Novartis AG (NVS) 2026 Q1 法說會逐字稿

Good morning and good afternoon, and welcome to the Novartis Q1 2026 results release conference call and live webcast. (Operator Instructions) The conference is being recorded. (Operator Instructions) A recording of the conference call, including the Q&A session, will be available on our website shortly after the call ends.

各位早安、午安，歡迎參加諾華（Novartis）2026 年第一季（Q1 2026）業績發布電話會議與線上直播。(操作員指示) 本次會議將被錄音。(操作員指示) 包含問答環節在內的會議錄音，將於通話結束後不久在我們的網站上提供。

With that, I would like to hand over to Ms. Sloan Simpson, Head of Investor Relations. Please go ahead, madam.

接下來，我想把時間交給投資人關係主管 Sloan Simpson 女士。女士，請開始。

Thank you, Sharon. Good morning and good afternoon, and welcome to everyone to our Q1 2026 conference call. The information presented today contains forward-looking statements that involve known and unknown risks, uncertainties and other factors. These may cause actual results to be materially different from any future results, performance or achievements expressed or implied by such statements. For a description of some of these factors, please refer to the company's Form 20-F and its most recent quarterly results on Form 6-K that respectively were filed with and furnished to the US Securities and Exchange Commission.

謝謝你，Sharon。各位早安、午安，歡迎大家參加我們 2026 年第一季電話會議。今天所呈現的資訊包含前瞻性陳述，涉及已知與未知的風險、不確定性及其他因素。這些因素可能導致實際結果與此類陳述所明示或暗示的任何未來結果、表現或成就存在重大差異。關於其中部分因素的說明，請參閱公司向美國證券交易委員會（SEC）提交的 Form 20-F，以及最近一期以 Form 6-K 形式提交/提供的季度業績資料。

(Operator Instructions) And with that, I will hand across to Vas.

(操作員指示) 那麼，我將把時間交給 Vas。

Thank you, Sloan, and thanks, everyone, for joining today's call. So if we go to slide 4. As you saw this morning, we delivered a strong start to the year across our priority brands and launches, which is really where our focus is at the moment. These brands and launches are what's going to drive our mid- to long-term growth and where we believe now we have demonstrated that there's strong momentum behind these medicines.

謝謝你，Sloan，也謝謝各位參加今天的電話會議。那我們請看第 4 張投影片。如同各位今天早上所看到的，我們在優先品牌與新上市產品方面，為今年帶來了強勁的開局，而這正是我們目前的重點。這些品牌與上市產品將推動我們中長期的成長；我們也相信，現在已經證明這些藥品背後具有強勁的動能。

When you look at sales for the quarter, you saw that those growth drivers were up 34% in constant currency. Our base business was largely stable, but we did see significant Gx erosions as we've guided to, and Mukul will go through some of the dynamics for that over the course of the rest of the year.

從本季銷售來看，這些成長動能來源以固定匯率計成長 34%。我們的基礎業務大致穩定，但如同我們先前指引所述，確實看到顯著的學名藥/仿製藥（Gx）侵蝕；Mukul 會在接下來說明今年其餘期間的相關動態。

On Core OpInc, we were down 14%, driven by the sales decline as well as the increased investments in R&D, which we also guided to. When you look at some of the pipeline highlights a number of important highlights, including the continued progress for Rhapsido across a number of indications. Ianalumab received a breakthrough therapy designation and priority review in Sjogren's disease as well as a few other important milestones, which we'll go over the course of the call. Importantly, we're maintaining our full year sales and core operating guidance for the year.

核心營業利益（Core OpInc）下滑 14%，主要受銷售下滑以及研發（R&D）投資增加所影響，這也在我們先前的指引之內。就研發管線重點而言，有多項重要進展，包括 Rhapsido 在多個適應症上的持續推進。Ianalumab 在乾燥症（Sjogren's disease）獲得突破性療法認定與優先審查資格，此外還有其他幾個重要里程碑，我們會在本次電話會議中逐一說明。重要的是，我們維持全年銷售與核心營業利益的全年指引不變。

Now moving to the next slide. When you look at those growth drivers in a little bit more detail, that 34% was driven, in particular, by very strong performance we saw in Kisqali, Pluvicto, Kesimpta, Leqvio driven by our strong launch overseas, particularly in China and the continued performance of Scemblix. So I'll look forward to going through now some of the dynamics for each of our key brands over the course of the remaining slides.

接著看下一張投影片。更細部來看這些成長動能來源，34% 的成長主要由 Kisqali、Pluvicto、Kesimpta、Leqvio 的強勁表現所帶動，這也受惠於我們在海外、特別是中國的強勢上市推進，以及 Scemblix 的持續表現。接下來在後續投影片中，我也期待逐一說明各個關鍵品牌的動態。

Now moving to slide 6. In quarter one, Kisqali grew 55%. And as you know, Kisqali now is -- has a lot of momentum, both in early breast cancer and metastatic breast cancer and given our global launches, we're starting to see a pickup of the ex-US markets.

現在請看第 6 張投影片。第一季 Kisqali 成長 55%。如各位所知，Kisqali 目前動能非常強，不論是在早期乳癌或轉移性乳癌；隨著我們在全球的上市推進，也開始看到美國以外市場的成長加速。

So focusing in on the US, you can see our NBRx share now in the early breast cancer setting is very strong, 65% plus 2% now versus prior quarter. In addition, in metastatic breast cancer, we have 47% NBRx and 41% TRx. So taken together, we're in a very strong position in metastatic and early breast cancer.

聚焦美國市場，各位可以看到我們在早期乳癌適應症的新處方（NBRx）市占目前非常強勁，達到 65% 以上，較上一季再增加 2 個百分點。此外，在轉移性乳癌方面，我們的 NBRx 為 47%，總處方（TRx）為 41%。綜合來看，我們在轉移性與早期乳癌領域都處於非常有利的位置。

And when we look at that data in more detail, we see that Kisqali has a strong position, not only in the overlapping segment with our competitor in early breast cancer, but also in our unique segment, particularly the Node 1 high risk and the Node 0 high-risk patients. And going forward, our focus will be very much continuing to expand Kisqali's utilization in those early breast cancer populations. Now turning to the ex-US.

當我們更深入檢視這些數據時，可以看到 Kisqali 的優勢不僅在於早期乳癌中與競品重疊的族群，也包括我們的獨特族群，特別是淋巴結 1（Node 1）高風險與淋巴結 0（Node 0）高風險患者。展望未來，我們的重點將是持續擴大 Kisqali 在這些早期乳癌族群中的使用。接著轉向美國以外市場。

I think one of the markets that we're keenly focused on is our performance in Germany, where we saw outstanding performance in quarter one. You can see in early breast cancer, our shares are approaching 80% now in Germany. Overall, we were growing 50% in constant currencies in the first quarter. We have continued metastatic breast cancer leadership across our key markets with 50% NBRx share. And we also see growth accelerating now as we have more EBC launches across a range of markets, 69 countries and we reimbursed now in 40 of those markets.

我們特別關注的市場之一是德國的表現，第一季我們在當地表現非常出色。各位可以看到，在早期乳癌方面，我們在德國的市占已接近 80%。整體而言，第一季以固定匯率計成長 50%。在我們的主要市場中，我們在轉移性乳癌仍維持領先地位，NBRx 市占達 50%。此外，隨著我們在更多市場推進早期乳癌（EBC）上市，我們也看到成長正在加速：目前已在 69 個國家上市，其中 40 個市場已獲得給付。

Some of the other markets, we're paying close attention to in the UK. We have 78% early breast cancer. And we have a strong early start in China where we do have now NRDL listing. So looking ahead, Kisqali is a brand we expect to have continued strong momentum over the course of this year.

其他我們密切關注的市場包括英國。我們在早期乳癌的市占為 78%。在中國方面，我們也有一個強勁的早期開局，因為目前已納入國家醫保藥品目錄（NRDL）。因此展望未來，我們預期 Kisqali 在今年將持續保持強勁動能。

So turning to slide 7. Kesimpta had also a solid quarter, 26% growth ahead of both the MS and B-cell markets. In the US, we saw a 21% TRx growth versus prior year. That was 2 points ahead of the market and 1.5 points B-cell class share increase versus prior year. Importantly, when we look at our NBRx market share, both in the overall market, we reached 17% and the B-cell class we reached 28%. So we're gaining share on both (technical difficulty) B-cell class competitors as well as the older drugs that still -- nearly the majority of patients are taking in the US.

接著看第 7 張投影片。Kesimpta 本季同樣表現穩健，成長 26%，領先於多發性硬化症（MS）市場以及 B 細胞市場的整體增速。在美國，我們看到 TRx 較去年同期成長 21%。這比市場高出 2 個百分點，且 B 細胞類別市占較去年同期提升 1.5 個百分點。重要的是，從 NBRx 市占來看，我們在整體市場達到 17%，在 B 細胞類別達到 28%。因此，我們不僅從（技術問題）B 細胞類別競品手中取得市占，也從美國仍有近半數患者使用的較舊藥物中取得市占。

Overall, we continue to see a significant runway for Kesimpta. I think a lot of that performance in the US is down to strong operational execution. We've gotten much better, I think, at targeting the right patient groups -- the right physician groups as well as owning our messaging around the unique benefits of Kesimpta as a self-administered monthly therapy. So excited about that. We also continue to progress now or every two-month dose Kesimpta, which we're looking forward to reading out next year.

整體而言，我們仍看到 Kesimpta 具有相當可觀的成長跑道。我認為美國的許多表現來自於強勁的營運執行。我們在鎖定正確的患者族群與醫師族群方面做得更好，同時也更能掌握並傳達 Kesimpta 作為每月一次、可自行施打治療的獨特效益。因此我們對此感到振奮。我們也持續推進 Kesimpta 每兩個月一次給藥方案，並期待明年公布結果。

Now in the ex-US setting, 31% constant currency growth, strong growth in Europe. We estimate one in six MS patients now are in Kesimpta. We see 79% of patients that are coming on to Kesimpta either as naive or first switch in the EU5. We also have continued NBRx leadership at 9 out of 10 major markets.

在美國以外市場方面，以固定匯率計成長 31%，歐洲成長強勁。我們估計目前約每 6 位 MS 患者就有 1 位使用 Kesimpta。在歐盟五國（EU5），我們看到新開始使用 Kesimpta 的患者中，有 79% 為初治（naive）或首次換藥。此外，我們在 10 個主要市場中的 9 個持續維持 NBRx 領先地位。

We do find, in general, outside of the US, a strong interest in self-administered medicines that can get patients out of the hospital or out of needing ongoing visits for infusion. So very amenable to the Kesimpta's profile. And we see an opportunity for continued expansion with two-thirds of BMT treated patients continuing to not be on a B-cell therapy in our key markets.

整體而言，在美國以外市場，我們發現對可自行施打的藥物有強烈興趣，因為這能讓患者不必住院，或不必為輸注而持續回診。因此市場非常接受 Kesimpta 的產品特性。我們也看到持續擴張的機會：在我們的主要市場中，接受 BMT 治療的患者仍有三分之二尚未使用 B 細胞療法。

Now moving to slide 8. Pluvicto continued its strong rollout, particularly driven by the pretax MCRPC setting. We saw strong demand. And we also saw good progress on our US rollout.

現在轉到第 8 張投影片。Pluvicto 持續強勁推進上市，尤其是由紫杉烷治療前的 mCRPC（轉移性去勢抗性前列腺癌）治療情境所帶動。我們看到需求強勁。同時也看到我們在美國的上市推進取得良好進展。

Starting with the US, we saw the US sales grew 76% in the quarter with 70 -- over 70% of that business now coming from the pre-taxane setting, and that's coming from a mix of urologists and community oncologists. Right now, we estimate about over 60% of our NBRxs are coming from the community. And I think that demonstrates we've not successfully made RLT, a medicine that can be prescribed in the community setting for patients who prefer to access care in the community.

先從美國來看，本季美國銷售成長 76%，其中 70%——超過 70% 的業務目前來自紫杉烷治療前的情境，且這些處方來源混合了泌尿科醫師與社區腫瘤科醫師。目前我們估計，超過 60% 的 NBRx 來自社區端。我認為這顯示我們已成功讓 RLT 成為一種可在社區醫療場域開立的藥物，供偏好在社區接受照護的病患使用。

Outside of the US, we saw 48% growth with NBRx is up 92%. This was driven by strong EU uptake, but also, I think, a notable solid start in Japan where we're seeing very strong interest in Pluvicto, so we're excited about that. And the initial stages of a launch as well in China. As a reminder, we have manufacturing sites that are being build and getting up to speed now in Japan and China, which will allow us to serve the Asian market. So diving a little bit deeper to think about some of those growth drivers.

在美國以外地區，我們看到 48% 的成長，NBRx 成長 92%。這主要由歐盟的強勁採用所帶動，同時我認為日本也有一個值得注意的穩健開局，我們看到市場對 Pluvicto 的興趣非常高，因此我們對此感到振奮。此外，中國也正處於上市初期階段。提醒一下，我們在日本與中國的製造基地正在建置並逐步提升產能，這將使我們能服務亞洲市場。接下來我們再更深入探討其中一些成長驅動因素。

A key element of our story is driving depth in the existing sites and expansion into urology that continues, and I think we're making good progress on that front. And then we also expect the hormone-sensitive approvals in the second half. There, we expect the hormone-sensitive indication to increase the total patient pool available to Pluvicto by 75%, so a substantial expansion and one that I think will enable us to get the next inflection of growth for Pluvicto.

我們故事中的一個關鍵要素，是在既有據點深化滲透並持續擴展至泌尿科領域，我認為我們在這方面進展良好。此外，我們也預期在下半年取得荷爾蒙敏感族群的核准。在那裡，我們預期荷爾蒙敏感適應症將使 Pluvicto 可觸及的總病患池增加 75%，這是相當可觀的擴張，我認為也將使我們迎來 Pluvicto 下一個成長拐點。

You can see here at the bottom of the slide, some of the data on the number of sites, so over 830 sites now prescribing in the US, 580 in the ex-US I think that all just gives us confidence that we've been able to make RLT standard that's available now broadly in the communities that we serve and also sets us up well for the future radioligand therapy portfolio over the coming years.

你可以在投影片底部看到一些據點數據：目前美國已有超過 830 個據點在開立處方，美國以外則有 580 個。我認為這些都讓我們更有信心：我們已能讓 RLT 成為一項標準治療，並且如今可在我們服務的社區中廣泛取得，同時也為未來幾年放射性配體治療產品組合奠定良好基礎。

Now moving to slide 9. Leqvio had a really strong quarter, and that was driven primarily by our performance outside of the US with strong growth in China as well as in Europe and Japan.

現在轉到第 9 張投影片。Leqvio 本季表現非常強勁，主要由美國以外市場的表現所帶動，包括中國的強勁成長，以及歐洲與日本的成長。

Now first, let's start with the US, where we saw 31% growth in the quarter. We continue to outpace the advanced lipid-lowering market, but I think in the US, the next inflection point we would expect is when we get the outcomes data in the first part of next year with -- in the secondary prevention setting, and that will be an important milestone for us.

先從美國開始，本季我們看到 31% 的成長。我們持續跑贏進階降脂市場，但我認為在美國，我們預期的下一個拐點將是明年上半年取得結局（outcomes）數據——在次級預防情境中——這將是我們的一個重要里程碑。

Now when you think about some of the other data, the highlights we're seeing, we're seeing that we are expanding in the Medicare Part B population, up 11 points versus prior year. That's about two-thirds of our current business. And we also see that our TRxs are consistently up 41% versus prior year. So I think all heading in the right direction, consistent, steady growth across the US in the buy and bill segment.

再看其他一些重點數據，我們看到在 Medicare Part B 人群中的滲透正在擴大，較去年提升 11 個百分點。這約占我們目前業務的三分之二。同時我們也看到 TRx 相較去年持續成長 41%。因此我認為一切都朝正確方向前進，在美國 buy-and-bill（先購後付）通路呈現一致且穩健的成長。

Outside of the US, 106% constant currency growth, that was led by China, the NRDL listing unlock significant demand. It is early days. So I think we'll have to see how the coming quarters evolve in China to really understand how much of this was a bolus versus a steady demand. But I think the early benchmarks that we're looking at suggests very strong demand in China and something that we're excited about for our future siRNA portfolio.

在美國以外地區，以固定匯率計算成長 106%，主要由中國帶動，納入 NRDL（國家醫保藥品目錄）釋放了顯著需求。目前仍屬早期階段。因此我認為我們需要觀察未來幾季在中國的發展，才能真正理解其中有多少是一次性放量（bolus），又有多少是穩定需求。但我認為我們目前觀察到的早期基準顯示中國需求非常強勁，這也讓我們對未來的 siRNA 產品組合感到振奮。

Now lastly, in terms of evidence base for Leqvio, I mentioned the importance of the outcomes trials. So we also are advancing -- we received an FDA approval for adolescents in two specific rare disease indications, and that will be important as well from a long-term pediatric exclusivity standpoint.

最後，關於 Leqvio 的證據基礎，我提到結局試驗的重要性。我們也在推進——我們已獲得 FDA 對青少年在兩項特定罕見疾病適應症的核准，從長期的兒科獨占期角度來看，這也將很重要。

Leqvio is included in the ACC and AHA guidelines. And I think many of you likely saw that the guidelines highlight aggressive lipid management now even at younger ages for patients. So I think that really points to not just statin use but adding statin and PCSK9 use wherever possible. So I think that all points to a positive outlook for the medicine.

Leqvio 已被納入 ACC 與 AHA 指南。我想各位可能也看到，指南強調如今即使在較年輕的病患族群，也要進行更積極的血脂管理。因此我認為這不僅指向他汀類藥物的使用，也指向在可行之處加入他汀與 PCSK9 的使用。所以我認為這些都指向該藥物的正向前景。

Now moving to the next slide. Scemblix was up 79%, I think, really outstanding performance for this brand, both in the US and ex-US. We see in the US, very strong performance in the frontline setting and outside the US, both second, third line and frontline now starting to pick up.

現在轉到下一張投影片。Scemblix 成長 79%，我認為這個品牌表現非常出色，無論在美國或美國以外地區皆然。我們看到在美國，第一線治療情境表現非常強勁；在美國以外地區，第二、第三線以及第一線也開始加速成長。

Let's take each of those in sequence. So first in the US now we've reached 31% first-line NBRx share. You can see the steady climb upwards in the graph. So very excited about that. And then hopefully, soon, we'll be consistently the leader in NBRx brand scripts in the United States. When you look at the -- we're also a leader across all lines now with 42% share. So I think that also demonstrates the breadth of interest in Scemblix.

我們依序來看。首先在美國，我們目前已達到第一線 NBRx 市占 31%。你可以在圖表中看到穩步上升的趨勢。因此我們對此非常振奮。並且希望不久之後，我們能在美國的 NBRx 品牌處方量上持續成為領導者。再看——我們目前在所有治療線別也都是領先者，市占 42%。因此我認為這也顯示市場對 Scemblix 的廣泛興趣。

Outside of the US, we grew 68%. That's driven primarily by our third line leadership, 73% share across our key markets. But we are seeing early line indications now starting -- the indications are a new advanced. We're approved in 63 countries. You can see in the chart here that the NBRx share in the first line in Japan, we've already reached 50%. In Germany, we're seeing early traction as well with 11% NBRx in the front line.

在美國以外地區，我們成長 68%。這主要由我們在第三線的領導地位所帶動，在主要市場的市占達 73%。但我們也看到早期治療線別的適應症現在開始——這些適應症是新近推進的。我們已在 63 個國家獲准。你可以在此圖表看到，日本第一線的 NBRx 市占我們已達到 50%。在德國，我們也看到第一線的早期動能，NBRx 達 11%。

And of course, for the long-term outlook for the brand, our goal is to make this the standard of care in the frontline setting across all major geographies. And as you can see in the data, we're well on our way to deliver that goal.

當然，就品牌的長期展望而言，我們的目標是讓它在所有主要地區的第一線治療情境中成為照護標準。如你在數據中所見，我們正穩步朝著達成該目標前進。

Now moving to slide 11. Now Cosentyx had a broadly stable quarter, and we were impacted by some of the onetime effects that we had in the prior quarter in 2025. So when you net out those effects, we would estimate that our global sales growth was about 2%. In the US, we were roughly flat to 1% growth. So I think that indicates that we're stable and I think set up well now as a new indication come online for Cosentyx. And that's going to be very, very important to ultimately achieve our peak sales goal.

現在轉到第 11 張投影片。Cosentyx 本季整體表現大致穩定，但受到我們在 2025 年前一季出現的一些一次性因素影響。因此若扣除這些影響，我們估計全球銷售成長約為 2%。在美國，我們大致持平至成長 1%。因此我認為這顯示我們表現穩定，且隨著 Cosentyx 新適應症即將上線，我們也已做好良好布局。而這將對最終達成我們的峰值銷售目標非常、非常重要。

So when you look at some of the data, when you look at the hidradenitis suppurativa/NBRx naive share, you can see here pretty consistently around 50%. We did see a slight dip in January because of the degree verification and the availability of biosimilars, but we see that now climbing back up. So we expect to be stable in that 50% range. Importantly as well, for IV patient share, we see steady growth up to now 14%. And so both of these will continue to be important.

因此當你看一些數據時，觀察化膿性汗腺炎（hidradenitis suppurativa）/NBRx 新用藥者（naive）市占，你可以看到這裡相當一致地維持在約 50%。我們確實在 1 月看到些微下滑，原因是學位驗證（degree verification）的影響以及生物相似藥的可得性，但我們看到目前正回升。因此我們預期將能穩定維持在 50% 左右。同樣重要的是，在靜脈注射（IV）病患市占方面，我們看到穩定成長，目前達到 14%。因此這兩項都將持續很重要。

We are hoping that the HHS market continues to develop not just for Cosentyx, but as we'll address later remibrutinib now will also have a readout later this year in HS. So we want to see this market expand for the patients who need better therapies are getting them.

我們希望 HHS 市場能持續發展，不僅是為了 Cosentyx；而且正如我們稍後會提到的，remibrutinib 今年稍晚也將在 HS 取得讀出結果。因此，我們希望看到這個市場擴大，讓需要更好療法的病患能夠獲得這些治療。

Outside of the US, we were up 3%, that's primarily driven by growth in Europe and emerging markets. We continue to see competitive pressures in China with multiple local NRDL entrants. And so there's a long list of competitors that we have, and we've had very strong share performance in China now over many years, but our goal will be to maintain now share and hopefully can stabilize this well performance in China over the coming quarters.

在美國以外的市場，我們成長了 3%，主要由歐洲與新興市場的成長所帶動。我們持續看到中國面臨競爭壓力，因為有多個本土 NRDL 進入者。因此我們面對一長串競爭對手；而我們在中國多年來一直有非常強勁的市占表現，但我們的目標是維持市占，並希望在未來幾季能讓中國的這項良好表現趨於穩定。

We continue to advance the new indications. Importantly, the PMR submission happened across geographies, and we expect the FDA approval in the second half. And we also received FDA approval for the pediatric HS indication. We completed EMA submission as well. So all on track on that front.

我們持續推進新的適應症。重要的是，PMR 申請已在各地區提交，我們預期 FDA 將在下半年核准。我們也已獲得 FDA 對兒科 HS 適應症的核准。我們也完成了 EMA 的送件。因此在這方面一切都按計畫進行。

Now moving to slide 12. I wanted to just say a few words on our renal portfolio by talking about each of the key brands. So first, let's talk about Fabhalta. Sales were up 103% in quarter one with NBRx leadership now, both in PNH and C3G.

接著看第 12 頁投影片。我想透過逐一談談各個關鍵品牌，簡要說明我們的腎臟產品組合。首先談 Fabhalta。第一季銷售額成長 103%，目前在 PNH 與 C3G 兩個領域都取得 NBRx 領先地位。

In PNH at the moment, we're seeing 50% NBRx share as well as important and significant contributions from some of our key ex US markets. In C3G, 56% NBRx share that were now approved in 46 countries. So both of those indications really having solid and consistent performance.

就目前的 PNH 而言，我們看到 NBRx 市占達 50%，同時也有來自部分關鍵美國以外市場的重要且顯著貢獻。在 C3G 方面，NBRx 市占為 56%，且目前已在 46 個國家獲准。因此這兩個適應症的表現都相當穩健且一致。

Now importantly, in IgAN, I think we believe our uptake in US patients will continue to build in patients with persistent proteinuria and glomeruli inflammation. So here, we're a later line therapy. But I think very important was the two-year Phase III APPLAUSE-IgAN data, which was published in the New England Journal. It showed an impressive slowing and kidney function decline of 49% versus placebo and a reduction in progression to kidney failure by 43%. The FDA has granted us priority review for the traditional approval. So I think that just indicates the strength of the Fabhalta data in IgAN.

另外很重要的是，在 IgAN 方面，我們相信在美國病患中的採用率將持續提升，特別是在持續蛋白尿與腎小球發炎的病患族群。在這裡，我們屬於較後線的治療。但我認為非常重要的是第三期 APPLAUSE-IgAN 兩年期數據已發表於《新英格蘭醫學期刊》。結果顯示，相較安慰劑，腎功能下降的減緩幅度達 49%，且進展至腎衰竭的風險降低 43%。FDA 已授予我們傳統核准的優先審查資格。因此我認為這也顯示 Fabhalta 在 IgAN 數據的強勁性。

For Vanrafia, we see steady US uptake in a very competitive field, I think, as all of you know. That launch is ongoing. We have about 11% NBRx share. We see a significant market expansion opportunity with most patients still on supportive care as that market grows, we hope that Vanrafia will ultimately benefit as a really effective and safe vascular agent endothelin agent.

至於 Vanrafia，我們看到在競爭非常激烈的領域中，美國的採用率穩步上升，我想各位都很清楚。該產品上市推進仍在進行中。我們目前約有 11% 的 NBRx 市占。隨著市場成長、且多數病患仍以支持性照護為主，我們看到顯著的市場擴張機會；我們希望 Vanrafia 最終能受惠，成為一個真正有效且安全的血管作用藥物／內皮素（endothelin）藥物。

And we do expect traditional FDA approval to drive future growth. You saw in the quarter, we top lined the ALIGN data, and we do expect to submit that data to FDA and EMA in the first half. We will present that data in full and while we didn't reach statistical significance, we feel confident that the data is compelling, will allow that full approval to ultimately happen.

我們也預期傳統的 FDA 核准將帶動未來成長。各位在本季也看到我們公布了 ALIGN 數據的主要結果（top line），並預期在上半年將該數據提交給 FDA 與 EMA。我們將完整呈現該數據；雖然未達統計顯著性，但我們有信心該數據具說服力，最終將能促成完全核准。

Now moving to slide 13. Now Rhapsido CSU launch off to a strong start in the US, and we have the early steps now to begin the rollout as well outside of the US. And I think when you look at the profile we're building, pipeline and a bill potential, significant medicine here that could address a range of different dermatology and immunology indications.

接著看第 13 頁投影片。Rhapsido 在美國的 CSU 上市開局強勁，我們也已開始在美國以外市場推動初期的上市鋪陳。我認為，從我們正在建立的產品特性、研發管線與潛在適應症擴展來看，這是一個具有重大潛力的藥物，可能可涵蓋多種不同的皮膚科與免疫學適應症。

So starting with the CSU launch, the US uptake, we see 3,000 prescribers to date, across allergists and dermatologists now prescribing the medicine, 6,000 patient starts and we're seeing very positive feedback on the speed of the onset of action. And we estimate an NBRx share now of 24%, which I think is very good in these early phases of launch.

先從 CSU 上市談起：在美國的採用方面，截至目前已有 3,000 位處方醫師，包括過敏專科與皮膚科醫師正在開立此藥；已有 6,000 位病患開始用藥，我們也收到對起效速度非常正面的回饋。我們估計目前 NBRx 市占約為 24%，我認為在上市初期這是非常好的表現。

We are having early access wins, but I would say that access will build over the course of the year. So it will take us the full year to get to where we want to ultimately get to from an access standpoint. And that will be important as well because that's what allows us to bridge from three drugs to ultimately paid scripts. So that will be a steady uptake over the course of year, not a fast inflection.

我們在早期准入方面已有一些進展，但我會說，准入將在一年內逐步建立。因此，從准入角度來看，我們需要一整年才能達到最終希望達到的狀態。這也很重要，因為這能讓我們從「三種藥物」過渡到最終的「付費處方」。因此，這將是全年穩步提升的採用，而不是快速的躍升。

And then outside of the US, the China commercial launch and the European EC approval that we've received will enable us to hopefully have a solid launch to Rhapsido in the second half of the year.

而在美國以外，中國的商業化上市以及我們已取得的歐洲 EC 核准，將使我們有望在今年下半年為 Rhapsido 帶來穩健的上市表現。

We did also have the positive CIndU readout, primary endpoint in chronic-conducible urticaria. We saw significantly higher rates of complete responses versus placebo across all three CIndU types. First time a medicine has delivered that. Well tolerated with a favorable safety profile. We're on track now for the FDA approval in the first subtype of CIndU and FDA submission of the other two types in the second half.

我們也取得了 CIndU 的正面讀出，在慢性誘發性蕁麻疹的主要終點達標。在三種 CIndU 類型中，相較安慰劑，我們看到完全反應（complete response）的比例顯著更高。這是首次有藥物達成這樣的結果。耐受性良好，且安全性特徵有利。我們目前按計畫推進，預期在 CIndU 的第一個亞型取得 FDA 核准，並在下半年提交另外兩種類型的 FDA 申請。

Now building on the overall profile for Rhapsido, when you look at the next slide, slide 14. We did release as well the Phase II results for remibrutinib in food allergy to support a fast-acting oral option for these patients. We also have -- are on track now to initiate the Phase III study. You can see here on the left the data that we read out. The 100-milligram dose provided 86.7% of responders, which I think a very impressive result.

接著在 Rhapsido 的整體產品特性基礎上，請看下一張投影片，第 14 頁。我們也公布了 remibrutinib 在食物過敏的第二期結果，以支持為這些病患提供一個起效快速的口服選項。我們也——目前按計畫啟動第三期研究。各位可在左側看到我們讀出的數據。100 毫克劑量的反應者比例達 86.7%，我認為這是非常令人印象深刻的結果。

Our modeling indicates that the 75-milligram BID would be the appropriate dose for the patients moving forward. So that's the dose we've taken forward into the Phase III study.

我們的模型顯示，75 毫克 BID（每日兩次）將是後續病患最合適的劑量。因此，我們已將此劑量帶入第三期研究。

Our focus will be a multi-allergen prevention study. So I think that's really exciting across a broad range of age 12 years all the way up to 65 years. And as I mentioned, anticipate initiation in the second half. This has the potential to address a significant unmet need, 3.5 million high-risk eligible patients across major markets. So very excited to add this to the indication less, hopefully, for Rhapsido.

我們的重點將放在多種過敏原的預防性研究。因此我認為這在涵蓋 12 歲到 65 歲的廣泛年齡層方面非常令人振奮。如我所提到的，我們預期在下半年啟動。這有潛力滿足一項重大的未被滿足需求：在主要市場中，約有 350 萬名高風險且符合資格的病患。因此，我們非常期待將此項適應症加入 Rhapsido 的適應症版圖（希望如此）。

Then moving to slide 15. Also in the quarter, we completed the acquisition of Avidity, adding three late-stage medicines for neuromuscular disease. And I just wanted to highlight two data points from the quarter. We did release the one-year results for del-zota our -- for our DMD exon 44 skipping medicine, which was presented at the Muscular Dystrophy Association to a standing ovation, which I think shows the impact that this medicine could have for these patients.

接著看第 15 頁投影片。本季我們也完成了對 Avidity 的收購，新增三項用於神經肌肉疾病的後期階段藥物。我想強調本季的兩個數據重點。我們公布了 del-zota——我們的 DMD 外顯子 44 跳讀（exon 44 skipping）藥物——的一年期結果，並在肌肉萎縮症協會（Muscular Dystrophy Association）會議上發表，獲得全場起立鼓掌；我認為這顯示該藥物可能為這些病患帶來的影響。

You can see here the creatine kinase declines, which are remarkable. And you can, I think, really -- experts have opined that is really a revolution with this medicine. We're excited to also build after this a range of additional exon skipping medicines for DMD. We are expecting the submission now in the first half as we work through some of the additional CMC topics to make sure that the file is fully submission-ready.

各位可在此看到肌酸激酶（creatine kinase）的下降幅度，非常顯著。而且我認為，專家們也評論這確實可能是此藥物帶來的一場革命。我們也很期待在此基礎上，為 DMD 建立一系列額外的外顯子跳讀藥物。在我們處理一些額外的 CMC 議題、以確保申報檔案完全符合送件要求的同時，我們預期將在上半年完成提交。

And then with Del-desiran, we had the final results for the Phase I/II study MARINA trial published in the New England Journal. Those are results you all know well. But I think to highlight the excellent profile that we've seen with this medicine, and we're on track for the Phase III readout for the HARBOR study in the second half.

接著在 Del-desiran 方面，我們已在《新英格蘭醫學期刊》發表了 MARINA 試驗（第一/二期研究）的最終結果。這些結果各位都非常熟悉。但我想特別強調的是，我們在這項藥物上看到的優異特性，而且我們也正按計畫在下半年取得 HARBOR 研究的第三期讀出結果。

Now moving to slide 16. I did want to say a word on the pipeline readouts for the rest of the year. We have quite a bit happening and we're excited about that. So in the first half, I already mentioned the Rhapsido CIndU positive readout. We did have Ianalumab readout in warm autoimmune hemolytic anemia, which did not meet significance, so we won't be taking that forward. But we don't expect that to be a read-through to ITP, where we already have positive second line data, and we'll look forward to the first-line data in the second half.

現在轉到第 16 張投影片。我也想簡要談一下今年其餘時間的研發管線讀出。我們有相當多進展，對此感到非常振奮。因此在上半年，我已提到 Rhapsido CIndU 的正向讀出。我們也取得 Ianalumab 在溫抗體自體免疫性溶血性貧血的讀出，但未達統計顯著性，因此我們不會再推進該適應症。不過我們不預期這會影響到 ITP；我們在 ITP 已有正向的二線治療數據，並期待下半年的一線治療數據。

We also have data in-house now for votoplam, which confirm our approach for the Phase III study based on that data, we feel very comfortable taking the 10-milligram dose now forward into the pivotal Phase III readout. We are, in collaboration with our partner, PTC, now discussing the best next steps for that medicine, including further interactions as well with the FDA, and we'll keep everyone apprised as we continue to progress that medicine forward.

我們目前也已取得 votoplam 的內部數據，該數據確認了我們對第三期研究的策略；基於這些數據，我們非常有信心將 10 毫克劑量推進至關鍵性第三期讀出。我們正與合作夥伴 PTC 討論該藥物的最佳後續步驟，包括與 FDA 進一步互動；隨著我們持續推進該藥物，我們也會讓各位隨時掌握最新進展。

We also are on track as well for the FSHD biomarker cohort readout as well. Our plan would be to ultimately disclose that data after we've had any discussions with FDA to understand better if the data meets the standard for an accelerated approval. We do not have that data in-house yet, but we do expect it over the course of the remainder of the first half.

我們也同樣按計畫推進 FSHD 生物標記（biomarker）隊列的讀出。我們的計畫是，在與 FDA 完成討論、以更清楚了解該數據是否符合加速核准標準之後，再對外揭露這些數據。我們目前尚未取得該數據，但預期在上半年剩餘期間內會收到。

Other important readouts include, of course, the pelacarsen readout, which I'm sure we can discuss. The remibrutinib MS readout, which will have two replicate studies. The Del-desiran DM1 study, which I also mentioned. And then we've accelerated now the Rhapsido HS program into the second half of this year. That study enrolled extremely quickly.

其他重要讀出當然包括 pelacarsen 的讀出，我相信我們可以進一步討論。以及 remibrutinib 在 MS 的讀出，將包含兩項重複驗證研究。還有我先前提到的 Del-desiran DM1 研究。另外，我們已將 Rhapsido HS 計畫加速至今年下半年。該研究收案速度非常快。

So very excited because that will give us another first oral option for patients with HS. We also have our QCZ484 siRNA for hypertension Phase II data reading out. And then lastly, VHB, our ALS TREM2 antibody reading out as well in the second half.

因此我們非常興奮，因為這將為 HS 患者帶來另一個首個口服治療選項。我們也有 QCZ484 siRNA 用於高血壓的第二期數據即將讀出。最後，VHB——我們的 ALS TREM2 抗體——也將在下半年讀出。

So with that, I will hand it over to Mukul.

那麼，我把時間交給 Mukul。

Thank you very much, Vas, and good morning, good afternoon, everyone. I will now take you through our financial results for the first quarter, which, as Vas mentioned, was strong despite significant US generic entries. As always, my comments refer to growth rates in constant currencies, unless otherwise noted.

非常感謝你，Vas，各位早安、午安。接下來我將帶各位回顧第一季的財務結果；如 Vas 所提，儘管美國有顯著的學名藥進入，我們的表現仍然強勁。一如往常，除非另有說明，我的評論所提及的成長率皆以固定匯率計算。

Slide 18, please. Our Q1 results, as expected, were impacted by UX Gx erosion with sales down 5% and core op inc down 14%. And Worth noting is that we did have a positive gross net in our base from Q1 last year that also had a negative impact on the overall quarterly growth rate. Core margin in Q1 declined 4.1%. This was mainly due to higher R&D investments as well as the impact of generics on the gross margin.

請看第 18 張投影片。如預期，我們第一季的結果受到 UX Gx 侵蝕影響，銷售額下降 5%，核心營業利益下降 14%。值得注意的是，我們在去年第一季的基期中有正向的 gross-to-net（毛額到淨額）因素，這也對整體季度成長率造成了負面影響。第一季核心利潤率下降 4.1%。這主要是因為研發投資增加，以及學名藥對毛利率的影響。

These results were fully in line with our internal expectations and how we see 2026 P&L phasing through the year panning out. Most importantly, our growth drivers continue to show very positive growth momentum something that Vas has shared earlier on in the presentation, with growing at 34% in Q1.

這些結果完全符合我們的內部預期，也符合我們對 2026 年損益表（P&L）在全年節奏的判斷。最重要的是，我們的成長驅動因素持續展現非常正向的成長動能——Vas 先前在簡報中也已分享——第一季成長達 34%。

Slide 19, please. What's great to see is that our continued focus on free cash flow generation has paid off in Q1. The lower core open was compensated by favorable working capital movement and this brought back the free cash flow broadly in line with previous year quarter one. Our strong cash flow continues to support our reinvestment into our business, including bolt-on M&A as well as gives us the opportunity to return capital to our shareholders through dividends and share buybacks.

請看第 19 張投影片。令人欣慰的是，我們持續聚焦於自由現金流的創造，在第一季已見成效。較低的核心營業利益由有利的營運資金變動所抵銷，使自由現金流大致回到與去年第一季相當的水準。我們強勁的現金流持續支持我們對業務的再投資，包括補強型併購（bolt-on M&A），同時也讓我們有機會透過股利與庫藏股回購向股東返還資本。

Slide 20, please. We remain committed to our talent shareholder-friendly capital allocation strategy, alongside an increased R&D, in the first quarter, we closed Avidity acquisition, and we also announced two early-stage deals to support our oncology and immunology disease franchises. On the other hand, for the return of capital to our shareholders front, we did pay $9.1 billion in dividend in March and April, as previously announced, and in addition, we continue to progress with our up to $10 billion share buyback program. This program still has around $6.1 billion remaining and is targeted to complete end of 2027.

請看第 20 張投影片。在提高研發投入的同時，我們仍致力於以人才為本、對股東友善的資本配置策略；第一季我們完成了 Avidity 的收購，並宣布兩項早期階段交易，以支持我們在腫瘤與免疫疾病領域的產品組合。另一方面，在向股東返還資本方面，我們如先前公告，已於 3 月與 4 月支付 91 億美元股利；此外，我們也持續推進最高 100 億美元的庫藏股回購計畫。該計畫目前仍剩約 61 億美元額度，目標於 2027 年底前完成。

Slide 21. With that, I'll move to the guidance piece. So with our Q1 results, we are now reaffirming our full year 2026 guidance. We continue to expect 2026 to have low single-digit sales growth and low single-digit decline in core operating income. Worth noting is that this is the year we are growing the top line of the company through the largest LOE period that the company has seen. Core net financial expense will be around $1.7 billion and core tax rate would be about 16.5%. And these two parameters are consistent with our previous estimates.

第 21 張投影片。接著我將談到財測指引。基於第一季結果，我們現在重申 2026 全年指引不變。我們仍預期 2026 年銷售額為低個位數成長，核心營業利益為低個位數下滑。值得注意的是，在公司歷來最大規模的專利到期（LOE）期間，我們仍能推動公司營收（top line）成長。核心淨財務費用約為 17 億美元，核心稅率約為 16.5%。這兩項參數與我們先前的估計一致。

Slide 22, please. We continue to expect 2026 to be a year of two halves, H1 growth will be impacted by a tough previous year base following US generic entries for Entresto, Promacta and Tasigna mid-last year. And with that, in the base, we had guided H1 sales to decline low single digit and core op inc to decline low double digits. With our Q1 results now in the bank, we are on track to meet that guidance with Q2 sales expected to decline low single digits and core op inc expected to decline high single digit to low double digit.

請看第 22 張投影片。我們仍預期 2026 年將呈現上下半年分化；上半年成長將受到去年基期偏高的影響，原因是去年年中美國學名藥進入 Entresto、Promacta 與 Tasigna。因此在基期假設下，我們先前指引上半年銷售額將低個位數下滑、核心營業利益將低雙位數下滑。隨著第一季結果已落袋，我們正按計畫達成該指引；預期第二季銷售額將低個位數下滑，核心營業利益將高個位數至低雙位數下滑。

In half two, the impact of the US generic entries and the base will start to minimize, and this will allow strong growth of our priority brands and launches to show through the overall P&L. And hence, we continue to expect H2 sales growth of mid-single digit and core op inc growth of mid- to high single digits. And that brings us to our full year guidance.

在下半年，美國學名藥進入及基期因素的影響將開始減弱，這將使我們優先品牌與新上市產品的強勁成長更能反映在整體損益表（P&L）上。因此，我們仍預期下半年銷售額為中個位數成長，核心營業利益為中到高個位數成長。以上即為我們的全年指引。

Next slide, please. If exchange rates remain at late April levels, we expect positive plus 2% impact on full year sales and positive 1% on full year core operating income. As a reminder, updated exchange rate assumptions are published monthly on our website.

請看下一張投影片。若匯率維持在 4 月下旬水準，我們預期對全年銷售額有正向約 +2% 的影響，對全年核心營業利益有正向約 +1% 的影響。提醒各位，我們每月都會在公司網站公布更新後的匯率假設。

And that concludes my remarks, and I'll hand it back to Vas.

以上是我的說明，接下來把時間交還給 Vas。

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

很好。謝謝你，Mukul，也歡迎你，Mukul——他作為CFO的第一個季度就有非常出色的開局。總體而言，我們在2026年於重點品牌與新品上市方面取得了強勁開局，並且我們對中長期成長展望仍然充滿信心。我們持續推進研發管線，完成了Ability的收購，並已為下半年多項讀出做好準備，同時也仍按計畫達成我們的全年指引。我們也期待這些讀出結果，這些結果可能使我們得以上調中長期成長展望。

So with that, we can open the line for questions here.

那麼，接下來我們可以開放提問。

(Operator Instructions) Peter Verdult, BNP Paribas.

(接線員指示) Peter Verdult，法國巴黎銀行（BNP Paribas）。

Pete Verdult, BNP. Just one question, just a deep dive, please, Vas, on HS. Could you perhaps talk about NBRx during the presentation, but could you talk about current volume price dynamics for Cosentyx in HS, the target clinical profile for Rhapsido in HS? And how, if the data is positive, you would intend to position both assets in the market?

Pete Verdult，BNP。我只有一個問題，想請Vas就HS做更深入的說明。你在簡報中或許談到了NBRx，但你能否談談Cosentyx在HS目前的量價動態、Rhapsido在HS的目標臨床特徵？以及如果數據是正面的，你打算如何在市場上定位這兩項資產？

Yes, Peter. Absolutely. So overall, with Cosentyx, we've had stable, I'd say, gross to net across our indication suite this year. So I think we've been able to manage things pretty well. So overall, with this primarily, we saw very solid volume growth in the quarter with HS.

好的，Peter。當然可以。整體來看，Cosentyx今年在我們各適應症組合的毛到淨（gross-to-net）表現我會說是穩定的。所以我認為我們把各項因素管理得相當不錯。總體而言，主要是在HS這一塊，我們在本季看到非常扎實的銷量成長。

More of the headwinds that we saw with some of the older indications. But nothing notable in terms of increased gross to nets for Cosentyx in the quarter. So when you think about remibrutinib, the Phase II data indicated, I think, impressive -- well, early but impressive results in disease management. I think we'll ultimately have to see how the Phase III results play out. But the ambition would be to play -- as we have with remibrutinib in CSU and plan to do in CIndU, is to hopefully have an oral option that could be placed ahead of biologics.

更多的是我們在一些較舊適應症上看到的逆風。但就本季而言，Cosentyx的毛到淨並沒有出現任何顯著上升。至於remibrutinib，第二期數據顯示——我認為在疾病管理上有令人印象深刻的結果，雖然仍屬早期但很亮眼。我想最終還是要看第三期結果的表現。但我們的企圖是——就像我們在CSU的remibrutinib所做、以及計畫在CIndU所做的一樣——希望能提供一個可在生物製劑之前使用的口服選項。

And so clearly, having two medicines would be helpful. We would have the oral option and ultimately, the biologic option as well. But I think this is really dependent on the data set. This is a heterogeneous population, and we're going to have to see how the data looks before we can fully define the positioning.

因此，很明顯地，同時擁有兩種藥物會很有幫助。我們會有口服選項，最終也會有生物製劑選項。但我認為這真的取決於數據集。這是一個異質性族群，我們必須先看看數據長什麼樣子，才能完整界定定位。

Sachin Jain, Bank of America.

Sachin Jain，美國銀行（Bank of America）。

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

如果可以的話，我想就前一個關於HS的問題再追問一下。你剛才有稍微評論，但考量到第二期因為劑量反向反應以及經安慰劑校正後的比率而較難解讀，你們相對於現有生物製劑的目標療效特徵是什麼？另外，在你看來，HS或MS哪一個更可能是更大的適應症？

Yes. I mean I think -- I don't know if I have the details Sachin, and we may have to follow up with you on our expectations on the Phase III study of the design in HS. But I would still say, it's all really going to depend, in terms of your second part of your question, the overall data profile that we see. I think clearly, if remi and MS proves itself both in relapse rate and disability progression to be better than the anti-CD20s, then, of course, the opportunity here is massive.

是的。我的意思是——我不確定我手上是否有這些細節，Sachin，我們可能需要後續再跟你更新我們對HS第三期研究設計的預期。但我仍會說，就你問題的第二部分而言，一切都將取決於我們看到的整體數據特徵。我認為很明顯地，如果remi在MS上無論是復發率或失能進展都證明優於anti-CD20，那麼這裡的機會當然非常巨大。

I think if it's in line or ultimately a little bit worse than I think HS could be a similarly sized indication. We know the HS market is growing. We've guided it to be a $5 billion market, growing -- certainly, the potation potential is there to be much larger. And it might be that a safe and effective oral option would be really attractive. So I think it's really going to be dependent on that MS readout to understand the size of the MS opportunity.

我想如果它與之相當，或最終略差一些，那麼我認為HS可能會是規模相近的適應症。我們知道HS市場正在成長。我們給出的指引是這會是一個50億美元的市場，且仍在成長——當然，擴張的潛力可能更大。而且一個安全且有效的口服選項可能會非常有吸引力。所以我認為，真的要看MS的讀出結果，才能理解MS機會的規模。

But I think it's exciting that we have two shots on goal with two -- with remi to add to what's two already very compelling indications that we have going forward. But we'll get back to you on your question on the HS.

但我認為令人振奮的是，我們有兩次進球機會——remi再加上我們已經擁有的兩個非常具吸引力的適應症，讓我們未來更具看點。不過關於你對HS的問題，我們會再回覆你。

Richard Vosser, JPMorgan.

Richard Vosser，摩根大通（JPMorgan）。

A question about China. You referenced competition for Cosentyx, but we also saw much lower growth in general in China across Q1 despite the strong start for Leqvio. So should we expect more slower international growth for Entresto, Cosentyx going forward? And slower overall China development? Or can Leqvio continue to post drag China growth to double digits?

一個關於中國的問題。你提到Cosentyx面臨競爭，但我們也看到儘管Leqvio強勁開局，中國整體在第一季的成長普遍低很多。所以我們是否應該預期未來Entresto、Cosentyx的國際成長會更慢？以及中國整體發展更慢？或者Leqvio能否持續帶動中國成長回到兩位數？

And I have one quick linked question on Leqvio. How much of the peak do you think can come from China given the strong start?

我還有一個與Leqvio相關的快速追問。考量到強勁開局，你認為峰值中有多少可以來自中國？

Yes. Thanks, Richard. So overall, the dynamics in China, we've seen a stabilization in the early part of this year. I don't think we're back to the pre 2025 growth levels, but we do see a stabilization overall in the market as well and in our key segments. And so we feel confident that our China business can be in that high single digit to low double-digit growth range.

是的。謝謝你，Richard。整體來看，中國的動態方面，我們在今年年初看到趨於穩定。我不認為我們已回到2025年之前的成長水準，但我們確實看到整體市場以及我們關鍵細分領域都出現穩定。因此，我們有信心中國業務可以維持在高個位數到低兩位數的成長區間。

So that's been positive overall. I think -- but there's no question it won't get back to the really high growth rates we saw a few years ago. We also see a higher number of competitors entering in, in each segment as well, which is something we have to just be ready for when we do launch in China. Nonetheless, very large market, highly attractive.

整體而言這是正面的。我認為——但毫無疑問，它不會回到幾年前我們看到的那種非常高的成長率。我們也看到每個細分領域都有更多競爭者進入，這也是我們在中國上市時必須做好準備的事情。儘管如此，這仍是一個非常大的市場，吸引力很高。

And I think you've seen the strong performance that we've had. I think for Leqvio, we have guided that Entresto can be $1 billion medicine across its indications. And certainly, we have the aspiration to make Leqvio as big or bigger than Entresto over time.

而且我想你也看到我們的強勁表現。我想就Leqvio而言，我們的指引是Entresto在其各適應症合計可成為一個10億美元的藥物。當然，我們也有志向讓Leqvio隨時間推進做到與Entresto一樣大，甚至更大。

It's early days. I think understanding the trajectory of how we get there. But I would say we see very solid demand for the medicine. And I think if we could make it in the range of Entresto, that would be a success.

目前仍是早期階段。我想我們還需要理解達成該目標的成長軌跡。但我會說，我們看到對這個藥物非常穩健的需求。而且我認為如果我們能做到接近Entresto的規模，那就是成功。

Simon Baker, Rothschild.

Simon Baker，Rothschild。

I will stick to the one. Taking up on your offer, Vas, could you give us your updated levels of confidence on the timing and outcome of the pelacarsen HORIZON study?

我會遵守只問一題。承接你剛才的提議，Vas，你能否提供你對pelacarsen HORIZON研究在時間點與結果方面的最新信心程度？

Yes, Simon. So I don't think I have anything new to add unfortunately because we don't have any new information. But I think we, of course, continue to make sure that the study is on track, no change in our expected readout. We do expect a readout in the early part of the second half of the year. So no change with respect to that.

好的，Simon。我想很遺憾我沒有新的內容可以補充，因為我們沒有任何新資訊。但我們當然會持續確保研究按計畫進行，我們預期的讀出時間沒有改變。我們預期在今年下半年初會有讀出結果。所以在這方面沒有變化。

I think if we get a positive result overall, that regardless of the relative risk reduction, we'll find a way to ultimately launch the medicine. I think what we'll be really looking for is, are there either the 90-milligram prespecified subgroup or other subgroups where we can really demonstrate a significant benefit for patients that I think will help with the uptake, but we have no insight yet as to what that be. We've modeled it extensively.

我認為如果我們整體得到正向結果，無論相對風險降低幅度如何，我們都會想辦法最終把這個藥物推向上市。我認為我們真正會關注的是：是否存在90毫克的預先指定亞組，或其他亞組，能讓我們確實證明對病人有顯著的臨床效益，我想這將有助於市場採用，但我們目前還無法洞悉會是哪一個亞組。我們已經做了非常廣泛的模型推演。

We continue to believe that we've done the right study and are fully powered for a 20% relative risk reduction in the 70-milligram per DL and higher patient population and a 25% relative risk reduction in the 90-milligram per DL patient population. As a reminder, the median level of the study is 108. So we definitely have enrolled the right patient group. And so we'll ultimately have to see.

我們仍然相信我們做了正確的研究設計，且在70毫克/分升及以上的病人族群中，對20%的相對風險降低具備充分統計檢定力；在90毫克/分升病人族群中，對25%的相對風險降低也具備充分檢定力。提醒一下，本研究的中位數水準是108。因此我們確實納入了正確的病人族群。所以最終我們還是得看結果如何。

I think some of the other dynamics that will be important is cardiovascular versus stroke and how those different elements contribute to the primary outcome. We do have a MACE 4 endpoint here, so we do include stroke. And I think some of the recent literature would suggest stroke is going to be an important element of the story for Lp(a). So we'll see how that unfolds.

我認為另一個重要的動態是心血管事件相對於中風，以及這些不同要素如何共同影響主要終點。我們這裡有一個MACE 4終點，因此我們確實納入了中風。而我認為近期一些文獻顯示，中風將會是Lp(a)故事中很重要的一個元素。所以我們會看看後續如何發展。

So exciting, but we'll also have to see. I do want to highlight as well that as I've articulated in the past, this will be a slow building market simply because we need the testing rates to get much higher, so this will be, assuming it all plays out as we hope, of multiple iterations. But our DII235 is ready to go into Phase III studies, which could be a once-yearly Lp(a) injection. So we're quite excited about that as well to be ready.

所以令人振奮，但我們也必須拭目以待。我也想強調，如同我過去所說，這會是一個緩慢建立的市場，原因很簡單：我們需要檢測率大幅提高；因此，假設一切如我們所希望的那樣發展，這將會是多次迭代的過程。但我們的DII235已準備好進入第三期研究，這可能是一種一年一次的Lp(a)注射。所以我們也對此感到相當興奮，並且已做好準備。

Lastly, I would note that ACC and AHA have now added that everybody in the United States should receive an LP(a) test once in their life. And that's an important milestone to hopefully get testing rates up and to start to build the market over time.

最後我想指出，ACC與AHA現在已新增建議：美國每個人一生中都應接受一次LP(a)檢測。這是一個重要的里程碑，有望提升檢測率，並隨時間推進逐步建立市場。

Matthew Weston, UBS.

Matthew Weston，瑞銀（UBS）。

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

我的問題是關於Rhapsido。Vas，既然我們正邁向歐盟核准，Rhapsido將會是MFN之後，針對一個數十億美元產品所進行的首批定價討論之一。因此，假設你們已與歐洲各國政府進行了一些初步討論，你們是否看到各國更傾向於在歐洲為創新支付更高的價格？

Thanks, Matthew. So first, it's important to note Rhapsido only has an MFN impact for Medicaid because the approval happened before the signing of our MFN agreement. Our first launch that will have, I think, clear MFN-related implications across all segments in the US would be Ianalumab. So I think that's just one clarification.

謝謝你，Matthew。首先需要指出的是，Rhapsido只在Medicaid上受到MFN影響，因為其核准發生在我們簽署MFN協議之前。我認為我們第一個在美國所有細分市場都會出現明確MFN相關影響的上市產品，將會是Ianalumab。所以這點先澄清一下。

Nonetheless, I'll still answer the question in terms of the ongoing discussions with government. We are engaging with governments across Europe as well as in Japan to hopefully get to a better place. I think we're not seeing the progress that we had hoped to see at the pace that we had hoped to see. So I think there has to be some urgency here because I do expect across the industry, there will be difficult decisions companies will have to take in terms of how they launch or ultimately progress medicines.

儘管如此，我仍會就與政府持續討論的角度來回答這個問題。我們正在與歐洲各國政府以及日本方面接觸，希望能達到更好的狀態。我認為我們看到的進展，無論是幅度或速度，都不如我們原先所希望。因此我認為這裡必須有一些緊迫感，因為我預期整個產業都將面臨艱難決策：企業在藥品如何上市或最終如何推進方面，可能不得不做出取捨。

We're already in a situation where, depending on how you look 30% to 40% of medicines in Europe -- available in the US don't ultimately come to Europe. You could have that number grow. You have, in general, significant delays for introduction of medicines into the European Union. So there's a lot of work to do.

我們已經處於一種情況：視你如何衡量，歐洲約有30%到40%的藥品——在美國可取得——最終並未進入歐洲。這個比例可能還會上升。而且一般而言，藥品引進歐盟往往存在顯著延遲。所以還有很多工作要做。

We certainly have, I think, proposals to all the key governments and most important, in my mind, are Japan and Germany, but we haven't seen the progress that we need to see. So this is something we'll have to continue to advocate for over the next year because I think it's really a 2027 story, where you start to see the impact of MFN on launches in Europe.

我們當然已向所有主要政府提出了我認為的方案；在我看來最關鍵的是日本與德國，但我們仍未看到所需的進展。因此，這將是我們在未來一年必須持續倡議的議題，因為我認為這其實是一個2027年的故事——屆時你會開始看到MFN對歐洲上市所造成的影響。

James Gordon, Barclays.

James Gordon，巴克萊（Barclays）。

James Gordon from Barclays. The question was on hormonal breast cancer. So Roche looks set to have Giredestrant as a US approval for adjuvant hormone breast cancer well before the year-end because they've used a PRV, and they're suggesting this could be an $11 billion-plus product across adjuvant second line, but mostly in adjuvant. So -- and that seems to assume a big broad uptake.

我是巴克萊的James Gordon。問題是關於荷爾蒙受體陽性乳癌。Roche看起來很可能在年底前就讓Giredestrant取得美國核准、用於輔助治療的荷爾蒙乳癌，因為他們使用了PRV；他們並表示，這在輔助治療二線等多個情境合計可能是一個超過110億美元的產品，但主要是在輔助治療。所以——而這似乎是建立在非常廣泛的採用率假設之上。

I think the logic is that, that could be used instead of someone using an aromatase and a CDK4 for some of the patients. So based on what you know about hormonal breast cancer, do you think that's plausible, do you think even from the end of this year, you could see some pressure in CDK4 use because people instead would just do a SERD. So any thoughts on that, please.

我認為其邏輯是：對部分病人而言，這可能會被用來取代芳香化酶抑制劑加上CDK4治療。因此，基於你對荷爾蒙乳癌的了解，你認為這是否可行？你是否認為甚至從今年年底開始，就可能看到CDK4使用受到一些壓力，因為大家改用SERD？請分享你的看法。

Yes. We don't see that in the same way. I mean what we expect -- continue to expect is that physicians will want to use something to ultimately impact the hormonal access and then cyclin-dependent kinase access, especially for patients that we're talking about here which are patients that are Node 0, Node 1, Node 2 or more and have other risk factors that indicate they have a higher risk of recurrence of breast cancer. So that's point one.

是的。我們不以同樣方式看待這件事。我的意思是，我們預期——也持續預期——醫師會希望使用某種方式來最終影響荷爾蒙路徑，然後再影響細胞週期蛋白依賴性激酶（CDK）路徑，特別是我們在此討論的病人：也就是淋巴結為Node 0、Node 1、Node 2或以上，且具有其他風險因子、顯示其乳癌復發風險較高的病人。這是第一點。

That's all of our market research suggest that. And I think part of the reason the major oral SERD companies are partnering with us to do combination studies as they ultimately see it in a similar way as well. I can't comment on patients who are very early or less high-risk early breast cancer patients, we used to call them kind of Stage 1. I think that would be a separate topic that you can talk to our competitor about, but that's not something that we see.

我們所有的市場研究都顯示如此。而我認為主要口服SERD公司之所以與我們合作進行聯合用藥研究，部分原因也是他們最終也以類似方式看待。至於非常早期或風險較低的早期乳癌病人——我們以前大概稱之為第一期（Stage 1）——我無法評論。我認為那會是另一個議題，你可以去和我們的競爭對手討論，但那不是我們所看到的情況。

I would also say that it is not a straightforward thing to replace established therapies like aromatase inhibitors that have been used for decades. So I think this is something that will take time. I think when you look at the data in almost any class of drug, when you're trying to replace a very established therapy, it requires a lot of education and a lot of work and that ramp will come up over time. So we don't view this as having an impact on the Kisqali outlook.

我也想說，要取代像芳香化酶抑制劑這種已使用數十年的既有療法，並不是一件直截了當的事。所以我認為這需要時間。我認為當你看幾乎任何藥物類別的數據時，當你試圖取代一個非常成熟的治療，都需要大量教育與大量工作，而那個爬坡曲線會隨時間逐步上升。因此我們不認為這會影響Kisqali的前景。

Particularly now that in the first-line setting, it seems clear that CDK4/6 remain the standard of care for the remainder of Kisqali's life cycle. Our focus very much is on CDK2, CDK2/4, CDK4 to make sure that we can lifecycle Kisqali, you saw us bring in Pikavation, which we think has the opportunity to be a pan-mutant PIK3CA that has the ability to avoid some of the toxicity profiles that we've seen with hyperglycemia and off-target toxicities.

特別是現在在一線治療情境下，看起來很清楚CDK4/6在Kisqali剩餘的整個產品生命週期中仍將是標準治療。我們的重點非常放在CDK2、CDK2/4、CDK4，以確保我們能延長Kisqali的生命週期；你們也看到我們引進Pikavation，我們認為它有機會成為一個泛突變（pan-mutant）的PIK3CA藥物，並有能力避免我們在高血糖與非靶向毒性上所看到的一些毒性特徵。

So that could be an exciting medicine that hopefully might be able to be used broadly in approximately 50% of patients who have those mutations over time and then developing the combination drug studies, which we continue to do with the oral SERD companies.

因此，這可能是一個令人興奮的藥物；希望隨著時間推進，它能在約50%帶有這些突變的病人中被廣泛使用，並且我們也持續與口服SERD公司開展聯合用藥研究的開發。

Michael Leuchten, Jefferies.

Michael Leuchten，Jefferies。

Vas, question for you on Avidity. So Dine Therapeutics presented the ACHIEVE data recently with a splicing correction at month 3 to 11 at a higher rate than we've seen with Del-desiran. And they also showed positive trends in MDHI, I think we haven't seen any data for Del-desiran. Can you elaborate on how this data fits with your decision to pursue Avidity as opposed to other assets?

Vas，關於 Avidity 我有個問題。所以 Dine Therapeutics 最近公布了 ACHIEVE 數據，在第 3 個月時的剪接校正率達到 11%，高於我們在 Del-desiran 上看到的水準。他們也顯示 MDHI 有正向趨勢，我想我們還沒看到 Del-desiran 的任何相關數據。你能否說明這些數據如何影響你們選擇推進 Avidity、而不是其他資產的決策？

Yes, absolutely. No, I think, obviously, the way biomarker data, splicing correction data ultimately correlates with function is to be determined. And I think this is obviously a complex topic given that the target here is in the nucleus. And so it's definitely something where you're going to have different profiles for the different drugs, given that we're comparing here an siRNA versus an ASO versus other technologies that are being deployed.

是的，當然可以。我認為，生物標誌物數據、剪接校正數據最終如何與功能改善相關，仍有待確認。而且這顯然是一個複雜的議題，因為這裡的靶點位於細胞核內。因此，當我們在比較 siRNA、ASO 與其他正在採用的技術時，不同藥物之間必然會呈現不同的特徵。

When we look at the data set that ultimately was published in the New England Journal of Medicine, very clear that you saw compelling data with the hand opening time. We saw functional endpoints going in the right direction. And so we saw everything the way we would expect it, and we have the opportunity here with a fully enrolled fully powered Phase III study that's going to read out well ahead of the competition.

當我們看最終發表在《新英格蘭醫學期刊》的那組數據時，可以很清楚地看到手部張開時間（hand opening time）的結果相當有說服力。我們也看到功能性終點朝正確方向改善。因此，一切都符合我們的預期；而且我們在此有機會進行一項已完全收案、且統計效力充足的第三期研究，並且其讀出時間將明顯早於競爭對手。

And I think once that happens, would make it harder for accelerated approval to ultimately happen in the field as historical precedents have shown. So I think being first to market with the key -- first-to-market medicine with a key -- with a compelling profile is going to be very attractive.

我認為一旦那件事發生，正如歷史先例所示，這將使得該領域要取得加速核准變得更困難。因此，以具關鍵性、且具吸引力特徵的產品率先上市——也就是以具關鍵優勢、具說服力的產品搶先上市——將非常有吸引力。

And then I would also say that with the Avidity acquisition, we have not only DM1, but we also have the opportunity to be the first medicine even if we need to complete the Phase III study in FSHD. So it would be first to market, DM1, first-to-market FSHD. And now we're increasingly excited as well about the opportunity we're seeing in the pipeline to address more forms of DMD as well as apply the technology of anti-antibody whether sRNAs or ASOs to our own internal pipeline.

另外我也想說，透過收購 Avidity，我們不僅擁有 DM1，若我們需要在 FSHD 完成第三期研究，我們也有機會成為第一個上市的藥物。所以會是 DM1 第一個上市、FSHD 也第一個上市。而且我們也愈來愈對管線中看到的機會感到興奮：可望涵蓋更多形式的 DMD，同時也能把抗體偶聯技術（無論是 sRNA 或 ASO）應用到我們自有的內部研發管線。

So taken together, we think that was the right decision and everything that we've seen since completing the acquisition continues to confirm that.

綜合來看，我們認為那是正確的決策，而自完成收購以來我們所看到的一切也持續印證這一點。

Graham Parry, Citigroup.

Graham Parry，花旗集團。

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

關於 remibrutinib 在 MS 的部分，你們現在已有三項試驗讀出，且都有 Aubagio 對照組，讓你們對該族群的年化復發率（ARR）有相當清楚的掌握。那麼你們在多大程度上可以把那些數據與 remibrutinib 第三期復發型 MS 試驗中的盲態數據做比較？在你能評論的範圍內，這是否讓你們對達成終點的能力更有信心？另外，也請你在此階段再次確認：在盲態數據中，你們沒有看到任何藥物誘發性肝損傷（DILI）或 ALT 顯著升高的情況。

Yes. Thanks, Graham. So I don't have any comment on the ARR data. I'm not up to speed on any blinded views that we have or have not taken on the ARR data. But we do track the blinded safety data quite carefully.

是的。謝謝你，Graham。關於 ARR 數據我沒有任何評論。我不清楚我們是否有、或沒有以盲態方式檢視 ARR 數據的任何觀點。但我們確實非常仔細地追蹤盲態安全性數據。

And I think all of the data that we've looked at and that I've also seen indicate that we don't see any contribution if we assume that the historical rates that we've seen with teriflunomide in historical studies for liver -- drug-induced liver injury, enzyme elevations, et cetera, there is no contribution from the remibrutinib arm because all we see in the blinded data would be consistent with what one would see from having teriflunomide in the study.

我認為我們所檢視的所有數據——以及我所看到的——都顯示：如果我們假設在既往研究中 teriflunomide 的歷史發生率（肝臟相關的藥物誘發性肝損傷、酵素升高等），那麼在 remibrutinib 組並沒有額外的貢獻；因為我們在盲態數據中看到的情況，與研究中包含 teriflunomide 時所預期看到的結果一致。

So that gives us a high degree of confidence given that all these patients are now are well past three months, where normally you would see any liver injury showed up. So it gives us a high degree of confident of the safety profile for remibrutinib is clean and consistent with what we've seen in CSU, in CIndU, in the Phase II HS study, in the Phase II food allergy study. So now we have a pretty large portfolio of studies that have indicated the clean profile of remibrutinib with no insights so far on ARR, and I think we'll obviously read out the studies this summer, and we'll see where we are.

因此，鑑於這些患者現在都已遠超過三個月——通常若有任何肝損傷會在那段時間出現——這讓我們對安全性有高度信心。所以我們對 remibrutinib 的安全性特徵有很高的信心：乾淨且與我們在 CSU、CIndU、第二期 HS 研究、以及第二期食物過敏研究中看到的一致。目前我們已有相當龐大的研究組合都顯示 remibrutinib 的特徵乾淨；至於 ARR 目前尚無任何洞見。我想我們會在今年夏天讀出研究結果，屆時再看進展如何。

Thibault Boutherin, Morgan Stanley.

Thibault Boutherin，摩根士丹利。

So my question is just on Rhapsido. The previous communication was that you should see limited sales in Q4 last year, Q1 this year because of the free scripts before we see a step-up in Q2. And actually, we saw quite decent sales in the first two quarters.

我的問題是關於 Rhapsido。先前的溝通是，由於在看到第二季付費處方量上升之前會先有免費處方（free scripts），因此去年第四季與今年第一季的銷售應該會比較有限。但實際上，我們在前兩季看到的銷售表現相當不錯。

So I guess, question is how much stocking have we seen so far? And should we still expect a step up in Q2 as we bridge to paid script? And in general, if you could help us with the dynamic in terms of bridge for the rest of the year.

所以我想問：到目前為止我們看到了多少鋪貨（stocking）？而且在從免費處方過渡到付費處方的過程中，我們是否仍應預期第二季會有一個台階式上升？更一般地說，若你能協助說明今年剩餘時間在「過橋（bridge）」方面的動態就更好了。

Yes, absolutely. I would say, first on stocking, we've seen stocking levels that are in line with what we've seen historically for brands. So I don't think there's a significant -- anything that's out of what we would expect from a stocking perspective. I think when you look at the early data, as I mentioned, 6,000 patient starts, 3,000 prescribers, about a quarter of the top CSU physicians prescribing the medicine.

好的，當然。先談鋪貨：我們看到的鋪貨水準與過去品牌的歷史情況一致。所以我不認為在鋪貨角度有任何顯著、超出預期的情況。至於早期數據，如我提到的：6,000 位患者開始用藥、3,000 位開立處方的醫師，約四分之一的 CSU 頂尖醫師正在開立這個藥。

So that's all, I think, in the right direction. We think that the early script data probably has to be interpreted carefully because we are using sampling and bridge programs, and as payer coverage expands, we will start to see the conversion from free to paid, but that's going to be a stepwise process over the course of the year.

我認為這些都朝正確方向發展。我們認為早期處方數據可能需要謹慎解讀，因為我們正在使用試用（sampling）與過橋計畫（bridge programs）；隨著付款方覆蓋範圍擴大，我們會開始看到從免費轉為付費的轉換，但這會在一年當中以階段性方式逐步發生。

We have some early access wins ESI, Cigna, Optum, and we have been able to secure first-line post antihistamine coverage across those commercial plans. So I think overall, that gives us confidence. But I would expect it to be a steady increase in these initial months, not a hockey stick, simply because it does take time to get all of that in place and then ultimately start bridging patients.

我們已取得一些早期准入的進展，包括 ESI、Cigna、Optum，並且在這些商業保險計畫中，成功取得抗組織胺後的一線用藥給付。整體而言，這讓我們更有信心。但我預期在這些初期月份會是穩定增加，而不是「曲棍球棒式」暴增，因為要把所有事項到位需要時間，之後才會逐步把患者導入過橋流程。

We would expect them to see an acceleration in 2027 as we then have a payer coverage in place and then we're well suited to have a significant launch. It doesn't change our long-term outlook. As we've guided, we think this can be a very large medicine in CSU alone. And then when you add CIndU on top and then hopefully, MS hopefully HS and then down line additional indications, food allergy, et cetera. We have a really exciting path ahead of us for the medicine.

我們預期在 2027 年會看到加速，因為屆時付款方給付覆蓋將更完善，我們也更適合進行一個顯著的上市推廣。這不會改變我們的長期展望。如我們所指引的，我們認為僅在 CSU 這個適應症上，它就可能是一個非常大的藥物。再加上 CIndU，然後希望還有 MS、希望還有 HS，以及後續更多適應症，例如食物過敏等。這個藥物未來的發展路徑非常令人振奮。

James Quigley, Goldman Sachs.

James Quigley，高盛。

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

我有一個關於 Del-desiran 在 DM1 的問題。在我們即將看到數據之際，你們認為在影片手部張開時間（video hand opening time）上，什麼樣的影響幅度才算具有臨床意義？另外，在從功能性角度解讀整體效益時，次要終點在多大程度上反而更重要？以及你對 Sarepta 最近在同一適應症公布的早期數據有何評論。你認為相較於新興競爭者，Del-desiran 的差異化會在哪裡？

Yes. I think we'll be in a position to kind of comment on a specific event video hand opening time, but we do believe it's a well-understood endpoint. And if you reach statistical significance, we think that would be an important milestone. And all of our physician discussions would suggest that would be sufficient to warrant broad use of the medicine. I think importantly as well, we're going to be looking at additional functional outcomes such as the quantitative muscle testing and patient reported ported outcomes as well as a 10-meter walk and run test.

是的。我認為我們將能夠就特定事件影片中手部張開時間發表一些評論，但我們確實相信這是一個被充分理解的終點指標。而如果達到統計顯著性，我們認為那將是一個重要的里程碑。而我們與醫師的所有討論都顯示，這將足以支持該藥物的廣泛使用。我認為同樣重要的是，我們也會觀察其他功能性結局，例如定量肌力測試與病人回報結局，以及10公尺步行與跑步測試。

I think all of that will help us to further characterize the treatment effect. Now when we look at some of the competitor data, I think it's important to note it's quite early. And as we know in these medicines that ultimately, you need a relatively broad patient group because of the diversity of manifestations of the disease. So I wouldn't want to over interpret what we're seeing. Certainly, it's exciting that there are many medicines coming forward to treat DM1 patients.

我認為這些都將幫助我們進一步刻畫治療效果。現在當我們看一些競品資料時，我認為重要的是要注意目前仍相當早期。而且如我們所知，對於這類藥物，最終需要相對廣泛的病人族群，因為疾病表現具有多樣性。因此我不希望過度解讀我們所看到的結果。當然，看到有許多藥物正在推進以治療DM1病人，這令人振奮。

But we feel like because of the large data set that we have now, over 100 patients treated across multiple disease states, 500 infusions, up to four years of multiyear exposure, that gives us a longitudinal data set that can really help us interpret the impact we're seeing.

但我們認為，由於我們目前擁有的大型資料集——跨多個疾病狀態治療了超過100位病人、累計500次輸注、最長達四年的多年暴露——這為我們提供了一個縱向資料集，能真正幫助我們解讀所觀察到的影響。

And I think most important for us is the muscle manifestations. I know there's been a lot of discussion as well about CNS. But I think in this particular disease, what really matters is muscle mobility and managing those muscle-related manifestations and that's very much our focus.

而我認為對我們而言最重要的是肌肉相關表現。我知道也有很多關於中樞神經系統（CNS）的討論。但我認為在這個特定疾病中，真正重要的是肌肉活動能力，以及管理那些與肌肉相關的表現，而這正是我們的重點。

So having, I think, 54-week follow-up long-term data on a large cohort of patients, gives you a very robust read, and I think we feel confident that based on everything we've seen in the Phase II study that we're set up well as well as we can be towards that Phase III readout.

因此，對一大群病人取得我認為是54週追蹤的長期資料，能提供非常穩健的讀數；而我認為我們有信心，基於我們在第二期研究中看到的一切，我們已盡可能為第三期讀出做好準備。

Florent Cespedes, ODDO BHF.

Florent Cespedes，ODDO BHF。

Florent Cespedes from ODDO BHF. A big picture question for Vas. On your last slide, you highlighted that there will be multiple readouts in H2 that can raise your midterm to long-term growth outlook. Maybe, Vas, could you be a little bit more specific and give us a bit more color or from where do you see the potential upside coming from?

我是ODDO BHF的Florent Cespedes。給Vas一個宏觀層面的問題。在你最後一張投影片中，你強調下半年（H2）將有多個讀出，可能提升你們中期到長期的成長展望。Vas，你是否能更具體一些，提供更多細節，或你認為潛在上行空間會來自哪些方面？

Yes. Thanks, Florent. When you look at what we guided to last fall, I mean our focus was very much on what we had in hand and a probabilized view of our pipeline. And I think when then some of these medicines if they ultimately come forward and we unprobilized that can lead to significant upside versus where we are today. I think, obviously, the big readout is not surprisingly, I think to all of you will certainly be remibrutinib -- for the five-year term, remibrutinib in MS, remibrutinib in HS, Del-desiran, the DM1.

是的。謝謝你，Florent。回顧我們去年秋天給出的指引，我們的重點非常放在手上已有的資產，以及對研發管線做機率化（probabilized）的評估。我認為當其中一些藥物若最終取得進展、而我們將其「去機率化」（unprobabilized）納入時，相較於我們今天的位置，可能帶來顯著上行空間。我想，顯而易見、也不意外地，最大的讀出你們都會關注remibrutinib——在五年期內，remibrutinib於MS、remibrutinib於HS、Del-desiran，以及DM1。

We also believe Ianalumab in first-line ITB can be $1 billion-plus indication. I think pelacarsen will be significant. I think it will take longer to build over time. And I think overall, the combination of pelacarsen plus DII235 will give us a very significant opportunity. But in that kind of five-year term, I think that medicine will take time to build up.

我們也相信Ianalumab在一線ITB中可能是一個超過10億美元的適應症。我認為pelacarsen會很重要。我認為它需要更長時間逐步建立。而我認為整體而言，pelacarsen加上DII235的組合將帶來非常重大的機會。但在那種五年期的時間範圍內，我認為那個藥物需要時間逐步放量。

But I think those are the medicines where if we see some wins, it could allow us to once we do the modeling to reevaluate the 5% to 6% growth that 2030 and hopefully drive additional upsides.

但我認為這些藥物若出現一些勝利（正面結果），在我們完成模型推估後，可能讓我們重新評估到2030年5%到6%的成長，並希望帶來額外上行空間。

So I think that's a great story. And I would say also in 2027, we have a number of readouts -- important readouts as well. Abelacimab in stroke prevention. We will have as well the -- we'll have as well the Kesimpta data as well as some other Phase II readouts as well as starting to read out as well our immune reset portfolio. So I think a number of readouts coming that could further bolster the long-term outlook of the company.

所以我認為這是一個很好的故事。另外我也想說，在2027年我們也會有多個讀出——同樣是重要的讀出。Abelacimab用於中風預防。我們也將有Kesimpta的資料，以及其他一些第二期讀出，並且也會開始讀出我們的免疫重置（immune reset）產品組合。因此我認為接下來會有不少讀出，可能進一步強化公司長期展望。

Kerry Holford, Berenberg.

Kerry Holford，Berenberg。

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

我想請問關於Pluvicto的問題。在近期於歐洲撤回於taxane前（pre-taxane）治療情境的申請之後，我想了解你們是否計畫進行任何額外試驗以滿足EMA的要求。如果不會，那麼在該地區的核准缺少pre-taxane適應症，是否會對你們對該藥物的峰值銷售預測造成任何影響？

Yes. Thanks, Kerry. So no impact on the peak sales forecast. We continue to expect $5 billion-plus. We had assumed all along that navigating the European feedback on the comparator arm would be a challenge.

是的。謝謝你，Kerry。所以對峰值銷售預測沒有影響。我們仍預期會超過50億美元。我們一直以來就假設，因對照組（comparator arm）問題要回應歐洲的意見會是一項挑戰。

We evaluated multiple ways to try to address it, and we try to make the best arguments that we could. But ultimately, we thought it was prudent at that point to withdraw. We do see continued strong uptake in the vision population in Europe. It's important to note as well in Japan and in China, we are able to both have the PSA IV and PSMA vision populations, which are critical long-term markets. And the next step now for Europe will be the hormone-sensitive setting where we -- because Pluvicto is used in combination with an ARPI versus an ARPI, there, the comparator arm is what EMA would want.

我們評估了多種方式試圖回應，並提出我們能提出的最佳論點。但最終，我們認為在那個時間點撤回是審慎之舉。我們確實看到在歐洲的vision族群中持續強勁的採用。同時也要注意，在日本與中國，我們能同時涵蓋PSA IV與PSMA vision族群，而這些都是關鍵的長期市場。而歐洲接下來的步驟將是荷爾蒙敏感（hormone-sensitive）情境；在那裡——因為Pluvicto是與ARPI合併使用、相對於ARPI——其對照組設計將符合EMA的期待。

And I think would allow us then if we're to move forward now, we have the strong -- as you know, our PFS data, we're waiting on the OS data. Once we have that OS data, we should be able to file in Europe and then expand the patient population there. So I think that was the best outcome we decided rather than running additional studies that would take many years to just withdraw the file and wait for the HSBC readout.

而我認為這將使我們在往前推進時——如你所知，我們已有強勁的PFS資料，正在等待OS資料。一旦取得OS資料，我們應該就能在歐洲遞交申請，並在那裡擴大病人族群。因此我認為，與其再做需要多年時間的額外研究，我們決定撤回申請並等待HSBC的讀出，這是我們所做出的最佳結果。

Steve Scala, TD Securities.

Steve Scala，TD Securities。

Some of your competitors are becoming increasingly vocal about extending big LOEs at the end of the decade. Novartis is the notable exception. It could be attributed to nothing more than communication practices. But if Novartis feels it has a good shot at delaying Cosentyx LOE then why not note that? And if this is an area of active pursuit, what is it that you're doing, co-formulation extended dosing?

你們的一些競爭對手對於在本十年末延後大型專利到期（LOE）變得越來越高調。諾華是顯著的例外。這可能僅僅歸因於溝通方式不同。但如果諾華認為有很大機會延後Cosentyx的LOE，為什麼不提一下？如果這是正在積極推進的領域，你們正在做的是什麼——共同配方、延長給藥間隔？

And related to all this, if Karen Hale is in the room, can she compare and contrast the store experience at AbbVie?

另外也相關的是，如果Karen Hale在場，能否請她比較並對照一下在AbbVie的「store experience」？

Yes. Thanks, Steve. So Karen Hale is in the room, but I'll spare her from having to compare her thoughts with AbbVie. I think it would be not the appropriate setting to do that, but we appreciate the question. I mean, of course, we have extensive efforts to defend our IP and then look at other ways to formulate our medicines.

是的。謝謝你，Steve。Karen Hale在場，但我就不讓她必須拿AbbVie來做比較了。我認為在這個場合這樣做不太合適，但我們感謝這個問題。我的意思是，當然，我們在捍衛智慧財產權（IP）方面投入了大量努力，同時也在尋找其他方式來改良我們藥物的劑型。

I mean a good example is Kesimpta two months, which we do have now, planned readout. We have additional efforts as well as the life cycle managed Kesimpta into longer intervals as well, which are still in the early phases of efforts. We'll see how that progresses.

一個很好的例子是Kesimpta的兩個月給藥間隔，我們現在已有規劃的讀出。我們也有其他努力，包括將Kesimpta做生命週期管理、延長到更長的給藥間隔，但這些仍處於早期階段。我們會看看進展如何。

All of that would generate new IP, I think -- and so that one is clear. I think with Cosentyx, we have a number of cell line formulation and other patents that we continue to prosecute. We, as a practice, don't add those in as potential scenarios until we've gotten further along and I think in the litigation phase to really understand where those trials ultimately fit. So I think with Cosentyx, with Kesimpta, many efforts. I think we've discussed extensively with Kisqali the efforts around CDK2, CDK2/4, the Picavation efforts as well.

我認為，所有這些都會產生新的智慧財產權（IP）——所以這一點很清楚。我認為在 Cosentyx 方面，我們有多項細胞株、配方以及其他專利，並且仍在持續推進申請程序。我們的慣例是，在進一步推進、且我認為進入訴訟階段、真正了解那些審理最終會落在何處之前，不會把這些納入潛在情境。所以我認為在 Cosentyx、Kesimpta 方面，都有許多努力。我想我們也已就 Kisqali 方面圍繞 CDK2、CDK2/4 的努力，以及 Picavation 的相關工作做了充分討論。

Harder with a small molecule, as you know, to come up with significant reformulation efforts, but something that we're certainly looking at. I would point out even for medicines like Scemblix, we're actively already working on ways to hopefully extend that franchise even further. You know with Leqvio, we moved from 6 months also to 12 months and also to look at combinations of Leqvio to target other siRNA targets within cardiovascular disease things like HMG reductase, amongst others.

如你所知，小分子藥物要提出具重大意義的重新配方方案會更困難，但這確實是我們正在評估的方向。我也要指出，即使是像 Scemblix 這樣的藥物，我們也已經在積極研究，希望能進一步延長該產品線的生命週期。你知道在 Leqvio 方面，我們也從 6 個月延長到 12 個月，並且也在研究 Leqvio 的聯合用藥，以鎖定心血管疾病中其他 siRNA 標的，例如 HMG 還原酶等。

So I think we have quite a broad effort to always think about this. But we don't want to overpromise at this stage, sitting here in 2026, one may or may have not happen five years from now. But rest assured, those efforts are ongoing. And as soon as we have something that we think is credible to put forward, we certainly will let the markets know.

所以我認為我們在這方面的投入相當廣泛，並且一直在思考這些議題。但我們不想在這個階段過度承諾——坐在 2026 年的此刻，五年後可能會發生、也可能不會發生。但請放心，這些工作都在持續進行。而一旦我們有我們認為可信、可以提出的內容，我們一定會讓市場知道。

Naresh Chouhan, Intron Health.

Naresh Chouhan，Intron Health。

Just one, please, on Cosentyx. As we think about the margin impact of the Cosentyx LOE, is it fair to assume that you've already started optimizing the profitability as would be typical ahead of any other LOE?

關於 Cosentyx 我只有一個問題。當我們思考 Cosentyx 專利到期（LOE）對毛利的影響時，是否可以合理假設你們已經像其他產品在 LOE 前一樣，開始優化其獲利能力？

Thanks, Naresh. I'll give that Mukul.

謝謝你，Naresh。我把這題交給 Mukul。

Yes. Naresh, thanks for the question. Yes, absolutely, I would confirm that. I think as we have previously indicated, I think we are -- we projected an LOE in the US for Cosentyx in 2029.

是的。Naresh，謝謝你的提問。是的，完全正確，我可以確認這一點。我想如同我們先前所指出的，我們預估 Cosentyx 在美國的 LOE 會在 2029 年。

There is also an IRA event in 2028 that we have factored into our numbers. And this is all baked into our back to 40% latest by 2029 guidance on the margin.

另外在 2028 年也會有一個 IRA 事件，我們已將其納入我們的數字假設中。而這些都已反映在我們對毛利率的指引：最晚在 2029 年回到 40%。

Seamus Fernandez, Guggenheim Securities.

Seamus Fernandez，Guggenheim Securities。

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

我是 [Zach Dunn]，代表 Seamus Fernandez 提問。我們對你們 IL-15（GIA632）推進到白斑症（vitiligo）感到鼓舞。你們能否分享一下，對於符合生物製劑治療資格的白斑症患者，其市場規模你們是如何思考的？以及如果方便的話，也請連結談談你們對異位性皮膚炎（atopic dermatitis）以及那裡市場機會的看法？

Yes, thanks. I mean the IL-15 is something we did mention at the meet the management, and we are quite excited by the profile of the of this medicine. For those of you who are not aware, this is a medicine that we in-licensed, it's overexpressed in patients with atopic dermatitis, but we also see the opportunity to address a number of other diseases over time, including vitiligo. And so it's early days. I mean, these Phase II studies are ongoing.

好的，謝謝。IL-15 是我們在「與管理層會面」時提到過的項目，我們對這個藥物的特性非常興奮。對於不熟悉的人來說，這是一個我們透過授權引進（in-licensed）的藥物；它在異位性皮膚炎患者中呈現過度表現（overexpressed），但我們也看到隨時間推進可用於多種其他疾病的機會，包括白斑症。因此目前仍屬早期階段。這些第二期（Phase II）研究正在進行中。

The Phase IIa study in atopic dermatitis is now recruiting. The vitiligo study is set to begin. Obviously, if we can show meaningful improvements over the standard of care in atopic dermatitis or can obviously become a standard of care in vitiligo. These would be very large indications. I wouldn't be in a position to give you precise numbers, but obviously, very large market opportunities.

異位性皮膚炎的第二期 a（Phase IIa）研究目前正在招募中。白斑症研究也即將啟動。顯然，如果我們能在異位性皮膚炎中展現相較於標準治療（standard of care）的具意義改善，或是在白斑症中成為標準治療，這些都會是非常大的適應症。我目前不便提供精確數字，但顯然是非常龐大的市場機會。

And we are actively looking at moving that IL-15 across multiple other immunology indications over time. So I think as we progress, we'll of course keep you posted.

而且我們也在積極評估，隨時間推進將該 IL-15 推進到多個其他免疫學適應症。所以我想隨著我們的進展，當然也會持續向各位更新。

And may I will also in atopic dermatitis, we also have the GHD program, which also IL-13, IL-18, which we're also on track.

另外在異位性皮膚炎方面，我們也有 GHD 計畫，涵蓋 IL-13、IL-18，我們也都按計畫推進中。

(Operator Instructions) Matthew Weston, UBS.

（接線員指示）Matthew Weston，UBS。

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

我想就我第一個關於 Rhapsido 與美國以外（ex-US）的問題做個快速追問。我對你提到在 MFN 之前先取得美國核准的評論很感興趣。我在想中樞神經系統（CNS）的適應症——我記得你們之前說過會有不同的品牌名稱，但顯然是相同的活性成分、只是劑量不同。那是否意味著它也會因為原始核准而被排除在 MFN 的考量之外？還是說這會是我們在多發性硬化症（MS）情境下需要納入思考的？

Yes. So our current assumption, Matthew -- it's a very good question. Our current assumption -- working assumption is that this is based on the chemical compound in question. So all -- because remibrutinib has an approval that even with different brand names that all of the subsequent remibrutinib indications would be susceptible to the Medicaid element of the MFN story, but not the overall MFN across all segments of US reimbursement environment.

是的。所以我們目前的假設，Matthew——這是個非常好的問題。我們目前的假設——工作假設是：這是以所涉化學化合物為基礎來判定。因此，因為 remibrutinib 已經取得核准，即使後續使用不同品牌名稱，所有後續的 remibrutinib 適應症都會受到 MFN 議題中 Medicaid 要素的影響，但不會受到涵蓋美國整體給付環境各區塊的全面 MFN 影響。

I would say that is our current working assumption. And if that changes, we'll let you know. But our current expectation is that would be how remibrutinib would be treated. As would be the case for other medicines where such as Zolgensma, where we have but while the dose is changing, of course, the underlying gene therapy is the same. So that is our assumption for all of those medicines.

我會說，這就是我們目前的工作假設。如果有變化，我們會告知各位。但我們目前的預期是 remibrutinib 會以這種方式被對待。其他藥物也會是同樣情況，例如 Zolgensma，雖然劑量有所改變，但底層的基因治療本質相同。所以這就是我們對所有這類藥物的假設。

Michael Leuchten, Jefferies.

Michael Leuchten，Jefferies。

Question for Mukul, please. The gross margin is pressured by negative mix effect. Obviously, that is partly driven by the generic erosions and partly by the new products having payaways. Is there a scale factor in here that we should take into consideration as we think about the first half, second half of the year or is the gross margin just plain and simple mix driven?

請問 Mukul 一個問題。毛利率受到負向產品組合效應（negative mix effect）的壓力。顯然，這部分是由學名藥侵蝕所驅動，部分則是新產品的讓利（payaways）。當我們思考上半年、下半年的走勢時，這裡是否有規模因素（scale factor）需要納入考量？還是毛利率就是單純由產品組合所驅動？

Yes. So I think there is -- as you rightly said, I think there's two things at play here. If you look at Q1, the overall decrease in the margin is 4.1%, 3 percentage points of that comes from R&D spend and 1 percentage point comes from the Gx impact on gross margin. Now Gx impact on gross margin pretty much. I think if we take 2025 as a base, pretty much H2 base is what we should -- what you guys should model going into this year, and that should be the base.

是的。所以我認為——如你所說，這裡確實有兩個因素在作用。如果你看第一季（Q1），整體毛利率下降 4.1%，其中 3 個百分點來自研發（R&D）支出，1 個百分點來自 Gx 對毛利率的影響。而 Gx 對毛利率的影響基本上——我想如果以 2025 年作為基準，你們在建模今年時，基本上應該以 2025 年下半年（H2）的基準作為參考，那會是基底。

And as far as R&D spend, is concerned, I think we have to take into account not just the Avidity deal that we did, but we also did three other pretty significant deals in Tourmaline, Anthos, as well as Regulus. And I think they -- they all came into the P&L from Q2 onwards.

至於研發支出方面，我認為需要納入的不只是我們做的 Avidity 交易，我們也做了另外三筆相當重要的交易：Tourmaline、Anthos，以及 Regulus。而我認為它們——它們都是從第二季（Q2）開始進入損益表（P&L）。

So in Q1, all of these three deals plus one month of Avidity is incremental. And going forward, I think part of it is already in the base. So the incremental R&D spend would start to run on our P&L.

所以在第一季（Q1），這三筆交易再加上 Avidity 的一個月，都是增量影響。而往後看，我認為其中一部分已經反映在基底之中。因此，增量的研發支出將會開始在我們的損益表上持續反映。

Thibault Boutherin, Morgan Stanley.

Thibault Boutherin，摩根士丹利。

Just a question on your comments on votoplam and the potential discussion with FDA on the Phase II. We had Phase II data some time ago. Have you seen anything new in the full data open-label extension that makes you more confident on the potential for the FDA to accept a fast-track approval?

想就您對 votoplam 的評論，以及與 FDA 就第二期試驗可能進行討論一事提個問題。我們在一段時間前就已經有第二期數據。您是否在完整數據的開放標籤延伸試驗中看到任何新的內容，使您對 FDA 可能接受快速通道核准更有信心？

Yes. I think as I said, we feel like the results that we've seen confirm our plan design in Phase III and also confirmed that the 10-milligram dose is the right dose to take forward. I think at this point, we're still in discussions with our partner company on the right approach with PTC on the right approach with any further engagement with FDA. And I think as soon as we have clarity on that, we'll, of course, and have those discussions with FDA, we can keep the market updated. But I think no further comment until those discussions are complete.

是的。我想如我所說，我們認為目前看到的結果確認了我們第三期試驗的設計方案，也確認 10 毫克劑量是適合推進的正確劑量。我想在這個時間點，我們仍在與合作夥伴公司討論，關於與 PTC 一起採取的正確做法，以及與 FDA 進一步互動的正確方式。一旦我們對此有了明確方向，當然也會與 FDA 進行那些討論，我們也會讓市場保持更新。但在那些討論完成之前，我想暫時沒有進一步評論。

Graham Parry, Citigroup.

Graham Parry，花旗集團。

Just on Cosentyx if you could qualify the gross to net adjustments, both in the base year and this year or the quarter. And previously, you talked about US growing mid-single-digit growth over the midterm to an $8 billion peak on that asset. Just that was absent from the release and slide stage, I just wondered if that still sound?

關於 Cosentyx，您能否說明一下毛額到淨額（gross-to-net）的調整，無論是基期年度、今年或本季的情況？另外，先前您提到在中期內美國市場將以中個位數成長，並在該資產上達到 80 億美元的峰值。這次新聞稿與投影片中沒有提到，我想確認這個說法是否仍然成立？

Yes. So on the gross net and adjustments for Cosentyx from quarter one last year.

是的。那麼，關於 Cosentyx 的毛額到淨額調整，從去年第一季開始。

Yes. So I think if we exclude the gross to net impact on Cosentyx. Cosentyx moves into a positive growth territory for the US. I think to be exact, around 1% -- 0% to 1%, closer to 1% for the quarter. We have to think of -- and then I think if you think of an overall basis, we spoke -- we have 2 percentage points in our base for gross net in the US in Q1 2025. And I think we also have a positive impact this year. The net comes to about 1% on an overall P&L.

是的。我想如果我們排除 Cosentyx 的毛額到淨額影響，Cosentyx 在美國就會進入正成長區間。Cosentyx 在美國就會進入正成長區間。更精確地說，本季大約是 1%——0% 到 1%，更接近 1%。我們必須考量——然後我想如果以整體來看，我們提到——在 2025 年第一季，我們在美國的基礎假設中，毛額到淨額約有 2 個百分點。而且我想今年也有正面影響。淨額在整體損益表（P&L）上的影響約為 1%。

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

而且我想，Graham，展望未來，是的，我們仍預期全球會維持在中個位數的區間。我想這將是美國與美國以外市場的組合；我們需要觀察接下來幾季的發展，但目前的預期是會落在中個位數區間。很明顯，Cosentyx 的峰值銷售最可能出現在 2027 年，因為 2028 年的 IRA 事件將影響 Medicare 的整體定價，也會在 2028 年影響到 Medicaid 的最佳價格（best price）。因此，所有這些動態都在與 PMR 的上市以及 IV 的持續上市同步展開。

James Quigley, Goldman Sachs.

James Quigley，高盛。

My second question. So just following up on the remibrutinib food allergy data from the Phase II that are supporting the Phase III trial. So what is it in the modeling that you saw that makes the 75-milligram the most appropriate dose given the data we've seen for the 100 milligram and the 25 milligram. Is there a bridge between where the efficacy is between the two or would the 75-milligram dose had the same target engagement at 100 milligrams?

我的第二個問題。接續關於 remibrutinib 在食物過敏的第二期數據，這些數據正在支持第三期試驗。那麼，在您看到的模型分析中，是什麼讓 75 毫克在我們已看到的 100 毫克與 25 毫克數據之下，成為最合適的劑量？它是否在兩者之間的療效上有一個銜接，或是 75 毫克劑量能達到與 100 毫克相同的標的結合（target engagement）？

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

這是個很好的問題。我們基於手上完整的數據集，非常仔細地進行了建模。我們確實相信在 75 毫克時，我們可以達到完整的標的結合，並且能夠實現接近 100 毫克劑量的療效。因此我們認為這是一個合理的做法，特別是因為我們希望推進到青少年族群，而 FDA 勢必會要求我們使用達到所需療效的最低必要劑量。所以根據我們所有的模型分析，我們相信在 75 毫克可以取得必要的標的結合，並交付您在研究中看到的療效；如您所見，那確實非常令人信服。

Steve Scala, TD Securities.

Steve Scala，TD Securities。

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

第 25 張投影片不再提到 MFN，而第四季簡報中的同一張投影片有提到；我只是好奇為什麼。我聽到了您先前對 Matthew 問題的回應，但第 25 張投影片似乎顯示諾華對於應對 MFN 的能力愈來愈有信心；我想知道在 2026 年開始之際，有什麼改變了？

Okay. So I think no change in our perspective on MFN. I mean we don't -- we fully factored in MFN into the guidance that we've given, both for this year and the five-year period. So that's fully factored. And if anything, I think we've gotten even better now in modeling the MFN impact.

好的。所以我想我們對 MFN 的看法沒有改變。我的意思是，我們已經把 MFN 完整納入我們所提供的指引中，無論是今年還是五年期間。所以這已完全反映在內。如果有什麼不同的話，我想我們現在在建模 MFN 影響方面做得更好了。

So we've made clear assumptions on the impact on the existing portfolio of medicines for the Medicaid effect as well as on future launches, a set of assumptions on launch phasing for drugs that have a full MFN effect, and then we'll ultimately, of course, see how this all unfolds.

因此，我們對既有藥品組合在 Medicaid 影響上的衝擊做了明確假設；對未來上市產品也做了一套假設，包括對於會完全受到 MFN 影響的藥物，其上市節奏（launch phasing）的假設；然後最終，當然，我們會看看這一切如何發展。

We also have signed the agreement to allow us to not have an impact from tariffs with the commercial agreement that we signed with the US government as well as scaling up, as you've seen, our manufacturing plants around the United States to allow us to produce fully in the US for the US such that we wouldn't expect any tariff impact.

我們也已簽署協議，透過我們與美國政府簽訂的商業協議，使我們不會受到關稅影響；同時也如各位所見，我們正在擴大在美國各地的製造工廠規模，使我們能在美國為美國市場完全生產，因此我們預期不會有任何關稅影響。

So all that to say, I guess, at this point, we feel confident enough with MFN that we don't need to mention it anymore. Hence, that's why you're not seeing it on the slides.

總而言之，我想在這個時間點，我們對 MFN 已經有足夠信心，因此不需要再特別提及。因此，這就是您在投影片上看不到它的原因。

I think that is all the questions. So thank you all very, very much for an engaging discussion. I know we have some follow-ups, so we'll get back to you. We appreciate your time, as always, and we look forward to keeping you up to date in the months ahead. Have a great day.

我想問題就到這裡。非常、非常感謝各位帶來一場引人入勝的討論。我知道我們還有一些後續事項，我們會再回覆各位。一如既往，我們感謝各位撥冗參與，也期待在接下來幾個月持續向各位更新進展。祝各位有美好的一天。

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

謝謝。今天的電話會議到此結束。感謝各位參與。您現在可以掛線。