaling, et cetera. I think from a patient convenience point of view, I think we have the view that a weekly injection is a very attractive way to treat patients. We do have an oral option in Rybelsus and we can see that in the markets where we have injectable therapy. There's actually very strong momentum in injectable therapy even though you can get also a strong efficacy in terms of type 2 diabetes treatment on oral. Having said that, it's also clear that we talk about high volume complex molecules when we talk about peptides comes in a device. So if you are to scale big time, I think we are doing that. But if you have to scale even above that, it's an obvious thing to consider a small molecule whether that can work.

是的。因此，您可以透過不同的方式來解決口服與注射的問題。您可以查看便利縮放等。我認為從患者便利的角度來看，我認為我們認為每週注射是一種非常有吸引力的治療患者的方式。我們確實有 Rybelsus 口服選擇，我們可以在註射治療的市場上看到這一點。儘管口服第 2 型糖尿病治療也能獲得很強的療效，但注射療法的發展勢頭實際上非常強勁。話雖如此，很明顯，當我們談論設備中的勝肽時，我們談論的是高容量複雜分子。因此，如果你想擴大規模，我認為我們正在這樣做。但如果你必須擴大規模甚至超過這個範圍，那麼顯然要考慮小分子是否可行。

And in doing that, I think you need to get to in its essence a small molecule because if you get into a significant number of synthetic steps in making a small molecule, it actually ends up being a relatively large molecule and it might not scale. And then you can get also into considerations around what is required in terms of getting both efficacy, full day coverage and an acceptable safety profile and how does receptor binding and off-target binding work for different mechanisms. So I think there is a role to play for all medicines. But with safe and efficacious medicines being available, I think there's a low appetite for products that comes with some kind of safety caveats that is often known from small molecules. Having said that, I think there is a potential play there.

在這樣做的過程中，我認為你需要獲得小分子的本質，因為如果你進入大量的合成步驟來製造小分子，它實際上最終會成為一個相對較大的分子，並且可能無法擴展。然後，您還可以考慮獲得功效、全天覆蓋和可接受的安全性方面所需的條件，以及受體結合和脫靶結合如何針對不同的機制發揮作用。所以我認為所有藥物都可以發揮作用。但隨著安全有效的藥物的出現，我認為人們對某種小分子安全警告的產品的興趣較低。話雖如此，我認為那裡有一個潛在的發揮。

We actually have 1 in terms of Inversago. We have acquired that recently and interestingly enough, it's a non-GLP-1 approach so you can say it works in addition to GLP-1. I think there's a lot of hype on small molecule GLP-1 because it's a GLP-1. But what if you have a world where you're actually adding a small molecule on top of an injectable GLP-1? I think that could be really, really interesting. And that opportunity we have in Inversago where we'll start getting some data during this year. So that's a bit our perspective. And in all scenarios I would say there's a lot of patients to go for. So there's room for many approaches to address these unmet needs. And then perhaps Martin.

就 Inversago 而言，我們實際上有 1。我們最近獲得了這一點，有趣的是，它是一種非 GLP-1 方法，因此您可以說它除了 GLP-1 之外也有效。我認為小分子 GLP-1 有很多炒作，因為它是一種 GLP-1。但是，如果您實際上在可注射的 GLP-1 上添加了一個小分子，該怎麼辦？我認為這可能真的非常有趣。我們在 Inversago 擁有這個機會，今年我們將開始獲得一些數據。這就是我們的觀點。在所有情況下，我都會說有很多病人需要治療。因此，有許多方法可以解決這些未滿足的需求。然後也許是馬丁。

Martin, on Oasis 4.

馬丁，《綠洲 4》。

Yes. That's going to read out during the course of this year. My recollection is first half of this year.

是的。這將在今年期間宣讀。我的記憶是今年上半年。

Ready for the next question. We have 1 down here.

準備下一個問題。我們這裡有 1 個。

[Anna Sulley] from (inaudible). I just wanted to come back to the CapEx. You've given this guidance of DKK 45 billion for this year. How should we think about the future? I think in the release you talk about coming back to kind of low double digit. But if we're thinking about the opportunity and the fact you've been growing at 25% and this could continue for several years, I mean shouldn't that make sense to kind of rollout the DKK 45 billion for like several years in a row? And attached to that, I mean for every dollar of CapEx that goes into the business, how much revenues can you generate? Is there like a rule of thumb?

[安娜·蘇利] 來自（聽不清楚）。我只想回到資本支出。您今年的指導金額為 450 億丹麥克朗。我們該如何思考未來？我認為在新聞稿中你談到要回到低兩位數的水平。但如果我們考慮到機會以及您一直在以 25% 的速度增長並且這種情況可能會持續幾年的事實，我的意思是，在幾年內推出 450 億丹麥克朗是否有意義？排？除此之外，我的意思是，投入業務的每一美元資本支出，可以產生多少收入？有類似的經驗法則嗎？

So in terms of our CapEx guidance, then what we've said for the last, I don't know, year plus or something like that is low double-digit CapEx to sales and some people have translated that into low teen. But it was actually intentional already from the get-go that we've been talking about low double digits and now we're around the 15% mark. And that is also to indicate in the coming years we'll be rolling at a relatively high CapEx level. Of course we're not guiding for '25, '26 at this point in time. But yes, you can safely assume that we'll be running at fairly high CapEx levels in the medium term also? And then could you just remind me the second question?

因此，就我們的資本支出指導而言，我們去年所說的，我不知道，一年多或類似的情況是銷售額的低兩位數資本支出，有些人已將其轉化為低青少年。但事實上，我們從一開始就有意在談論低兩位數的數字，現在我們已經在 15% 左右了。這也顯示在未來幾年我們將維持相對較高的資本支出水準。當然，目前我們還沒有為 25、26 年提供指導。但是，是的，您可以放心地假設我們在中期也將保持相當高的資本支出水準嗎？那你能提醒我第二個問題嗎？

The second question was related to if there's a rule of thumb for when you put $1 into CapEx, what you output wise get?

第二個問題與是否存在經驗法則有關，當您將 1 美元投入資本支出時，您會得到什麼？

Yes, but that's not for public consumption.

是的，但這不適合大眾​​消費。

I think we'll go back to Mark Purcell.

我想我們會回到馬克·珀塞爾。

Maybe for Martin. Martin, could you help us understand for the GLP-1/GIP you have, if this is different from Tirzepatide and what those differences are? But then clearly one of the differences is this monthly formulation. So in your mind, how important could monthly be as an option for patients and is this a technology or a set of technologies you can roll out across the rest of your pipeline, including amycretin, CagriSema, et cetera?

也許對馬丁來說。 Martin，您能幫助我們了解您擁有的 GLP-1/GIP 是否與 Tirzepatide 不同以及這些差異是什麼？但顯然差異之一是每月的配方。那麼，在您看來，每月一次作為患者的選擇有多重要？這是一項技術還是一組技術，您可以在您的其他產品線（包括阿黴素、CagriSema 等）中推廣？

So these are still early days for our GLP-1/GIP. So our aspiration is to be on par with everything else that is out there from an efficacy safety perspective. That's interesting in and of itself. Obviously when it comes to the monthly format, that is even further interesting. Very, very clear, patients prefer infrequent dosing. We have now moved from once daily to once weekly. That has moved the needle quite substantially. But obviously if we can move to once monthly, that would be attractive. We are pursuing several different avenues in terms of infrequent dosing. We are currently testing 1 in Phase I that could potentially be applied to different molecules, which is also why it's interesting. But still early days and again we're testing several different modalities.

因此，我們的 GLP-1/GIP 仍處於早期階段。因此，我們的願望是從功效安全的角度來看，與其他所有產品持平。這本身就很有趣。顯然，當談到每月的格式時，那就更有趣了。非常非常清楚，患者更喜歡不頻繁給藥。我們現在已從每天一次改為每週一次。這已經大大改變了局面。但顯然，如果我們可以改為每月一次，那將很有吸引力。在不頻繁給藥方面，我們正在尋求幾種不同的途徑。我們目前正在第一階段測試 1，它可能適用於不同的分子，這也是它有趣的原因。但仍處於早期階段，我們正在測試幾種不同的模式。

We have a question down here.

我們在這裡有一個問題。

(inaudible) Canaccord Asset Management. I was wondering whether given the obesity care market, the sort of consumer awareness of the brands, which is maybe very different to what you've experienced before, whether that's going to require any change in sort of attitude towards marketing maybe not now, but certainly in sort of 2, 3 years' time and whether that's an area that could be sort of a real point of differentiation for you in sort of securing your position in the market?

（聽不清楚）Canaccord 資產管理公司。我想知道，鑑於肥胖護理市場，消費者對品牌的認識可能與您以前經歷過的非常不同，這是否需要改變對行銷的態度，也許不是現在，但當然是在2、3 年的時間內，這是否是一個可以成為您真正的差異化點以確保您在市場中的地位的領域？

Camilla, it sounds like right down your alley.

卡米拉，聽起來就在你的巷子裡。

Yes, absolutely there is for sure difference in the patient behavior when it comes to diabetes and obesity. One of the more remarkable differences we've seen especially with the launch of Wegovy is that there's a different patient dynamic in terms of asking and driving the demand, going to see the physicians, knocking on the door, asking for that treatment. Whereas historically in diabetes, we have seen that it has often been the specialist or the GP that would have to initiate the discussion about additional treatment. So that is different and the way that we of course also plan our marketing also takes that into account all subject to all business ethics requirement of course. But informing also about obesity. Why is it important to treat obesity? Because of the serious chronic conditions that are related to obesity. And of course that is something that is both important to understand for people living with obesity, but also for payers and providers. So yes, there is certainly a difference and we have also in our approach internally organized ourselves in 2 different you can say marketing units because of that difference.

是的，在糖尿病和肥胖方面，患者的行為肯定有差異。我們看到的最顯著的差異之一，尤其是 Wegovy 的推出，是患者在詢問和推動需求、去看醫生、敲門、要求治療方面存在著不同的動態。而從歷史上看，在糖尿病領域，我們發現通常是專家或全科醫生必須發起額外治療的討論。所以這是不同的，我們當然也計劃行銷的方式也考慮到了所有遵守所有商業道德要求的情況。但也告知有關肥胖的資訊。為什麼治療肥胖很重要？因為與肥胖有關的嚴重慢性病。當然，了解這一點對於肥胖患者以及付款人和提供者都很重要。所以，是的，肯定存在差異，而且由於這種差異，我們在內部也將自己組織成兩個不同的行銷部門。

We have 1 up here.

我們這裡有 1 個。

Nadim Rizk from PineStone. So do you have a sense of what percent of patients taking obesity drugs are actually either severely obese or diabetic or pre-diabetic versus what I call casual users that are maybe my shape, but they want to lose 15 pounds before they go on vacation to Greece? And also the second part of that is would you be eventually concerned about an FDA kind of crackdown to say okay, any drug has significant side effects. And then it would be either changing labeling or kind of cracking down and saying, "Okay, yes, the drug is very efficient, has high efficacy and has limited side effects; but it has to be prescribed only to patients that actually should be taking that drug"?

來自 PineStone 的 Nadim Rizk。那麼，您知道服用減肥藥的患者中實際上患有嚴重肥胖、糖尿病或糖尿病前期的患者所佔的百分比是多少，而那些我所說的臨時使用者（可能與我的體型相似，但他們想在去度假之前減掉15 磅）的比例是多少？希臘？第二部分是你最終會擔心 FDA 的鎮壓嗎？好吧，任何藥物都有顯著的副作用。然後要么改變標籤，要么嚴厲打擊並說：“好吧，是的，這種藥物非常有效，功效很高，副作用也有限；但它只能開給真正應該服用的患者那種藥”？

Thanks for these questions. So maybe Camilla, you can talk about some of the data we have and Martin, you can potentially add a comment on safety afterwards.

感謝您提出這些問題。所以也許卡米拉，你可以談談我們擁有的一些數據，馬丁，你可以在事後添加有關安全的評論。

Yes. So on the data that we have that we know especially from our launch in the U.S., we see from our real-world evidence data that the average BMI of the people that are treated with Wegovy is approximately around a BMI of 37. This has also been confirmed in additional countries where we have launched in Europe. So that is sort of the average BMI, well above the label that we have that is BMI of 27 with comorbidities or above 30. What is very important to us and also in our communication is that Wegovy is used for people that are living with obesity and no one else. So we also have collaborations with regulators to inform about this, to keep making sure that we stay within that label and that is prescribed for the right population. And that is something we do across the world and that also goes by the way for type 2 medication like Ozempic that that is prescribed for people with type 2 diabetes. Having said that, we know that of course there is a strong correlation between diabetes and obesity and that obesity is the leading cause of diabetes. And we've seen even in the SELECT data that we've just published a short while ago that we see that the relative risk reduction when it comes to onset of diabetes for people living with obesity is very strong when they're using semaglutide 2.4. So above 72% risk reduction.

是的。因此，根據我們所掌握的數據，特別是從我們在美國推出以來了解到的數據，我們從現實世界的證據數據中看到，接受 Wegovy 治療的人的平均 BMI 約為 37 左右。這也已在我們已在歐洲推出的其他國家得到證實。這就是平均 BMI，遠高於我們的標籤，即 BMI 為 27，有合併症或高於 30。對我們以及我們的溝通來說非常重要的是，Wegovy 用於肥胖患者沒有其他人。因此，我們也與監管機構合作，通報這種情況，以確保我們保持在該標籤內，並且是針對正確人群的。這是我們在世界各地所做的事情，也適用於 2 型藥物，例如為 2 型糖尿病患者開立的 Ozempic。話雖如此，我們知道糖尿病和肥胖之間當然有很強的相關性，而且肥胖是糖尿病的主要原因。我們甚至在不久前剛發布的 SELECT 數據中也看到，使用索馬魯肽 2.4 的肥胖患者罹患糖尿病的相對風險降低非常明顯。因此風險降低了 72% 以上。

I don't think I can add a lot to that. I mean given that the average patient has a BMI of 37 in U.S., they actually also have 2 to 3 comorbidities on top of that. Those are the data that we have right now and that is also what the FDA gets to look at. Both we obviously, but also the FDA discourage off label use and that communication can be strengthened. But based on our current data, we actually see a large level of adherence to the label and we'll continue to monitor that.

我認為我無法對此添加太多內容。我的意思是，考慮到美國患者的平均 BMI 為 37，除此之外，他們實際上還有 2 到 3 種合併症。這些是我們現在掌握的數據，也是 FDA 需要查看的數據。顯然，我們和 FDA 都不鼓勵標籤外使用，並且可以加強溝通。但根據我們目前的數據，我們實際上看到了對標籤的很大程度的遵守，我們將繼續監控這種情況。

I know a lot of people that are definitely BMI way below 30 that are either on Ozempic. There are more also on the Ozempic and they take it not casually, but they just want to lose a little bit and it's a lot easier to. It's more a concern that potentially this kind of a market is not significant.

我認識很多 BMI 遠低於 30 的人，他們要么服用 Ozempic，要么服用 Ozempic。 Ozempic 上也有更多的人，他們不會隨意接受，但他們只是想失去一點，而且更容易做到。更令人擔憂的是，這種市場可能並不重要。

And again we can only relate to the numbers that we have. And actually I mean don't misunderstand me, I don't want to rule out that some of us will see people who take this not as intended. That should be discouraged. I think also it's maybe fair to say it's a small, small minority even though you know them. And therefore, we can only look at if the average BMI is 37, that indicates that the vast, vast majority are actually with either BMI of 37, but also higher. So I think we are in a reasonably good place, but we will continue to monitor it.

再說一次，我們只能與我們擁有的數字連結起來。事實上，我的意思是不要誤解我，我不想排除我們中的一些人會看到那些不按預期行事的人。這應該被勸阻。我認為，即使你認識他們，也可以公平地說這是一個很小的少數群體。因此，我們只能看平均 BMI 是否為 37，這表示絕大多數人的 BMI 實際上為 37，但也較高。所以我認為我們處於一個相當好的位置，但我們將繼續監控它。

Thanks for the question. We have 1 more from Kerry over here.

謝謝你的提問。我們還有 1 封來自凱瑞的信。

A question for Martin, please, on amycretin. I guess we had lots of debate yesterday about your relative excitement or not on oral, but nonetheless, it's clearly you're starting now the weekly Phase I. So my question would be when if at all we see the Phase I data? And then if you are progressing with weekly, what do you see as a key differentiation for weekly injectable amycretin versus weekly injectable CagriSema?

請問馬丁一個關於阿黴素的問題。我想我們昨天就您是否相對興奮進行了很多辯論，但儘管如此，很明顯您現在正在開始每週的第一階段。所以我的問題是我們什麼時候才能看到第一階段的數據？然後，如果您每週注射一次，您認為每週注射一次的阿黴素與每週注射一次的 CagriSema 的關鍵差異是什麼？

So right now we have availability of some Phase I data that are oral. That's very early days. This is also why we typically do not disclose the data. And if we decide to disclose the data at one point, that's typically the prerogative of (inaudible) and you have to talk to them about that. We have been encouraged by the data that we've seen and that basically means that we have taken the decision to not only go oral, but also subcutaneous and take that potentially into further development. When it comes to the differentiation for example to CagriSema, again too early days. The potential that we've seen has been encouraging potentially on CagriSema. But we can't go further into that because we need to see the data basically.

所以現在我們可以獲得一些第一階段的口頭資料。那是很早的事。這也是我們通常不披露數據的原因。如果我們決定在某個時刻披露數據，這通常是（聽不清楚）的特權，你必須與他們討論這一點。我們對所看到的數據感到鼓舞，這基本上意味著我們決定不僅口服，而且皮下注射，並將其潛在地用於進一步開發。談到與 CagriSema 等公司的差異化，現在還為時過早。我們在 CagriSema 上看到的潛力令人鼓舞。但我們不能進一步深入，因為我們基本上需要查看數據。

So we have time for 2 more questions I think. So we'll take Emily first.

我想我們還有時間再問兩個問題。所以我們先帶艾米莉來。

Kind of a follow-up on a couple of questions. On the call yesterday when I asked about sort of the bar for amycretin, I believe you said that it's likely CagriSema given that it's a GLP-1 in amylin. So that makes sense. But sort of as you're thinking and then the answer to the previous question about the GLP-1 GIP, you said the goal is to be sort of the best out there from an efficacy and safety perspective. But just 1 question that we're getting is that as more assets come to market, are you targeting potentially longer down the road maybe assets that have less weight loss like lower than on the scale of that that maybe have a better side effect profile for those patients on the lower BMI spectrum and thinking about more of a portfolio of assets to serve across the BMI spectrum rather than going for bariatric like surgery weight loss?

有點像是對幾個問題的跟進。在昨天的電話中，當我詢問胰島澱粉樣蛋白棒的種類時，我相信您說它很可能是 CagriSema，因為它是胰島澱粉樣多肽中的 GLP-1。所以這是有道理的。但正如您所思考的，然後回答上一個有關 GLP-1 GIP 的問題時，您說目標是從功效和安全性的角度來看是最好的。但我們遇到的唯一一個問題是，隨著越來越多的資產進入市場，您的目標是否可能是未來更長的時間，也許是那些減重較少的資產，例如低於可能具有更好副作用的資產規模那些 BMI 譜系較低的患者，是否考慮更多地利用資產組合來服務 BMI 譜系，而不是進行減重手術等減重手術？

So the short answer is we look at everything. We see obesity as not just 1 simple disease where 1 size fits on, but actually a quite a complex disease. And already now we can see different patient categories with different needs. So you described the low BMI patients that may or may not have comorbidities. So let's assume you have BMI 30 for example, that's border line between obesity and severe obesity or overweight and obesity. And they may have 1 need where a patient BMI 40 with or without outcobidities may have other needs. I've just described 4 categories of patients that we intend to develop drugs that will cater to their needs. So we will look at all of the modalities and obviously for some patients who are either overweight with comorbidities or obese but in the lower end of the spectrum, a reasonable weight loss without side effects would also be attractive.

所以簡短的回答是我們專注在一切。我們認為肥胖不僅僅是一種只有一種尺寸適合的簡單疾病，而且實際上是一種相當複雜的疾病。現在我們已經可以看到不同類別的患者有不同的需求。您描述了可能有或沒有合併症的低體重指數患者。例如，假設您的 BMI 為 30，這是肥胖與嚴重肥胖或超重與肥胖之間的界線。他們可能有 1 種需求，而 BMI 40 的患者（無論是否患有合併症）可能有其他需求。我剛剛描述了四類患者，我們打算開發藥物來滿足他們的需求。因此，我們將研究所有的方式，顯然對於一些患有合併症的超重或肥胖但處於範圍較低端的患者來說，合理的減肥而不產生副作用也會很有吸引力。

We'll take the last question from -- maybe the last 2 if they're quick from over here.

我們將回答最後一個問題——如果他們很快就從這裡回答的話，也許是最後兩個問題。

I had a question on your assumptions behind Eli's ramp of Mounjaro and Zepbound. Just to understand what you have assumed in terms of that market share loss possibly this year? And when do you think that the kind of ramp in capacity from you and them starts like adding pricing pressure into the system?

我對 Eli 的 Mounjaro 和 Zepbound 坡道背後的假設有疑問。只是為了了解您對今年可能出現的市佔率損失的假設？您認為您和他們的產能提升何時開始為系統增加定價壓力？

Lars, I think I will give that to you, big supply question.

拉爾斯，我想我會把這個大供應問題交給你。

So I hope you think it's fair that we don't want to comment on assumptions about competitors because we actually have limited insight to their tactics. In terms of your second question in terms of ramping and when there's enough capacity to supply the market, that could well take some time. If you consider the number of patients and if you consider that here we have actually patients asking to be on treatment. It's completely different dynamics we see compared to other medicines where it's the reverse. We have to convince physicians to give it to patients. That means that it's just I think a very large commercial opportunity. If you consider the number of years we have had Wegovy out there and how few countries we have still launched in and I think it's similar for competition.

因此，我希望您認為我們不想評論有關競爭對手的假設是公平的，因為我們實際上對他們的策略的了解有限。就第二個問題而言，當有足夠的產能來供應市場時，這很可能需要一些時間。如果您考慮到患者的數量，並且考慮到這裡實際上有患者要求接受治療。與其他藥物相比，我們看到的動態完全不同，而其他藥物則相反。我們必須說服醫生將其提供給患者。這意味著我認為這是一個非常大的商業機會。如果考慮到我們推出 Wegovy 的年數以及我們推出的國家/地區的數量，我認為這對競爭來說是類似的。

That talks to that here we're dealing with high volume complex products. And typically when you scale fast, you're talking lot about smaller volumes and less complex products, which inherently also talks a bit about the entry barriers to this because there are very few categories where you see as high volume as diabetes and obesity. And we think that for a foreseeable future, this will be addressed by complex molecules in complex presentations. So we're building that whole capacity to cater for that and I think there's tremendous commercial opportunity in it, but I think there's also a tremendous opportunity in terms of driving population health outcomes and that's really what the regulators are looking for. And many of those are also those who set the prices for our products.

這說明我們正在處理大量的複雜產品。通常，當你快速擴張時，你會談論很多較小的銷量和不太複雜的產品，這本質上也會談論一些進入壁壘，因為很少有類別的銷量像糖尿病和肥胖症那樣高。我們認為，在可預見的未來，這將透過複雜的分子以複雜的方式來解決。因此，我們正在建立整體能力來滿足這項要求，我認為其中存在著巨大的商業機會，但我認為在推動人口健康結果方面也存在著巨大的機會，而這正是監管機構所尋求的。其中許多人也是我們產品價格的製定者。

So there's this dynamic journey of establishing obesity as a disease, acknowledging the burden that follows living with obesity in terms of number of comorbidities and the whole value point in treating that for the payer and for the health care systems. And while we establish that, we actually scale supply. And I think this goes hand-in-hand and I'm very optimistic about the long-term opportunity and for what we can do for patients and then the return to society, which is ultimately what makes a sustainable company that there are products that deliver so much benefit for society not only the individual citizen, but also health care systems that you will continue paying for them. So I think it's a great opportunity.

因此，這是將肥胖確定為一種疾病的動態過程，承認肥胖帶來的伴隨疾病數量的負擔，以及為支付者和醫療保健系統治療肥胖的整體價值點。當我們確定這一點時，我們實際上擴大了供應。我認為這是齊頭並進的，我對長期機會以及我們能為患者做的事情以及對社會的回報非常樂觀，這最終是一家可持續發展的公司的原因，因為我們的產品不僅為公民個人，而且為醫療保健系統帶來如此多的好處，您將繼續為其付費。所以我認為這是一個很好的機會。

One final question here before we round off..

在我們結束之前還有最後一個問題。

You already kind of answered half the question. So my question was 2 parts. The recent strong pricing that we've seen is I'm guessing due to the 3D supply being constrained. Is that a fair statement?

你已經回答了一半的問題了。所以我的問題分為兩個部分。我猜最近我們看到的強勁定價是由於 3D 供應受到限制。這是一個公平的說法嗎？

I think we launched Wegovy at more or less established price point for Saxenda, our first generation products. Then we come with a way more efficacious product. And when you then look at short-term pricing, I think there are some true-ups across quarters so we have to be a bit careful about that. But we believe that the price point is actually very meaningful for the value of the products and it's a price point that has previously been accepted in the market also for a significantly less efficacious product. Then of course when you see many patients starting treatment, this becomes a large ticket for payers. So we see that for some payers, this is a challenge. And I think we see as many opting in and I think that talks to this dynamic phase we're in now where the disease is being acknowledged and also the value of treating obesity is being established. So we'll see some flux of payers coming in and out in this dynamic journey, but I'm quite confident that it ends up in a situation where the value of the product is established. And of course when there's a shortage of products, there's also less incentive to drive down price. That obviously also plays in. But it's actually more let's say the longer-term destiny that we are focused on.

我認為我們推出 Wegovy 的價格或多或少是為 Saxenda（我們的第一代產品）確定的。然後我們推出了更有效的產品。當你考慮短期定價時，我認為各個季度都有一些調整，因此我們必須對此保持謹慎。但我們認為，這個價格點實際上對於產品的價值來說非常有意義，而且對於功效明顯較差的產品來說，這個價格點之前已經被市場所接受。當然，當你看到許多患者開始治療時，這對付款人來說就成了一張大票。所以我們看到，對於一些付款人來說，這是一個挑戰。我認為我們看到有很多人選擇加入，我認為這與我們現在所處的動態階段有關，在這個階段，這種疾病正在被承認，治療肥胖的價值也正在確立。因此，我們會看到一些付款人在這個動態的旅程中進進出出，但我非常有信心它最終會達到產品價值已確立的情況。當然，當產品短缺時，壓低價格的動機也會減弱。這顯然也起作用。但實際上更多的是我們關注的長期命運。

And also similar to the question on capital, just to understand, I'm not looking for numbers. But given that there's obviously a lot of demand and there's capacity constraints. In theory, you want to build unlimited CapEx like forget about the dividend and the share buyback and all that. Again this is theory. Is the limitation on CapEx a question of capital? Is it a question of technology? Is it a question of just the system is complex so even if you had unlimited money, you could still not ramp up? Just help me understand what's the limitation.

也類似資本問題，只是為了理解，我並不是尋找數字。但考慮到需求顯然很大，但產能卻有限。理論上，你想要建立無限的資本支出，例如忘記股利和股票回購等等。這又是理論。資本支出的限制是資本問題嗎？是技術問題嗎？是不是系統太複雜了，就算你有無限的錢，你還是無法升級？請幫我了解限制是什麼。

When you saw the picture from before, it's easy to build the building. But these are highly complex manufacturing systems and there are a defined number of vendors who can consult on that the machinery that goes in. If you take fill/finish machines, most pharmaceutical companies in the world would be shopping among the same manufacturers. So there's not an unlimited amount of machinery and people to build it. Of course we also have to handle it. So there is a bit of a rate in terms of what you can handle from a complexity point of view. So it's not the CapEx amount that's constraining us, it's more the whole execution of it. So of course if there are ways to accelerate that, that is attractive. So I mentioned before that we try to expand on our different sites, which means that it's different vendors, it's different people who have to lead it more than building everything in 1 place. So it's not the money as such. It's handling the complexity of it that plays in.

當你看到之前的圖片時，建造這座建築很容易。但這些都是高度複雜的製造系統，並且有一定數量的供應商可以就所使用的機械進行諮詢。如果您採用灌裝/包裝機器，世界上大多數製藥公司都會在同一製造商中購買。因此，建造它的機械和人員數量並不是無限的。當然，我們也必須處理它。因此，從複雜性的角度來看，您可以處理的內容有一定的速率。因此，限制我們的不是資本支出金額，而是整個執行過程。當然，如果有辦法加速這一進程，那就很有吸引力。所以我之前提到過，我們嘗試在不同的網站上擴展，這意味著不同的供應商、不同的人必須領導它，而不是在一個地方建立所有東西。所以這不是錢本身。它正在處理它的複雜性。

Thanks for the questions. So this concludes the Q&A session. Thanks for watching the webcast. For those of you in the room, management will stay around for a bit of time so should you have any final question, you can come up and I'm sure they will be happy to chat. And before we finally close, Lars, any final words from your side?

感謝您的提問。問答環節到此結束。感謝您觀看網路廣播。對於房間裡的人來說，管理層會留下一段時間，因此如果您有任何最終問題，可以上來，我相信他們會很樂意與您聊天。在我們最終結束之前，拉斯，您還有什麼想說的嗎？

I hope it has come across that we are hugely excited about where we are as a company. The opportunity we have for ramping our business, continue the scaling. Some say that we have manufacturing challenges, I say there's opportunities and we are delivering significantly more products already. So I think we're executing quite well and we look forward to continue that journey and serve more patients and make a strong business trajectory based on that. So thank you all for your attention.

我希望大家看到我們對公司目前的狀況感到非常興奮。我們有機會擴大業務，並繼續擴大規模。有人說我們面臨製造挑戰，我說有機遇，而且我們已經交付了更多的產品。因此，我認為我們的執行情況相當好，我們期待繼續這趟旅程，為更多患者提供服務，並在此基礎上建立強大的業務軌跡。謝謝大家的關注。