Novo Nordisk Aktie

Good day, and thank you for standing by. Welcome to the Q3 2026 Novo Earnings Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded.

I would now like to hand the conference over to your speaker today, Michael Novod, Head of Investor Relations. Please go ahead.

Thank you very much, operator. Welcome to the Novo earnings call for the third quarter of 2026. My name is Michael Novod, and I'm the Head of Investor Relations at Novo. With me today, I have CEO, Mike Doustdar; EVP, U.S. Operations; Jamey Millar; EVP, International Operations, Emil Kongshoej Larsen; EVP, Research and Development and Chief Scientific Officer, Martin Holst Lange; and Chief Financial Officer, Karsten Knudsen. All speakers will be available for the Q&A session.

Today's call is being webcasted live, and a recording will be made available on our website. The call is scheduled to last 1 hour. Next slide, please.

The presentation is structured as outlined on Slide 2.

[Technical Difficulty]

Standby, as the speakers reconnect.

All right. Sorry for that. We'll try to start it from the getgo. On Slide 3, we need to advise you that this call will contain forward-looking statements. These are subject to risks and uncertainties that could cause actual results to differ materially from expectations. For further information on the risk factors, please see the company announcement for the third quarter of 2026, and the slides prepared for this presentation. With that, over to you, Mike, for an update on our 2030 ambitions.

Thank you very much, Michael. Next slide, please. Back in September at our Capital Market Day, we set out our 2030 ambition to deliver mid-single-digit compounded annual sales growth in line with our industry peers from 2026 to 2030. Three commitments drove that ambition. We will grow and diversify our pipeline, we will drive sustainable growth, and we will deliver attractive returns to our shareholders. From this quarter onwards, we will hold ourselves accountable and report progress against each of them.

On growing and diversifying our pipeline, we have initiated 7 first human dose trials so far this year. In addition, we have 10 ongoing Phase III programs. Martin will cover the key pipeline developments about those later on. In terms of driving sustainable growth, we are now reaching around 48 million people with our diabetes and obesity treatments. This is 2 million more than just a year ago, especially within obesity, we are treating 5.6 million people, almost doubling during the past 12 months.

Obesity sales grew by 22% in quarter 3, supported by continued GLP-1 volume growth across geographies as well as the accelerated rollout of our innovative products, namely Wegovy Pill, and Wegovy Pill 7.2 milligram also known as Wegovy PillHD.

In terms of delivering attractive returns, we generated DKK 32 billion in adjusted operating profit and more than DKK 28 billion in free cash flow in Q3 2026. On the back of this strong quarter, we now expect adjusted sales growth of minus 2% to plus 2% and adjusted operating profit growth of minus 2% to plus 2%, both at CER. Karsten will speak to the updated guidance later. Please turn to the next slide.

The quarterly development clearly shows that we are at the growth recovery phase, and that is progressing well. Following adjusted sales decline of 2% in the fourth quarter of 2025 and 4% in the first quarter of 2026, we returned to 7% and 4% growth in the second and the third quarter, respectively. Additionally, we are happy to see that this quarter, both operating units are in growth territory again. Behind this is a clear turnaround in patient volumes. After a flat end to 2025 and a slight decline in the first quarter of 2026, we have now added 1.2 million patients in the second quarter and 1.3 million in the third, which is quite encouraging.

What is promising is that growth comes from both obesity and diabetes. In obesity, we've added patients every single quarter, with 0.8 million in Q2 and 0.7 million in Q3. In diabetes, we have moved from losing 0.8 million patients in Q1 to adding 1 million patients in the past 2 quarters. In short, more patients are choosing novel treatments, and we are reaching them across both of our core therapy areas.

Next slide, please. In the third quarter, the adjusted sales growth was driven by both operating units. U.S. operations grew 1%, while international operations grew 8%. Within IO, Region EUCAN remained the key growth area, delivering 18% growth. Across therapy areas, obesity continued to be the main growth driver.

And with that, I'll pass it to you, Emil, for a closer look at IO.

Thank you, Mike. Please turn to the next slide. Growth in IO continued to be driven by our GLP-1 portfolio in the third quarter. The total GLP-1 sales increasing by 8%. Obesity remains the key growth driver, delivering 24% growth, supported by continued volume uptick of Wegovy across regions.

From a regional perspective, EUCAN was the main growth contributor, with strong performance across both GLP-1 diabetes and obesity. However, performance in Canada was negatively impacted by lower realized prices following the loss of exclusivity for semaglutide. We continue to be the GLP-1 volume leader in IO with a market share of 54%. We are supporting this position with the rollout of Wegovy Pill, Wegovy Pill 7.2 milligram and Ozempic 2.0 milligram.

Please turn to the next slide. We continue to expand our all obesity leadership across IO. The pill has now been launched in 7 markets, most recently in Mexico, France, Spain and Poland, and with further launches planned during the fourth quarter. By first half of 2027, we now expect Wegovy Pill to be available in more than 20 markets. The market response in the U.K. and UAE is encouraging. While it is early days, we are seeing that Wegovy Pill is leading the oral obesity segment with around 90% market share in the U.K. and around 80% market share in the UAE in recent weeks.

Six weeks into the launch in Germany, we've also seen solid uptake with approximately 100,000 packs sold mainly driven by GLP-1 naive patients, which suggests market expansion. While the U.K. market share development is encouraging, we're starting to see a normalization in the uptake, which naturally follows a bolus launch will pent-up demand. Our focus is now to further build the obesity market. We'll do this by driving continued GLP-1 naive patient initiations, supporting patients throughout their treatment journey, ensuring clear switch guidance from injectables and expanding subscription options that can improve affordability and retention.

Overall, these early launches reinforce our confidence that Wegovy Pill can reach a broader group of people living with obesity and strengthen our leadership across IO.

With that, over to Jamey for an update on the U.S.

Thank you, Emil. Please turn to the next slide. The uptake of the Wegovy Pill has continued to outpace the oral competitor in Q3, with Wegovy Pill still capturing around 80% of NBRxs. This underpins the strong competitiveness of Wegovy Pill. Since launch, we have seen more than 8 million cumulative prescriptions, which remains the strongest U.S. pharma launch by volume in over a decade outside of vaccines. We see a long runway for the pill in the U.S. with current and incoming initiatives expected to drive more uptake into the new year.

In Q3, Wegovy Pill volumes grew around 20% versus Q2 and injectable Wegovy volumes grew around 10% sequentially, Q3 versus Q2. Part of the volume growth comes from the Bridge program, where we see encouraging uptake over the last few months. Further, we continue to see the Wegovy franchise leading new-to-brand prescriptions with more than 50% market share. The breadth of the franchise is central to our approach. Wegovy injectable, Wegovy high dose, and Wegovy Pill allow us to serve different patient preferences and treatment needs while building on the established profile of semaglutide.

Please turn to the next slide. Turning to Diabetes. The transition from Rabelsis to Ozempic pill is now complete with new patients starting directly on the Ozempic brand. Since launch, weekly new-to-brand prescriptions for the oral franchise have more than doubled, demonstrating the strength of the Ozempic brand and the opportunity in the oral GLP-1 segment. Ozempic pill strengthens the franchise by giving patients and physicians an oral treatment option under a well-known and trusted brand. It also creates opportunities to engage additional prescribers to compete more effectively across channels. Importantly, more than 60% of Ozempic pill new-to-brand prescriptions are from people who are new to GLP-1 treatment. This indicates that the launch is helping to expand the treated market rather than only switching patients within the class.

We will continue to build awareness, support the transition across commercial channels and strengthen the combined Ozempic franchise. Over time, the oral and injectable offerings give us an opportunity to serve a broader range of people living with type 2 diabetes. We look forward to the potential FDA approval of Ozempic pill 25 milligrams by the end of the year, which will further strengthen our offering in diabetes with a highly competitive product profile.

With that, I hand it over to Martin.

Thank you, Jamey. Next slide, please. During Q3, we continued to advance our pipeline. Starting with CagriSema, we have continued to build the evidence base ahead of the potential launch. In type 2 diabetes, we completed the 6-week Phase III reimagine 5 trials, a robust head-to-head study enrolling over 1,000 patients comparing CagriSema 1 milligram of each component directly with Tirzepatide 5 milligram. This is a very relevant comparison as around 50% of global patients on Tirzepatide are on the 5-milligram dose or less, thus doing a more or less like real-world evidence study.

At 1 milligram of each component, CagriSema demonstrated superior weight loss of 12.4% compared with 9.1% for Tirzepatide, while delivering on PAN noninferior HbA1c reduction of around 1.7 percentage points. The results from Reimagine 5 will supplement the regulatory submission for CagriSema in type 2 diabetes.

In obesity, we completed Redefine 9, which also added evidence of the lower maintenance dose maintenance dose of CagriSema. In the trial CagriSema confirmed a highly attractive weight loss profile as the 1 milligram dose of each component demonstrated 21% weight loss at 68 weeks.

As Novo expands its focus in women's health, as part of our broader consumer RX ambition, we are building our understanding of how CagriSema may address women's treatment needs across different stages of life.

Women represent a large proportion of people receiving obesity medicines. And the menopause transition is associated with change in body composition, including bone, increased abdominal fat and rise in cardiometabolic risk making effective weight management particularly relevant. Two recent post-hoc analysis of women in Redefine 1 may help address this evidence.

Overall, CagriSema was associated with an average weight loss of 25% in women. A separate analysis examining life stages largely classified using age-based criteria showed substantial weight loss across groups averaging 27, 25 and 23 percentage points, respectively, in pre-menopausal, perimenopausal and postmenopausal women. Taken together, these data broadened the evidence base of CagriSema and support the potential for a more individualized treatment approach, recognizing that patients have different needs and may not necessarily require the high stage.

Lastly, on CagriSema, we conducted a Phase II trial in people with type 2 diabetes and painful diabetic peripheral neuropathy. The study in CagriSema reduced pain by 2.4% -- sorry, 2.4 points from a baseline on the PI NRS score corresponding to approximately 38% reduction in pain on top of standard of care with more than 53% of patients reaching at least a 30% reduction in pain. Based on these very encouraging results, we plan to initiate Phase III trials in the neuropatic pain across the portfolio during 2027.

Turning back to the broader pipeline. We advanced oral zenagamtide into Phase III in the AMAZE-9 trial. Oral zenagamtide brings GLP-1 and amylin dual agonism into a differentiated unimolecular oral treatment. AMAZE-9 is linked to the extensive subcutaneous AMAZE program through exposure response modeling and bridging data to support the planned regulatory submission of both oral and subcutaneous. We expect AMAZE 9 to read out in 2028.

Within blood and endocrine disorders, we are excited to potentially launch the in the European countries by the turn of this year, with a broader rollout in 2027. In the U.S., we're aiming to launch in the first half of 2027, pending regulatory decision.

Next slide, please. Looking ahead, we are set to deliver important pipeline and regulatory milestones. Following the comprehensive pipeline update at our recent Capital Markets Day, I will focus today on a few key highlights.

Starting with obesity Amylin 355 recently advanced into Phase II with an expected readout in the second half of 2027. The trial investigates both subcutaneous and oral Amylin 355 in around 170 patients with overweight and obesity. For the oral formulation, we see the potential to leverage the Amylin biology to deliver a meaningful double-digit weight loss with potential fewer side effects.

Continuing in the oral obesity space. We are anticipating the Phase I results of the oral ACSL5 inhibitor in the second half of 2027. ACSL5 inhibition is a non-GLP-1 oral small molecule approach with the potential to deliver double-digit weight loss alongside a differentiated tolerability profile and no need for dose titration. As a small molecule, it also offers the potential for high scalability. Cagrilintide with its amylin-based biology is expected to expand into a new patient pool and set a new standard for tolerability. Later this year, we expect to initiate Phase III of the high dose of cagrilintide. Further, we anticipate Phase III results of the renew -- sorry, RENEW 1 and 2 programs around mid-2027.

Lastly, with obesity, we anticipate Phase I/II results for both of our tri-agonists in the first half of 2027. These include UBT251 targets and the receptors of GLP-1, GIP and glucagon, and our internal triple molecule targeting GLP-1 GLP and amylin. Within liver disease, we submitted mass data for all semaglutide 25-milligram in the U.S. The submission is based on Part 1 of the trial investigating semaglutide 2.4 milligram in mesh with moderate to advanced liver fibrosis. We're anticipating a U.S. decision in the first half of 2027. In addition, we are still anticipating Phase III safety results from the Synchrony real world trial of in people living with and fibrosis stages F1 to F4. The trial's primary endpoint is safety and tolerability.

With that, over to you, Karsten.

Thank you, Martin. Please turn to the next slide. In the third quarter of 2026, our adjusted sales increased by 4%, reaching DKK 79.2 billion. This was driven by continued GLP-1 volume growth across U.S. and IO, primarily in obesity. Adjusted operating profit increased by 27% driven by GLP-1 sales growth and a favorable comparison base following approximately DKK 9 billion of company-wide transformation costs recognized in the third quarter of 2025. This was partially offset by around DKK 3.5 billion of onetime costs recognized in Q3 2026 within other operating expenses and R&D.

For the first 9 months of 2026, Novo has delivered better-than-expected sales and operating profits. As a result, we have raised our guidance again. The adjusted sales growth is now expected to be from minus 2% to plus 2% at CER. The improvement in the outlook is mainly driven by increased expectations for GLP-1 product sales. The outlook reflects expectations for sales growth within I/O and expectations for sales decline within U.S. operations.

In IO, the outlook is based on current growth trends, including continued volume penetration from GLP-1 treatments and market expansion. Novo continues to roll out the Wegovy product portfolio in more markets during 2026, including the Wegovy Pill. In U.S. operations, the outlook is based on current prescription trends for the injectable TH1 portfolio. Lower realized prices linked to investments in market access amplified by the MFN agreement are assumed. Uptake related to the launch of Wegovy Pill is reflected in the outlook based on a range of assumptions.

Adjusted operating profit growth is now expected to be from minus 2% to plus 2% at constant exchange rates. The raised adjusted operating profit growth outlook reflects the improved sales outlook combined with targeted investments in current and future growth opportunities within R&D and commercial. This is partially funded by reinvestment of savings from the company-wide transformation program started in 2025 as well as further optimization initiatives and disciplined resource allocation. Our key modeling considerations for 2026 are shown on the slide including the improved free cash flow outlook now expected between DKK 60 million and DKK 70 billion. That was the outlook for 2026.

Now over to you, Mike.

Thank you, Karsten. Next slide, please. As we closed yet another strong quarter above expectations and another guidance raise, I would also like us to take a moment and focus on what comes next. I've been at Novo for more than 30 years, and I can truthfully say that few things energize this organization like new launches. The coming period will bring 2 exciting potential launches. FREHEMGO and CagriSema.

Let me start on the left side with FREHEMGO. People living with hemophilia have been asked to accept the trade-off between good protection and a heavy treatment burden for way too long. FREHEMGO is designed to remove that exact trade-off. The Frontier program demonstrated durable bleeding protections with the flexibility and the convenience of a once weekly once every second week or once-monthly injection in a simple, safe and easy-to-use device. That means more time living and less time managing a disease.

Our job now is to make switching from today's standard of care seamless, safe and the preferred choice for patients and doctors. That is exactly why I'm excited to roll out FREHEMGO globally during 2027 pending approval.

Turning to CagriSema. Here, our job is simple. We need to get it to patients fast across channels. We are preparing as we speak. So we can go from approval to launch as quickly as possible. We will use Novo Care and our partners to reach consumers directly and make the customer experience as seamless and as simple as possible.

So to sum up, we have delivered a strong quarter, raised our guidance again and introduced a new strategy, culture and a brand for Novo. Across the organization, we are focusing on turning our innovation into successful launches that makes a meaningful difference for patients and society. I'm excited about what lies ahead for Novo and look forward to sharing our progress quarter after quarter.

Next slide, please. Before we open for Q&A, I would like to say a few words about the change in our executive management. As announced earlier today, our CFO, Karsten, is leaving Novo after 27 years with the company. Throughout his career, Karsten has made a lasting contribution to Novo, most notably over the past 9 years as CFO. He has been a trusted colleague and a highly respected leader known for his integrity and sound judgment and genuine commitment to patients and our people. On behalf of the entire Board of Directors, executive management and all of our employees, thank you, Karsten, for your many years of dedication, we wish you every success in the future.

At the same time, I am excited to welcome Luigi La Corte as our incoming CFO. Luigi joins us from Galderma as CFO, and he brings more than 30 years of international financial leadership experience across health care and consumer businesses. Karsten will remain with the company until end of this year to ensure a smooth transition and therefore, we turn to Q&A now. I would like -- before doing that, though, give the word to you, Karsten, for a few words.

Thank you for your kind words, Mike. As Mike mentioned, this will be my last conference call as CFO at Novo. It has been a privilege to serve this company and to engage with all of you. Your questions, challenges and insights have consistently made us sharper and I have truly valued our open and constructive dialogue over the years. I leave with great confidence in our strategy, our strong financial foundation and above all, the people who drive Novo forward every day. Thank you all for your trust and support over the years. And with that, let's open up for Q&A.

Over to you, Michael.

Thank you, Karsten. Thank you, Mike. Next slide, please. With that, we're now ready for the Q&A, where I kindly ask all participants to limit her or himself to 1 or maximum 2 questions, including subquestions. Operator, we're now ready to take the first question.

[Operator Instructions] Our first question comes from the line of Peter Verdult from BNP Paribas.

Pete Verdult from BNP Paribas. I rarely do this on a public conference call, but I will make an exception this time for Karsten to say thanks for the interactions over the years and best wishes on your next career chapter. On to the questions, two for you, Mike. Just firstly, on the upcoming CagriSema approval, is the probability of CagriSema having some sort of halo effect of a Wegovy-containing brand name high, medium or low?

And then secondly, I realize you're not going to provide any official guidance ahead of a CFO change, but a frequent question we get from investors is whether Novo can return to revenue growth in '27. I know there are many moving parts. I just wanted to keep the ties with you on your confidence that a positive growth number could feature in any guidance range you provide in February given what you're seeing across IO markets with a pill and post the Ozempic pill launch.

Thank you very much, Pete. So that was sort of 1.5 question. So both questions for Mike around first, CagriSema and sort of the halo. And then secondly, on close to '27, although we don't guide to '27.

So thanks, Pete. To answer your question on CagriSema, the brand name ends with Sema. So there's semaglutide in there, but there is more than Sema insight, which actually makes us incredibly excited. I think the introduction of Amylin as the first comp to do that, gives us a huge opportunity to build on the credibility that semaglutide has had for so many years and Wegovy, of course, brand, but go beyond that. I would say it's medium. It's not it's not high. It's not low, it's medium because we actually think that this is much, much more than semaglutide on the back of Amylin being mixed with it.

On the 2027 I think you are correct. As usual, we're not going to guide, but let me go out of my way and provide even more building blocks for next year. So maybe you can do your own math. I think the starting point, of course, is that we are nicely positioned in a growing GLP-1 market with a good runway and still quite a bit of unmet need as we have been able to show this year with our volume upticks, both on the injectable side as well as the PI.

We start 2027 with the current runway and how we will end December. We just guided a midpoint of 0% for the first 9 months. We will monitor how October, November and December will also look like and that's how really we build our own budget as well as, of course, the guidance to you. Now as usual, we'll have some pushes and some pulls, some pluses and minuses, let me give you 3 plus and 3 minus. The pluses for us next year is the continued Wegovy Pill uptake in U.S. and IO. I don't foresee why should that completely change and how well we've done both in U.S. and in IO does not change just because January comes after December.

The other plus is we have seen a good uptick in U.S. Bridge program. That program started mid this year. So you need to annualize it when you make your calculation for next year. Then the third positive element, I would say, is the 2 launches I just spoke about. CagriSema, FREHEMGO are 2 launches where we plan to introduce CagriSema in U.S., FREHEMGO in both sides of the Atlantic and hopefully, both of those will prove to be fantastic launches.

On the negative side, I would say we've talked about the LOE this year in international operations and the early LOE markets. We have seen some of that already, more of it in Q3 than we saw in Q2. And next year, I would say, annualize that and see how that goes. Then the continued headwind that you currently see in China, minus 2% that we just showed, it's not going to go away just because Christmas turns into, again, a new year. And in addition, in China, we have loss of exclusivity next year, which we need to take into consideration.

And then last, maybe why not least, you see some favorable gross to net in 2026 that we should maybe under normal circumstances, not expect to the same degree next year. I don't know that. So those are the pluses and the minuses as far as I can go. And then we will, of course, guide with all of this in mind in 2027 at the full year announcement.

All right. Thank you, Mike, and to the brand name for CagriSema, that will come in due time. Next question, please.

And our next question comes from the line of Sachin Jain from Bank of America.

One for Jamey, one for Emil. For Jamey, on the U.S., Wegovy Pill script trends. Thanks for commenting to sequential growth. On your data, how much of that growth is the Bridge program? Are they just the bulk of Medicare and that's sequentially slurry, perhaps you could comment to that? And any color on why ex Medicare trends are flattish, if that's correct.

For Emil, you commented on U.K. normalizing just after an updated pack number relative to the 65,000 per week you gave at the CMB. And perhaps I can just squeeze in a clarification from Mike. When you talk about current momentum continuing, I was a little bit confused in the answer to Pete's question, is the midpoint of guide 0% best proxy or the recent 2Q, 3Q growth rate of mid-single digits?

Thank you, Sachin. So we'll stick with the 2 first questions. It's already beyond the #1. So first one question to Jamey on Bridge and then a question to Emil on uptake in IO.

Yes. Thanks, Sachin. Relative to Bridge, latest weekly data, we're seeing about 60,000 TRxs across injectable and oral in terms of Bridge. So the sequential growth of 20% in the quarter is largely been not exclusively Bridge volume. For the whole category, if you look May to October, and eliminate the contribution of the Bridge, the whole category is relatively flat, consistent with the seasonality that you see in that period outside of the consumer activation that we see in the wellness period that starts here in the fourth quarter and really peaks at the beginning of the year, with New Year's resolutions and a recommitment to health, if you will.

Yes. On the U.K., we are still very pleased with 90% market share despite a competitor launch, of course, is very strong. In terms of how we fare versus what we shared at the Capital Markets Day, back then talked about 65,000 as weekly sales. Now we are probably around 60,000. So despite a competitor launch super strong and also with the seasonality at the moment being a bit low. We move into November, December, that's typically peak where the online providers also invest heavily. I think what you should also take note of which we really are keenly focusing on is, of course, that this is not cannibalizing our injectable business. So that's perhaps what I'm most pleased about. This is really adding to our overall market share. So we are still faring more than 10 percentage points higher than we did prior to the launch overall. So very positive.

Now the focus, of course, is to build the segment, the class, that's probably up to us given our overall leadership with 90%. So we are focusing on subscription models, proving very successful for the providers to offer that focusing on clear switch guidance in the U.K. There are a lot of people with obesity who have tried the GLP-1. So if they've been on an injectable, we want to work with the private providers to ensure they start on the right dose. So there's a lot of the long haul of building this segment, but so far, we really see good synergistic effects between injectables and the pill, and that's perhaps what we are really celebrating at the moment.

Thank you very clear, Emil and Jamey. Next question, please.

And our next question comes from the line of Simon Baker from Rothschild & Co Redburn.

Let me echo Pete's comments earlier and wish you the robust for the future, Karsten. So on Wegovy, I wonder if you could give us an update on the impact of the subscription program. Is that affecting the capture rate of scripts that we're seeing because we kind of have to assume it's constant, but maybe it isn't.

And then secondly, on Wegovy high dose. You hopefully told us that it's 5% of total Wegovy Scripts in the U.S. But I wonder if you could give us any more color both within and outside the U.S. on where that's coming from. Are these predominantly titrations up from Wegovy, switches from tirzepatide or patients starting afresh on that therapy. Any color on that would be really helpful.

Thank you very much, Simon. So questions for Jamey to start with, and then maybe Emil can add a bit of color, at least on initial expectations.

Yes. So first question related to capture rate. The low capture relative low capture rates from IQVIA are not isolated simply to the subscription model. We have a much more extensive ecosystem of partners for Wegovy than our competitor, and those partners don't report to IQVIA in absolute terms. So we've consistently seeing a lower capture rate for Wegovy Pill than the competitive oral product. So not explained specifically by the subscription model.

In terms of Wegovy high dose, the 7.2 milligram as you stated, about 20,000 prescriptions a week, 5% of total volume. If you look at the injectable business, both Lilly's and ours, about 15% of the TRxs are in the highest dose -- so there is still opportunity to move Wegovy HD further. 80%, your specific question, 80% of Wegovy high dose is titration from 2.4 milligrams. So those 20,000 scripts a week are scripts that otherwise would have been lost to the Wegovy franchise.

Yes. I mean, we talk a lot about the Wegovy Pill. But of course, year-to-date, it really is the Wegovy Injectables that has been driving our growth in IO with a very, very strong volume uptake and I would say, very disciplined in pricing where we've not given up. So just to give you a sense that volume growth year-to-date for Wegovy Injectable, been close to 70%, so very, very meaningful. That's, of course, why the high dose launches 7.2, we call the IO top priority. We promised more than 30 launches by the end of the year, and we'll get there. We've had 3 so far.

The one where we have the most meaningful experience from is the U.K. We launched back early June. And today, around 5% of our injectable patients have already started on a high dose. That's pretty good. And we, of course, keep supporting that. We, over time, will also look at, of course, how can we facilitate patients who have maxed out on Wegovy Pill 25-milligram and also offer them an even more efficacious treatment with 7.2. So we give a lot of priority to this just launched in Germany, Poland and the rollout continues these very weeks.

Next question, please.

And our next question comes from the line of Martin Parkhoi from SEB.

Martin Parkhoi for SEB. With the 2 questions. Just a question for Martin. With respect to expectations ahead of the Phase I/II readout in obesity of the 2 trial agonist. I'm not expecting you to give some kind of indication of where you see the weight loss. I would more like to get you to get some expectations of how we should view the adverse event profile going out to this because there has been some noise when Novo Nordisk come out for Q2 -- sorry, with the Phase II results and high level of adverse events. How have the trials on the triagonist been set up with respect to this just to control expectations?

And then secondly, maybe that is for me, we can see in U.S. that the Ozempic pill rebranding has been quite a success so far. Does that make any sense also to do that in some of the IO markets where Ozempic also is a high household name?

Thank you, Martin. First question to Martin around triple reading out and then to Emil on the IO question.

Yes. Thanks very much, Martin. So first of all, I just wanted to clarify where we typically see adverse events rates being captured in a very rigorous way is in Phase I because basically, we follow the patients very, very closely there. I think that is what you are referring to also because most of these trials are built with technicalities around how we capture the rate, but also how we want to drive the dose escalation in a meaningful way. So those are a little bit technical but also a little bit artificial.

What we will see readout of is proper Phase II trials. And here, we actually expect to see the, I would say, expected adverse event profile and tolerability profile of these 2 drugs. You've actually seen some readouts from Phase II, albeit in patients from UBT251. It looks very, very attractive with low adverse event rates and lower drawn rates. We cannot fully expect to see that in a global study, but our aspiration is to have adverse events in line with what we've seen with Wegovy and with other GLP-1 incretin-based therapies.

And actually, for the triple, we potentially expect to see either in line and potentially even a more attractive safety profile and tolerability profile because the GIP component will come to its own right here.

Yes. On Ozempic pill in IO, we have definitely taken note of the success that Jamey and team have delivered in the U.S. That's good inspiration. You'll be the first to hear if we end up concluding that it's a good product for IO as well. At the moment, our focus is the 2.0 launches. We've come late to that NIO launched in 13 markets year-to-date, 20 by the end of the year. And so far, we have good results. We shared the results from Germany and the Netherlands, 2 early launch markets, but a number of other markets are also proving promising here. So that's our focus. That will already be enforced the Ozempic brand at a moment where for your building blocks for next year, we, of course, are facing increasing competition particularly in reimbursed markets across IO from a well-known competitor to you all. So it will be key to reinforce Ozempic, first with 2.0.

Thank you very much, Emil. Thank you very much, Martin. And then just to kind of ask again to limit yourself to one question. So as many as possible can get to ask the question. Next question, operator.

Our next question comes from the line of Matthew Weston from UBS.

I'm going to actually ask Sachin's question, Mike. Is the positive growth exit rate in the second half of 26%, the best proxy for '27? Or is the full year 0% average at the midpoint of guidance that you referenced earlier, the best baseline for next year? And if I can slip in one because I managed to get to Slide 83. If roxifermin looks like you have no plans to launch until 2030 when you get the F4 data? Can you confirm no plans to go early with F3?

Yes. So the way that it works, we look at the totality of this year, we look at the pluses and the minuses that we had this year. And we look at quarter-by-quarter, frankly speaking, and then we look at the exact same thing for next year. I told you that on some notes, we see positive results for next year. I think the Bridge program is a great example of that. We've had half of that. We're happy with it. Let's do that for the full year next year.

On the other hand, LOE in international operations is exactly the opposite of that. So I would not give you numbers again today, we're not guiding. But what I do tell you is that right now, we've guided 0% midterm for the first 9 years -- 9 months. So that's basically how we're going to look at this going forward. On the question, we have to follow the data. We will look at the data for F2, F3, F4, and then make a decision. I don't know if Martin wants to add any more to that.

I think it's important to call out that is where we see the big unmet need. We already have a drug on the market for F2 and F3. It's called Wegovy. And therefore, to Mike's point, will be guided by the data as we see them.

Thank you, Matthew. Next question, please.

And our next question comes from the line of Richard Vosser from JPMorgan.

One on Ozempic, please. Maybe you could talk about the underlying price dynamics this quarter throughout this year, whether there's any impact from lower 340B rebates going through to better prices? And how you're thinking about that into next year? I noticed you didn't mention IRA next year. I know we talked about that last quarter, but is that still a headwind in terms of price? Or are there price benefits that offset that next year?

And then the second question, maybe you could just talk about that oral rollout. I think 12 or so incremental markets in the first half of '27. Maybe you could talk about the relative opportunity of those markets relative to the U.K. and how early days, France, Poland, Mexico, et cetera, are going and their relative opportunity?

Thank you, Richard. The first question to Jamey and then the second question to Emil.

Yes. Thanks for the question, Richard, on Ozempic gross to net trend. So as we've guided before, suggested the 10% to 15% price erosion on an annual basis is the way to think about it. There's so much fluctuation variability quarter-to-quarter. Obviously, in the quarter, we saw significantly better range than the 10% to 15%. But year-to-date and over a 12-month period, we still feel 10% to 15% is reasonable. The payer pressure on net prices in the type 2 diabetes category remain and will continue. So that's our best judgment there.

Emil?

Yes. On the rollout in IO, of course, I'm very pleased with our manufacturing colleagues because they keep upping the output. And you noticed at Capital Markets Day, we promised 20 markets by end of next year. Now we promised by end of first half. So that's, of course, incredibly positive. We also back then shared that this would correspond to 2/3 of the market potential. So we reached that earlier, of course. And then across the markets, I've learned to be rather humble predicting potential in this space. But of course, you could say markets with a low penetration and a propensity to tablets such as Mexico. That is a relatively speaking, bigger market expansion opportunity versus the Danish market, for instance, that's more mature with a 10% treatment rate. So there's something about where are we on treatment rates, what is the propensity to online and tablets altogether. But overall, of course, we see it as a hugely important opportunity.

And in the early innings, it will still be Europe driving the majority. Then of course, we'll see, and that's what we will learn next year. In markets that have gone LOE what does the fact that this would be a premium offering from a pricing perspective means to the volumes we can secure there. And we'll keep you posted on those learnings as we move into next year.

Next question, please.

And our next question comes from the line of Michael Leuchten from Jefferies.

I'll stick to one and Karsten, thank you so much for the interactions over the years. A question is just a follow-up on your commentary, Jamey, on the Bridge contribution to the franchise. So do I understand correctly that without Bridge you wouldn't have grown the GLP-1 franchise? And what does that mean as Bridge starts to annualize?

Thank you very much, Michael. Question to Jamey on Bridge in the U.S.

Yes. Without the Bridge contribution, there is less growth in the 20% sequential growth that we talked about. Bridge is definitely creating an inflection in the category and without Bridge, the AOM category, not just Novo, but the category looks relatively flat in the May to October time frame, reflecting the seasonality.

Next question, please.

And our next question comes from the line of James Quigley from Goldman Sachs.

Also thank you, Karsten, for your help over the years and better luck in the future. Maybe one for you, Karsten. So on the upgraded guidance range of -- for 2026, the implied range for Q4 is super wide. I think it DKK 12 billion swing. So what are the key factors side there. And then as we look into next year with the gross to net is quite high this year, how should we treat that as we're thinking for '27? Is that an unwind? Or is that a new base from which sales need to grow from?

And then secondly, quickly for Jamey on the CagriSema launch in the U.S. As you prepare for the launch, how are you thinking about market segmentation which patients or consumers will the initial marketing campaign target? Sounded a little like older women from Martin's comments, but will you have sufficient data for the launch here? And what is the best analog we should look at as we start to model the launch.

Thank you very much. First question to Karsten on a year to go in 2026, and then over to Jamey on.

James, thanks for the nice words. And specifically to your question on implied growth and guidance ranges then I'll just say, as to the guidance ranges, the breadth we have here in Q3 is completely customary at this point in time. And the reason why we have this breadth is that we are navigating a rapidly growing category with a certain degree of volatility. So that's why we keep it a little bit wider compared to the heydays when it was pure insulin and extremely linear. So that's really the reason there.

And in terms of implied growth, it's important to note that while we are growing 2% year-to-date, and we have a midpoint of 0, then we do have a tough comparator in the fourth quarter due to U.S. gross-to-net last year of DKK 3 billion in the fourth quarter. And then LOE in mainland Canada, Emil spoke to also having a bigger impact in the fourth quarter compared to the first 9 months. So those are really the 2 biggest ticket items impacting the fourth quarter and the implied growth there.

For you, Jamey?

Yes. And as for segmentation, it's absolutely the right question, but you'll understand and appreciate if I don't graphically describe our launch strategy. But that said, I'll make 2 points. one, super excited about CagriSema and expanding the optionality for physicians and for patients. Increasingly, as more competitors come into the category having a portfolio of singles doublet, triplets over time is going to be really important from a competitive standpoint.

And as you described, as the information data emerges on CagriSema, there is a nice profile that is emerging in terms of the efficacy of the product even at lower doses, as Martin described, and the patient population perimenopausal women where we recently announced the 25% weight loss seen in the study. So thank you for your question, and we're super excited about the launch coming up.

Next question, please.

And our next question comes from the line of Martin Brenoe from Nordea.

I just have 2 left, please. First question would be whether you can provide a bit of color on how you see the price dynamics heading into 2027. Just what the main building blocks that we need to be aware of when we do our modeling?

And second question, is on the Wegovy Pill. Now you're committing to rolling out the Wegovy Pill a bit faster than what you indicated just less than 2 months ago. Can you just help us understand what's been the main driver behind this assumption and whether you still see some upside to this accelerated rollout that you are now promising here?

Thank you very much, Martin. So some high-level comments from Jamey on the U.S. and then over to Emil on accelerating Wegovy Pill in IO.

I apologize if a bit repetitive. But on the Ozempic side, as we've suggested that 10 to 15 price degradation trend is kind of our experience in what we would suggest not guiding, but that trend continues. And then on the Wegovy side, we've again seeing 30%, 35% in the quarter, again, with the variability a little on the high end, but we expect that or a little better moving forward. Just to clean up maybe one question that was asked before that I missed and has been answered previously. Because of the Ozempic trend, NFP pricing, we don't expect to have an incremental negative consequence because that's been the trajectory we've been on. So someone asked that before, and I didn't cover it.

Thanks, Jamey.

Yes, on the acceleration, it is really back to, of course, manufacturing stepping up, producing above what the lines are expected to be able to deliver. I've been visiting myself to chair and the teams, and they're really doing a great job working 24/7.

Another aspect is regulatory. We've actually taken some learnings of how we also rolled out. Wegovy injectable very quickly, working with multi-country packs, et cetera. So great work to also optimize. That simply means you can have launch batches, serving more countries and hence, speed up productivity in manufacturing. So that's helped. You saw maybe also the breaking news of the day, Australia. We got approval also great local regulatory work, so another front loading there. So it's a combination of manufacturing, regulatory work and really close collaboration.

Next question please.

And our next question comes from the line of Seamus Fernandez from Guggenheim Securities.

So my question is just kind of going back to that -- the comment about the sequential growth from March basically being flat and the contribution of the Medicare Bridge program being the main accelerator. That speaks to, I think, to some degree, a cautionary tail for payers potentially lowering the price or helping to lower the price of treatment. I guess the big question is, how do you get commercial pay to really step in and start to reveal the benefits, the medical benefits that we all know, GLP-1s actually have given several appear to have pulled back from supporting the obesity opportunity.

Thanks, Seamus. So to Jamey, on that question regarding dynamics in the U.S. payer market.

Yes. It's a great question. It's a simple question with a difficult answer. But the reticence on behalf of the downstream payers, employers, government, private payers is increasingly about the volume concern side of the equation. Price keeps coming down, net prices, competition is working in that sense. Our list prices will also come down 1127 as previously announced. But how payers control the cost trend that they see, which is the price times volume equation, is the challenge. We're engaged daily with employers, third-party payers, PBMs on their behalf to try and manage the volume in a unique and different way so that they can manage the cost trend. But you're right, whether it's Pepsi, Starbucks, other large employers, when they see the cost trend, they move against despite the clinical and economic benefit long term of medical cost offsets that have been demonstrated in the market.

So we continue to fight that battle and seek greater access for the category, by the way, again, not unique to Novo. This is a categorical issue and opportunity that we're working on.

Right. Thank you very much. Last question, please.

And our last question comes from the line of Kerry Holford from Berenberg.

And thank you again also to Karsten for the many years of interactions. I won't finish again on Bridge. Just linking to that question in a way with regard to commercial options as it does now settle up to the U.S. returns today, Jamey, I wonder if you can comment on your expectations on the Medicare Bridge, let's say, the Medicare coverage extend beyond the end of Bridge, which I know that you come to an end at the end of next year, if that appetite is not there to provide access more broadly, how do you see it playing out within the Medicare channel?

Thanks, Kerry. Last question to Jamey around dynamics again on Bridge and also how it's all panning out in the U.S.

Yes, it's difficult to predict what the political environment is going to look like at the end of '27. But as the '28 presidential elections come into play, health care continues to be a dominant topic for U.S. citizens. Family insurance premiums have increased 28% over the last 5 years. So health care costs continued issue for both parties. I think as more and more seniors enjoy this coverage for GLP-1s for weight loss that will put pressure politically on continuation of the program.

The benefit of this demonstration project is to document eligibility, inclusion, cost and outcomes so that they can make a determination. And obviously, we'll continue to work with the administration, with CMS, with both parties to continue this access opportunity for seniors who are finding it beneficial and affordable.

Great. Thank you very much, Jamey, and thanks, Kerry. So this concludes the Q&A session. And before we ended completely, I also would be remiss even though there's been a lot of thank yous, I also need to say thank you very much to you, Karsten, both from being an analyst on the sell side, and most recently, internally as my direct boss and leader. So thank you very much, and best of luck going forward.

Thank you.

That was it. Thank you for participating. And feel free to contact Investor Relations regarding any follow-up questions you may have. Thank you very much.

This concludes today's conference call. Thank you for participating. You may now disconnect. Speakers, please stand by.

Welcome to Novo's Capital Markets Day. Before we begin, we need to advise you that this event will contain forward-looking statements. These are subject to risks and uncertainty that could cause actual results to differ materially from expectations. For further information on the risk factors, please refer to this disclaimer, which will also be available on our website.

[Presentation]

Welcome all of you here in beautiful London as well as to all of you who are joining us online. I think it's an understatement to say we've been looking very much forward to today. The reason for that is that we're incredibly excited to tell our story to you. We are incredibly convicted that there is a bright future for Novo. But we also realize that it's not enough for us to be convicted. We have to convince you. And that starts with a bit of a story. It starts with where are we going to go? How are we going to get there? And maybe more importantly, how should you hold us accountable along the journey. That's what we're going to do today.

Our story really starts with this slide. It's a slide that shows, on one hand, how large the market for Novo Nordisk is. On the other hand, how horrible this unmet need is for billions of people that are suffering every single day. But yet Novo, of course, has treatments for many of them. We are very, very proud that 46.5 million people wake up every single day using one of our products. And while we are proud of the number of 46.5 million, these are billions. The gap is incredibly large, and we need to somehow close the gap. We need to work harder, and we will.

Of course, unmet need on its own does not translate into good business proposal. We need to be able to develop medicine, best-in-class medicine. We need to be able to make plenty of it. And we need to make sure that somehow our medication gets connected to a good portion of these individuals through access, affordable access. And we will be able to share all of that with you today as we go through our presentations, how we're planning to make medications, how to make them in abundance and how to provide access. By the end of today, when you leave through these doors and the Capital Markets Day is finished, we have a hope that we've been able to somewhat explain the story of our growth and the diversification of our pipeline.

We need to be able to show you through our pipeline that we can make medication that is diversified and goes across different therapy areas. We will also need to explain to you that we need to be able to go from science to some incredibly successful launches over this period, giving us a sustainable growth for years to come. And last but not least, we'll need to invest in R&D and in our commercial activities to remain competitive, but also have the discipline to be incredibly cost conscious where we need to be, so we can deliver attractive returns.

For the agenda of today, we'll take you from strategy all the way towards execution. I'll start by setting the direction by explaining where we need to go, where we are planning to end up in 2030 and even beyond. Then I'll have Martin come and explain about science, how we're planning to fuel all that scientifically based on innovation. Together with Hong, they will talk about the portfolio strategy and where to play and what gives us the right to win in playing in those areas. Then we'll move to execution, and I'll have my colleagues, Jamey and Emillion on east side of the Atlantic, telling you how they are operating now and how they plan to continue that operation as we go forward.

We'll have Kasper explain to you how we're going to be okay supply-wise and how we're going to make plenty of these products to make them available. And then Karsten will come at the end, put it all together and try to tell you what our financial ambition is going to be. So this is really the team who's going to drive this today, but also lead 67,000 individuals afterwards as we go back home executing on these strategies. It's a group of people that many of you know already, some familiar faces, but there are also some new ones in there. Despite the diversity, what unifies them is their experience, very large amount of pharma experience is within this single picture.

And experience is important, but I would say much more important than that is a can-do attitude. It's compassion, commitment and the general conviction that we're going in the right direction, and they have that. And you can test that during the breaks and the lunch, grab them, please, and try and see are we in the right hands or not. I am incredibly proud of this team, and you can be the judge yourself as we go forward. We're going to need all their energy because the environment around us has fundamentally changed over the last, even, I would say, 5 years ago. There are so many things that are different today than maybe even the last time where we had a Capital Markets Day.

Consumers, consumerism was not in our vocabulary last time we met. Today, many of our patients act more and more as consumers do. We have a situation where competition as we are seeing it, has never been at least in Novo's historical back. For decades long, this company operated in what you could argue as a duopoly often. Thank to us, we created an incredibly attractive market. And now almost every other single pharma company, big or small, is trying to come and compete with us. We need to be ready for that. Of course, semaglutide became incredibly an important molecule in our industry, but so will the attention to its loss of exclusivity. And we are seeing the early signs, of course, of that as some of the markets have gone LOE.

And last but not least, price and access is also very different than what it just was a few years back. Yes, there's price pressure, health care pressure as it was always there. But there are new dynamics that are certainly new to us. Who would have thought just a few years back that 90% of our Wegovy pill sales will go through a cash channel in the U.S. So it is very different than before. Now we need to have a response to all of that. And the good news is that we do. We do recognize it, and we actually think we have a response to all of that.

If you think commercially, we are now running almost as an analogy, an airplane with two engines. We knew how the original engine works incredibly well. This is the health care professional world, the hospital setting, our sales force in the front lines going and convincing the physicians about our value and getting a prescription. That we know incredibly well, better than anyone else. We also, during the last couple of years, had to very quickly learn the second engine, the consumer engine, not speak only to KOLs, but DOLs, digital opinion leaders.

We have built a second to none version of the second engine also, I would say, thanks to our entrance with semaglutide in obesity. We have to really hurry up and make sure that the demand is matched with supply. And I think all of that is public information now. And through that process, we also learned a lot. One of the better decisions I would subjectively say we made when I became a CEO was put the research and development together. They belong together. And in less than 12 months, we started to see the benefits of the R&D being united again and we are launching while we're doing all of this. We're transforming while we basically are performing on the basis that we've had.

We're also relooking at our organization. Today, we have 66,000 individuals, and that's substantially lower than just 12 months back. We're trying to simplify the company, have less committees, have less bureaucracy and do more work and do it with a sense of urgency. And I would dare to stand here with all the subjectivity that I have and say early signs are pretty good, just 12 months into our transformation. We looked back and we tried to see has some of that shown an impact already. And I would dare to say, I think they have. The 7 million prescriptions that has been so far written for Wegovy pill makes it the best product launch in volume in U.S. across all different companies.

That's pretty good. And I think we do get credit for that. Perhaps equally excited coming from a commercial background, I get -- when I look at our market share graphs, they used to be going down for a period of time. We stabilized it. And over the last number of months, we've gained market share quite a bit. And both Jamey and Emil will show you those numbers as we go through. And that is something we are very proud of and something we're working hard to retain. Last year, for the entirety of 2025, we brought 3 programs into clinical development, first human dose. As I stand here in August, September, we ended up basically having 5 so far, and Martin will show you then the numbers are going to go up much, much higher than this before we finish this year. That speed and perhaps connected to the unification of the organization I just spoke to.

We made an incredibly difficult decision to say goodbye initially to 9,000 individuals and then afterwards, a further 4,000 have left the company. These are not easy decisions for us, but they were necessary. They were incredibly important as we're using the funds coming through this exercise to fuel for the future, fuel the R&D organization as well as, of course, make ourselves more competitive. Now all of that brings me to our so-called updated corporate strategy. This is where we're going to go.

We're going to start with what we know and we do incredibly well. That's our core. Diabetes and obesity. This should not be a surprise to you. We do this incredibly well. We will strengthen our diabetes care, and you will see how shortly when my colleagues come on the podium. And we recognize that a lot of growth will come from obesity. So we will expand from that. We will show you one of the broadest pipeline and explain more details into exactly how we're going to play with that. But we also have decided that it's time to further diversify the company to build out future growth engines. And to do that, first and foremost, we looked into some of our expertise.

We have decades-long expertise and great people and scientists within rare blood disorders that we have operated in. We're broadening that. We're going further into that area and creating a new segment called blood and endocrine disorders. We have some fantastic drugs already on the market, and we are incredibly proud of some of the new ones that are coming very, very soon. You'll hear about those also from my colleagues as they get on. Liver disease is an obvious place for us to also go. We have an indication with semaglutide, but that's not enough. We have some other assets, think about efruxifermin that are exciting us incredibly a lot. Think about a person that might be worried about getting a liver transplant, and this drug might actually avoid that surgery and more to come. So that's an obvious place to go as well.

The other obvious place is CV. Despite the setback that we all noticed with our ZEUS trial, this is a very obvious location for us to continue exploring and expanding upon when it comes to cardiometabolics. So CV also will be explained to you in the session. Then there is this third bucket, exploration of Consumer Rx. What is that? This is where serious condition, prescription medication meets incredibly strong consumer demand. The crossroad of these two will give us Consumer Rx and our exploration within that area. This is not what many of our peers call consumer care or an entry into over-the-counter OTC products. This is where Novo has become second to none in expertise over the last 2 to 3 years in our ability to take a prescription medication and directly provide that to the consumers.

We are very good at that today, and we will not let this go to waste. We'll take two different routes. We'll take some of our own assets where we feel there is a pathway, a scientific pathway to these conditions and develop them for that. We could do it as a stand-alone or in combinations with others or we could go and look at assets that are out there through business development, and we will explore all of that. Along the way, we'll make sure that exploration comes with a good business case and financials as well. So this is our promise to you. What gives us the right to win?

Our unparalleled understanding of metabolic diseases, our best-in-class biomolecular engineering with especially the oral peptides world-class manufacturing that I think you agree with us, it is really at scale and second to none. And last but not least, our global footprint. That's what we believe gives us the right to win within these areas. Many of you have heard me in various different forums talk about how proud of our pipeline we are. This slide is the reason why. This gives us multiple opportunities across different therapy areas, both in injectable as well as orals. And speaking of orals, I'm specifically really proud of the oral pipeline that we have.

And Martin will go much deeper into it and dissect this slide in different pieces and show you what excites us the most. We have seen with our Wegovy pill launch that there are a lot of people and increasingly number of people on both sides of the Atlantic that simply do not want an injectable. They prefer an oral medication. It is fantastic that we're able to have such a high market share despite competition having arrived with our oral medication, and it is improving, and we will show you the numbers that we have. But it's not going to cut it on its own. We need to already today think about how we can keep that leadership.

On one hand, of course, it will be all about manufacturing. On the other hand, it will be about innovation and comes at the end, of course, our ability to continue launching these products like we just did. And I'm very, very, I would say, excited about this. When you look at this slide, what I'd like you to remember from it is the headline. That's our ambition. We will have the plan to launch at least 5 multi-blockbusters by 2030, pretty much every year and deliver a combined sales of more than DKK 150 billion in value in less than 10 years from today. This ambition is risk-adjusted, which means it allows for development risks. This is what you should remember.

Then I also want to make it incredibly concrete when it comes to our growth story for the next few years. We have a plan and an ambition to deliver from now until 2030 revenues and compounded annual growth rates related to that on par with our industry peers. It's quite simple. Now the question is, how are you going to do that? What are the building blocks of that? There are 3, 4 things actually. One, we will broaden the injectable portfolio that we have beyond sema. We'll start with CagriSema very early next year. We'll move from that to cagrilintide, CagriSema high dose the following year, zenagamtide, the year after that and soon after that, with our 2 triple agonists.

You will see all of that also as my colleagues get on this podium. That's broadening the injectable portfolio to cover so many of the segments that we believe can benefit from these injectable products. But we will also not stop there and expand our leadership on the oral side. We will continue with our Wegovy pill and make sure that we will basically able, first and foremost, to expand both molecularly but also manufacture to have the leadership that we currently see go through this decade.

At the last quarterly meeting, we announced to you that right now, we have 1.5 million people on the Wegovy pill. Our promise to you is that by the end of this decade, we'll have manufacturing that is able to cater for 10x that number of patients. 10x what we basically do now, we will have ready to go. So that is actually secured. I just talked about our heritage with blood and endocrine. Our promise to you will be that by the end of the decade, that will also continue giving us a very decent growth. And we say more than 50% than today should be clocked in before the decade is over. And again, we'll explain a little bit how and where and which products are behind that.

And last but not least, I just spoke about it. We need to go to more patients. We need to capture a lot more volume and get some good value out of it. A huge tool in that front will be our direct-to-consumer capabilities that are becoming really second to none. Our enhanced Novocare platform will allow for that, and it will also allow for our Consumer Rx to come and tag along as we will continue exploring that area. And as we do that, we will also make sure that we improve the margins through this process as we go directly to consumers and don't need perhaps all the middle layers. So those are the pillars on how we will get there in the short period.

Now what happens after that? Let me get the elephant in the room out. Semaglutide LOE is what's in most people's mind and rightfully so, it should be. We do not belittle LOE or the challenges that comes with it related to the price pressure. We see early signals of that, of course, here and there. But the slide also shows you that we plan to come on the other side of the LOE as a bigger company than we are today and a much more diversified version of it. That is our plan and promise to ourselves, and we wanted to execute that and explain that to you today.

Now what are the building blocks of that? And how are we going to actually do that? Well, they are written on the right-hand side of this graph. We will fiercely compete for some of volumes pre and post LOE. Our scale, our brand recognition and basically our footprint on the ground allows us to do that. We are doing that today with some of the markets that have gone LOE, and we're learning a lot through that process. But we also recognize that's not going to be enough. We will get some volume, a lot of volume actually and some value out of that, but that's not enough. We need more value. That's where innovation comes in.

We will launch next waves of diabetes and obesity innovations long before the LOE has kicked in. And I just elaborate on that when I showed you my pipeline slides and even gave some key performance indicators for you to be aware of. So that is the second building block. Then we will basically need to really make sure we continue and expand on the oral segment. It is a segment that most people have a bit undervalued perhaps just 12 months back. You can see what has happened with the Wegovy pill. And maybe more importantly, you could see what Novo is able to do despite competition and competitive pressure.

We will try to explain to you how we believe strongly we can keep that leadership as we go through the LOE process, and that will be a big part of the calculation. Last but not least, we spoke about building a future engine by launching more products outside of our core, especially within blood and endocrine, liver, that will also be part of the story post LOE.

And finally, Consumer Rx, we're going to explore that and don't write that off. There could be also some good things coming around that. And actually, Martin will give you some hint of what we already started to work on within that area. And then there is the business development part on the side, and I have also mentioned that we will be more active within business development. We've done quite well on trying to look at the gaps we have, scientific gaps or strategic gaps in the company over the period and gone shopping.

On the other hand, we also are not shy to say, increasingly, we tell ourselves, we don't have a patent or a monopoly on all the good ideas. So we have to go out and look what else people are doing. Look at this chart. We would not have been able to do what we're doing with Wegovy pill without Emisphere. They gave us a technology that allows us to encapsulate the peptide and administrate it orally. Forma has given us etavopivat. You will hear about that, possibly best-in-class drug for sickle cell.

Akero is giving us efruxifermin for late-stage MASH. United Lab on the other side, of the world is giving us perhaps one of the best-in-class triple agonist, UBT251. So we will continue doing that as we go forward. We will be selective. We will be disciplined, but we will continue bolting on via business development. And we will also partner out with experts, AI leaders, e-Health leaders to augment and do more than we can do on our own commercially and technologically.

So in conclusion, I started with these 3 buckets and my wish for you to remember these as you go through the various different sessions. But I also mentioned we would need your conviction but we also need us to be held accountable vis-a-vis on some very concrete things as we go forward quarter-by-quarter. What are those are going to be presented in every single session that you're going to see from now until 3:30. They will basically tell you that we are planning to launch more than 5 mega multi-blockbuster by 2030. And we will deliver a value risk-adjusted of more than DKK 150 billion in less than 10 years.

We will also tell you that we plan to launch at least 10 Phase III launches, 5 in the core, 5 in other areas. And that's at least. To drive sustainable growth, we will give you a CAGR in line with our peers for this part of the decade. And we will scale our oral manufacturing to 10x more than the patients we serve today. So you don't have to worry anymore about can they actually drive this through with their orals. Now we are revealing the numbers to you.

And we will go from 46.5 million patients we serve today to more than 60 million if our calculation holds. To deliver attractive returns to you, we will have margins that will be broadly stable, so you don't have to worry about that. And we will maintain an attractive dividend per share, and Karsten will touch upon both of those at the end of today's session. So this is our promise to you, and you will hear all the details of it as we go forward.

First and foremost, with Martin, who will take a deep dive into R&D. Thank you.

Thank you very much, Mike. A very good morning to all of you. In principle, Mike has made life in R&D quite easy. The task is simple. We are to deliver a full diversified but also differentiated pipeline and portfolio to drive growth towards 2030, but also beyond 2030. We'll do that in our core therapy areas of diabetes and obesity, but we'll also expand into other therapy areas, building on our 100-year long expertise within cardiometabolic diseases. To deliver on that, we also have defined our 2030 ambitions. You've seen some of them from Mike. Part of driving pipeline growth is obviously to drive what comes into Phase I, what comes out of research, what comes through business development.

And as Mike alluded to, we had 3 first human doses last year. That's not good enough. This year, we're already at 5. I'll show you later in the day that we will have at least 10 first human doses throughout the year, but actually, the current list is 16. I have to assume for some attrition, but that's a fundamental step-up going from 5 to 10, 15. These first human doses will happen in obesity. That's where we doubled down in the last year. They will happen in diabetes, but they will also happen in cardiovascular and liver disease.

We also had to speed up. Again, in diabetes and obesity, where we are basically the most established drug developers. We have an ambition of delivering time lines of less than 5 years or equal to 5 years from first human dose to regulatory submission. That's a step-up for us. It would also be a step-up across industry. But based on our expertise, but also based on the digital AI levers that we have, this can be done. That also means that some of the first human doses that we've had this year, we had the ambition to bring to the market either before or around the turn of this decade. We spent the last year reestablishing the leading pipeline in diabetes and obesity. We have that in the clinical space. We will also have that in the research space. And you'll see through the quality of the first human doses that they are not only driving for best-in-class within the incretin and amylin space, but also driving for novel targets within diabetes as well as obesity.

For us, it's important to acknowledge that both diabetes and obesity are complex diseases. Not one treatment will deliver what every patient wants or needs. And therefore, we need to have a portfolio or a pipeline that delivers to individual patient needs. That also means that we have to drive beyond the incretins, beyond amylin for novel targets. At the end of the day, by 2030, we will deliver more than 10 programs. As Mike alluded to, 5 in diabetes and obesity at least, and at least 5 in other therapy areas and we are driving for at least 5 multi-blockbuster launches by 2030. This obviously doesn't happen in isolation.

Mike alluded to less than 1 year or slightly more than 1 year ago, we became one R&D organization. We have spent some time streamlining the organization. As Mike alluded to, I have less than half of the direct reports that I had 1 year ago. That's actually more reflective of a streamlined organization with less silos, more synergies. That's driving efficiency, but it's also driving scientific synergies. We'll talk more about AI. But based on the data that we have driven for the last 100 years in the research, but also in the clinical space, starting with diabetes, moving into obesity, then into the broader cardiometabolic space, we can leverage AI in a different way than most of our competitors.

Someone brighter than me has said that data in AI is not just an input, it's the underlying foundation for AI intelligence. The quality, the representativeness of the data that we can put into our AI models will drive for something very unique. We'll come back to that later in the day. We've also had to acknowledge that we need to understand where patients are. Very clearly in obesity, you're all talking about that. There's almost a consumer-like behavior in obesity as we speak today. Patients taking obesity medication are still patients, but they are acting like consumers.

In an R&D space, we need to understand that starting in research, but also moving into the development space. We'll actually take that approach not only in obesity, but also in diabetes and all of our other disease areas, acknowledging that patients are not only faced with unmet medical needs, but they also have ones. They have things that they require from their medication, acknowledging that patients are decision-makers, we need to get broader input from our commercial colleagues in a timely fashion. So we've already invited commercial colleagues in research. We do that through continuous development.

And we actually stay as R&D people in the commercial space as well. So we have a continuous circle of feedback, guiding us what do patients need from a medical perspective and what do patients want from their perspective. And then we have to acknowledge we don't do this in isolation. We established a lot of collaborations in the recent years. We've also done some acquisitions, and we'll continue doing that, not only in diabetes and obesity, but specifically also when we move into novel therapy areas.

Now while we have restructured the R&D organization, we've not been idle. We've basically driven a very strong Phase I pipeline. As you see, we already have a number of assets in Phase I in diabetes, in obesity, in cardiovascular, in blood disorders, in liver disease. This is a major step up compared to where we've been in recent years. You will also notice that there are novel targets there and novel targets in diabetes, in obesity going beyond what is GLP-1, what is amylin.

As Mike alluded to, for the rest of the year, we are still looking into potentially 11 additional first human doses, slightly more than half of those in obesity, but then more or less equally distributed among our other disease areas. I can't promise you that there will be no attrition among those 11. So we are committing to a total number of 10, but in reality, it could be as many as 15, 16. Again, this is a major step-up of what we've done in recent years and obviously a testament to what this organization can do when it comes to innovation.

I also want to talk about the progress that we see in Phase II. We have some really strong potential for best and for the triagonist first-in-class assets that will cater to not only diabetes and obesity, but potentially other disease areas in cardiovascular, but maybe even beyond cardiovascular. Importantly, you will also see oral amylin 355 in Phase II. This is again a testament to we are all driving for the highest weight loss. That's good. But not everyone with obesity needs a 20% plus weight loss. There will be some patients, let's say, patients with BMI 30, 35, we just need a moderate weight loss, but then preferably without too many side effects and too much hassle.

The amylin biology in monotherapy is promising to be that. You've seen the cagrilintide data at the doses that we've tested so far, around 12%, 15% weight loss, but with less than half of the side effects that we see with the GLP-1 analogs. If we can deliver that as an oral as well, I think we'll make a lot of patients feel that we try to meet them where they actually want their therapy. But on the other side of that, we also have zenagamtide. We have UBT251. We have the triple that are driving for the bigger weight loss while still balancing safety and tolerability and also addressing comorbidities.

And obviously, in the Phase III, this is specifically where we are. We have zenagamtide, we have cagrilintide. And importantly, again, zenagamtide is not only a subcutaneous offering, it's an oral offering. I think you will hear a theme here. We are very, very focused on the oral offerings. We will have at least 5 oral assets in clinic by the end of this year with the aim on delivering holistically to patients on the magnitude of weight loss, on tolerability, on convenience and maybe also affordability. I'll come back to that in a later session.

At the end of the day, all of this is obviously reflective of a streamlined R&D organization, but it's also reflective of a substantial step-up in R&D investments since 2021, does then lead to a great number of assets in diabetes and obesity, all of which being differentiated for different patient segments. At present, we have around 130 ongoing clinical trials reflective of around 40,000 patients in those clinical trials. As you can probably imagine, with what we currently see in Phases I and II and what we also see in the preclinical space, we expect to see a substantial step-up in our clinical activities over the next just 1 to 2 years.

Super exciting, but also leading to the potential of having at least one multi-blockbuster launch year-on-year towards 2030 and beyond 2030.

Now a little bit about how we think about the R&D approach. We have the unique opportunity in there. We have a foundation of biology. We have foundational disease areas that still allows for substantial growth. When we work with insulins, when we work with GLP-1s, when we work with amylin in diabetes and obesity, we understand the biology. We understand the mechanism of action. We can allow for faster time lines. This is what we call slightly the lower risk parts of our pipeline. But we also had to acknowledge that within diabetes and obesity and specifically beyond diabetes and obesity, we had to look at novel targets, novel modalities that will be associated with higher risk. But it's an incredible strength and benefit for us to being able to balance that portfolio so that at this point in time, we have approximately 50% of what I would call low-risk, high reward and around 50% of assets in our portfolio that is probably higher risk because of the novelty of their mechanism of action, their level of innovation, their ability to fundamentally change patients trajectory, higher risk, also very high reward.

But at the center of all of this, we put the patient. Conventionally, we talked about disease modification focusing on efficacy, safety, comorbidities. This is not bad. We'll continue doing that. That's why we are here. But we also have to understand the patient is part of the journey. The patient is a decision-maker. We clearly learned that in obesity, but I think we're missing out if we don't take that learning into diabetes and all of our other therapy areas.

So we'll think about convenience. We'll think about affordability. We'll think about tolerability of our medicines. Hong and I will discuss that in a later session. But again, this is something that we need to take in already in research and then obviously through development. One of our enablers is that we can move beyond proteins and peptides. Now we believe that there is an incredible strength in peptides, still in obesity, still in diabetes.

We've seen the data comparing, for example, peptides and small molecule. There's no doubt at this point in time, with current technology, the peptides deliver the better efficacy, the better tolerability. But in some areas and maybe in the future, other modalities, both in diabetes and obesity, but certainly also beyond will be required for us. We have those modalities. We have the ability to do siRNA. We have the ability to do small molecules.

And as you will also see in a later session, we have at least 4 first human doses this year based on RNA technology in diabetes. This is based on our Dicerna acquisition. In that acquisition, we bought the technology, but we also bought the human capabilities to drive that. And that basically means across our therapy areas, we can think about oligonucleotides as part of the journey. We can do the same in small molecules. Sometimes we'll need to think about antibodies and gene therapy. Typically, there, we will partner up. But importantly, when we think about peptides, oral and subcutaneous, siRNA obviously giving a lot of possibilities. And the small molecule, sometimes we'll focus on the oral journey, either because the biology wants that or because it's just a small molecule that will deliver convenience for the patient.

I've talked about it a little bit. AI is another very, very important lever to us. We drive AI across R&D in research, in development, sometimes for efficiency, sometimes for speed, most of the times for science. I'm super happy to present and invite to the stage, Mishal Patel, who is heading up the R&D, AI and digital innovation to talk about that.

Thank you, Martin. Good morning. As Martin mentioned, I have the privilege of leading our AI functionality within R&D. And the role of the department is to actually translate the potential of AI into better R&D productivity. And we do this by combining a century's worth of cardiometabolic knowledge along with proprietary data and state-of-the-art technology. And that allows us -- should move on to the slide. That allows us to improve our quality as well as allow us to increase our speed of execution. And we deliver this by having over 600 AI and digital professionals working alongside our scientists. And we complement this with partnerships with the external ecosystem where we can obtain leading-edge capabilities and help to scale our innovation faster.

So what does this mean? In early discovery, we're able to take AI-driven virtual assays and prioritize genes, which will demonstrate the biology of interest. This means we're able to get a threefold improvement in target hit rate, which allows us to focus our experimental efforts on the genes and the targets which are most promising. We have the ability to actually develop state-of-the-art machine learning models, and we can actually deploy these in chemical design. Combined with automation, we're able to drastically improve and expand the chemical universe that we can sample and then reduce the time from hit ID to lead optimization. Within clinical development, we deploy AI to analyze our prior clinical studies, real-world and operational data to allow us to evaluate portfolio and trial design questions within minutes as opposed to weeks. Moreover, we're able to actually utilize predictive modeling to assess trial site performance and make better informed decisions around clinical trial country and site selection and patient recruitment.

And finally, AI allows us to rapidly generate regulatory-grade documents, which we've been able to scale across multiple document types. On this slide, I wanted to actually give you an example and go deep dive into where we've actually seen real potential. We actually bring all 3 components together here. internal expertise, decades of proprietary data as well as technology. Here, we talk about a preclinical project where we want to accelerate the discovery of a once-monthly amylin molecule.

This is, in general, a difficult challenge. As you try to extend the half-life of amylin, you'd substantially decrease its potency. That typically can lead to lengthy discovery time lines and costly experiments. So what we do here is we actually deploy an active learning approach where data from each experimental round is used to train an AI model, which will subsequently propose designs for the next round.

More importantly, we leverage our internal expertise, decades of expertise to actually help guide the model to start off with towards the right path for discovery. And when I say model, I actually mean an AI system. We have 3 components to this system. The first is a protein language model, which allows us to introduce novel mutations, which are actually biologically relevant. The second is a suite of predictive models, which will predict properties from these different mutations that the previous model has introduced. These will be potency or other drug-like characteristics, which are relevant for formulation and manufacturing.

And third, we bring this all together with an optimization engine that will allow to actually look at the properties and make the right trade-offs to actually bring forward more appropriate molecules for experimental testing. So what does this mean? It means on a typical program like this would plan for 8 design rounds. We're able to achieve a 500-fold improvement in potency within 3 rounds. Within those 3 rounds, we're able to test approximately 2,000 molecules.

And the key here is actually the combination of technology as well as automation and process design to actually allow us to do each experimental cycle rapidly. So each design round here would approximately take 4 weeks. So that's 3 months for the entire campaign, which leads dramatically to actually decreasing the time it takes from the project start to achieving a frontrunner molecule.

So I've given some examples where we're actually using AI across the R&D continuum to actually help us to make better choices and to enable speed and execution. And my focus is to actually take these gains, make them repeatable and then to look at whichever R&D workflows where we can actually embed and redesign AI -- redesign those workflows with AI.

So with that, hand the mic, I pass it on to Martin.

Thank you very much, Mishal. So I've talked about AI. I've talked about speed and execution. You've heard Mishal talk about the same. AI is an enabler. It's a lever to deliver on speed and execution, but it's also a lever to increase our probability of success and increase our science. And we look at that and take maybe our first human doses as a proxy for research productivity.

As I said, we had 3 first human doses last year. The average from 2018 to '25 was 6.5, maybe not good enough. But when we take the world-class scientists that we have in research and combine it and amplify their abilities with technology and AI, not only for speed, not only for productivity, but also for amplifying the science, you can all of a sudden see that we can bring more differentiated potential first-in-class assets into the clinical space.

So already now, as we discussed a couple of times now, at least 10 potential for 15, 16, assuming that there will be no attrition for the rest of the year. This is across all of our therapy areas as we speak. Of course, it doesn't stop there. Clear ambition is next year and towards 2030, at least 15 first human doses a year. And beyond 2030, we are going beyond 20.

That's a great outlook for what we can do in diabetes and obesity, but it's also a great outlook for moving into new therapy areas. We need to build the cardiovascular. We need to build the liver, but we also need to potentially build the pipeline in other therapy areas. Some of you have asked, "Are you going to show data from Phase I" at this Capital Markets Day? It's a super good question. I'm, I think, as curious as you are, but the nature of things, given that we had 3 first human doses last year and that we only started to see the volume come in this year. I just have to say all of our trials are ongoing, and I don't have a lot of data to show.

Now I will show data, but it will be from Phase II and III. But from Phase I, we have to be a little bit patient. I want to provide you some examples of what we are taking into Phase I. So ALK7 is an example of an asset where we think -- well, actually targets because we have more than one asset to take into Phase I. A target where we think that this can make a fundamental difference in how we treat and think about obesity.

A lot of you are asking about the quality of the weight loss, muscle preservation. ALK7 is a target that in monotherapy, but potentially also in combination with a GLP-1 or an incretin-based therapy could drive a substantial weight loss while preserving muscle mass. Super exciting. Early days. Now our frontrunner is of one modality. Our successes in ALK7 will be in other modalities.

A little bit going back to we can use our different modalities to look at how do we find the best way of approaching this target? How do we make it most convenient for patients? How do we allow Kasper to look at differentiated how to scale it. And ALK7, as I said, we have a number of assets addressing this specific target, the first going into first human dose this year. A lot of focus on once monthly.

In this example, a once-monthly GLP-1. For us, once monthly treatment is obviously about convenience, again, meeting the patients where they are. Some will prefer the oral, some will prefer the weekly dosing, but some will also prefer a less frequent monthly dosing. The potential promise of the long half-life is also tolerability. Now again, we aim to take our first once-monthly GLP-1 into Phase I this year.

Given the nature of things over the next 1 year, I would say, we actually expect to see at least 3 or 4 first human doses with once monthly GLP-1 because I cannot promise you, obviously, that the first will be the best, and we need to fully understand the half-life of this. You've seen half-lives from others. They're not necessarily lending themselves fully to a once-monthly therapy. And we obviously want to have not only what we think is good enough, we actually want to have the best.

Mishal actually also alluded to, we are working on once-monthly amylin biology, and we are potentially also working with other once-monthly targets. So this is part of our armamentarium to address the full patient journey. Now the last one, some of you have asked some questions about. There are 2 fundamental needs when we think about how to think holistically for patients.

One is in the subcutaneous space. For most proteins & peptides, there's a restriction in Europe, U.S., but certainly also in Africa, in Asia, where thermostability is an issue. If you need to always keep your medicines refrigerated, you cannot do traveling. If you don't have a refrigerator, this becomes a problem. We have an asset that has the potential promise of being quite thermostable for the subcutaneous part.

The interesting thing about that asset is that it's also quite scalable. And it has the potential for maybe even better bioavailability than what we're used to from our GLP-1 analogs. That would mean that this would be what we call a high-yield oral asset. It would not necessarily be superior to Wegovy or tirzepatide when it comes to weight loss or tolerability. It would probably be on par but it would be very scalable and quite affordable, again, addressing an unmet need for patients.

Equally exciting is ACSL5. You heard me talk about that a couple of times. ACSL5 is ubiquitous throughout the body, but primarily works in the intestine. And through inhibiting ACSL5, we see in animal models a delay of gastric emptying, but also a release of endogenous GLP-1 and PYY, leading to reduced food intake. We actually see some animal data in the mid-section. 2 doses tested, leading to a really good double-digit weight loss with a higher dose. The interesting thing is there was no need for dose titration, and there was no apparent side effects.

And when we added that, which is the 2 right-hand bars to semaglutide, we saw a substantial weight loss again, without adding to the tolerability profile of what we see with semaglutide in monotherapy. Now this is a novel target. We have to say it's high on risk, but if this pans out, really, really exciting and huge potential. This is currently the first human dose, and this is one of the assets that we intend to take to the market around the turn of this decade.

We'll come back in the diabetes and obesity sections, obviously, with some more data, but also to talk about our oral aspirations. Goes without saying, I've said it a couple of times now, we really, really strongly believe of the relevance of peptides in the oral space. They appear to be more efficacious, mimicking probably the endogenous biology better. They appear to be more tolerable, and we can scale them.

We can still optimize what we're doing with SNAC. Currently, we are on third generation in the clinical. But in [indiscernible] collaborations, I think we are closer to Generation 9. And the interesting thing is we can employ that in obesity, we can employ that in diabetes. But we're also employing that technology, for example, in rare blood disorders with Inno8. Imagine an oral treatment for hemophilia. That would be super exciting.

But it doesn't stop there. We acknowledge also that in some disease areas and sometimes a small molecule is more relevant. So we are also working with small molecule. At the end of the day, oral delivery is key to us because this is where we see a true differentiator for Novo Nordisk and a true leadership. Mike alluded to that we want to explore other indications. We have the science. We also have the consumer needs and wants.

And we see a true unmet need in some disease area where our biologies, and now I'm not just talking about incretins and amylins lend themselves. Over the next year, we'll initiate at least 8 Phase II trials to investigate novel disease areas for Novo Nordisk. We'll start with our well-known assets and our well-known biologies. But through internal innovation and potentially also through acquisitions, we will expand deeper into those therapy areas.

Now we put them into buckets: immune-mediated inflammatory diseases that could be asthma, that could be inflammatory bowel disease, that could be gout. Pain and addiction, I think most of you have asked about addiction. We believe that we have more than GLP-1 in our armamentarium that would potentially alleviate addiction. And we can think about combination therapies, leveraging unique biologies to get to a next level.

In the diabetes section, I will come back about the pain. And that is then maybe a little bit of a cliff hanger. In women's health, PMOS, vasomotor symptoms, we know that we can do with our current assets, but we also have a legacy in women's health that will allow us to expand deeper into that space. Men's health, we could potentially be looking at male hypogonadism. So expanding from there, and these are just examples.

And as I said, we currently plan at least 8 Phase II programs across our different modalities and across different indications, potentially in monotherapy, most likely with combination therapies. Again, we are not doing innovation in isolation. Mike had a longer list. We are doing a lot of acquisitions. We're doing a lot of collaborations, sometimes for technology, sometimes for assets. We've actually done some quite exciting acquisitions. The Forma acquisition with etavopivat is closest to the market, looking towards regulatory submission later this year. But when we see a strategic fit, when we see an unmet need, but also when we see a strategic gap or scientific gap in our science, that's when we do the collaborations, that's when we do the acquisition.

To conclude, R&D, the new R&D organization is set up to deliver at least 5 blockbusters by 2030 with an additional -- sorry, an anticipated annual approval across all of our therapy areas in the coming years. We are rapidly expanding our pipeline as exemplified our first human doses, but also as exemplified by some of the new disease areas that Mike and I spoke to. And based on a significant change in the organization, but also the way we work, changing our processes, but also leveraging AI and digital technology, we are poised to deliver on all of our ambitions.

So with that, I'll invite Michael to come to the stage to conduct -- no, actually, I'll invite Hong to the stage. No? Michael to the stage. Sorry. That was too much for R&D to grasp -- sorry about that.

All right. Thank you very much, Martin. Thank you very much, Mike. So we are ready for the first Q&A session. Just a bit of housekeeping. We have a lot of people in the room and time is tight. So if we can stick to one question, including sub questions, then we'll do that. And we'll take the first question here in the front row, Richard?

Richard Vosser from JPMorgan. Maybe you could give us some color on your pricing assumptions within the midterm guidance, how you're thinking about that developing through and also the pricing for novel agents, is that in line with, say, oral Wegovy and Wegovy? But just thoughts on pricing embedded in the assumptions.

Thank you, Richard. Maybe summing up to one question to you, Mike, around pricing dynamics, including novel assets.

We -- I think you have to look at this from 2 different perspective. Obviously, with semaglutide going LOE, then you will see a step-down price decline like we've seen in some of the LOE markets, I would say. Don't take Canada as an example because that's a very special case, but you have seen what has happened in the other markets, and we will foresee that in 2031, '32 happening probably more broadly.

But we also see that there is plenty of room for innovative pricing, and there will be price differentiations. Orals will not need to be price declined as much as the injectable as an example. And again, it will come back to different segments of the market, different size population and different prices attached to them. But the overall picture will not be dramatically different than what you have seen over the last number of years, a gradual decline.

Thank you very much. Seamus?

Seamus Fernandez from Guggenheim. So Martin -- a question for you, Mike, you mentioned the potential launch of cagrilintide as a monotherapy. You guys are working on AM-355. Can you just help us understand how you see 355 really differentiating from cagrilintide and other DACRAs?

Yes, absolutely. So first of all, and I'll come back to discuss this in the obesity session. We're super happy with what we see with cagrilintide, 12%, 15% weight loss and a really tolerable profile. We're also testing higher doses of cagrilintide so that the full weight loss potential of that biology is investigated. But it's also important to call out, we would not compromise on tolerability.

We think that the promise of amylin biology and monotherapy is that it's going to be super tolerable. What we see from 355 so far in Phase I is that it has the same, maybe slightly differentiated efficacy, same tolerability, but it can be formulated orally. So the big differentiator is that we'll have cagrilintide as a subcutaneous offering in that space. But we also need -- if we are true to that, all of our offerings has to be either subcutaneous or and patients can choose. We want an oral amylin analog and monotherapy.

Michael?

It's Michael Leuchten from Jefferies. A question to Mike. The route to diversification for you as you have in your slides is mostly organic with some smaller bolt-ons. But that requires investors to take clinical risk into a fairly meaningful loss of exclusivity. Can you talk about why larger bolt-ons isn't part of the strategy?

I did not make a reference to the size of the BD deals that we're going to make. I said as we see it currently, bolt-on is an obvious place to go, even though we have a balance sheet that actually accommodates larger deals when and if needed. I think currently, the way that I see this, when you think about our core, we have a pipeline almost second to none, a very broad one with regards to obesity and I would even say diabetes. With some of the other ones where you see a gap, you should also expect probably we will be more active in looking in business development acquisitions. But we will not start with the size of the deal. We'll start with the quality of the assets and see where that will take us.

Great. Thanks, Mike. So strategy unchanged down there, Pete?

[indiscernible] here from BNP. Just one question, Mike, coming back to the pricing question. Just when we think about beyond sema, are we talking about you think that innovation will get price points as of today or your ability still to get premium price for innovation? I just want to understand that pricing dynamic a bit better.

Yes. So you have seen that the prices of GLP-1s have gradually gone down. And in our plans, we actually have that gradual decrease, let's say, 10% per year in the planning anchored. So there is no major change in that. You also have seen that when there is abrupt movements like the LOE situation, then, of course, the price comes down more magically, more marginally. But the volume uptakes are still there. And you see, again, my treat to you is take a look at what has happened in some of the early LOE markets.

And you see that the market starts to expand quite a bit. So it's not that one loses it to the generics fully. We have actually done quite decent in a number of these markets. And when you look at this in the context of the volume that is still out there for grab, then you start recognizing that, yes, the price might go down by 50%, but there is much more higher volume availability than doubling up to breakeven and even more so. So that's how you should look at semaglutide. Then there are segments of the population that will pay premium price for special products that do premium things. And that's where we will try to operate in.

Okay. Great. So there will also be sessions on operations going into the next part of the day and also around how we segment the market. So Sachin here on the front.

Sachin Jain, Bank of America. Just some more color, if you could, on the composition of the DKK 150 billion pipeline. So perhaps a sense of how much is sema linked to CagriSema or the pill, how much is obesity, how much is oral? Any color you can give? And then if your target is BD included or excluded from that?

So the target is excluded from the BD. So I mentioned in addition to what we have in the plan and in the current pipelines, you can add to it business development. It also excludes things like exploration of the consumer Rx and some of the other elements. It is real pipeline risk adjusted quite a bit for the future, giving you the numbers that we actually gave. And we said that build on top of that some of the so-called wildcards that we will work incredibly hard on. So risk suggested forecast without BD.

We'll stick to one question. Simon?

Simon Baker from Rothschild & Co Redburn. Mike, I wonder if you could just give us a little more color on the inline with peers growth CAGR to '26 to '30. I think some people may be interpreting that quite literally as a sort of in line with the straight average. Is it a bit more nuanced and open than that in terms of given the range of growth rates for that peer group?

It is a more nuanced version of it. I don't think you should -- I think it was an indication to you on basically a consensus that is moving, frankly speaking, that our plan is to be at least on par with our pharma peers over the period as a compounded annual growth. So not an annual base, but basically, as you take a look at the next 4 or 5 years, it is because it has been a question mark in many of your peers and colleagues as -- approximately what kind of a growth are you talking about? We felt like we should, without being exact, give you an indication.

Great. Thank you very much. And Kasper will also get back to more on that in his session. Florent?

Florent Cespedes from ODDO BHF. A question for Martin about diversification. Maybe could you elaborate a little bit on your strategy on cardiology? How you intend to differentiate your products versus the well-established ones because I saw some indications where we know where there is a well-established drug.

Yes, absolutely. So it's a really important question because we really want to take differentiated products to the market. The way we think about cardiology is taking a starting point in cardiometabolic diseases. We are not going into any cardiovascular disease. We're going into specific cardiovascular diseases where we still see an unmet need. So for better or worse, inflammation-driven ASCVD is still one.

And I'll come back to talk about that later in the day. Heart failure with preserved ejection fraction, also an area of huge unmet need, where if successful, you would clearly differentiate and you would potentially also be first-in-class. So that is our approach. And then when we combine that approach with the science that we have, you've seen what we can do when we doubled down on diabetes and obesity over the last year. In the years to come, we'll double down on cardiovascular and liver disease. I'm quite confident that you will see differentiated molecules come out of our internal innovation. But to Mike's point, sometimes also through acquisitions.

Thank you very much, Martin. So no doubt that we will be able to also give more color to that in the coming sessions. Kerry?

Kerry Holford at Berenberg. My question is for you, Martin and Mishal, on AI. You talked about increasing speed, bringing more assets into the clinic. But is it still too early to conclude that the probability of success is increasing? Will we ultimately just see faster failures as a result of AI, which in itself, I appreciate is not a bad thing, but it's also not ultimately what we need. So how confident are you, you can use AI to generate more positive?

So I'll start and then I'll ask Mishal to elaborate. So first of all, AI, as we just discussed, is never better than the data that you put in, and we get better and better data, which basically means that in research, but also in development, we can increase our possibility of success. But it's also important that at this point in time, we always apply also the human angle to this.

So we don't take assets blindfoldedly into the clinic just because AI says this is a good asset. We'd obviously do the proper testing, both in in-vivo pharmacology, but also in our assays. And then we apply our normal scientific approach to combine the best of 2 worlds. I think that is the winning formula. And so far, it looks okay. I mean let's discuss in a year from now when we have some first human dose data from this year.

Yes. And this is working now. So what I would say is actually where we're seeing the gains is 100% in preclinical. And then obviously, it takes a while for that to translate into clinical success. But just to be concrete here, I mean, when we're designing molecules, we're trying to encode from the very beginning, some of the challenges that we can see in terms of manufacturability and developability.

And so actually, what we're seeing even from our preclinical test is that we're able to actually improve our success rate in terms of actually having a developable molecule early. And then naturally, from a biological perspective, really -- it really is about trying to get the context together here. So the more context you can bring together and more different that tapestry of data to actually inform our biological understanding, that does translate into a faster progression of our projects, but also the ability for us to actually make much more informed decisions around what biology to pursue.

Thank you, Mishal. Much more to come on that later on in the journey on AI. And then the last question from Carsten, and then we move into a small break. I'll get back to the details.

Yes. Mike, a question to one of your comments on the first slides where you say that the '26 and '27 is about transformation and growth. So I was hoping that you could talk a little bit about the growth that you are seeing in 2027 because we're not seeing growth in '26. And maybe also in relation to the IRA pricing on Ozempic and how that will impact you in '27 because I think the pricing development has probably been a little bit more aggressive than what you initially anticipated for Ozempic in the U.S. market.

Thanks, Carsten. So let's take the Ozempic question in a later session around U.S. operations. And then Mike, you can more broadly speak to how we see growth evolving over the time.

I will not guide, as you know, Carsten, for '27 right now. But we are, of course, keep on improving our commercial execution as you've seen quarter-by-quarter. And we will continue, of course, try and see how we can continue doing that as we go forward. I would say our ending up this year is a good indication of how and where we should be for '27. When we make our own internal budget, it starts really with where the December end before we think about January and beyond. So that's the first block.

I would say we are incredibly encouraged by our ability to continue growing the Wegovy Pill franchise despite competition having increased their presence and under pressure we see a decent uptake of the pill. I am incredibly optimistic about CagriSema and the launch of that product compared to perhaps where the consensus is. So that's also, I would say, a building block you need to think about. And then we have some of the minuses and the negatives that you're also very well aware of. And my 2 colleagues, Jamey and Emil will get much more deeper into those dialogues when they come on board.

All right. Great. Thanks, Mike. So we're taking a small break now, but just to conclude on this session, clear strategy from Mike, clear ambition to grow the company, clear ambition to expand the pipeline further. And in that journey, also use AI significantly more, which also got the impression from Mishal. So there's a clear strategy with ambition for growth.

We go to a break now. It's a rather short break. Also, please remember to visit the booths out there. There's an innovation booth on devices and also on the tablet. And then also there's Team Novo Nordisk out there, the cycling team. And then there will be screens showing where you need to be back in the room where we then go into the different TA strategies. Thank you very much.

[Break][Presentation]

So it is my pleasure to present together with Martin, who could not wait the obesity and diabetes strategy. So we'll start with obesity. And after this session, we'd like to leave you with 3 points. First, obesity has driven unprecedented growth in health care. It has continued to do so. Second, that obesity market, as you have seen from Mike's presentation, has evolved rapidly, including the trend of consumerization, and we are confident to further expand and shape this market. Third, last but not least, we have the broadest obesity pipeline in this industry to meet diverse needs of these patients.

But before actually, I go to the numbers, I know you love numbers, but I would like to invite you to look at these 3 photographs here. So what do you see? I hope you can see on the side at the back. The photo on the left shows an entrance to a boutique hotel. A person after losing significant weight could first time go through the single door without the embarrassment to ask the hotel staff to open 2 doors for her.

In the middle, you're very familiar that the airline seat and another person after avoiding years of air travel can finally sit comfortably, even lower the tray table and enjoy a meal. And the last photo is actually about a person who is missing from that ride because he couldn't fit in. And this was a triggering moment for him to decide as a father, he want to participate in experiences of his children growing up.

So why I'm showing this photo. So this is a very small representation of vast consumer experiences we have collected through our ethnographic studies. And these studies show that there is a huge diversity of people living with obesity. They have different needs, wants, Martin said a few times and preferences. And understand it's very important because this would be our foundational concept, how we look at the obesity market starting from research and development.

But now to the numbers, which tell the story of the market. And I have been in this industry over 30 years, and I also have never seen a market who has grown so rapidly and still underpenetrated. So it is projected that by 2035, there will be over 1.2 billion people living with obesity. And obesity, as we know, is related to comorbidities, about 200 of them. Yet only less than 2% of people are getting treated with GLP-1s, less than 2%.

And even if they get on treatment, the average stay time is 9 months. Looking at it's related to other chronic conditions, but for obesity, they do not stay. So the market potential is very simple. It's more obese patients, more on treatment and stay longer on treatment. So it is not about fighting for market share. We do. You'll hear from Jamey and Emil, every person at Novo in every market, we're doing every day fighting for market share.

But yet, the story is actually about to grow and shape the market. And why we are confident because we've done that for 25 years. So we were the one actually unlocked the potential for obesity. We started with having obesity recognized as chronic disease, and we got selective reimbursement. But also with self-pay eHealth, it opened doors to many more patients. And we started early on to differentiate obesity beyond weight. We had cardiovascular outcomes trials.

And then we were the first to launch our first oral semaglutide. And with that oral launch, you have seen that a fantastic uptake that patients do prefer orals. And next, we will launch subject to FDA approval, the first dual mechanism GLP-1 plus amylin to address the need for quality of weight loss. And as market grows, of course, competition enter. Mike was saying, where big or small, they enter the market, and that require for economy of scale, and Kasper this afternoon will share with you how we have ramped up our economy of scale to deliver 10x more, for instance, on the oral.

But the journey doesn't stop here. the obesity market is actually evolving from what you see from our corporate video, lasting health starts now, is going to evolving to long-term health management. And that requires a different view, a different business model being consumer-centric. And Mike is saying it's actually flying with 2 engines.

So flying 2 engine means we truly understand the needs. So while HCPs are looking for clinical guidelines, consensus. They want to see more clinical evidences but consumer, they have different needs and wants and preferences. And this brings me to my last slide actually, where I'll take a bit more time to go through with you. So we have done recent global consumer research with 37,000 people with obesity. And this is what they are telling us, magnitude of weight loss. How much we lose weight is actually very important as we have realized, but only 32% of them are saying we seek the highest possible weight loss for healthy weight management. And with our Wegovy high dose and soon CagriSema and many more in our asset, Martin will show later, we are addressing this need. But equally, almost the same amount of people with obesity say, we care about quality of weight loss. We care about what we lose is not muscle.

And so 29% are actually concerned about muscle loss. So with our amylin containing assets, we will address this need for bone health and even muscle and bone health, the overall better body composition. And some will say they want to lose as fast as possible to engage and to stay on their treatment and tolerability remains key. So when we ask them, why do you don't initiate treatment on an obesity medicine, 38% would say, I'm afraid of GI side effects.

And those stopping treatment also quoting almost 1/3 of them say, it's because of the side effects, we are stopping. And Martin already alluded to with a drug like cagrilintide or our oral amylin, you have moderate weight loss, but you actually get the tolerability profile. And obesity-related comorbidities is of concern and increase the complexity because 40% of people with obesity, they actually have more than one comorbidity. And 1/4 of them would say they are concerned about drug interactions because they take other medicines like statins.

And this actually clearly shows that our Wegovy pill has much better advantage meeting this special preference and needs. And convenience and frequency. So it clearly has appeared that people with obesity prefer the oral. So more than 50 of them say they prefer the oral. And this we have seen a huge uptake of Wegovy pill. But Martin would show you also, we are already preparing for next generation. We are certainly determined and confident to win in the oral space.

Last but not least, affordability has been a big barrier. So more than half of them say they do not initiate costs or they stop early because of cost. And Jamey and Emil in the afternoon would show how we actually in U.S. and international markets do everything possible to work with stakeholders to drive reimbursement, but also to introduce innovative payment models.

So with that, I will invite Martin on stage to demonstrate to you that our pipeline is exactly developed to meet the diverse needs of obese patients. Thank you.

Thank you very much, Hong. And again, I feel that the task is simple for R&D. What we need to deliver, again, is a diversified, but also that is differentiated obesity pipeline. But we also had to think about what do the patients want. We had to acknowledge the patient as a decision-maker. It's not just about what they need from a medical perspective, it's what they want from their everyday life.

As I said in the previous section, we'll do that in obesity, but we'll also do that in other diseases. But starting with obesity, we also had to acknowledge that not every drug can do everything that the patient needs or wants. And we also had to acknowledge sometimes different patients have different needs. They don't necessarily want the same thing.

But if we think about the journey of the magnitude of weight loss, the speed of the weight loss, the tolerability, the safety, the comorbidities, the convenience, the affordability, we are well underway, have we go in the market as an oral as a subcutaneous.

Clearly, the oral has addressed a substantial unmet need out there or maybe I should rather say a substantial want because the patient wanted something beyond the subcutaneous. What we do in the next 4 years, starting in 2027 with CagriSema is to deliver on that holistic patient journey, making sure that maybe not in a single drug, but across a diversified portfolio, we can cater to every single patient need across everything that Tom described.

We'll follow up with cagrilintide in monotherapy. Speaking to the other side of the spectrum, the patients with BMI 30-35, no focus on comorbidities, but they need to lose weight. They would rather do it with convenience and with tolerability. What we've seen with cagrilintide, and I'll come back to that, is exactly that profile. 13% weight loss in the first study -- sorry, 12% weight loss in the first study with a tolerability profile that is less than half in terms of side effects than what we see with the GLP-1-based therapy.

CagriSema high dose will cater to the segment of patients who really needs to lose very high levels of body weight. Then comes a potential for our next-generation GLP-1, cagrilintide high dose, investigating the full weight loss potential of cagrilintide in monotherapy, still, again, not compromising on tolerability. And then comes semaglutide. Semaglutide right now seems to have the full package, substantial weight loss, good tolerability profile, subcutaneous and oral and hopefully also addressing comorbidities. I'll come back to that.

What we don't have yet is the affordability. I told you about what we in the subcutaneous space called the thermostable GLP-1. But in an oral setting, it could be affordable, scalable GLP-1. So come 2030 and beyond, we see a string of pearls of launches of differentiated products that caters to different patient needs. It starts with CagriSema. We believe still, and we are still excited about CagriSema. We believe that this will make a substantial difference to patients out there.

CagriSema, as you know, is the unique combination of 2 biologies. It's first-in-class GLP-1 plus amylin biology. Building on what semaglutide can do. We know that semaglutide can give up to 20% of weight loss. We know that it has a really, really strong benefit, basically second to none on cardiovascular, on liver, specifically in the cardiovascular space, it's the only obesity medication with approved cardiovascular reduction label. And the same thing for NASH.

We have rolled across diabetes and obesity patient experience -- sorry, and physician experience, 50 million patient lives to talk about the safety profile of what semaglutide can do. When we then combine it with a biology that is complementary in the brain, we can see additivity on the weight loss. At this point in time, we have to talk about the 23% that we saw in REDEFINE 1. As I'll talk to in just a minute, we still believe there is more potential. We will not know until we've seen REDEFINE 11.

But what semaglutide also showed is that 1 in 5 of patients lost more than 30%. The women lost more than 25%, but most importantly, the redefined program so far has taught us about the individualization of treatment. If we are serious about not all patients respond in the same way to the same treatment, not everyone has the same needs in terms of magnitude of weight loss, speed of weight loss, tolerability to side effects and so on.

Then CagriSema or the combination of the GLP-1 and ambient biology seems to offer something special. I'll come back to talk about that when I talk about semaglutide as well. And on top of that, we've seen that despite of the weight loss, 23% weight loss. There's a doubling in terms of improved physical function and there's a preserved muscle strength that we see during the REDEFINE program. We've not really shown with imaging and so on what the ambient biology can do. But this is what we want to investigate next. I just want to talk a little bit about individualization of treatment.

Now we've conducted REDEFINE 9. That's a reasonably small study, investigating patients on CagriSema 1 milligram, 1.7 milligram and placebo. Here, I showed the 1 milligram data. Clearly, in this study, patients going to 1 milligram, and most of them actually did go to 1 milligram, show a substantial 21% weight loss. Speaking to maybe you don't have to go to the full dose and still accrue true benefits for the patients. Reasonably low withdrawal rate compared to that of placebo, 5%.

And in the REDEFINE 9 protocol, we allow for flexible dosing. This speaks to the importance of individualization, but it also speaks to the power of the CagriSema biology. I'll come back to that also in the diabetes section showing you a little bit of more data, but this clearly has bearing on what the amylin and the GLP-1 biology can do together.

Right now, we are waiting for regulatory approval. We expect to see that in Q4 of this year. We're waiting for the REDEFINE 11 data to read out in Q1 of next year. So we have them around the time of launch in the U.S. And then we expect to see the readout of the CagriSema high dose during the course of 2028. We're not done with the CagriSema journey. But we also want to build on what do we think amylin biology can do when it comes to the healthy weight loss, the quality of the weight loss.

So we are conducting the RASMO study, where we are going deep on looking at muscle biology in terms of imaging, biopsies, biomarkers, but also functional testing. And then we conduct the REDEFINE 8 trial, a reasonably long trial, 2 years, where we'll look at full-body composition and muscle strength. Thing that we don't talk a lot about is bone. For us, bone is an important part of the qualitative weight loss, particularly if women in the postmenopausal space start to lose weight, there's a risk of they also then decrease their estrogen levels, which then leads to because fat produces estrogen, but that can lead to osteopenia potentially osteoporosis.

What if there is something about bone preservation in the amylin biology. We're investigating that in the RAMBOW study specifically, but we are taking it to a next level where we look at REDEFINE 3 and actually look at fracture risk to assess what does a weight loss with CagriSema actually do. I talked a lot about cagrilintide in monotherapy. We do believe that there is a huge segment of patients that have obesity, let's say, BMI between 30 and 35, 37 that need to lose weight, but are not focused on comorbidities.

Having that potential for, let's say, at least to start with a 12% weight loss, again, we are testing higher doses of cagrilintide in monotherapy, but with a very low risk of side effects. You can see the discontinuation rate from REDEFINE 1, 2.6% is comparable to that of placebo. And more than halving in gastrointestinal side effects and only 1/3 of vomiting as compared to GLP-1 receptor. This is a tolerable, convenient offering that will cater to a lot of patients, and we'll see the potential of launching that in '28 and follow up then with a higher dose CagriSema a year after that.

On the other side of that coin is the bigger weight losses. You've seen these data before. 24% weight loss with subcutaneous in 36 weeks, 13% weight loss in only 12 weeks with the oral offering. This speaks to the power of the biology again. This speaks to the potential of what this can do. And obviously, we are doing the Phase III program to look at the weight loss potential.

Employing all the learnings, good and bad that we have taken from CagriSema, but we are also looking at comorbidities, sleep apnea, knee osteoarthritis, and specifically because we are building on 2 biologies that at least on the biomarker side, have shown tremendous CV benefit with a more profound blood pressure lowering, lipid lowering, inflammation lowering than we see with GLP-1s alone.

We are also very focused on establish the cardiovascular benefit of semaglutide. So we're doing 2 outcomes trials, one for conventional CDMAs, one for heart failure, specifically heart failure with a preserved ejection fraction, we discussed in the previous session. It's a huge unmet need. We've seen with semaglutide, what semaglutide can do. We want to investigate what can semaglutide do in this space.

But we also want to deliver semaglutide as a subcutaneous and as an oral. So therefore, we're also doing MACE 9. Our original intent was to bring the oral later to the market. Now we want to do it simultaneously. So therefore, MACE 9 is carrying sort of the exposure for oral. And then we intend to bridge all of the subcutaneous data, the sleep apnea data, the cardiovascular data, the heart failure data into the oral label. So we expect to see simultaneous approval, simultaneous launch with similar labels, speaking to the benefits of what semaglutide can do.

Now I've been asked a couple of times around the safety profile of semaglutide. Some of you were concerned about what you saw in Phase I. It's important to remember that Phase I, first of all, captures everything that the patient reports. Second of all, there are some technicalities in terms of which patients are allowed to continue the study. And specifically in the semaglutide studies, patients who lost so much weight that they didn't want to continue to the next dose were excluded from the study. So that's just a technicality. They did not necessarily leave because of side effects.

And when we do the modeling, we see a safety and tolerability profile similar to that of CagriSema. And I'll just remind you, CagriSema is comparable to that of Wegovy. So we can get to these high weight loss potentials with hopefully, a tolerability profile that is similar to that of Wegovy, similar to that of CagriSema. To really safeguard that, we not only do some titration, and we do it in a way that caters to individual patient needs, but we also intend to individualize the treatment.

This is exemplified with the doses that you see on the lower right-hand side for oral semaglutide, we intend to have 5 maintenance doses approved, catering to the different patient needs. That speaks to magnitude of weight loss, speed of weight loss, and potentially also how to maintain weight loss once accrued. UBT251 is the next candidate on the block. You've seen the data, you heard us talk about it with a lot of enthusiasm. In a reasonably short 24-week study in China and in Chinese subjects, around 20% weight loss, which is when we try to do the model and transcribe into a potential for weight loss in Phase III that is comparable to other triagonist.

But the safety and tolerability profile of UBT251 seems to be quite differentiated. We had very little withdrawals and very few side effects reported. Now that can be done either or that can be caused either because the drug is really, really good, which is obviously our aspiration, could also be because of study technicalities. In order to rule out any doubt, we are currently doing a Phase II study with UBT251.

But the aspiration is best-in-class weight loss, best-in-class tolerability and obviously moving into comorbidities. You all know that glucagon biology really caters to, for example, MASH. The profound weight loss really caters to sleep apnea. So we intend to pursue those indications as well. A little bit I've talked about it, so I'll do it fast on the all aspirations.

In obesity, we see oral as a true driver of preference from the patient side. And if we can deliver what they want from an efficacy, from a tolerability, from an affordability perspective, which we can if we materialize our oral portfolio, then we're really catering to the patient needs. Talk about oral semaglutide. This is where we see the big weight loss, still with a tolerable profile, but also with some side effects.

Talked about Amylin 355, tremendous potential, really good double-digit weight loss, very good tolerability profile and in an oral setting. And then slightly more risky, but certainly very, very exciting. ACSL5 inhibition that at least in the animal models, again, leads to very profound double-digit weight loss without need of titration, without any clear tolerability issues and with the potential of combining that with our incretin-based portfolio.

All of these assets, we intend to have on the market around the turn of this decade. It doesn't stop there without going into too much details, we also -- as we discussed heavily all high-yield GLP-1 catering to patients affordability. And then we have continuous efforts to improve our SNAC technology, but also looking at other modalities for oral delivery. We intend to lead the oral space across efficacy, across tolerability, across convenience, and across affordability.

But we also intend to lead in the subcutaneous space. Here, obviously, the pipeline is deeper. Here, we are talking about what you've already seen, CagriSema, cagrilintide, semaglutide, Amylin 355. We'll not spend so much time discussing the triple today. Also really, really exciting, both from a weight loss perspective, potentially also from a tolerability perspective. We have a couple of amylins in Phase I. We have what we call next-generation GLP-1. We have a recombinant GLP-1. We have the potential of a once-monthly GLP-1, a thermostable GLP-1, and then some assets that we are not disclosing going into Phase I over the next couple of months.

This is super exciting, and this should really cater to our ambition level. We want the industry-leading oral and injectable portfolio in the obesity space, delivering on at least one multi-blockbuster obesity launch year-on-year towards 2030 and obviously beyond. We have clear and differentiated assets in CagriSema, semaglutide, cagrilintide, and UBT251.

And that potential for differentiation leads to a potential of also leading the subcutaneous space, but specifically also the oral space in years to come. In the last year, we've seen a significant step-up in our early clinical efforts. And while business development is maybe not at the forefront of what we do in obesity, we are not ruling out that we'll do acquisition also in obesity if the right fit is there.

So with that, I'll invite Hong back to talk about diabetes.

Thanks, Martin. So diabetes is where Novo started. It has been a heart of our DNA, so to say, for the last 100 years. And as you have seen from the new purpose and core strategy, it remains central. And this is an area we are clearly confident we're going to further lead because we combine the scientific leadership, clinical development excellence, scale in manufacturing and commercialization. And above all, it's also our responsibility to stay there.

So you see now the prevalence of diabetes, and it is projected to go to over 850 million by 2050. It means adding 10 million every year. Who you know the population in Greater London. Most of you are from London. So I checked up, it's less than 9 million. So actually, we are adding more than the population of London people living with diabetes. So that's a huge, huge unmet need we have.

And despite all the therapeutic progress we made, actually, there's still unmet need in this area because more than half of people living with diabetes, they do not achieve their HbA1c target. And in U.S., 58% of them suffer from obesity. And that consequence is very serious because diabetes is associated with reduced life expectancy for about 5 years for type 2 diabetes and 10 years for type 1. And just in 2024, 3.4 million patients died from obesity -- from diabetes.

So this is actually the reason why we feel as a leader in diabetes, it is our responsibility, but also opportunity to remain in this field and continue to innovate. And now talk about the opportunities in terms of the market. Despite Ozempic being one of the best known brands in this industry, actually, the GLP-1 usage is less than 7%. I mean, for your context, SGLT2 inhibitors have about 17% and the traditional antidiabetic oral medicines predominantly metformin have 33%.

I'm not suggesting that these treatments are comparable, yet it illustrates the headroom we have if GLP-1 will be used earlier and if access can be expanded because it's important that it starts early. So I would like draw attention to the disease journey. Those newly diagnosed, some of them would have no symptom or limited symptom, but then soon, they have raising glucose level, weight gain, and also cardiovascular risks. There are some, we call them the fast progressors. They will actually progress very fast beyond first-line therapy.

Actually, my father had diabetes. When he was diagnosed, he was very few months of metformin that he had put on insulin. And then you have to look at the other end of the spectrum, those advanced in disease and those elderly and frail because they will have complications with comorbidities. And oral therapies will support to overcome the barriers of treatment to bring diabetic patients earlier on GLP-1.

And we also -- more assets we have in our pipeline would actually support broader adoption also in the later stage of diabetes. So talking about oral therapies, actually, we have one, which is Ozempic 2.0 or Rybelsus. It's the world's first oral GLP-1 antagonist approved type 2 diabetes. And as you see from the PIONEER PLUS trial, there is a dose-dependent efficacy both on Hb1c and weight.

And we have already got approval in Europe for our Ozempic 25 milligram, and we are awaiting U.S. approval soon. And it was launched in 47 countries under the brand name Rybelsus. And Jamey will share with you later, we actually, this year, have rebranded to Ozempic till. And there are very interesting insight from that rebranding, not only prescription increase, but really standing out was that 60% of new-to-brand prescriptions are actually from patients who are naive to GLP-1.

So this is a very, very important strategic insight because it really illustrates that how a known brand combined with convenience could drive more patients in diabetes also towards GLP-1. So I'm sure Ed and Jamey will share more insights from that. So we talk a lot about -- when we talk about obesity, about consumerization, about needs and wants and what about diabetic patients.

But actually, they are also consumers because there's overlap between diabetes and obesity, but also they do have needs and wants we have seen. We have seen, of course, HbA1c stays core of the treatment target, but yet weight loss become very important. When you have attended ADA, you'll probably see more sessions on obesity than on diabetes. But yet more attention also towards other diabetes-related comorbidities. And then people with diabetes also looking for tolerability and convenience.

And eventually, they would like to see something which is disease modifying. They want to see new mode of actions. And you will see later on from Martin, this is actually how we build our pipeline. But before Martin go to the long term, let me share what we have in the near term. So of course, near term is about fighting for the volume, the sema volume.

But I would also like to draw your attention to 2 of our recent launches. One is a weekly. You actually see the weekly pen also outside. A weekly is our weekly insulin, which break down the treatment barrier, brain convenience. And we have Kyinsu, which is combining semaglutide with a weekly insulin combining glycemic control, weight loss and convenience. So Martin would share with you what we have in our pipeline.

But what I want to leave with you is also like obesity, it's not one-single disease, one-single patient journey. It is really about us to meeting the diverse needs along the patient journey and truly become partner of life. And for being part of life, it starts to bring innovative medicines. So Martin, what do we have in the pipeline?

Thank you very much, Hong. So we've been in diabetes for 100 years. And I think Hong very nicely illustrates that the unmet need in type 2 diabetes, but certainly also in type 1 diabetes are still very, very substantial. People are still dying from comorbidities to diabetes. People are still in poor glycemic control. That calls for more innovation. So our first shot on goal in the incretin space is obviously CagriSema.

We talked about it before. CagriSema builds on 2 unique biologies. One is obviously being semaglutide. And again, semaglutide, super good diabetes drug, good glycemic control, good weight loss, but uniquely to semaglutide, 26% risk reduction when it comes to cardiovascular events, 24% reduction in kidney-related events. That magnitude is not seen with other GLP-1s.

And again, we have a very, very robust safety database to talk about the safety and the tolerability of semaglutide. When we combine that with cagrilintide, the amylin biology, we actually get a superior depending on the study, 1.8 to 2.3 percentage point reduction in A1c. We get a substantial weight loss around 15%. And I'll just remind you, I mean, we're all discussing these 20% plus weight losses. These are in patients that do not have diabetes.

Diabetes patients seem to be a little bit resistant to weight loss. So 15% is close to best-in-class when it comes to weight loss. And when we think about it, around 43% gets more than 15% weight loss in this space. So cagrilintide comes with offerings again that talks to really strong glycemic control, really good weight loss, but also potentially some of the added benefits that we discussed in the obesity section.

I want to go back to the individualization. It's very, very clear on the market on our products, but also our competitor products, not every patient decides to go to the highest dose. So when we talk about glycemic control, when we talk about weight loss, we talk about some numbers, but they're reflective of the highest dose that is obviously also sometimes associated with some side effects.

A lot of patients decide to go to lower doses because it caters to their needs. In fact, for our competitor, their lowest approved dose is the most prevalently used dosed. So we decided to conduct a study comparing CagriSema to our competitor drug using the lowest intended dose. So in the space of CagriSema, that's 1 milligram. In the space of the competitor, it's 5 milligram, the most used dose in the market. That's clinically relevant. That's relevant from a real-world perspective.

REIMAGINE 5 was a 1,000-patient study, randomized equally to either CagriSema or the competitor drug, as I said, 1 milligram versus 5 milligram. And in this study, we saw a superior weight loss with CagriSema around 12.5% versus 9% for the competitor drug with exactly the same level of glycemic control. This is obviously super exciting.

We really like these data also because they are truly reflective of what happens for the majority of patients in the real world. Now for CagriSema in type 2 diabetes, before we can do the regulatory submission, we had to have the REDEFINE 3 data. REDEFINE 3 will read out in second half of next year, which basically also means that we'll do the regulatory submission for type 2 diabetes in the second half of next year, expecting a launch for type 2 diabetes in 2028.

Just like in obesity, we're also investigating higher doses of CagriSema in the space of diabetes. Now it doesn't stop there. You've heard us talk about comorbidities. And we're super happy with what semaglutide potentially also CagriSema and semaglutide can do in the space of cardiovascular disease and other comorbidities. Where no one has really gone to do innovation in many years are in some of the other areas of comorbidities. 25% of patients with type 2 diabetes are suffering from neuropathic pain.

And if you know anyone with type 2 diabetes who have neuropathic pain, you also know this is a debilitating disease or debilitating condition. 20% of these are on opioids to manage their pain. Most of them are on gabapentin. This is bad. Now I had to give a little bit of a disclaimer. There's a mistake in my slide, so -- and we didn't have time to correct it. But we did conduct a small Phase II study, 70 patients in each treatment arm, comparing the effect of CagriSema to placebo on neuropathic pain, quality of life, and sleep quality.

And in that study, we saw a superior and clinically relevant reduction in neuropathic pain with CagriSema. And I'll just give you the comparison. Typically, regulators say around 1 point, and this is where, by the way, there's a mistake in my slide, it's not percent. It is just points on a scale going from 0 to 10. So it's not a 2% decrease. It's a 2.4 point decrease. That being said, around 1 point reduction is clinically relevant from a regulatory perspective.

The gabapentinoids are showing typically 0.5 to 1 point benefit. CagriSema does 2.4, placebo-adjusted 1.2. This is not only clinically relevant. It's also obviously statistically significant in a space where there's really not a lot of innovation for patients with diabetes. On top of that, we saw improved quality of life. We saw improved sleep quality. And I'm not the expert in this, so we had to talk to some key opinion leaders about how important is this.

And just quoting one of the key opinion leaders, this is a potential game changer in the space of diabetes because no innovation have come into this space. Goes without saying, we'll initiate Phase III trials for our GLP-1, amylin-based portfolio already this year to make sure that potentially for CagriSema, potentially for semaglutide, potentially for follow-on compounds, this is part of the differentiator that we can show in type 2 diabetes on top of the good glycemic control, on top of the really good weight loss, on top of the other comorbidities.

Speaking of semaglutide, I just want to mention it. This is really an exciting offering. You remember the data I showed you in the previous session. Here, we show Phase II data for type 2 diabetes, 36 week, 15% weight reduction or 14.6% weight reduction. Really good A1c lowering as well and a tolerability profile that we believe will be comparable to that of Wegovy and CagriSema. We are doing the AMBITION program, again and importantly, as a subcutaneous but also as an oral offering. Now in the space of diabetes, recent years has called a lot of attention on incretin-based therapies. I don't think that's wrong. I actually think that's good.

We've just shown with CagriSema and potentially also with semaglutide and certainly with Ozempic, what we can do. But there's still an unmet need. There's still an unmet need in the early stages of type 2 diabetes. There's still an unmet need in type 1 diabetes. There's still an unmet need in people who need insulin. And despite the advent of GLP-1 therapies, insulin is still very much in fashion from a volume perspective, which also means there is value to be had there.

So we are building a pipeline that attempts to cater to that. We are still going for the best incretin-based therapies, starting with CagriSema following on with semaglutide, potentially UBT and our triple, but we are also taking novel targets into the space of diabetes. In this case, these are from a modality perspective, siRNA based, addressing new targets, looking at potential for better insulin sensitivity, potential for better beta cell preservation.

We're not disclosing everything, but some of the targets are already publicly available. So they are shown a few targets that we are not disclosing. But just to say, based on the unmet need, based on the growth of diabetes, there's huge value potential in diabetes still, and we intend to lead that. On the other side of the disease spectrum, there's still need for insulin innovation. We are still progressing our glucose-sensitive insulin portfolio. This is difficult.

You've heard us talk about that for a couple of years. And I cannot promise you that we'll get there at a specific time point. But I can say that right now, things are looking reasonably good. But we also know that we can do all insulin delivery, again, addressing an unmet need. We've done that before actually showing that in Phase II oral insulin was as good as subcutaneous insulin for people with type 2 diabetes.

Now from a bioavailability perspective, from a manufacturing perspective, this is actually feasible. So we intend to take oral insulin also into the development space. Across the board, the idea is that we want to address diabetes as a still unmet need. Despite all of the innovation that we've brought into diabetes, there's still a tremendous unmet need in type 2 diabetes and type 1 diabetes.

We have already now differentiated profiles with CagriSema and with semaglutide, but we also intend to take our early pipeline to the next level in the early stages of type 2 diabetes, but also in the insulin-dependent diabetes. This is the only way that we can serve our patients and taking the approach that Hong also alluded to of going beyond just the need, but also the wants from the patients. So with that, I would invite Hong and Michael up for Q&A.

Thank you, Martin. Thank you, Hong. Same rules as before for the Q&A. So please go to one question each and then also please state your name and organization. Michael...

It's Michael Leuchten from Jefferies. Can I just go back to REDEFINE 9, the 1 milligram, 1 milligram dose? You didn't mention the 1.7 milligram in that, if you could comment to that. And if the right dose for CagriSema is really the lowest one, what does that tell us for amycretin?

So specifically on the 1.7, it was actually in the footer of the slide. It gave in that study, which was a reasonably small study, approximately the same weight loss as the 1 milligram. But a little bit to what we discussed before, the 1.7 milligram was maybe not titrated in the optimal way. And therefore, we see these data also when looking at what we saw in diabetes as a testament to if you titrate the higher doses in the right way, there is further potential for weight loss potentially also for glycemic control with CagriSema. We'll know when we see REDEFINE 11. That was the second part of the question. Second part of the question.

Just what are the learnings for the amycretin dose selection?

That's specifically what I mentioned for the oral -- we are doing the same thing for the subcutaneous. We want to have more than one maintenance dose approved. So specifically, for example, for the oral, we are going for 5 maintenance doses. So patients can actually choose. Most of them would be going for that maybe more than 20% weight loss, but they would need maybe different doses to achieve that weight loss and therefore, also balancing the speed of the weight loss, and the tolerability side of things.

It's Graham Parry from Citi. So just could you run us through what you expect to have in terms of the cardiovascular and NASH data and benefits from semaglutide on the CagriSema label at launch? And then on REDEFINE 11, I think you indicated the data would be available around the time of launch. So is that data you'd also expect to get on label over time?

Yes. So it's a good question on the cardiovascular and the MASH data. This is a dialogue with the regulatory authorities. Obviously, we're attempting to get the semaglutide data into the label. There is some precedent for that, but that's an ongoing dialogue with the authorities, and we cannot guarantee that. The good thing is we'll see the readout of REDEFINE 3 already next year. And that obviously has the clear intent of going into the label as soon as possible if we don't get the semaglutide data mentioned in the first label. Same thing for REDEFINE 11. The intent is to negotiate with the regulators when we have the data to get the data represented in the label.

I am Thibault Boutherin from Morgan Stanley. Just a question similarly on CagriSema label. You mentioned you highlighted some of the data, the 1 milligram and the head-to-head with the 5-milligram tirzepatide. To what extent can you sort of highlight this in the label and promote it to physicians? And how can you avoid sort of the overall message of REDEFINE where CagriSema inferiority in weight loss and HbA1c reduction. So basically, how can you sort of highlight the data that you mentioned versus the sort of headline results of the studies?

So the good thing about REIMAGINE 5 is that it's a reasonably large 500-patient study. It's well controlled. And therefore, we have a good assumption that, that will enter the label. And therefore, we'll have the ability to talk about superiority in that space. Again, it's a dialogue with the regulators, and we'll have to wait and see.

And in terms of launches, we'll be launching hopefully, early next year, CagriSema obesity first and 2 years later in diabetes. And I have shown that for diabetic patients, actually, they care about weight loss. And I think in that trial, we have shown we are a little bit less on Hb1c, but that on weight loss. And then by then, we will also have more data, including the cardiovascular outcomes data.

James Gordon from Barclays. One question was just -- so how much the 2030 target does see on Zena's success? And could you still get there in terms of growing at an industry growth rate without a? Do you think there are other assets even if a wasn't successful that you'd still be able to get there? And the other one was just a clarification. I think it was Slide 7 of Martin's presentation. It looked like a 2029 launch for the next-generation GLP-1. But I think that's only just starting the Phase I now. So that seems like quite fast time lines. So how would you bring it to market so quickly? And can you elaborate on the differentiation from that asset, please?

So maybe, Martin, a bit on the overall importance of how we focus on Zena. So first on that, please.

Yes, absolutely. So first of all, we don't want to be one-trick pony for too long. And therefore, having the diversified pipeline that will de-risk the overall portfolio is the approach that we take. Obviously, with semaglutide, we have Phase I, we have Phase II. So from a risk perspective, that's reasonably de-risked and never guarantees. But the important thing is to build assets around that, that will de-risk the entire portfolio. And the other question?

That was on Slide 7 around the speed to market for new assets.

Yes. One of my hobby horses, obviously, with better processes with the employment of digital tools and AI, we can actually speed up our development time lines quite substantially. We've actually done it a couple of times. And it cannot be done in isolation either. I have to work very closely with Kasper and Kasper will come back and talk to that. The Ambition levels that we have for speed, but also for volume of the pipeline really takes a lot from an R&D perspective, but also from a CMC perspective, and this has to come together.

Now specifically for what I call the lower-risk assets like a GLP-1, we believe that it is somewhat de-risked, and therefore, we do intend to take some of our incretin-based therapies to the market around the time of 2030, even though they are still only in Phase I.

Great. So speeding up and also broadening the pipeline over there.

Yes. [indiscernible] Markets. A question on oral obesity. You showed on one slide that affordability top, convenience top, and specifically then for patients who's been on oral obesity for a while. What about the challenge then about affordability to actually make them sticky to keep on weight management phase.

So Hong, a bit on market segmentation and also including affordability?

Yes. So for the oral, we do not have enough time to look at the stay time, obviously, right? So -- but I think later on in the afternoon, you'll hear from Jamey, we are having different models including subscription model in order to increase the stay time. And of course, in the long term, Martin is working really hard also and Kasper too on more scalability and economies of scale. But currently, I would say people dropping oral, it's too early to tell we are dropping. The data I will talk about dropping is mostly from the injectable data.

I am Rajesh Kumar from HSBC. Thanks for showing the CagriSema comparison with tirzepatide. The dose you have picked and which you probably imagine to be the one which will -- people might go for maintenance. The weight loss profile is not very different from last generation Wegovy, right? So when you're thinking about pricing in your future forecast for DKK 150 billion, have you considered what sort of premium your pipeline assets, which are all fantastic from the list of it, can command over a generic Wegovy. And then I know there are 2 questions on pricing before this. And you said the decline, but you didn't tell the starting point. We are very curious what starting point have we assumed for pricing.

So maybe, Martin, a bit on the data first and then a bit on positioning again.

Absolutely. So 12.5% weight loss with our lowest CagriSema dose is actually on par or slightly better than what is currently out there, which also presumably means when you go to 1.7, 2.4, again, using the right titration and the more individualized titration, that could lead to even bigger weight losses. So we do believe that already at the low dose, CagriSema is differentiated, specifically also when we think in, for example, neuropathic pain and other benefits on comorbidities. And to the pricing questions, I'm super happy to leave that to Hong.

Yes. I mean I will not comment on price, but I comment why I see differentiate. So first of all, with 23% weight loss, it is not the same like Wegovy. And then also, we have -- if you look at the detail, actually, most of user are women and women get 25% and 1/5 of them actually get 30%. And then you have the amylin biology with already proven where we have patient-reported outcomes, the twice as better physical function. And hopefully, we have more data, RASMUS and RAMBO data to prove on bone, on muscle. I mean when I talk to HCPs even, they are very excited about to see the new mechanism. But I will not steal the thunder from the U.S. team presenting how we're going to position CagriSema.

Thanks, Hong. So we're concluding here. But clearly, as you say, strong differentiation of CagriSema. Lots of segmentation to be done in the market, both across obesity and diabetes. And then we're concluding this session. There's going to be a small video, and then we're going into the subsequent sessions on Blood & Endocrine and also cardiovascular and liver.

[Presentation]

Now let's discuss Blood & Endocrine Disorders, CVD and Liver Disease.

Good morning, everyone. My name is Habib Bennaceur and I'm leading the Blood & Endocrine Disorder unit in Novo. I hope I will leave you with 3 messages in mind at the end of this session. One that we are present in the right disease area and indication based on unmet need and potential for market growth. Second, that Novo has the ability to win in those diseases through bringing new standard of care. And finally, linking it back to Mike's statement about Blood & Endocrine being a new engine of growth through blockbuster launches, this therapeutical unit will significantly contribute for the Novo growth in the mid and long term.

The story of Blood & Endocrine is a story of expansion, is a story of leadership and a story of growth, guided by 4 principles. First of all, we look at disease indication with significant unmet need and potential for market growth. Then to fix this unmet need, we aim at nothing else than new standard of care and/or blockbuster potential. We consider third principles, which is do we, as Novo have the ability to win in those disease areas based on our expertise in R&D and also biology. And how can we leverage our current network legacy from the rare disease through the HCP and through the patient advocacy. By doing this right, actually, we managed to be in a place today where we have 3 blockbuster potential launch, 2 coming very soon, FREHEMGO in hemophilia, etavopivat in sickle cell disease and later on zaltenibart in the complement-mediated space, hemato-renal. On the backbone of an already successful business running and growing mainly today through the launch of Sogroya.

And again, we believe by doing this right, as you can see here, the Blood & Endocrine Disorders will grow more than 50% between 2026 and 2030. That's the ambition. And Mike keeps telling me that this is at least 50%. He wouldn't worry if we do much more. Very few words about those 4 therapeutical areas we are present in. As you heard it before, our legacy is in hemophilia or was in hemophilia and the endocrine space. And then we expanded from the hemophilia market or disease. Hemophilia will be roughly around more than $19 billion market in 2032, driven by innovation in a switch market.

From this area, we expanded into hemoglobinopathy, sickle cell disease. Why? Because it's also hematology because the patient care model is very similar to hemophilia is sickle cell disease treatment center quite centralized and concentrated. And if you look at the U.S., there is an overlap in terms of geolocalization of those sickle cell disease treatment center with the hemophilia treatment center, actually, a little bit more than 60% overlap. Sickle cell disease or hemoglobinopathy today is probably one of the most underserved therapeutical area I have been exposed to. It is 10 million patients. We cannot call it rare. The estimated market of around $4 billion in 2032 actually reflect decades of lack of innovation. It reflects as well the recent failures and setback we've seen in that field. So we expect this, again, to move forward at an accelerated level.

Then our hemato-renal, where we aim at building a leading portfolio. Actually, that's not a new disease area for us. We already had some complement inhibitor assets in our early pipeline as well as we had also in hemoglobinopathy. And in the hemato-renal space, we will talk a bit about hematology, again, with diseases like PNH, but also takes the opportunity to expand into a very dynamic and also growing market in the renal part of that space. But I cannot mention all this and not spend a little bit of time speaking about the endocrine space and our growth hormone portfolio. The market is estimated to be more than $3 billion in 2032. And here, our ambition is really to maximize through life cycle management and the expansion into other indications with Sogroya.

And why I'm saying that is because the story we have and the success we have in the endocrine space is equal to none. This is what happen when you stick all the boxes right. We have a portfolio in both, one asset, Norditropin in the short-acting, Sogroya in the long-acting. We are leading in both segments, and we are growing the new class, which is the long-acting. We've done a fantastic job across the value chain to not stop at the growth hormone disorder, but we went to the non-GHD space as well and look at the life cycle management of Sogroya beyond the GHD. Actually, we had just last week, CHMP positive opinion for the ISS, which is a first for that therapeutical class.

And so this is a perfect example of what we do or are able to do in Blood & Endocrine and in Novo from having a portfolio rightly co-positioned, leading in all the segments while pushing for the most growing one and having a very strong life cycle management behind it. Now if I look at hemophilia, which is our legacy and the proper rare disease here within the Blood & Endocrine, Novo has a unique portfolio in that space. Why? Because we do cover all patient segment and also all indications and also all country archetype or market archetype from replacement factor to new nonfactor therapy, being able to address an individualized approach for the patients so far, but as well address all kind of country archetype. When you look at hemophilia A, there is still an unmet need despite the recent innovation. Patients are still bleeding under current standard of care. But most importantly, talking with patients and listening to this community, you realize that they still and always compromise between the need of efficacy and feeling covered and protected from bleeding and the burden of treatment.

And that, we believe, is something that we have to fix because no patient should be living under burden of treatment just for the sake of being -- feeling secured and safe from bleeding. Can we do it? We absolutely can do it. This is what I'm sharing here with you is the latest data that we have from our FRONTIER program with denecimig, FREHEMGO. What you see here is that we have a consistent efficacy data across all dosing regimen once weekly, every 2 weeks, once monthly across both pediatric and adult/adolescent population with 0 bleeds of approximately 70% in the adult and adolescent population and up to 90%-ish in the pediatric indication.

I want just to specify here that I'm talking about overall bleed, overall treated bleed that includes spontaneous and traumatic bleed. If I want to talk only about spontaneous bleed, this will be, respectively, almost 90% and 97% 0 bleed. More importantly and very interestingly, we have the FRONTIER 5 data, which is a switch study from emicizumab to FREHEMGO. And we have looked at various parameters. One of them is the preferred injection pen versus emicizumab device and also the overall ease of use evaluated by the patients. You can see here the results. I'm sure many politicians would love to see those kind of results in their polls. It's almost unanimous. We have 97% device preference for FREHEMGO compared to emicizumab. Making this direct switch, again, in a market which is mainly a switch market, this direct switch, quite seamless and smooth.

All in all, we believe that FREHEMGO has the best value proposition to patients, starting with the efficacy. You heard it previously, maybe a few, not that a long time ago from Martin about the potency that is higher than emicizumab. We also today know through the FRONTIER 5 data that after a switch from emicizumab, FREHEMGO takes the thrombin generation value into normal range even through the once monthly. And thrombin generation is today a marker that is used by hematologists to follow on their hemophilia patients. This has translated into very robust, consistent clinical data across population, pediatric adolescent, adult and also across all those regimen, making FREHEMGO the first truly once-monthly optionality for hemophilia A patients, also thanks to the preferred administration and the preferred device. Actually, the preferred administration device also to be linked to the potency since it doesn't matter if it's once weekly, every 2 weeks or even once monthly, it is 0.8 milliliter injection volume across all dosing regimen, making this a big difference today.

Again, we had a busy week last week, not only with Sogroya, but we had CHMP positive opinion for FREHEMGO. We're also positively surprised to have a global -- first global approval by Saudi coming as well. We will continue looking forward for, of course, additional launches, and we are also looking forward for the FDA response as well, as you can imagine.

Talking about sickle cell disease. This is a global disease. Around 8 million, 8.5 million sickle cell disease patients around the world, highly prevalent in Africa and India, but obviously, also an increasing number of patients in U.S. and in Europe. And actually, you have a little bit more than 2,000 new born per annum in the U.S. diagnosed with sickle cell disease. So those numbers in U.S. and Europe will keep increasing. As I said, one of the most underserved disease. We hear a lot about anemia. We hear a lot about VOC, vaso-occlusive crisis. But what we need to know and remember that this is a chronic systemic disease, leading into multiple organ damage that ultimately will result in a life-threatening life-shortening disease.

The life expectancy in the high-income countries is between 48 and 55 years old. I'm not going to speculate around the average age of the room, but I'm sure many of us will feel uncomfortable knowing that with sickle cell disease, that the life expectancy that you should expect. The significant unmet need remaining here. It's not only about access to treatment, it has to be addressed through access to care and improving the patient pathway. Probably you have seen the top line results that we presented a few months ago. Just make it very short. This is the first and only asset that has proven reducing both VOCs and increasing hemoglobin in a study with those 2 parameters as co-primary endpoint. 27% VOCs reduction on an annual basis, almost 50% of hemoglobin response. 70% of the people on the trial were on hydroxyurea, meaning that etavopivat can be used either on monotherapy or/and add on to hydroxyurea.

We have a substantial reduction in transfusion -- in blood transfusion with etavopivat. If you want to need more, you need to wait for ASH in December. And the time to first VOCs was delayed by 4 months. So that's clearly a best-in-class that we have today in our hands in the sickle cell disease. Our strategy is very clear, straightforward. We need to raise the understanding of sickle cell disease, not as a one-off crisis that you need to manage in emergency room, but as a chronic systemic disease that you need to fix on the long term. We want to establish etavopivat. We will establish etavopivat as a standard of care, as I said, either monotherapy and/or add-on to HU in both pediatric and adult population.

And finally, this is Novo. So there is no way we will turn and shy away from the need to expand patient access in sickle cell disease also by ensuring that we increase the maturity of the patient care model in countries like -- in a continent like Africa, but in countries as well like India. That ultimately will increase the accessible patients that will be able to afford an innovative treatment like etavopivat. And that work is already ongoing in Africa, like a country like Kenya, but also in India. You've seen it. It's a rule in the Blood & Endocrine. When we have one asset, we don't limit to one indication. It is true for FREHEMGO. It is true for Sogroya, it's true as well for etavopivat. We aim to file by the end of the year for sickle cell disease and also to move next -- to the next indication, which will be thalassemia.

One quick word on the hemato-renal space with zaltenibart, another success story in terms of BD, as mentioned by Mike. Etavopivat was from Forma. We acquired more recently zaltenibart from Omeros. It's a MASP-3 innovative mechanism of action, MASP-3 inhibitors that we believe will work in the alternative pathway, addressing large set of diseases, starting, as I said, with PNH, where we still have roughly 20% to 30% of patients not being able to achieve Hb normalization. Early data from zaltenibart here are showing positive signal in terms of efficacy in patients either naïve -- PNH patients, either naïve or suboptimal responders to C5 inhibitors.

In IgAN, much larger population, we know that still a progressive disease, patients still progressing into end-stage renal disease. We also see a lot of innovation and the very fast-moving guidelines toward more aggressive targets to treat. And we foresee zaltenibart as becoming part of the standard of care in a market where combination therapy will probably be the rule of the game, particularly in the renal disease. Phase III study in PNH expected by mid -- to start by mid-2027, followed by also IgAN and potentially other indications. In a nutshell, Blood & Endocrine has a robust clinical trial pipeline -- sorry, clinical pipeline, fueled by internal development as well as from BD. So a very good mix.

I'm not going to go through all of them. I just want to mention that innovate as well is there. The bar is high, but we still invest in rare indication and hemophilia trying to bring the first oral treatment for this population. And I will not repeat those 3 points. I hope I've been able to convince you and to gain a little bit of share of mind and soon share of voice in your very busy brains and agenda and to have Blood & Endocrine on top of it. Thank you very much.

So you have heard from Habib the very exciting the Blood & Endocrine Disorder growth engine. And Martin and I would go through our 2 other growth engine. I know lunch is waiting. So Martin and I will try to be fast. First of all, you heard from Habib to say, how do we select this growth engine. It's about look at unmet needs, science and ability to win. And in Cardiovascular and Liver is the area we see unmet need and also about our ability to win. Mike already mentioned in the morning, we already serve more than 46 million patients. And these patients, they have already cardiovascular and liver risks. And this connection is already shown also in the guideline you have seen, whether for diabetes or obesity management, even GLP-1 treatment is now recommended for selected MASH. So we see overlap there.

But now let's look at the unmet medical need. So Cardiovascular diseases is projected to double, nearly double by 2050. And these are the areas we're going to focus on. So it's about atherosclerotic cardiovascular disease, ASCVD and heart failure. And on the right, you see your own forecasted consensus, which is despite seeing the growth, you still project to grow double digit because Cardiovascular is still the leading cause of death.

And then despite the treatment, why is that? Because there are residual risks which remain. And we have seen that inflammation is recognized as one contributor of that inflammation. Despite the negative readout of ZEUS, we are actually trying to follow the science and to find more about the inflammatory pathway. So ATTR cardiomyopathy is actually one of the areas, give you an idea for what type of area is Novo looking for. And this is one type of area we will be focusing on because there is undertreated, underdiagnosed first, undertreated. So it is estimated that U.S., there will be 150,000 patients who have ATTR cardiomyopathy, but only a tiny fraction are being treated. And if they are diagnosed and not treated, the median survival is between 2 and 6 years. But even treated, it's still very, very poor.

The reason for that is that because the current treatment, it would slow down the formation of amyloid but doesn't deployed -- deplete the deposit already accumulated. And with our TTR depleter coramitug, we are going to address this. And we are very excited, and Martin would explain much better than I do and share more. So let me conclude the strategic part on why Cardiovascular? So there is overlap in patients, and we have proven developed expertise in running large Cardiovascular outcomes trials, including the SELECT trial, and we have built relationships with payers, prescribers and health systems. Even despite the readout ZEUS, actually through ziltivekimab, we have gained so many experience in that field and developed very profound relationships. And of course, we complement that with our pipeline.

So now moving to the other growth engine, Liver. So our focus on MASH. MASH is actually represents a large unmet need. It's defined by the different stages of fibrosis. And what you really have to remember is that the progression could be very fast. So 20% of F3 patients could progress to F4 cirrhosis. What does it mean, F4 cirrhosis? There's an increased risk of liver decompensation and liver decompensation may require a very expensive liver transplant, could be up to $1 million in the U.S. And EU, U.S., 42,000 liver transplants are conducted annually because the mortality rate, of course, increases a lot with the later stage of fibrosis. You already heard from Martin that we would have drugs addressing that, and he will come to that in a minute.

And if you look at right side, the hepatology market is expected to grow and the main driver is MASH. But actually, in most of the models, ALD, alcohol-related liver diseases is not in the model. And why ALD is important? Because in ALD patients, the progression is even twice as faster than MASH patients and 70% are cirrhotic. And this is actually the major cause for liver transplant. On the right, you actually see the waiting list for liver transplant. It has dropped due to hepatitis C become curable, but then yet MASH and ALD become the driver for the increase of liver transplant. So you may ask, how are you going to enter into liver? Well, we are already in MASH with Wegovy injectable. And soon, we expect approval for Wegovy pill for MASH. And we have UBT, which you heard from Martin will bring spectacular, hopefully, weight loss, but it's not only the weight loss, but also other benefits, including liver.

And for the late stage, especially for the F4 with high mortality risk, we have acquired the asset of Efruxifermin, very promising from Akero, which they were developing in late stage, but also in ALD. And Martin always say it doesn't stop there. We have to go further, and we will have novel mode of actions. But -- beside treatment, we actually look at diagnosis because liver diseases or MASH, the issue was it was depending on liver biopsy. And we are actually working with our partners to develop tests which are broad and scalable and noninvasive. So on Echosens, we work on FibroScan and Roche Diagnostics and Siemens Healthineers, we work on blood test, which are hopefully made available broader even to non-liver specialists. So Martin, we will increase the diagnosis, and we are eagerly awaiting more and faster innovative medicines.

Thank you very much. So as Hong already alluded to, when we talk about Cardiovascular Disease, at least certain parts of Cardiovascular Disease. When we talk about liver disease, there's a substantial unmet need. One of the areas that is truly unmet because there's no treatment available is inflammation in Cardiovascular Disease. And while I don't like to talk about neutral data, I think I have to address ziltivekimab a little bit because there's a very strong correlation between inflammation and the risk of Cardiovascular Disease, ASCVD. It's also a very strong correlation between inflammation and heart failure.

Nevertheless, when we took the first anti-IL-6 drug into a cardiovascular outcome trial, the ZEUS trial, randomizing patients to either ziltivekimab or to placebo, we saw absolutely nothing. So the hazard ratio was 0.99. And you can then either conclude the concept of inflammation as a driver for cardiovascular risk is wrong. Ziltivekimab as a drug or IL-6 as a target is not doing the trick or it was the wrong population. It needed a less advanced population in this space. Now based on what we've learned from ZEUS and ZEUS was a really well-conducted trial. So we've taken a number of learnings already. Our conclusion is we still had to pursue quite actively inflammation in Cardiovascular Disease. We are not done with ziltivekimab. We are still doing the ARTEMIS trial. We're not done with oral IL-6 that will go into Phase I later this year, actually next month. But we also want to actually expand that footprint, focusing on NLRP3 inhibition.

So again, I apologize not going into what we have specifically learned, but our conclusions are quite clear. NLRP3, next to what we are doing with IL-6 inhibition is interesting because it's further upstream from IL-6. But NLRP3 is also one of a number of inflammasomes, those inflammasomes being not touched by the NLRP3 inhibition, therefore, being able to respond to, for example, infections and presumably then leading to we can inhibit NLRP3, we can potentially accrue CV benefit, but not necessarily with the infection risk that we've seen with the IL-6. It's still early days for the NLRP3. We still have to generate the outcomes. So to pursue still both IL-6, but also specifically a reasonably broad portfolio of NLRP3 assets. We have one in Phase I as we speak. We will take another, in a couple of months, and we'll take more in next year, potentially also doing external collaborations or acquisitions.

We also have to acknowledge that sometimes we need to think about combination therapies, getting the best of 2 worlds. We talked a lot about what we specifically know from semaglutide and the CV benefits, but we also have other GLP-1s that we think will resemble what semaglutide can do in the Cardiovascular space. You've heard me talk about a lot that we don't think that all the GLP-1s gives the same magnitude of CV benefit, semaglutide obviously being leading from an outcomes data perspective. And we want to find the best of 2 worlds when we combine maybe next-generation GLP-1 with an oral PCSK9 inhibitor that we've had in Phase II already.

We're showing the data from that Phase II trial here, where we're showing when we compare to placebo, when we compare to an active comparator, that peptide-based oral PCSK9 is actually quite efficient and combining that with the GLP-1 analog could potentially lead to substantial benefits in the cardiovascular space. The beauty of it is we can develop that as an injection therapy, and we can do that quite fast, initiating Phase I next year, potentially being on the market around the turn of the decade. The oral is also doable. It's also scalable. It will take a little bit longer because we have to generate more data. But having that offering, that differentiated offering in the space of what we can already do with GLP-1s in Obesity and Diabetes is going to be very attractive.

Hong also mentioned ATTR cardiomyopathy. It's basically amyloid transthyretin deposits in the heart that leads to impaired cardiac function, but also impaired outcomes for patients. Now there are assets on the market and in development that are stabilizers or silencers in nature. What they do not do is to remove the already deposited TTR in the heart. The depleters have the potential to do that. So coramitug is an ATTR antibody. It's currently in Phase III -- sorry, wrong way. We have already conducted Phase II and reported on that. And the important message here is that Phase II was conducted in patients of whom 80% was already on standard of care.

So in recent months and years, there's been a dialogue on can we improve this space on top of standard of care. Here, you see one biomarker of efficacy, namely NT-proBNP being significantly reduced compared to placebo. And actually in the space of 1 year, the placebo arm increased substantially while the active treatment decreased. We've also looked at obviously other biomarkers, and we've decided to take coramitug into Phase III, simple trial. Speaking to the unmet need, it's a reasonably small trial, but still an outcomes trial. We need approximately 1,500 patients randomized to either coramitug or placebo, event-driven, and we'll see the readout in the years to come.

In the MASH space, I've already talked about UBT, substantial weight loss potential building on 3 biologies. You all know, again, glucagon biology seems to be very good for reducing steatohepatitis. The promise of UBT251 is that it seems to be as efficacious as other triagonist out there. We have to prove that in Phase III, obviously. But it also seems to be more tolerable, potentially giving a true differentiator to both glucagon co-agonism, but also glucagon-based triagonism. UBT251, we intend to take into Phase III for MASH in addition to, obviously, the weight loss program, definitely in monotherapy, potentially also in combination therapy.

Hong and I agree, it doesn't stop there. We also have efruxifermin. And efruxifermin is potentially hugely exciting. We already have -- we are going in the market for F2 and F3 MASH. UBT251 and other dual and triagonist based on glucagon will be primarily for F2 and F3. But F4 is where the huge unmet need is, one, because patients die with F4, have a lot of both liver but also cardiovascular morbidity with F4, and there's no treatment available. In Phase II, efruxifermin showed not only an ability to decrease steatohepatitis, but also fibrosis in a significant and a clinically relevant way in patients with F4. That means it has the potential to be first and best-in-class in F4.

On top of that, it also had really, really competitive data in F2 and F3. So this is a super strong asset. It's important for us to call out, we see the true excitement of efruxifermin in F4. So yes, we will have a readout in F2 and F3, and we believe that to be very strong next year. But the true value for treating physicians and patients will come with F4. So therefore, we're doing our very best together with our partners to speed up the Phase IV trial. So we'll see the readout as soon as possible. Again, Hong mentioned alcoholic liver disease. Here, we can truly also see high benefit, potential benefit of efruxifermin in either monotherapy or in combination therapy.

The beauty of having different targets in our armamentarium, different assets that are addressing different biologies is that we can think of them as monotherapies, but we can also do the combination therapies that generate, hopefully, the better efficacy, the superior and differentiated efficacy without compromising on safety and tolerability. This basically means that we have a very strong foundation for Cardiovascular, but also a Liver-specific pipeline when we talk about cardiometabolic cardiovascular disease or metabolic cardiovascular disease and metabolic liver disease. We obviously intend to build on that with Phase I assets with research, but also with external innovation. I think with that, I will invite Michael and Hong and Habib to the stage for Q&A.

Thank you very much, Martin. Habib, have you seen the questions? Go for Richard again.

, Richard Vosser, JPMorgan. Maybe just on ZEUS. If you could give us a bit more detail on the final impacts on LDL cholesterol and triglycerides. Do they have any impact on the CV outcomes in the trial? And thinking about the NLRP3, what effect does that have on some of the dimensions that IL-6s do that are counter-regulatory to the effect on CV mortality?

Absolutely. So we primarily saw an effect on inflammatory markers, so free IL-6, CRP, and we saw a substantial reduction there without seeing major impact on triglycerides. So the big question, and again, I'm not really able to disclose is what is then potentially driving benefit and where. And very happy to share in maybe the future when we have shown where exactly we are going with this. But suffice it to say, we do have some quite substantial insights that we believe can potentially derive a lot of value in this space. Specifically for NLRP3, as we discussed, it's more upstream, it does, in principle, lead to IL-6, IL-1 beta release, also CRP increase. And by inhibition, you inhibit that specific cascade, but you don't inhibit the other inflammatory cascades that are maybe more driven by, for example, infectious agents. So you could expect to see more efficacy on the cardiovascular side without having necessarily to compromise on infection on the tolerability side.

Thank you, Martin. Just looking for Seamus.

Seamus Fernandez from Guggenheim. So just a couple of quick questions. Martin, on the F4 side of things, your emphasis on F4, I think, has been very consistent. But do you see an opportunity to advance into F3 with FGF21? Or are there safety concerns associated with that, the bone effects or bone biomarker dynamics? We saw some BMD changes in some of the F4 population that might be concerning the earlier you go. But just wanted to get your thoughts on the opportunity to move further forward there.

I think it's a fair question. And obviously, you don't have pharmacology without having also the potential for side effects. And from a regulatory perspective, but also from a clinical perspective, we have to think about the benefit risk. Now at this point in time, we clearly keep the door open for F2 and F3 but if you think about benefit risk, F4 is where the huge unmet need is, and that's also where we think that we'll see the biggest benefit.

Pete?

Pete Verdult, BNP Paribas. Martin, can we go back to a question earlier that wasn't answered because you talked about in the GLP-1 portfolio, thermostable and once monthly, but you're also talking about next gen. So if it's not a convenience or dosing play, then perhaps a bit more -- something a bit more exciting on the efficacy and safety side. So what are you willing to say about next-gen GLP-1?

So without going into specific, I think you touched on the parameters that we're interested in looking at. I think you can all read in our disclosures, it's not necessarily on the affordability side. But when we look for differentiation, we look for efficacy, we look for convenience, we look for safety and we look for tolerability. We need to see the Phase I readout. But we do believe that, that next-gen GLP-1 is differentiated on one and potentially more of these variables.

Sachin, question?

Sachin Jain, Bank of America. On the oral PCSK9, obviously, you've got a couple ahead. Could you please just clarify how you think you're going to be differentiated? Is that efficacy? Is it the combination? Because another competitor also has a combination, perhaps a little bit more detail there.

Yes. So I think what we are clearly seeing also obviously in Diabetes, where we've been for a number of years, but also in Diabetes, different patients have different needs. There will be patients who are very much focused on Cardiovascular Disease and reducing their long-term cardiovascular risk. Now we all know that GLP-1s introduce a reduction in cardiovascular risk, specifically semaglutide in both Diabetes and Obesity. But it does so more through decrease in inflammation, decrease in body weight, decrease in maybe blood pressure than it does decrease in lipids. If we combine a GLP-1 with a PCSK9 inhibitor, that sort of missing link could add to the CV benefits that we see with the GLP-1s. That would make it differentiated if we can document a substantial decrease in lipids on top of what we just discussed on the weight loss, the glycemic control, the hypertension, the inflammation benefits.

Graham?

Graham Parry from Citi. Just a question on coramitug and differentiation versus cliramitug, the AstraZeneca depleter. I think they would highlight they have multiple binding sites across the amyloid protein, which potentially can give better clearance. So I think you only got a single binding site. If you just talk to that mechanism of action and what you've seen in data that gives you confidence that it wouldn't be an inferior product?

So if I think about the data, obviously, I can only do indirect comparison, but I showed you data on NT-proBNP. When we look across what we've seen from others Phase II versus what we see in our Phase II, it actually looks reasonably comparable. That basically means that I think we have a competitive drug. Timing then also becomes important. But I think it's too early to speculate into differentiation as this is a new field. we take a lot of comfort in is obviously that this -- our asset coramitug seems to work on top of standard of care.

Florent?

Florent Cespedes from ODDO BHF. A question on your cardiorenal portfolio. Could you elaborate on how you will position your products on the PNH and IgAN versus the existing treatments?

Cardiorenal?

Yes. Cardiorenal. No.

I heard cardiorenal. Hemato-renal?

Hemato-renal.

Hemato-renal.

Okay, Hemato-renal. On the positioning -- sorry?

of zaltenibart.

Yes. But the positioning in PNH will be obviously different from the positioning that we see in the renal indication. The way we see it in the renal indication is to move earlier right after the current palliative standard of care based on the higher efficacy profile versus most innovative drugs that were on the market today, a good safety profile and also a very convenient administration regimen we are aiming for subcu. But also to fully answer your question, in the IgAN and the renal, we also foresee that combination therapy will gain more and more as a standard of care between complementary mechanism of action. And this is also something that we want to leverage on. On the PNH, we want to see that who can do the most, can do the least by addressing the naïve and the suboptimal C5 responders and thus position it also as a potential lead in this indication.

So final question, Simon Baker.

Simon Baker from Rothschild & Co Redburn. A question on sickle cell disease. You talked about the size of the opportunity, 10 million patients. So it's a big indication, but those -- a lot of those patients are not easily accessible. And you touched on how we've seen a number of clinical and commercial setbacks, missteps by others. What have you learned from the disappointments of others? And how do you see -- what is your strategy for really addressing that core opportunity in sickle cell disease?

Well, first of all, I think we look at it from each country as a different country archetype. I want to make sure that we address all patients needs and pain point in the patient journey in the U.S., in Europe. If your question is more specifically around low mid-income countries, I'm not going to say about mistakes, let me call it learnings from other projects. If you jump too fast in trying to fix the access to treatment before you also improve and address the diagnosis, infrastructure, physician training, public awareness, then you will fail. And that is not only for sickle cell disease. I have a bit of experience in my past in Africa as a general manager for a region, actually, it's true for any disease. We rush -- we tend to rush too fast into trying to fix it by just giving the drug and forgetting the overall picture. So it's much harder, but that's our commitment today is to improve sickle cell disease patient care from diagnosis to improve access to treatment. And that's one learning. The second learning, you don't do it by yourself. It has to be in collaboration with the government and other private partners, but it's absolutely essential that you have a commitment from national authorities. Ultimately, they are responsible for their population.

All right. Thank you very much. Thanks, Hong. Thanks, Martin. Thanks, Habib. So we're going into lunch now. And after that, we are going into some exciting sessions on the operations in the U.S., IO, global manufacturing supply and also financials. But just to wrap up this session, I think we got a very clear strategy from Mike aiming to grow the business. We are strengthening diabetes. We're expanding in obesity. You saw the pipelines evolving there. We are building also blood endocrine as a new growth engine and also adding to that on the cardiovascular and liver side.

So with that, I hope you will enjoy lunch and also be aware that there will be plenty of extra Q&A possibilities. So it's going to be half an hour at the end of the day for a full panel debate with all the EVPs. So we will get to all of you, but thanks for the morning session.

[Break]

Thank you. Welcome back from lunch. For those of you that brought plates back in, please continue. I'm Jamey Millar. I'm the EVP for U.S. Operations. And shortly, I'll be joined by Ed Cinca, who's Senior VP for Marketing and Patient Solutions. I'm going to start upfront with the message I will close with, and that is that the obesity market remains incredibly attractive, if not yet still underpenetrated. We're growing volume aggressively and see a long runway for this category.

Make no mistake, Ozempic is a critical priority and the Ozempic pill is a key market event here with the recent launch in the United States. And lastly, the pipeline is very compelling, not just simply as individual assets, but increasingly as the portfolio approach emerges within various disease states. So let's get into it. The chart on the left speaks to GLP-1 total volume, second quarter of this year versus same period a year ago, up 26% overall. The middle chart shows TRx market share, specifically in the obesity category.

Since January, we've gained roughly 8 share points across the obesity franchise behind the launch of Wegovy pill and the Wegovy HD 7.2 milligram introduction. Nonetheless, as we reported out in our Q2 earnings, we see sales decline 4% at CER, indicative of the price pressure in the mandated space, i.e., the government program space as well as the discretionary commercial or private market. Our strategy in the U.S. is consistent with the overall corporate direction, as you'd expect. We're going to focus primarily on type 2 diabetes and obesity and the other disease states we are executing and preparing for several imminent launches.

In the diabetes space, as mentioned, stabilizing the Ozempic share erosion has been a priority and then launching the Ozempic pill, and Ed will share more about the progress to date on that. Within obesity, we want to expand the Wegovy franchise overall, winning in the oral segment with the differentiated profile that we have with Wegovy pill, successfully launched the first combination GLP-1 and amylin product in CagriSema, and Ed will speak to that. We also are excited about the expanded access in Part D behind the Bridge program, CMS-sponsored Bridge program in the United States, offering for the first time seniors access to obesity medications.

This will be enabled by a continued focus on 4 core capabilities: increased access and affordability, building differentiated core competencies in the commercial space, inclusive of the Novocare ecosystem, and I'll explain a little more of that momentarily. We're going to leverage fully the new culture imperatives and specifically the customer obsession, the outside-in view from any customer, whether that be a regulatory customer, a payer customer, an HCP customer or the patient or consumer as customer.

Additionally, competitiveness. We've instituted a measurement culture of KPIs where we measure competitive share of voice, share of spend in every category as we look forward. Ensuring competitive launches round that out, the set of core capabilities. In terms of payer access, and many of you know, I joined Novo in February after 5 years with OptumRx, the pharmacy benefit manager of UnitedHealth Group. Ironically, the first medicine my team there reviewed for clinical economic and formulary inclusion was Wegovy injectable. The payer reticence in this category is significant and overcoming that is a key priority of ours.

Table on the left shows the unfortunate cascade in the category. This is not Novo specific. This is a categorical fact. GLP-1 new-to-brand Rxs, if you take 100 of them, only 35 get filled today. In between, you have all the expected impediments in terms of utilization management, prior authorizations, inclusion criteria, exclusion criteria, step edits, et cetera. That compares to an analog, chronic disease state, type 2 diabetes, where half of all NBRxs are filled. So it is subpar access in the United States for GLP-1s for obesity.

So our focus is to address payer concerns around cost trend, which increasingly tends toward the volume side of the equation, especially as you consider in '27, beginning in January, we will reduce our list prices for Rybelsus, Ozempic and Wegovy to $675 as announced. So on the volume side of the equation, we'll continue to look at competitive net pricing that is sustainable in the marketplace. We'll address a key insight of payers, which is predictability by examining increased access in targeted subpopulations over time. We'll continue to demonstrate value through outcomes and real-world evidence to express the value proposition of our medicines from a payer-centric point of view.

We're also exploring innovative access models, inclusive of direct-to-employer approaches. And lastly, we don't want the 18-month pilot in Part D to be eliminated at the end of '27. So we're looking and working with CMS and the administration closely to ensure a durable benefit for seniors and again, demonstrating the value of that access in the Part D space. The obesity market, make no mistake, is being driven by consumer dynamics. And that is the consumer as not just the end user of the medicine, but the budget holder and the decision-maker, unlike traditional prescription models.

It's also indicative of the fact that 50% of our Wegovy franchise volume is now in the self-pay channel. And as Mike said earlier today, 90% of Wegovy pill is self-pay versus reimbursed. So this is a dynamic that will continue in this category. We meet the patients and consumers where they are, whether that be accessing the medicines at retail outlets across the United States through our telehealth network or through our own pharmacy, Novocare pharmacy. In the telehealth space, we will soon announce the addition of a 10th high-volume telehealth partner to the ecosystem, and we look forward to that.

Speaking of one telehealth partner, Ro, we launched a very innovative subscription model at the end of March of this year, where for the consumer, it offers predictability, a flat monthly price, consumers can sign up for 3-, 6- or 12-month subscriptions. It obviates what they don't like, which is the escalating price as they titrate through the regimen. And what the data shows already with Ro is rapid uptake. We have 90,000 orders that are accompanied by a subscription and 55,000 active subscribers. But importantly, the usage is influenced by the subscription model.

Consumers in the first 4 months, so granted, it's the first 4 months of experience since end of March. Literally, those in the subscription model have filled 4 prescriptions in 4 months. So 100% adherence as compared to 3 prescriptions in 4 months in a matched cohort of nonsubscribers. They tend to sign up for the longer duration plans, the 6- and 12-month subscriptions. And really importantly, over 50% of patients enrolled in the subscriptions are utilizing 9 milligrams or 25-milligram strength. So they're titrating through the Wegovy pill regimen, which creates a flywheel effect in terms of the efficacy and the experience achieved at those higher dose-dependent doses. And Z, the CEO of Ro, recognizes the innovation and the approach to the subscription model.

And lastly, Novocare 2.0. The simple summary of this slide is that we are evolving our platform as we speak. The old platform that we launched with was available for cash-only consumption. This platform will be cash, cash to coverage as well as coverage only, inclusive of Bridge patients. It also dealt with fundamentally access and availability, access and distribution. We're seeking to meet the patient across their patient journey all the way from acquisition to access to adherence and loyalty, building support programs throughout their treatment journey. The overall imperative for this is better functionality than the first version of an Novocare pharmacy with a lower cost to serve.

Our current model is labor-intensive, lower margin. And as Mike laid out in his opening slides, we seek to increase the margin of our self-pay business through this improved functionality and lower cost to serve. It is literally live as we speak for cash pay, self-pay and the additional functionality will phase in through the balance of this year.

So with that, it's my pleasure to introduce my colleague, Ed Cinca, who leads our marketing effort. And while he's coming up, I'll just briefly introduce him. Ed launched Ozempic, launched Rybelsus, launched Wegovy injectable. He's been with the company about 20 years, but took a brief hiatus, and we were glad that he returned late last year just in time to have significant impact on the Wegovy pill launch. So welcome, Ed.

Thank you, Jamey. Appreciate it. Really appreciate that. And it's my pleasure to describe a little bit of what's been happening in the U.S. and give you a little bit of a flavor of how we're coming to market. But I do want to build on the comments that Jamey made because I think that the telehealth business and Novocare have fundamentally changed the way we're engaging with patients today, creating new routes for access and truly meeting patients where they are.

But I would say that as much as things change, some things still remain the same. We need strong science. We need really strong execution and, of course, strong patient demand. And I think the Wegovy pill is a perfect example of that. First of all, the clinical profile for the Wegovy pill is second to none. We have such a compelling clinical profile with 17% weight loss, patients who start and stay on therapy. It's the only oral obesity medicine that carries with it a cardiovascular indication on label. And all of this predicated on some 50 million years of real-world patient experience. That's some pretty heavy stuff.

And more recently, we're seeing now a unique advantage that's not on our label. And in fact, that's the fact that we do not carry a drug-to-drug interaction warning or any sort of precautions. And so from that perspective, we're seeing that in certain segments start to elevate. So we take that clinical profile and we pair it with real strong execution within the U.S. market. And I have to say I'm incredibly proud of the way our organization came together for the Wegovy pill launch. In a matter of 14 days from approval until the day of launch, we had a product supply already shipped out to some 70,000 pharmacies stocked across the United States as well as an entire field force ready, trained and on the ground in offices, ready to sample and to start educating around the pill.

And we complemented that with really strong patient communications, very smart and efficient direct-to-patient advertisements that culminated with a very large awareness campaign in and around the Super Bowl. And that was even further augmented with our telehealth partners and how they were coming to market. So as you can see on the right-hand side, all of this has led to significant uptake and something that we're very proud of. There's been no let up. And today, what we're seeing is, on average, some 285,000 TRx per week with the Wegovy pill relative to another oral entrant into the market at approximately 45,000 TRx per week.

And everybody in this room is good at math, but I'm going to do some math for you and tell you that on average, that's about 40,000 TRx per day in Wegovy pill relative to what the competitor is doing on a weekly basis. And I know that there's been some headlines and maybe a little bit of confusion within the marketplace recently. So I want to address that and take it on. Wegovy pill NBRx, new-to-brand prescriptions, is greater than 80% within the market. As you can see within the data, often underreported is the Wegovy pill volume. And when looking at the total picture, then you have a much cleaner view.

And what's really exciting about the Wegovy pill launch is that it's doing exactly what we expected it to do within the marketplace. And what you're seeing here on the left-hand side is a view of the Wegovy pill performance in the first, 3- and 6-month period of time. Looking at OASIS 4 relative to real-world data that we've seen from our telehealth partners at Ro as well as patients who participate with WeGoTogether app. Now obviously, the OASIS 4 study carried forward much longer. So this is only the first 6 months since launch, and that's why you're only seeing the 10% reduction, not the 17% that was carried through the totality of the study.

But what I want to draw your attention to is not only the consistency of what you're seeing in a randomized clinical trial relative to real-world experiences, but the market improvements in weight loss that are happening early at the onset of the administration of the pill. But then in some cases, equal, if not greater overall performance in the real-world setting. So if we kind of distill that down and better understand what that implications here are, we're talking about real world, not in a highly controlled environment. My friends, the idea of food and water restrictions is not real as an implement here in overall performance. Patients are getting in the real world what we're seeing in the clinical trials.

And one of the other things that's kind of exciting in seeing the development of how our pill is coming to market is that some 90% of our prescriptions are self-pay. We take that as a real strong sign of value because patients are voting with their wallets. They see the value that they're getting in the pill, and they recognize that this is something that they want. And as a result, we're seeing persistency in pill that's comparable to that of injection, which means that it's working exactly the way that we anticipated and patients are starting and staying on therapy.

And in fact, another aspect here that's really quite exciting is that 80% of patients who are coming into the Wegovy franchise now via pill are GLP-1 naive. And that's really exciting because one of our intentions was to expand the market, and it's happening. And more exciting is the fact that already in a very short order, oral obesity medications represent 1/3 of the total obesity prescription market. So in a very short time, not only is Wegovy pill capturing the majority of new-to-brand prescriptions as well as expanding the market, but this oral space is continuing to grow, and it represents significant upside into the future.

But it doesn't stop there because together with the Wegovy injection and Wegovy pill, we're seeing the opportunity to unlock this marketplace. As you all know, we're still just scratching the surface on the availability of patients, and this is a very undertreated population. But still, within that population who are taking obesity medicines, the Wegovy franchise now represents some 55% market share in new-to-brand prescriptions, which is really exciting, and there's a lot more room here for continued growth. And we think that we will have this opportunity because there's a really compelling offering, one that's rather unique to the Wegovy franchise.

With injection, we're offering 21% overall weight loss with multiple indications accompanying that, right? Patients start and stay on therapy. And then with the pill, some 17% weight loss, again, patients start and stay on therapy, complemented with cardiovascular indication. And so from that perspective, we want to continue to invest and see a lot of great opportunity. And it's that energy and momentum that we want to bring to market with CagriSema's introduction. CagriSema represents a really unique opportunity for us to now take the GLP-1 biology and accompany it with the amylin biology.

And I think it would be important to comment that the initial configuration here for CagriSema is not at the highest dose of semaglutide or Wegovy, but it is at the 2.4 milligrams of Wegovy compared -- or complemented with 2.4 milligrams of Cagri. And even at those levels, we're seeing 23% weight loss. And that 23% weight loss, achieving 1 in 5 patients getting greater than 30% weight loss. And one aspect that I think is just incredibly exciting to me, particularly is the fact that we're seeing an average 25% weight loss happening with women.

And the reason I'm excited is because on the previous slide, you saw that this is the bulk majority of the patients who are most engaged and most interested in taking prescription medicine for obesity as well as then having a very distinguishing and contributing factor here, which is to say we have an improvement in physical function as well as then preserving muscle strength. So it's a really unique offering and something that's going to complement our portfolio quite nicely. And of course, we need to bring that together in totality with the strong execution. And I'm happy to say that we're only days away, months away from our PDUFA before the end of the fourth quarter.

And from that perspective, we're ramping up already in unbranded ways, introducing amylin biology to our HCP customers, and we will start building demand with our patients in anticipation of this launch early into next year. But for a moment, I'd like to turn your attention to maybe the catalyst for all the reasons why there's so much excitement around the GLP-1 class, and that is Ozempic. Ozempic specifically within the type 2 diabetes market. There have been many followers, and there are a lot of other GLP-1s, but there is only one Ozempic. There's one Ozempic now in 2 presentations with 3 indications, on-label indications.

And that's really exciting because as you can see that even within the diabetes space, there's quite an underserved population here. And we have a huge opportunity and one of the reasons why we will continue to invest in diabetes and specifically with Ozempic. Now I'd be remiss without acknowledging the fact that we've had some ups and downs with Ozempic recently. And what I would tell you is that there have been quite a lot of changes within the health care landscape between utilization management requirements, prior authorization requirements as well as our own product supply constraints that have taken place both in and out of diabetes and obesity that have contributed to some highs and some lows.

But as you can see here, this past year, we believe a lot of this has washed out from the trends where we have now entered into this area of stabilization that speaks volumes about the strength and resilience of the Ozempic brand. And this franchise is performing really well and something, again, that we will continue to invest in because we have the ultimate in brand recognition. We are at the pinnacle of here having a household brand. And we're really excited about the fact that potentially having a 25-milligram pill to add to the armamentarium.

And the reason I'm so excited is because we have a little bit of proof positive already. Earlier this year, we introduced Ozempic pill, where we had a reformulation of what was once Rybelsus into Ozempic. And as you can see, we've had really nice transition occurring. But this is more than just a formulation change. This has actually opened up the door to quite a lot more utilization. In fact, as you can see, we have greater than 60% of the Ozempic pill new-to-brand prescriptions are coming from GLP-1 naive patients. And that's really exciting because what it speaks volumes to is that injection barriers are real for either HCPs or patients. And now having a GLP-1 in a pill for type 2 diabetes is really exciting with a brand like Ozempic.

And so again, this is the strength of having 1 brand with 2 indications or 2 product presentations in 3 indications. This is something that is most certainly exciting for us and one of the reasons we're going to continue to invest. I look forward to not only doing that with Ozempic and launching into CagriSema, but launching multiple products for the next 5 years.

And so Jamey, I'm going to hand it back to you to talk about those.

Thanks, Ed. So as you know now from the morning discussion as well, we're on the cusp of the potential to launch 12 new medicines in the next 5 years, and we're excited about that. So let me close before welcoming up my colleague for international operations with where I started. So we have a long runway ahead of us in the obesity space. Within diabetes, Ozempic pill is creating a new enthusiasm around semaglutide, around Ozempic specifically with new treatment-naive patients, GLP-1 naive patients coming over to the brand. And the excitement is palpable in terms of the breadth of the portfolio, as mentioned, not just individual assets, but increasingly a portfolio approach within multiple disease states.

So thank you very much. Look forward to your questions. And now I welcome Emil to the stage.

Thank you, Jamey and Ed. I have a microphone. Very good. I have around 20 minutes to give you a tasting menu of our strategy, our performance and, of course, the potential outside the U.S. So I will speed up, and I hope you are ready. Now we have a simple task from Mike, that is, of course, to be a key contributor to the growth outlook that was described earlier today. And we are confident we'll be exactly that. Our strategy, that's quite simple. No matter the archetype market, everyone is tasked with differentiating semaglutide across our brands.

We do that, of course, offline with our traditional customers, they're still important, but we more and more also focus, of course, on online differentiation on search engines with digital key opinion leaders, et cetera. The other key priority across our geography, that's, of course, to replicate what they've done so brilliantly in the U.S. when it comes to telehealth to really enable the reach of many, many more customers, but also to serve them better than we've done in the past to work on stay time, for instance.

Launching, of course, is also a brilliant way of reaching many more patients, particularly those with yet unserved needs, just as Habib has described earlier. Then we have talked already today about our upcoming loss and exclusivity. We are already facing that across many of our markets. And here, it's, of course, for us to capture the volumes when prices go down sometimes quite a bit. It's, of course, an immediate price effect and then we capture the volumes again week by week, and I'll also speak to that.

Longer term, the ambition is to grow through also the European LOE with growth. And here, we've already talked to some of the opportunities, particularly, of course, the obesity pill is an incredible opportunity in terms of Wegovy pill following on with oral zenagamtide, et cetera. We also have the growth engines described by Habib, Frehemgo in hemophilia, and sickle cell disease. The beauty of those 2 is we are not cannibalizing any of our current business. So it's a true add-on. I'll also speak a little bit to insulin. It's more of a steady diesel engine kind of growth, as you know, but it will also be a nice backdrop for our overall growth in the coming years.

This slide speaks a little bit to the performance. It will be familiar to some of you, how we have grown across therapy areas in recent years, also in first half and the regional contribution to that growth. I'll try and give a little bit more color to it. If you look at the therapy areas first, you see that it was really the year where obesity stood out in the first half. We grew 40% on top of the previous half year. That's quite something. Note that if you look at Wegovy alone, we grew more than 50%. You've asked about price. And within that growth of 50% in value for Wegovy, there was a mid-teens pricing headwind, but we are happy to give that up when we get that kind of growth and sometimes also good collaboration on stay time from telehealth providers.

If you look at, now not rare, but blood and endocrine due to our expansion, we had a very decent 5% growth there, very much driven by our endocrine business. But again, that's before some of the big launches that I will talk to later today. We have insulin. We had a little bit of a headwind in the first half. We do plan to grow on par with the market. I will speak to that. This was very much due to tender timing. And lastly, I'll also uncover a little bit our growth potential today when it comes to GLP-1 diabetes because it's actually better in some ways than what this growth would suggest in the first half.

Across geographies, you will see that it really was Europe and particularly Mainland Europe that stood out, also supported by Canada in the first half. There was a 20% growth with more headwinds in emerging markets where there's a lot of pricing and competitive pressure. So we, of course, would like to grow in all regions. But if we have to pick one region to grow strongly, Europe is great because that's, of course, where we have the longest runway when it comes to the patent.

Looking a bit outside in at the markets we operate in, how are they faring? You will see, as I said, that insulin is still a very decent area. We are selling or the market is worth around DKK 60 billion, growing 4% in value with 2% volume growth. And here, it's, of course, an upgrade game rather than a market that's expanding rapidly, and I'll also speak to that. GLP-1 diabetes in our part of the world outside the U.S., there's still very decent growth in that market, growing more than 30%.

But at the same time, it's probably the last time I present this slide with diabetes, GLP-1 being bigger as a market versus obesity because you will see obesity growing significantly more than 100% year-over-year. You might then, of course, say, can this continue with that kind of GLP-1 growth and particularly that kind of obesity growth in IO? And exhibit there, number one to the right, that's basically on the X-axis, the number of people across the 4 regions living with either type 2 diabetes or obesity, altogether, 1.7 billion. And on the Y-axis, you have the treatment rates.

And hopefully, you will gather that there's a lot of runway outside Europe and Canada, treatment rates that are well below 1% in most of these countries. But of course, also within these regions, pockets that look more like Europe. If you look to then Europe, treatment rates stand at 4%, but you have big variations within. So within Europe, you can easily find a factor 3 in difference in treatment rates. So there's a lot of room to also up treatment rates within Europe. When it comes to value, we, of course, want to win in all the markets, but it's worth calling out that Europe and Canada, that's 2/3 of the value when it comes to GLP-1 across IO.

And again, Europe is where we have, of course, most runway and where prices are holding up very nicely also when we look into the future. If we look at our competitiveness across, it's no secret that overall, we've been under some pressure if you look back the last year. You see a decline here overall to around 52%. That's around a 7 percentage point drop in 12 months when you look at our overall volume share across both diabetes and obesity in the once-weekly segment where, of course, the [indiscernible] is. The good news in this slide is we've actually been able to take our share up and so far stabilize.

So the low point around a year ago was a situation where we're enrolling 3 months took 3 out of 10 patients. We are now at a point where we are at 40% of the share growth, so 4 out of 10. That's quite a turnaround, and I'll speak a little bit to what drove that here, and that is actually region Europe and Canada, where we now have share of growth above our market share. And as you all realize, that's where you want to be if you are in commercial. So a significant turnaround driven by coming back to Ozempic in full supply, great performance in Eastern Europe where we launched late when it comes to Wegovy and also the U.K. really coming back, which I'll also speak to later.

At the same time, we recognize that we still have our work cut out when it comes to the other regions, share of growth is under pressure. Here, we are optimizing how we work. We can speak maybe about that in the Q&A. Now we are changing and transforming how we are set up across the globe. But at the end of the day, if you are ready and you have transformed yourself, there is nothing better in pharma than launching when it comes to changing dynamics. And we have planned what we internally call a launch festival in the coming 12 months or so. I cannot remember having been as busy launching during my 20 years in Novo Nordisk as we are right now.

Some of it, you might call life cycle management, but we treat it like true launches, and they have an opportunity to be transformative. You have up there 7.2. Our U.S. colleagues spoke to that. It's incredibly important when patients come to, for instance, a telehealth provider, what our weight loss promise is, whether patients need it a lot. It's a little bit like an electric vehicle. You might not need 700 kilometers, but if there's one car that has 400 kilometers and another 700, you're likely to pick that if the prices are somewhat similar. So efficacy still matters, particularly in a telehealth setting when 2 products are next to each other.

But of course, we also have the chance to improve stay time with 7.2. And you've seen the device out there. It's elegant in the sense that from a pricing perspective, the device cannot be clicked count. So we can also here be quite attractive. If you then look to the right, 2.0, we are late to that game in IO, but I'll show later that it really matters. We have great real-world evidence. Some of you might come to ESD, and we'll show the promise of that brand, both in terms of efficacy on weight and A1c. So really something where we add and then build on a brand that has, of course, phenomenal label with a critical organ protection. At the center, you have the Wegovy pill, best-in-class in terms of weight loss efficacy, great safety history with more than 50 million patient lives.

And then to Ed's point, if you -- for instance, our telehealth provider, drug-drug interactions and interference with statins, that's not very convenient for this patient population. And we also have a large share of women. So interference with all contraceptives, it's also messy. That's one of the reasons we think this is a real opportunity. And we know that there are a lot of patients on the sidelines. Many have felt that they are -- that going on in obesity treatment, there's perhaps a fear of needles, but there's maybe also just a perception where consumers don't see themselves as patients ready to start on an injectable treatment. So this has been a positive surprise as also shared by Ed earlier.

Here, a few examples of why we think these launches also when it comes to Wegovy and the high dose can really turn things around also across many more markets. The markets where we had the chance to launch first, that was in the U.K. And basically, you will see how in the U.K. from a low point, we have been able to increase our market share from around 10% to 30% during the span of a year. And it starts there at 10%, and you know how we came into the U.K. with obesity. We launched in a constrained and limited way that cannot be recommended. We are not going to repeat that for any other brands in the future.

But then with step-up data coming out last year and being able to communicate that medically, 21% hammering that away, coming with the label earlier this year and also having our commercial frontline out there talking to the data. And then finally, the device, we have really supported that turnaround. We have addressed many other things in the U.K. execution in the meantime, but definitely a big contribution from the step-up data and 7.2 in that significant turnaround here in the U.K.

Another slide that speaks to the power, of course, of launching and particularly the Wegovy pill. And this is a slide where there are a number of things to like, so I'll try and call them out. Basically, we have distributed more than 1 million packs in the U.K. since we launched early July. But what, of course, is really interesting is not just sell-in, but also sell-out data. Here, we extrapolate from insights gathered from 20 providers covering around 2/3 of the market. And you will see a very rapid takeoff. And just to give some sense of proportions, I also have an internal bragging slide comparing this to my good U.S. colleagues, basically looking at how we're faring here in the first weeks of launch versus the best launch in U.S. pharma history.

And what it shows is that the first 8 weeks in sellout, our U.K. colleagues, and we have our General Manager, Sebnem, here today, actually kept pace with the U.S. launch. Now in the latter 2 weeks, and that's why I'm not bringing it, the U.S. got ahead. And that's also good for Novo Nordisk, of course, given the importance of the U.S. and I don't want to take anything away from the best launch in U.S. pharma history. And also, of course, don't bet your pension on U.K. beating the U.S. So what is this speaks to, of course, is that if you nail it in the U.K. from the get-go and you're fully aligned also with the telehealth providers, it has an enormous potential. And I think some of you living here will sense that already.

Now what's also to like about this slide is that something happened between weeks 7 and 8. one of our better-known competitors launched into the market. And you will see that after that, we actually had an upward trend shift. So we had some of our best weeks in the last 3 weeks, adding 65,000 packs on average or so in sell-out data, so as soon distributed to patients. That, of course, is super important. We also can look at the sell-in data that's more messy here in the U.K. because there are a lot of fluctuations. But here, if you compare the first 3 weeks of our competitor with our first 3 weeks, we are around 4.5x up. So not far off what you heard in terms of share from our U.S. colleagues.

Then what's next? And I'm trying to preempt a question here a little bit that might come about the further rollout of the Wegovy pill in IO. And first, just recapping, we have now launched into 3 markets. They're important because they constitute around 1/3 of the current obesity potential in IO in value terms. And again, here, be a bit careful because when we look at current potential, we know that the Wegovy pill unlocks markets. So the markets we launch into will automatically become a bigger weight. But if you sort of look backwards, it's 1/3 of the current potential. That's, of course, all good and well.

We do have plans, as you can already see, to reach 2/3 of our potential going forward. And that's basically because our global manufacturing colleagues these days keep bringing good news in terms of how we crank up volumes in product supply. So really, really nice. And then you might ask, so what is the next market? And that is Mexico. And Mexico is actually a very exciting market. It's our largest obesity market in emerging markets. It's a market where we have just been able to extend our patent well beyond '29 for Ozempic and further for Wegovy. And it's a market where 7 out of 10 Mexicans -- adult Mexicans live with obesity overweight.

It's one that's typically been a very large oral market. It's one where the government is very engaged in obesity and it's one, of course, with a great pull from patients and one where we benefit from the halo effect of the U.S. So that's why we have picked Mexico as one of the next ones. We will have a number of other markets coming up. I'll not give all of them to you and competition today, but we are busy planning for an ambitious rollout, as you can see here.

In terms of Germany, I've gotten some questions, what's the potential of Germany and how are you looking at that? And why did you actually pick Germany as the next market? And one of them is that the unmet need, of course, is large in Germany. It's on par with what you've seen in the U.K. It's also a market that's changing these days. Germany, of course, has not been known to be sort of the most IT-friendly country in Europe. But actually, it's a market where telehealth is really taking off. A year ago, telehealth as share of the overall German market stood at around 7%.

Today, it's 30% and driving more than half of the growth. A lot of the players who are successful here in U.K. are also moving in successfully to Germany. So we, of course, collaborate with them. We see a significant opportunity here. How big it's going to be? Hard to say. We have 2 weeks of data. We are at around 46,000 in-market patients, very, very strong for Germany, so quickly into the launch, roughly half from telehealth and half from the traditional channels. What I also hear is that -- from the market that particular GPs are really excited about this opportunity. German doctors have traditionally been a little bit conservative. There's been some inertia. But here, we hopefully have a chance to unlock also the GP segment. That has been the way we got to close to 10% of the population in Denmark being treated similarly in Norway.

So if we can have both these engines going, GPs with good access and telehealth, it, of course, bodes well for Germany, but I'll let the numbers speak also in the future. Early on, I showed you that in GLP-1 diabetes, we were quite flattish in the first half. But this is as often as the case with IO, a story that maybe takes some unpacking because this is an area where we are washing out still some liraglutide sales. It's an area if you zoom in on Ozempic, we actually had decent growth, 8%.

But underneath that, again, there were sort of 2 stories. One was the markets where we have the long-running LOE, Europe, Oceania, Japan and now also Mexico. Here, we actually had phenomenally strong growth in the first half. Then we have headwinds across IO. We often talk about India, we talk about Canada, the early LOE markets, but generics are actually available in around 25 IO markets as we speak. Here, of course, we have more headwinds. Again, we take some of that pricing pressure immediately, and then we have to go in and fight for the volumes.

And in some of these markets, we've actually also been holding back on Ozempic, and we've launched quite late almost at the same time as generics. The strategy is clear in these early LOE markets. Often, we will launch with partners, second brands to really play the affordability game, also with strong partners that have good reach across these large geographies. In Canada, we have a savings card to keep the patients whole. 90% of Ozempic patients have opted into that card, and we're actually seeing good preservation of our volumes in the private channels in Canada.

And overall, we stick to our guidance that, yes, there's a solid impact here in IO, mid-single-digit impact this year in IO sales. Next year, we'll see a full year impact of that. We also have China coming in. We have -- with effect early next year. And of course, we will see an impact of that. After that, there's not so much happening until European LOE. And of course, those will be the years where we go in and fight hard for the volumes.

Looking then to the markets here, the sort of the old markets with a long LOE, we have definitely not given up on Ozempic, and that's where 2.0 comes in. We've now launched in around 10 markets. We'll be in 20 markets by the end of this year. And this is the 2 markets where we have the most insights, Germany and the Netherlands, around 13% of our total value in IO combined. Here you see the impact of the launches. We came from before this graph started being below in share of growth, our market share. And now we are above 7 out of 10 new patients to treatment in this space choosing Ozempic.

And again, it's the promise where most patients have already maxed out on 1 milligram. They stay longer if they move to 2.0, they have very good results, but it's also a good argument for starting if you're naive. This is then my closing slide. As I said, it really is a launch festival in the U.S. We are catching up with them in terms of some of the launches that have happened there in recent years already, and we are seeing a really good impact. But I do want to call out insulin. We serve 23 million patients with insulin across IO. Only 1/3 are benefiting from a next-generation insulin.

And if you look at modern insulins or analogs sort of the second-tier segment, we have a very low share when it comes to the basal segment, around 10% or so. So we have a real upgrade opportunity with our more than 40 weekly launches coming up in a number of markets, Kyinsu, so that's our weekly combination of GLP-1 and degludec and -- or icodec, sorry, and will drive that hard. It takes more time. This is not sort of an exponential kind of market. You are out there with HCPs, but we're also going to use what we have learned from a more consumer pull market and try and make patients aware that there are new opportunities. They can actually go from 365 injections to 52 with better outcomes in an easily used device that you can test yourself out there.

And then, of course, already end of this year, we launched Frehemgo in the first European market. That's the plan. It can become very big. We'll do our best to help Habib beat the 50% growth promise that was given on behalf of the company. It is more than, and we'll take that very seriously also in IO. Lastly, sickle cell disease. You saw 110,000 patients living across Europe. It is a population that's going to increase further and a huge opportunity. So there's a lot to come. You have the summary here. I'll not read it aloud. You can all do that while I invite, of course, Jamey, Ed, and Michael up here to guide the Q&A.

Thank you, Emil. Thank you, Jamey, and thank you, Ed. So we are ready for the next set of questions. So Kerry?

Kerry Holford at Berenberg. A question for you, Jamey, with regard to Medicare, the GLP-1 Bridge. How is that uptake tracking relative to your expectations? We can see your competitor has seen a more significant uptick in demand since that came online on the 1st of July. So what more do you need to do to capitalize on that opportunity and to unlock that going forward? And perhaps you can also talk to the opportunity with the pill Ozempic with [indiscernible] space?

Thanks, Kerry, for the question. We're pleased with the volume uptake. It is exceeding our expectations. Seniors are motivated for the first time to have access to weight loss medications. Not satisfied with our share achievement. We have crept up a few share points since the initial week. So in the latest week, our share emulates what I will call the share differential prior to Bridge in traditional Medicare Part D. As many of you may know, other indications, NASH, CVD, sleep apnea for GLP-1s were covered in Part D. So prescriber behavior has almost reflexively followed into the bridge. That's our job to influence and change. And Ed, maybe if you want to comment on the recent campaign launched with Wegovy pill.

No, absolutely. And I think you're right in mentioning the oral uptake and the opportunity that it represents. Our campaigns are very focused in and around Wegovy pill, knowing that most seniors prefer an oral administration. And we do believe that similar to what we've seen in the general market, patients will be more apt to ask for the pill once they know its availability. And so our campaigns feature very prominently the Bridge program and the affordability that it represents for seniors.

Great. Thank you very much. [indiscernible]?

Rune Majlund Dahl from DNB Carnegie. Emil, a question to you. You mentioned leadership in oral obesity. But when we look at consensus, then at least Eli Lilly has much higher sales going forward in oral. So leadership, is that in terms of sales? Or is that how do you define it?

That will be volume and value and keeping what we are delivering at the moment. That's definitely the plan. And as Hong suggested, we see this as a segment that by the turn of the decade, could be at least half of all volume in obesity care.

Sachin Jain, Bank of America. For Emil, thanks for the details on the ex U.S. rollout. Just more color as to the markets that are coming from a telehealth perspective, are they more close to the U.K. or more close to Germany as we think about sort of speed of launches through [ '23 ]?

Good question. And of course, when we talk telehealth, really the powerful model is when it's fully integrated. So dispensing is also together with prescribing. So the markets here that are big at the moment, that is the biggest U.K., it is Germany coming up, it's Australia, around 15% of the market in Australia, but it's, call it, 30% of the growth. New Zealand is really coming in as well. I'm not giving you the markets, but I'm telling you, the way we launched, but I'm telling you that they could, of course, be interesting markets as well. China is also becoming bigger and bigger when it comes to telehealth.

There are a number of other markets that are exploring this. One of the challenges telehealth companies have is that in markets, emerging markets where it's possible from a regulatory perspective, but where prescriptions are not fully implemented, part of their offering is somewhat less relevant and they have a difficult time competing with local pharmacies that also have scooter boys and girls that deliver, et cetera.

So it's possible in some emerging markets, but I would have to say we still need to see the models sort of work at scale in Brazil, in Mexico, in India, et cetera. But I gave you some of the big markets. We're also seeing more and more in some Scandinavian markets, particularly Sweden.

In the very back.

Emmanuel Papadakis from Deutsche Bank. Question for Jamey, maybe on your latest thoughts around the future evolution of net pricing in the U.S. across the various summer presentations. So maybe you could give us some thoughts both cash and commercial channel and just any perspectives on where you're thinking about pricing CagriSema relative to some launches?

So high-level thoughts on pricing only and then on the channels.

Yes. So just a high level on the channels. I truly believe that there needs to be a duality in the U.S., both reimbursed and cash pay or self-pay channels. The self-pay ultimately provides a release valve for the cost trend, cost burden of the branded marketplace and the reimbursed. So I think in terms of the future, I think there will always be viable channels, both reimbursed and self-pay, and they're not contradictions.

In terms of pricing going forward, we'll seek to, as I said, sustain net price viability moving forward. We'll value price the innovation that we deliver to the market with input from multiple stakeholders. But it is our intent, obviously, to hold value where we can and where the assets allow for that through the value that they deliver to payers.

Carsten?

Yes. Carsten from Danske. Just to reiterate the question that I asked in the beginning that Michael referred to this session about the Ozempic and IRA pricing now that you've seen volumes shift to different channels. So maybe the net pricing you're seeing today is not as high as you expected when you first talked about IRA impact? And then secondly, also on the Ozempic pillar, we've seen this very strong uptake. What's your assessment about cannibalization for Ozempic injectable franchise from this?

Let's just try to keep to one question, but if you can answer in very short, Jamey, on...

Yes. So in terms of Ozempic, as we've kind of suggested in your models from Q2 and previously, we see about a 10% to 15% degradation in terms of the price trend. Year-to-date, it's been closer to 10%, but still that range is viable. Playing forward that range into the MFP and IRA impact for '27, that is a good glide path. So other than that, obviously, we don't kind of guide on prices into '27. But there's less of a, I'll say, the stair step year-to-year because of the current price degradation that you see in the category with Ozempic as well.

It's Michael Leuchten from Jefferies. Jamey, a question for you on the subscription programs. You said there's a 3-, 6-, and 12-month option. Do you have any color on what the split is? What do customers opt for?

Yes. It is tending toward the longer duration plans. And thank you for the question because it gives me the opportunity to say, predominantly, it's Ro to date, we're scaling at Ro as well, but also beyond Ro. So the intent is to roll out subscription models throughout the telehealth network. And then also with the new functionality within NovoCare Pharmacy, we'll be able to tighter price over time, implement the subscription model within that platform.

Yes. Pete, I think it is -- okay.

Peter here from BNP Paribas. We spent a lot today talking about volume and about price. What about duration of treatment? Because you guys standing up there and us who've been following you over the years, it doesn't just seem to budge anywhere from 6 to 8 months. So I realize maybe it's a bit too early to talk about Wegovy pill because we're only 9 months into the launch. But what do you think it's going to take for that duration part of the equation to start shifting?

Maybe some comments both from the U.S. and also from IO.

Yes. One thing we haven't talked so much about today, that's reimbursement. And here, we're actually starting to get some real wins. You saw France coming in the other day. Here in the U.K., actually, we've got very good access into a 1.2 million patient population at high risk of CV and a nice broad prescriber universe. So reimbursement does move the needle. And here is where we get to sort of the almost type 2 like kind of stay times closer to 2 years. That's what we've seen in Switzerland, which is one of the early movers in this space.

The other is really telehealth. The best telehealth providers do a phenomenal job and can actually get close to 1 year in average stay time. And what we see is that if patients get past the first 6 months, the cohort does much, much better. So this is where we also commercially, of course, work to align our interest with, for instance, telehealth providers. So we benefit and we incentivize them to really do a great job of supporting the patients through that first titration stage.

And from a U.S. perspective, Peter, I'd say you're right, it's still early to kind of close out a discussion on stay time, but the early indicators are strong. The real-world evidence that Ed shared, you don't get to that efficacy without adherence in the real world as well as the subscription model clearly is encouraging patients to start and stay with by normalizing the monthly out-of-pocket burden. So we'll continue to look at the usage over time in the stay time and report back on that.

Take a final question. Yes, Rajesh?

You clearly have a very interesting new channel consumer emerging. So when you look at the demographics of patients who are being treated here, I'm pretty sure it must be slightly different, if not entirely different from the reimbursed channel.

How do you think the persistence compliance titrating up, et cetera, will react to economic cycles and sensitivity in the future? And given that so many of your competitors are going to, in the next 3 years, come to the market with a similar offering, I'm pretty sure yours is much better, but at a time when prices are become important in a weak economic cycle, how do you think the market would evolve in terms of pricing, adherence, persistence in your direct-to-consumer. Do you panic that you don't own these telehealth companies and direct relationships?

So consumer behavior and also something around segmentation and ownership of channels.

Yes. I would point you back to Hong's very first slide today about the multiplicity of motivators for consumers in this disease state. If you have asymptomatic hypertension, it's kind of one product category one patient characteristic, there are so many. We showed 3. There are thousands, right? So having a portfolio to play across that multiplicity of need is a huge benefit. And having a portfolio actually becomes a competitive advantage versus individual assets.

So we have to segment and apportion each product and appeal to, as your question alluded, the reimbursed space, which may want higher BMI starting points, more challenging patient populations with comorbidities and a cash pay, which will appeal to chronic patients, but also kind of acute recurrent episodic use of these drugs for their own individual motivations. So I think that's what we're building and what we see in the consumer insights back.

[indiscernible] demographic difference.

Yes. In terms of BMI, in terms of comorbidities in that respect.

Great. Thank you very much. So we will go into a small break before moving to the next sections, but definitely exciting around a festival of launches, product differentiation and best-in-class product and launch for the oral pill and what to come. Thank you very much.

[Break]

All right. I hope you're ready for some manufacturing. At least in manufacturing, we need to be ready to support the growth ambitions that we saw from Jamey and Emil, but also the ambitions from Martin to accelerate and diversify our pipeline.

And in manufacturing, we are confident that we have the capacity, scale and also the efficiency to do that in an attractive way over the coming years, not least because of the large investments that we have been through on the CapEx side over the past years. And I'll just start the presentation with a small video demonstrating the progress in a couple of the largest projects in our CapEx program. So if you can have the video, please.

[Presentation]

All right. What you saw in this video was Kalundborg. Some of you may have seen Kalundborg as part of the Capital Markets Day 2 years ago, where there was a visit to PP5 Line 1, which you also saw in the video here. Earlier this year, we had that first line validated and it has now been approved by the authorities, adding significant capacity to our network.

In Clayton, which you also saw, we are progressing according to our plans with our fill/finish expansions. And right next door, we also have our API manufacturing facility, which has been ramped up over the past couple of years. Last year, that facility alone delivered 5x the design capacity of the original plans, and we're on track this year to actually get to more than 6x design capacity and with even more to come in the future years.

But we also have very large expansions going on our other sites. Three of the main ones you see on this slide. We have Hillerød, where we both expand for API for our blood disorders franchise and cardiovascular diseases in a flexible way in some of the same facilities, and we're expanding fill/finish also in Hillerød. And in France and Brazil, we are continuing to expand our fill/finish network to get ready for future volumes and also to renew our network in terms of state-of-the-art fill/finish isolator technologies powered by AI.

Of course, capacity is not enough. We need to adapt our strategy to the new competitive environment that Mike was also alluding to in his introduction. And we are in the process of doing so with very good results so far. We have competition kicking in. We also have new customer dynamics requiring different variants, different device formats, new type of channels that we need to cater for. We have new requirements coming from the diversification of the R&D pipeline and of course, also geopolitics to take into consideration to ensure supply resilience. All of that is part of our new fast-to-customer strategy coming from manufacturing. And we believe we are well set up to deliver in this new environment, of course, partly based on the scale that we have from our network.

I'll remind you when we are talking market share developments, et cetera, that we are still by volume, the largest manufacturer of both insulins and GLP-1s in the industry with 41% and 51% volume market share, respectively. That scale is also turned into productivity through an engine of internal engineering and process optimization that we have been developing continuously over the past decades.

I started in manufacturing 24 years ago. Already at that time, we had a quite mature engine of process optimization that drove a large part of the COGS 20% journey that we were on in the '00s. And that is now being accelerated even further, also powered by AI. And we are confident with our program that, that can maintain a very healthy productivity journey ahead of us and at the same time, deliver on the same quality levels that we have seen historically.

Of course, new pipeline assets also require different modalities, and that's why we are expanding into new modalities. We are also going into synthetic manufacturing in a combination of partnerships, but also with internal capability building, most predominantly by our acquisition of the Petersburg site in the U.S. that has added a lot of capabilities recently. That flexibility will cater well for the growth in commercial, but also to the pipeline expansion that Martin was alluded to.

We have been reorganizing as part of our strategy to be closer with research and development to anticipate what does it call for from us, both upstream in the early asset development. And since the launch of Martin's strategy, we've been able to cater for the needs not just for product going into clinical trials, but also for process development so that we mature our processes and get them ready by the time that we are in an accelerated way getting to market with our assets.

So we feel that we are ready with the 5-year ambition also going through to submission, but we also have a focus on how we are ready through submission and approval to ramp up our capacities on the other side of approvals. And some of the things you see on the right-hand side of the slide is a testimony of our ability to adjust to that requirement. It was shared already that we were able at the time of launch of the Wegovy pill to have product available at pharmacies throughout the U.S., and we are aiming for the same in IO countries when we are launching there. We'll do the same as we are launching weekly across more than 40 countries in the coming 12 months.

And despite an uptick that also positively surprised us, we've been able to follow that demand development in a way that still leaves us confident that we can continue expanding into IO, as Emil was alluding to, with more than 20 countries launching over the next 12 months. All of that also powered by AI in our process development in order to mature as we are expanding to new disease areas as well.

And how you should think about our network going forward is that in addition to the legacy platforms that we have had in the network for decades, we have recently added in our new modalities with tablets in our new formats, significant capacity that enables us to be flexible across the different modalities.

Going forward, we will double down continuously on yeast. Yeast is yeast-based fermentation recovery and purification is a competitive advantage of ours. We have seen also as we have explored options for synthetic manufacturing that we are by far the most cost-effective producer in the industry according to all the data that we have been able to gather.

It comes with production process. Even other players that might have yeast-based production typically have fed-batch production systems where you add the ingredients into the tanks and you do your fermentation, but then you have to close the batch afterwards, whereas we have found a way to continuously produce and take out broth, send it through recovery and purification that is giving us immense edge in terms of cost effectiveness.

Also, downstream, you heard about the deal with Emisphere giving us the SNAC technology. That has given us a unique competitive edge in terms of how we can put peptides into orals, even larger ones without having them degraded in the gastrointestinal system and get through to the body for high efficacy, and we'll leverage that going forward. So those 2 areas are areas that we are doubling down on.

For the other areas, synthetic peptides, injectables and other platforms, we are focused more on flexibility by having capabilities in-house, but also having external partnerships to help us address different demands as they become more volatile in future years in a way that doesn't expose us cost-wise.

The same in terms of cost exposure, we also focused on in terms of geography with geopolitical developments, making that even more important. In terms of API manufacturing, we are concentrated in Denmark and the U.S. We want the concentration because that's also how we can accelerate our optimization program as we are coming to our fill/finish networks, we are geographically more dispersed closer to the markets where we are selling. That's more effective. It also lowers our exposure in terms of geopolitical developments.

And specifically for the U.S., we have been committed to the U.S. market for decades. And over the past 10 years, we have accelerated our commitments. We hear a lot of companies talking about their commitments to the U.S. these years. What you see here is what we have actually invested over the past 10 years, more than $10 billion and with already committed investments for the next 2 years, taking us above $12 billion. Add to that, our partnerships with another couple of billion dollars of U.S. partners also adding employment and of course, footprint. We now have 5 manufacturing sites across the states, which are also translating into a full U.S.-to-U.S. supply chain for our Wegovy pill.

And in terms of orals, we have a strategy on 3 legs in terms of how we think not just about our supply for Wegovy pill, but also for our full pipeline of orals coming through development. In the upstream API, we talked about CapEx. We talked about PP5 kicking in, but we are also exploring and developing further partnerships externally that will give us the flexibility to scale rapidly depending on how demand is evolving over the coming couple of years.

But also downstream in our tableting manufacturing. I'll remind you that it's not new to us to do tablets. We've done semaglutide tablets since 2019 in our Copenhagen facility in Måløv. That, again, was building off on almost 50 years of tableting experience within our women's health franchise, HRT. And we can see that we have evolving -- been evolving our capabilities over the years, especially now that we are adding capabilities from the outside, for instance, with our Athlone acquisition that we announced earlier this year in Ireland and which will add capacity and sufficient capacity to the network to follow what we are scaling up on the API side and of course, also supported in the U.S. with our Durham scale-up.

All of that combined gives us the opportunity, as Mike was alluding to, to get to 10x the number of patients that we are treating today. And we are very confident that we will get to at least that level by 2030. Of course, that's only attractive commercially if it's also attractive from a cost perspective, and that's why the third leg in our strategy is to continuously work on lowering the price of an already effective manufacturing setup.

We have a program in place to do so. And that leaves us confident that by 2030, we will be able to maintain our margins broadly stable compared to what they are today despite the price erosions that has also been alluded to earlier today. And we do that through continued API optimizations with the engine that I was talking about, which we are seeing is accelerating. But it's also through formulation upgrades. We have new generations of our SNAC technology coming through, increasing bioavailability and hence, lowering the need for API in our manufacturing. And in our fill/finish network, in particular, of course, we are also, on an ongoing basis, ensuring that we are rightsizing the network in order to stay productive across our network.

So as we look into the coming couple of years, in addition to our cost optimization programs within our existing network, we are, of course, also cautious in terms of how much depreciation load we are coming in with from our CapEx investments. And we are confident that we can sustain the growth trajectory that we saw in the strategy without adding too much extra CapEx.

Actually, we have committed to having last year as the peak year. And this year, we will get below DKK 55 billion in CapEx, and we will see a continued reduction, getting closer to industry level CapEx to sales by 2030, still with the opportunity to support the growth ambitions commercially and in R&D.

So I hope this leaves you with a flavor of our confidence from manufacturing to support growth while reducing CapEx to sales and maintaining our margins broadly stable over the coming couple of years, but I'll let Karsten allude a bit more to that on the financial side. Thank you very much.

Thank you, Kasper. That's a really nice segue to the CFO, lower CapEx and productivity and a strong gross margin. So thank you for that.

And great to see you all here this afternoon. This is the last presentation, then we move into Q&A. So hang in here. Now I'm trying to take the gist of all the presentations, all the strategies and plans that have been very nicely laid out by my colleagues and then articulate that in a financial manner.

So first, before we look ahead, then I think it's important that we kind of just stabilize and then say, so where did we come from? And when we look back for the past 4 years or so, then we've been through a period of hyper growth. So we more than doubled the company in 4 years' time. We tripled our investments into R&D in that period of time, and we scaled CapEx by 10x. So really a period of hyper growth that, of course, put the company into a totally different league.

So unfortunately, growth has come down. And now the reality is that we are looking into lower growth already where we are this year. So what we're looking at, as Mike Doustdar explained earlier today is that we're looking at an industry which is growing mid-single digits measured CAGR from this year until 2030. And our aim is to grow at the same pace as the industry, so mid-single digits.

So where does the growth come from? It's actually fairly simple. It comes from 3 main drivers for Novo as a company. The first driver, you heard about, that's all Wegovy. So the Wegovy tablets, we just heard from manufacturing, scaling 10x compared to where we are today, 1.5 million patients on the Wegovy tablet today. So we have the capacity to roll out. And then you heard from Emil that he's just getting started right now. So only 3 markets and many more to come. And Jamey and Ed are also just getting started in the U.S. in terms of penetrating the market.

So the Wegovy tablet, the runway we have there is one of the key drivers for growth until 2030. So that's number one. Number two is our pipeline in diabetes and obesity. And let me just remind you what you heard earlier CagriSema. We have PDUFA late this year, to launch early next year, knock on wood. We have cagrilintide. We have cagrilintide mono. We have zenagamtide later in the period. So we have a whole string of launches in diabetes and obesity, CagriSema in diabetes also. So that's the second driver.

And then the third driver is our blockbuster launches in blood and endocrine and even liver. So you heard from Habib on Frehemgo. So now we got the positive opinion from Europe just now, and we're awaiting PDUFA from the FDA. So starting to launch Frehemgo, clearly a multi-blockbuster potential product. And later on, etavopivat. And then towards the end of the period towards 2030, we're looking at efruxifermin that you heard about from Martin and Hong. So a whole string of pipeline launches, Wegovy tablet and then, of course, our in-line portfolio in the market. Some offset through price and LoE in some markets, as you also heard about. But net-net, we aspire to drive growth, mid-single-digit growth CAGR-wise towards 2030.

So but the lower growth, of course, comes on the backdrop of hyper growth. And as a consequence, exactly a year ago or like a year and 10 days ago, we launched a major transformation program. You heard about it from Mike. So a year ago, we announced 9,000 people being laid off by the company. That's not something we do lightly. It's the biggest ever in Novo Nordisk. It's the biggest ever in Denmark. So doing that was no fun at all.

But what we've done on the back of that through tight management of the company is actually getting us to 13,000 employees lower today compared to a year ago, and this is end of August. So even lower compared to end of first half. So tight management to drive an efficient organization. And on top of that, all our indirect spend, we really scrutinized with procurement, efficiencies, et cetera, in order to invest in our growth options I covered before, and of course, drive productivity with an increasing revenue per employee that you see on the right-hand side, which has gone up almost 50%, and we see continuing to go up.

So then how do we then allocate our resources and our capital for the coming years? It really takes a starting point in our corporate strategy you heard this morning, strengthen and expand our core, build future growth engines and then explore Consumer Rx. So clearly, the majority of our resources will be going into the core. They are already going into the core. They will continue to do so. But as you heard earlier today, we need to build further growth engines, blood and endocrine, liver diseases, cardiovascular diseases. So we are investing in those areas, mainly in R&D, but of course, also in the launches that you heard about in blood and endocrine.

And then finally, Consumer Rx. This is a smaller bet in financial terms right now. We need to prove some opportunities we see in R&D, as Martin alluded to. And then as we see those opportunities pan out, of course, we're going to invest hard behind that to drive growth. And the reason why we do so and we look for those future growth engines is, as you heard this morning, it's about creating a bigger company in 2035 compared to what we are today. And that is not only done by diabetes and obesity. There we need the additional growth engines.

So in short, invest in R&D to grow and diversify the pipeline, invest in our growth brands and then scale capacity to execute on that. So allow me to do this and go through the resource allocation line by line. The first one you just heard from manufacturing from Kasper. We have a gross margin around 80%. And when we look at the gross margin and how that works out towards 2030, our aim is to keep it broadly stable. There are pushes and pulls. So on the negative side, we do see lower prices of our biggest products, and we do see depreciations of the CapEx program we've been running. So to offset that, we really focus on driving optimizations, as you heard, both in our supply network, in process yields as well as new and better formulations of our SNAC platform and then a lot of AI across the board.

SG&A. I think here, it's really important also to look back. So we scaled SG&A for massive growth over the last 5 years or so. And -- but at the same time, we grew SG&A at a lower pace than our top line. So we've taken our SG&A ratio down from 29% to 23% over the past 4, 5 years. And what we're looking into over the coming period towards 2030 is to take the SG&A ratio further down. We still aim to increase absolute SG&A, but we see the ratio coming down closer to that of the industry around 20%. And the way we do that is really to drive a lot of efficiencies, both front office and back office through AI and just general optimization of go-to-market. Jamey was talking to the NovoCare platform and how we drive productivity and efficiency on that platform. But it's not only about efficiencies and productivity, it's also about really investing in the key growth opportunities we have as a company. I spoke about the growth levers in blood and endocrine, potentially in liver later in the period and then, of course, being competitive in obesity. So we are not saving at the expense of top line growth. We really want to drive top line growth in the mid-single digits towards 2030 CAGR.

All right. R&D, as I said before, we scaled that by 3x over the past 4 years or so. And if you look at the ratio, then we took the R&D ratio from just below 13% R&D to sales to 17% last year. And what we're looking into for the coming years towards 2030 is to continue to expand R&D at a faster pace compared to top line because we want to build a bigger company by 2035 compared to where we are today. And you heard earlier today about the risk-adjusted pipeline value of late-stage assets of around DKK 150 billion. And of course, the task is with these investments into R&D that we want to further build the DKK 150 billion and exceed that by progressing our early-stage assets, do BD and put that into our pipeline. So we are a bigger and stronger company in 2035 compared to what we are today. So when we put all that together and say what does that translate into in terms of operating margin, then the starting point is, and you see that on the left-hand side. When you compare our operating margin to that of the industry, we have one of the strongest operating margins in the industry. So that's our point of departure today. And what we aim for the period until 2030 is to maintain a broadly stable operating margin. And the way we're going to do that is a lot of efficiencies in manufacturing, so broadly stable gross margin, continue to invest in R&D and then optimize SG&A to neutralize the R&D investments on a ratio basis. So net-net, broadly stable operating margin by 2030. There may be yearly fluctuations depending on pipeline progressions and how that works out. But by 2030, our ambition is broadly stable operating margin compared to today.

But then you'd say, hey, Karsten, that's only accounting. What we have out is cash flow. So what happens to cash flow? And the ones of you who have followed us for a long time know that we have a long history of strongly converting our earnings into cash. And what you see on the left-hand side is that over the preceding 4 years, we also more than doubled our cash flow from operations and with an ambition to deliver mid-single-digit top line growth for the coming period at a stable operating margin, you should expect our cash flow from operations to continue to expand. Then put on top of that, that with manufacturing, we have passed the peak on CapEx. So we are going from a CapEx to sales ratio of around 20% last year towards an industry level of mid-single-digit CapEx to sales ratio by 2030. That yields a very, very attractive gearing in terms of cash flow generation towards 2030. Then what are we going to do with the free cash flow? And here, we come into our capital allocation, which has been discussed also earlier today. So our starting point on capital allocation is, first and foremost, invest in the company where we see attractive investment opportunities according to the strategy laid out earlier today. So that's the starting point. The second point is return capital to our owners, to our investors. And we have a long history of delivering an attractive dividend per share. You see that on the right-hand side, 31 years and counting of increasing dividend per share. And our starting point is really return around half of our profits to our shareholders, and that has yielded a very nice dividend per share trajectory for now 31 years and counting. Then thirdly, invest in pipeline, invest in BD, which has also been discussed earlier today. And when you look at what we have done over the last 5 years, then the BD investments over the last 5 years have been far greater than any time earlier in the 100-year history of the company. It was more or less nonexisting just 5, 7 years ago. So we have really ramped up our efforts in BD and we'll continue to do so in the coming years, provided that we find attractive targets that fit our strategy. I'll come back to that.

And then finally, excess cash, we return to our shareholders through the form of share buyback. So if you layer share buyback and dividends together over the last 5 years, then in combination, dividend plus share buyback the last 5 years, we returned DKK 270 billion to our shareholders. So massive cash generation and significant capital return to our owners.

Talk about business development. You heard about it earlier today. The strategy is a bolt-on approach focused on building a stronger, broader, more diversified pipeline to drive future growth of the company. The way we assess it is strategic fit to our strategy. Do we like the science? And finally, do we find the financials reasonable in what we're looking at? Can we afford it? Yes, we can. The starting point is the cash flow generation I showed you before. And beyond that, when you look at our balance sheet, then we have one of the lowest gearings in the industry in terms of net-debt-to-EBITDA. As you saw end of last year, 0.7, so one of the lowest in the industry. And as a consequence, our credit rating is top 3 in the industry, which is really important when we are out taking on debt in terms of new bond offerings. So our cost of capital in the debt market is really attractive with ratings like this. So that covers the financial presentation. So in summary, mid-single-digit CAGR sales growth towards 2030 at a stable operating margin, investing in pipeline through R&D and business development and expanding our free cash flow and maintaining an attractive dividend per share. So that's a short story on financials.

And with that, I'd like to invite Michael and Kasper on stage for Q&A.

Thank you, Karsten, and thank you, Kasper. Lots of stuff happening on the manufacturing side and tight financial control as well. Simon, you got a new one? Chris is running.

Simon Baker from Rothschild & Co Redburn. Just returning to the pretty much the last thing you said there, Karsten, on the growth CAGR to -- from '26 to 2030. You put a slide up showing the headwinds and the tailwinds. And some of the headwinds and tailwinds have clearly different visibility. So there's a lot more visibility on pricing as a headwind. There's a lot less visibility on volume as a tailwind because the whole elasticity of demand is still being worked out. Is that level of visibility reflected in that number? I'm basically angling, is that mid-single-digit growth number necessarily conservative because of the different visibilities of the price and volume over that period?

Yes, Simon, thanks for that question. And that's, of course, also -- when talking about a CAGR until 2030, you have push and pulls in a CAGR like that. One thing is just the underlying market fundamentals that you allude to. Put on top of that uncertainties regarding pipeline products and commercialization of pipeline products. So you can say we worked with a number of scenarios and including price elasticity and volumes and uptake and also realistic uptake of our pipeline products, and we put all that together. And then we said, in summary, it's reasonable to expect based on our full knowledge today that we should be able to grow the company by mid-single-digit CAGR towards 2030.

Richard?

Obviously, one of the key drivers is the CagriSema launch and obviously, the oral rollout. So just thinking about the proportionality of those key drivers to your top line growth. With regard to CagriSema, just thinking about that full launch, how much of a full launch is it? Is it all channels? Is it -- how do you position the product across the -- in the commercial oral place and also into the KOL doctor-led, just positioning and how much proportion is CagriSema in the launch -- in the growth [ profile ]?

Yes. So first and foremost, if I start with the modeling, then CagriSema is important. So I laid out 3 main growth drivers, again, Wegovy pill, our pipeline products in diabetes and obesity and then our pipeline products in our other therapeutic categories. So we're talking about the second category and CagriSema is a product that comes first. So that's, of course, one of the stronger gearings we get in generating the CAGR. So the short story in terms of our launch plan is all in across all channels. So we invested all in for Kasper and manufacturing. So we built the full supply chain network. You can see a very nice device outside the door. And then we're going all in across channels, and you should also expect us to launch in several geographies over the period.

In terms of more specific positioning and so on, I think we should save that question for the full panel Q&A coming up in 10 minutes.

Yes, there's a panel coming up. In the back.

It's Graham Parry, Citi. Just when we think about the growth drivers there, when you think about Wegovy pill and the geographic split of international operations versus the U.S., should we be thinking that this several years out would look like the same kind of mix as Wegovy injectable? Is that the right sort of analog to use? Or is supply still going to mean the 2/3 supply market, I mean that it will, by definition, be a bigger product in the U.S. proportionately than Wegovy injectable was at peak?

Thanks, Graham. So as I understand it, we can also save some of that for the panel in terms of exact split, but more generally speaking, Kasper, how you're sort of readying for additional launches outside of the U.S.

Yes. So what I hope became clear from our presentation is that we have found avenues to really ramp up our -- for our oral launches, maybe also more than what has been the narrative out there. And we are very confident, as you could see also in Emil's presentation, that we'll be able to support going to a much broader expansion into IO over even the short to medium term.

Sachin?

Sachin Jain, Bank of America. CapEx question. You sort of commented in your presentation, you've got visibility on the cost differential versus other players. I wonder if you could just touch on that. And the question really comes to the level of confidence your CapEx moat in 2031. Do you still believe in that or not? Because it wasn't really mentioned as sort of protection post-'31, it was more pricing down, volume offsets. Just some color on that would be helpful.

Kasper?

Yes. So as I mentioned, we have gained significant insight into the structural advantage of our yeast-based fermentation platform vis-a-vis the synthetic manufacturing that we are typically seeing also coming through on competition. And I don't think it's argued by anyone that it is by not a small margin -- we cannot allude exactly to the type of margin, but we are much more cost effective when you compare different peptides apples-to-apples, and that leaves us very confident, especially because we have in our platform flexibility to swap between some of the different products coming through our pipeline. They're not needing to be fully dedicated. And we have an optimization program that we're also confident will even let us stay ahead of the curve as we are going in also beyond the decade. So yes, we are confident in our competitive advantage in that area.

And if I can just add one comment to Kasper's explanation, then of course, the moat is most significant in the tablet space. So with the bioavailability and the required API for, for instance, the Wegovy tablets, then amount of API and the CapEx required to get to that magnitude of API, you've just seen our CapEx numbers, then it's a significant investment and financial bet that anyone will have to take to get into the Wegovy tablet. And then layer on that to Mike's earlier presentation that we actually do have formulation patents for the Wegovy tablet. Now we are on our second generation and more generations to come. So especially on the tablet, quite significant moat.

[indiscernible].

Just as we look at the -- should we look at the near-term investments in Wegovy Pill, Cagri and then the acceleration in clinical trial starts? Should we think of that as -- should we think of 2027 as an investment year as you try to diversify away from semi?

Well, so just looping back to what I said, then first and foremost, our ambition is to drive mid-single-digit CAGR growth until 2030. And unless we get going as fast as possible, then that gets harder and harder. So expect us to lean into growth drivers as hard as we can. But at the same time, you have the controlling measure with the margin being broadly stable in our commitments. Specifically for '27, I'm not going to comment today. On that, I look forward to guide about that in February. So we'll be coming back to that then.

Seamus?

Karsten, I guess one of the questions that I have is not about necessarily the scalability of the supply, but the durability of the assets beyond 2030. I know you're not providing guidance, but you have provided sort of a framework for how to think about 2035. So -- can you help us understand what is the most durable part of the semaglutide franchise? Is it the evolving SNAC technology that's going to draw those assets in Wegovy Pill out further than anticipated? Because when we've asked this question before, we've been told stick to 2031, '32, and it doesn't feel like that's possible given DKK 150 billion from the pipeline and the very large circle that you guys put up there for 2035. So just trying to get a little bit more color on how we should be thinking about that. It does seem like the SNAC technology is your advantage.

Yes. So first and foremost, the nature of this industry is that we have to renew ourselves every 10, 15 years. That's kind of the contract with society that patents run out and then competition comes in. And that's why we need to, at pace, renew ourselves. In terms of stickiness of the sema franchise, I would put it in a couple of categories. So first and foremost, regardless, we are going to defend vigorously what we have with Ozempic and Wegovy injectable. Prices will come down. That's what we see in Canada. But as you heard from Emil, we are fighting to keep as much volume as we can. And we have a lot of experience in that space also from our insulin base, and you can see that over the last 10 years. So that's one piece. The second piece is, as we spoke about on our oral franchise, I think it's a harder franchise for competitors to get into due to the reasons I mentioned before with the -- unit costs, CapEx requirements and patents. So I wouldn't issue 100% guarantees, but I think we have a stronger protection in that space. And then finally, with CagriSema, and we've seen some wonderful data today with REDEFINE 9 and REIMAGINE 5 with CagriSema and the combo of amylin, there we are into late '37 with the amylin compound patent. So there, we also have nice durability. But I'd say on top of that, that clearly will have pressure linked to LOE. And as a consequence, that's why we are pushing so hard on resourcing R&D and doing BD to expand the DKK 150 billion that we see today in the risk-adjusted pipeline.

All right. I think that was a really good summary, and we're sort of approaching also the final panel debate. So Kasper scaling like there was no tomorrow and Karsten also clearly with ambitions for the company also to grow both midterm and then, of course, also obviously towards the next decade.

So with that, I thank you for this session. And then I will ask Mike and all the rest of the EVPs to join the stage, and then we'll do a final panel Q&A on the day.

All right. Thank you very much for hanging in, and we are sort of going towards the last stretch. So I would also -- besides the familiar faces you've already seen during today on the stage, I'd also like to welcome 2 other EVPs. So Tania Sabroe at the very far right, it must be, EVP for People, Organization and Corporate Affairs. And also here on my left side, Thilde Hummel Bogebjerg, who's EVP for Enterprise IT and Quality. And before we sort of kick off the full session on Q&A, maybe I can just ask a few questions to you on stage. So Thilde, first to you, welcome to stage. So one of the things we've seen is that AI has sort of moved from being a topical theme to going all in across organizations. What is the biggest change you're seeing to AI in Novo? And also, what would you like the investors to be able to see when we come back to the next CMD that has really happened to technology adoption at Novo?

Yes. Thank you very much, Michael. As you have heard today, our AI strategy is fairly ambitious, but it's not an AI strategy on the side. It's really built into our business goals, targets and our corporate strategy. So we will push really hard towards productivity, but we also have some big bets, big focus area where we will invest where it really matters, going into supporting a broader and more faster-moving R&D pipeline. And at the next CMD, I'm pretty sure you will see that a quite a good part of our core processes has been completely redefined. We have really been thinking not only kind of squeezing out our core process where we're going to go from A to B, but really redefining how we do it with AI in the center.

Great. Thank you very much, Thilde. And to you, Tania, so strategy, I would say, is only as effective as sort of the ability to execute on it in the organization. So we have undergone a lot of change in Novo in the last 2 years. What has sort of been the most difficult mindset and behavior to change? And also, as the question to Thilde, what do you hope that investors will be able to see from that culture change going into the next CMD?

Yes. Thanks, Michael. I mean you saw both Karsten and Mike talk to the leaning of the organization that we have done over the last 12 months. We came from being a successful, large but also rather complex organization. So in the last 1 to 2 years, we have really focused on effectiveness on the leaning part, but also on simplicity in our structures, in our governance and in how fast we are able to make decisions. So I think that move is something we are still working on. And of course, it's all with the aim of executing on the strategy, but also on competing for the next 10 years in new markets and also in the consumer space. So those are fast and rapid changes for the organization and for our people as a whole. You can measure us when we come back to the next CMD to see if the transformation has worked, and that will be on basically measuring whether we're living up to our targets and the ambitions that we have presented today.

Very clear and also leaning on the competitiveness in the organization. So with that and 25 minutes to go, plenty of room for all the remaining burning questions. I'll do my best to allocate. It's not that easy to see from up here. but I have colleagues going around with microphones. So remaining questions, Florent, I see in the back.

Florent Cespedes from ODDO BHF. A question on M&A as there is a strong cash flow generation and also low gearing. Could you consider to go big and to acquire products, assets which are already on the market?

So to Mike, I would hand that question and maybe also Karsten with some follow-ups.

Yes. I would not rule it out. Yes.

Karsten?

All right. Thanks and nothing more to add. Nothing more to add. But the strategy is still bolt-on for the time being.

Next question, Thibault.

Thibault Boutherin from Morgan Stanley. Just a quick question on the U.S. market. One thing we haven't spoken about so much today is compounders and the competition from compounders. So I guess the question is what is baked in your assumption for mid-single-digit growth to the end of the decade in terms of what compounders will do? If you could give us a bit of color on what's happening now in terms of volume and anything you can see with your intelligence? And is this just a fixture of the U.S. market? And are they here to stay? And is that your expectation?

So I'll give it to Mike first, and then maybe Jamey can elaborate a bit more.

Yes. So -- I think as you have seen, the compounders and their financial impact has gotten less and less on our business, and we're speaking actually much less to them for a couple of reasons. One, because a number of them have decided to start selling the real products rather than the compounded version of them. Two, with the prices coming down, the incentive from the buyers has become much, much less, I would say, than what it was 2, 3 years ago. And we have seen quite a bit of success with that. But this continues, and we continue, of course, putting pressure, making sure that everyone understands that at these prices, there is really no reason to move to compounding. And I think the team in U.S. continues to be quite successful in those dialogues. And maybe you want to mention.

Yes. Just to add, this isn't just a GLP-1 or a sector issue for a couple of companies. This is industrial threat to the patented R&D-based industry, the idea that compounders can put products on the market that aren't even in some cases, FDA approved yet. So we continue to work with the U.S. government, increasing the pressure. And ultimately, our ask is to eliminate inauthentic API importation into the U.S. But as Mike said, the market evolution is also kind of alleviated some of the initial motivations. Obviously, our sustainable supply has relieved one of those motivators, our pricing another. So we continue to see less of the compounded market reflecting semaglutide compounding.

Karsten?

Yes. So Thibault, just adding that into our top line ambitions, you should hear what Mike and Jamey just articulated as it's an upside to our ambitions in case the U.S. regulators close down compounding in the U.S. So we have no upside baked into our numbers.

Or if some of the larger ones decide to join us?

Yes.

Kerry?

Thank you very much for the overview today. It's been great. So my question brings us back to business development, please. Should we assume you are only going to consider business development opportunities that align with your existing therapeutic areas of focus, obesity, diabetes, endocrine and maybe cardiovascular as well? Or will you consider TAs outside those focus areas? And maybe linked to that, you talked a little about the consumer opportunity. So again, are you looking to stay within your existing therapeutic areas of focus for that? Or is that an area you could go more broadly?

Yes. So as I mentioned earlier, now we have set the strategy quite clearly where we're going to operate, both be it in core, some of the new growth engines, so blood, liver and CV. But we also have the exploration of the consumer area where the consumer demand -- strong demand meets prescription medication. In all of those areas, in our slides, we actually had a reference to business development, making sure that, first and foremost, we start with what we have in-house. But when there is a strategic and/or a scientific gap, we actually go outside and look for interesting assets and bolting on those to what we do. So you should see BD activities and search in our core, in the middle area of new growth drivers, CV, liver and blood disorders, but also in the consumer Rx area.

Great. [ Thomas ]?

[indiscernible] From ADB. I just wanted to follow up on amylin 355 you discussed earlier. So I understood that you expect this to be sort of similar on efficacy and tolerability to Cagri. I'm just curious to hear your comments on the PK profile. So is this also sort of similar to Cagri on peak-to-trough and Tmax, Cmax? And then if I can squeeze in just on how you see the merits of DACRA compared to selective amylin given the recent clinical data?

Yes. So on the last question, I don't think there is anyone who can give you a clear answer today. This is why we specifically built a pipeline that caters to both the amylin side, the calcitonin side, but also the DACRA side because we clearly need to figure out is there a differentiation in terms of driving efficacy versus the tolerability. And having more than one shot on goal is obviously a way to mitigate the risk. So what we've seen with amylin 355 is the possibility to deliver a once-daily tablet. That should make you think that the half-life is probably more like the weekly injectable products because that basically caters to a really, really nice peak-to-trough. We're not going into details at this point, but we're happy with what we've seen.

Pete?

Pete Verdult, BNP Paribas. Just a quick one for Mike or Martin. Just on the zenagamtide, is there any scope or intention to file that as a BLA? Or will that be an NDA?

Martin?

That will be a BLA. It's a fairly large molecule. So it will be a BLA is the intent.

Quick question, quick answer. So that was good. Simon?

This is a fairly big picture question, but it's one that gets asked a lot and generates a huge amount of debate. And that's around the semaglutide LOE in the U.S. between those that think that the new generation products would move people off it. So those that think it not only kills your obesity franchise, but it kills everybody's obesity franchise. So it'd just be good to get your perspectives on how big the cliff is in '30, '31, '32, to the extent that you will have presumably moved a lot of people on to CagriSema, Wegovy pill and zenagamtide. And what does the bit on the other side look like in terms of the residual semaglutide there? Because this is slightly different because it's a branded category as well. How much does that keep the product in the same way that Tylenol is a $1 billion product 50 years after it went after patent?

Jamey and Mike perhaps and then also maybe me adding some comments also on how we see it in IO. Jamey?

Just in answer the way you phrased it from a macro kind of LOE environment, we are students and will continue to be students of kind of peri-LOE analogs in the market, and there's a lot to learn from past precedent, all sorts of strategic and tactical ways to compete in the peri-LOE period through price, through LOE tactics like private label, et cetera. So lots of examples over the last 5, 8 years, looking at HUMIRA, adalimumab as an example, looking at the respiratory space, where companies have preserved volume over time, not experiencing the dramatic cliff maybe as evidenced all the way back to atorvastatin and in the U.S. As you said, it's our goal to get as much volume in the pipeline assets as possible before the LOE. And we think we have the assets to do that. And then we will, as Mike laid out this morning, compete for volume. I think as semaglutide goes LOE, the amazing -- the receptivity of payers for access, which opens up opportunities to present the new innovation in targeted subpopulations because the value valve release will be there for the third-party payers. So I think we could be talking about competing in a much larger volume market with selective offerings in targeted subpopulations that command better prices.

I don't have much more to add. I think you covered it.

I can maybe say on Europe, to Karsten's point, the more we can shift to oral, the better, the bigger the moat, particularly also in the cash channel, where we will be competitive on production cost, but where branding also matters and trust. So that's an important shift. The more innovation we can get also on convenience and stay time and muscle preservation, the more that will also lend itself to a strong market share position beyond LOE in the cash channel. When it comes to the reimbursed play, here, we could see a future where there will be step-throughs, just like we've seen in the insulin space that it will be patients who are not well controlled with comorbidities that lend themselves particularly to some of the innovations that are then upgraded to future generations. So that's probably a more segmented market from that perspective.

Maybe I will add something. If you try to use a bit our insulin business as a proxy and look at it globally, then you see that today, we still sell a lot of human insulin, a generic -- we are the biggest generic insulin maker in the world. We don't sell them in U.S. typically, we don't sell them in Europe, but we sell them around the world, and it's a very large volume and somewhat okay-ish value albeit not super exciting. We have been able to, over the period to upgrade our insulins to better and better version of it. And we're just in the middle of, by the way, reinventing ourselves with a weekly and Kyinsu that Emil touched upon selectively in various different markets. While in other markets, human insulin continues to actually stay and sometimes even grow. If you think about semaglutide, you could see it as standard of care in 2035 in a number of places that's still at a relatively lower price, people are buying it and a standard of care. As I -- as Jamey already said, I cannot see that in a big way in a place like U.S. On the other hand, I remind you, we have a better semaglutide. It's called Cagri semaglutide that goes much longer in its patent. So if I was just a patient today on a semaglutide in U.S. and someone would come and tell me there is a better version of that available I would seriously consider that. So the idea of -- and then that's just one asset. We have multiple others. And then, of course, we have the oral as well. So this is how we see this. And there are major price differentiations available just because metformin existed in reduction of HbA1c at minimum price, nothing did not stop people going and buying out of pocket often and Ozempic at 30x more, which also reduced HbA1c initially. So you have to a little bit look at that from a segment, and that's why you need all these different assets.

And maybe I can also add a point. There's sometimes a discussion around telehealth in Europe. Would they just be interested in running with the generics? But in Europe, as most of you will know, patients don't like paying for consultation. They're not used to that from the health care system. Most of these telehealth providers also have a business model that's based on the markups on the products. So they will also have a strong interest in providing better care, selling products with a longer stay time and lifetime value, et cetera. So the more the market moves towards high-quality online providers, the more we will also have support for sort of a more quality offering with the newest products.

In the back.

Just a follow-up really. Maybe give us a sense of what proportion approximately in percentage terms of the sema franchise you think you can switch off sema by the time of LOE? And then maybe just help frame expectations a little for the CagriSema launch. Mike, you talked pretty consistently about your expectations being out of ours. So how much do you think you can convert sema into CagriSema over the next year or 2? How fast should we expect that to launch in the near future?

So high level, if we take the launch first in the U.S., Jamey, on high level without providing sort of specific numbers.

We'll provide conversion statistics on an annual or 2-year basis. But I go back to Mike's opening remarks, more than 5 mega blockbusters over the period. So that gives you a sense of the expansion and also within that, some degree of conversion.

Carsten?

Carsten from Danske. Emil, I guess this is a question to you. So looking a little bit about the performance in the U.K. market after you launched the Wegovy 7.2 milligram. Why aren't you focusing much more on 7.2 in IO, considering that this has apparently lifted your market share by 17 percentage points since you first published data there?

But I couldn't be more focused on it because, of course, I have 35 launches before the end of the year across IO. So when we have the regulatory opportunity, we launch in some markets outside EMA, it takes a bit longer. In Asia, we also don't have the local studies to allow for the launches, call it China, Japan, et cetera. So there are a few markets that are not in scope. There also could be 1 or 2 where we are just about to launch CagriSema, then that's the offering, we go for. But broadly speaking, we are all in on that life cycle management opportunity. Again, you saw the device cannot be click counted, super attractive also for reimbursement, et cetera. So we are fully behind it.

Final question, Michael Leuchten.

A quick one for Karsten. Just going back to the ambition to keep the gross margins stable. Can you talk about the path because going into '27, you've got a negative mix effect from CagriSema I guess the cash channel is still below profitability relative to the reimbursed channels. So what's the path going to look like to get to that stable gross margin?

Yes. So first and foremost, looking back to the slide, you didn't see Michael or Kasper for that matter, you didn't see us call out mix as a negative driver during this path. And that's because the negative mix effect is rather small in this time period. So a lot of people, they believe that the Wegovy tablet has a significant negative mix impact linked to the growth towards 2030. That's not the case. So the Wegovy tablet is reasonably close to group average. And as a consequence with the growth there, I think we have a very nice runway on the margin. So it really boils down to price and depreciations on the negative side are being offset by a lot of productivity, be that AI yields and network optimizations. And of course, with the launch product in the first few years, generally, you see a lower margin, but you also see a lower mix of the total book of business, right? So even if you take CagriSema that we have high hopes for, it's still a rather low percentage in the first few years of the group total. So even if it's below, then it's not materially going to impact group gross margin.

Very clear answer on the margins. And with that, I want to thank the entire panel for coming to stage, and I want to leave the final word to you, Mike, to conclude on the CMD.

Thank you very much. Very good. So we're at the end of the day, and I will not take too long of your time. I will recap some of the things that my colleagues brought forward today in the hope that as you leave, you will actually recall some of them in a single slide. We are planning to be a larger company in 2035 despite the very large LOE of semaglutide. We do that by diversifying the company starting with the core, what we know very, very well, diabetes and obesity. We will strengthen diabetes with the assets you saw my colleagues show and the launches that comes after that. We have perhaps one of the broadest portfolio of obesity products, both injectable as well as orals because we are at early innings of this game. And while some of our peers are coming with a single or 2 assets, we believe the winner will be the one who segments this part of the society into specific needs with very specific assets and provides that to them at different price points. And we will do that, and you have seen all the things that was shared by Martin and Hong related to that. We believe besides our core, we need to go broader and faster to some of the other adjacencies. Blood disorders was a very obvious place where we have a long heritage, and we will actually be incredibly excited with the upcoming launches and expanding from there. But also, you saw the data from our liver disease, efruxifermin asset, super exciting. And with CV, I also mentioned despite just a setback, you should not count us out, and you saw a little bit on that one as well. We also gave you an indication that, that will be one of the growth drivers as well for the rest of this decade. And if you take the base of today and add at least 50% on top of that number is where we expect ourselves and plan ourselves to be within that. We did say at least 5 blockbusters, actually multiple blockbusters will be launched before the end of the decade. We also mentioned that we will bring all of this together and grow in line with the peer average in revenue terms, CAGR terms, that would be midterm -- mid-single-digit number that they have announced. But we also said that by 2035, we see risk-adjusted minimum of DKK 150 billion in addition to where we are today worth of sales that should give you some comfort for how we are planning to play with the LOE and showed you the building blocks of that. Of course, these are just words today. It's a strategic document and a direction for you to judge us quarter-by-quarter, but for us to execute on. And to execute on that and ensure that we actually execute on that properly, last week, we announced a cultural transformation around 4 principles to our 67,000 employees, where we promise ourselves to make sure that everything that we do will start with a patient and a customer in front of us, that we make sure we are competitive not compared to our own past, but compared to everyone else that is running in the same field, that we increase clarity and speed and agility in our organization and that we actually show care and integrity, first and foremost, for ourselves and the employees, for those who we are serving and not least for our shareholders, i.e., you. Those are the way we will turn this strategic document into action and we'll execute on it. And it's for you to see our action quarter-by-quarter and put your judgment on it.

Thank you so much for coming to today and joining us. We look forward, of course, in seeing and visiting you on the road show and in various different forums that we usually interact. Have a great day. Thank you.

Good day, and thank you for standing by. Welcome to the Q2 2026 Novo Nordisk AS Earnings Conference Call.

[Operator Instructions]

Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Michael Novod, Head of Investor Relations. Please go ahead.

Thank you very much, operator. Welcome to this Novo Nordisk Earnings Call for the Second Quarter of 2026. My name is Michael Novod. I'm the Head of Investor Relations at Novo Nordisk. With me today, I have CEO of Novo Nordisk, Mike Doustdar; EVP, U.S. Operations, Jamey Millar; EVP, International Operations, Emil Kongshoej Larsen; EVP, Research and Development and Chief Scientific Officer, Martin Holst Lange; and Chief Financial Officer, Karsten Munk Knudsen All speakers will be available for the Q&A session. Today's call is being webcasted live, and a recording will be made available on our website. The call is scheduled to last 1 hour.

Next slide, please. The presentation is structured as outlined on Slide 2. Please note that all sales and operating profit growth statements will be at CER unless otherwise specified. Next slide, please. As usual, we need to advise you that this call will contain forward-looking statements. These are subject to risks and uncertainties that could cause actual results to differ materially from expectations. For further information on the risk factors, please see the company announcement for the second quarter of 2026 and the slides prepared for this presentation. With that, over to you, Mike, for an update on our strategic milestones for the second quarter of 2026.

Thanks, Michael. Next slide, please. In the second quarter of this year, we have continued to deliver on our priorities to improve commercial competitiveness, progress our pipeline and make focused investments while delivering returns. Today, Novo Nordisk is serving more than 46 million people living with obesity and diabetes. We are treating almost 70% more people living with obesity compared to just a year ago with nearly 5 million people on our obesity treatments. We've taken the successful U.S. launch of the Wegovy pill to global markets. We now have around 1.5 million people on the Wgobi Pill worldwide. This is a testament to our increased efforts in manufacturing and across the entire value chain to bring innovation to people.

Within research and development, we continue to advance our pipeline across therapy areas. We have received more than 10 regulatory approvals and started more than 5 clinical trials in the second quarter. We have also received -- we have also announced top line results from ZEUS, the first 3 trials with ziltivekimab in patients with ASCVD, chronic kidney disease and inflammation. While the outcome was not what we had hoped for. This single event does not change our strategy. Novo Nordisk remains committed to helping patients with comorbidities related to obesity and diabetes, including cardiovascular disease. Martin will speak to this later. In the second quarter of 2026, we continue to invest in growth opportunities to drive competitiveness and progress our pipeline. This includes more than DKK 26 billion invested into R&D and commercial activities.

And lastly, we're happy to see that we have been able to raise our 2026 guidance once again. Karsten will elaborate on this later on during the call. Next slide, please. In the second quarter of 2026, adjusted sales grew 7%, driven by volume growth, partially offset by lower realized prices. U.S. operations grew 4%, reflecting volume growth, primarily driven by GLP-1 in obesity. International operations grew 10% mainly driven by region [indiscernible] . From a therapy point of view, Obesity care sales increased by 16%, driven by volume growth across the Wegovy product portfolio in both U.S. and IO partially offset by lower realized prices. Our GLP-1 sales in diabetes increased by 2%, driven by U.S. operations. GLP-1 diabetes sales in U.S. benefited from a gross to net rebate adjustments related to prior periods. And with that, over to you, Jamey.

Thank you, Mike. Next slide, please. We continue to see encouraging use of the Wegovy pill 6 months into the U.S. launch. Wegovy is the strongest ever GLP launch by volume and we have now reached over 5 million total prescriptions. It took 12 weeks to reach the first 1 million TRxs, yet the latest 1 million TRxs were added in just 4 weeks. Weekly prescriptions as of July 17 were 267,000. The Wegovy pill uptake is driven by its efficacy, favorable tolerability profile and ease of use. Based on the latest data and in the face of competition launched in early April, the Wegovy pill has captured around 90% of the oral obesity medication market.

Furthermore, a recently published study showed that weight loss in the real world exceeded that seen in the OASIS 4 clinical trial at the same point in time reinforcing the efficacy's of the pill and patient usage in practice. The Wegovy pill is expanding the market as we continue to see roughly 80% of patients being GLP-1 treatment naive. We also find people coming to Wegovy pill from competitor products and limited cannibalization an injectable Wegovy, which is encouraging. On usage, we are seeing continued progress in titration dynamics with higher dose prescriptions increasing steadily week over week. This suggests people are progressing through titration and continuing treatment, which is also supported by more than 20,000 people currently utilizing the Wegovy pill subscription model for the 2 higher doses. Overall, trends remain in line with our expectations.

From an access perspective, quality of access for obesity GLP-1s remains poor and is a key focus area. While we see uptake for the pill in the reimbursed commercial channel, the majority of total prescriptions are self-pay. We're excited about the expansion of access for obesity medication in the 65-plus age population with the recently available Bridge program in Medicare Care Part D. While it is early days, we are encouraged by the strong participation in the program. Wegovy pill appears to be the oral option of choice, and we will continue to focus on educating and differentiating Wegovy injectable to capture higher market share. The branded obesity medication market continues to expand in Q2 2026, growing volumes at around 70% compared to Q2 2025. The Wegovy franchise is playing a major role in this expansion, where the franchise continues to be the leader measured on NBRx with a market share of around 60% during the month of July. And with that, I will turn it over to Emil.

Thank you, Jamey. Please turn to the next slide. In the second quarter of 2026, GLP-1 sales in international operations grew by 13%, driven by volume growth and market expansion with a highlight being obesity franchise growth of 37%. Novo Nordisk continues to be volume market leader outside the U.S. with around 58% GLP-1 volume market share. While our market share has been declining over recent quarters, we see encouraging trends as our share of growth continues to stabilize. This indicates that we are gradually seeing the benefits of our efforts, including the step-up approval and launches of the Wegovy 7.2 milligram and Ozempic 2.0 milligram.

In the U.K., we go with 7.2 milligrams in a single dose pen is now broadly available. Since the introduction of the step up data earlier this year, we have seen a market share increase in the GLP-1 market. In the EU, Wegovy 7.2 milligram in the single dose pen was recently approved, and we look forward to launching the pen in the first EU markets during Q3. Ozempic continues to see solid sales momentum with sales growth of 10% in the second quarter. This is partially driven by Ozempic 2.0 milligram, which is now launched in around 10 countries with good uptake coupled with strong overall Ozempic performance across key European markets. Recently, we saw the first generic entries in the early LOE markets. While modest so far, the LOE impact is expected to be back-end loaded in the second half of 2026. Although it is early days, we generally see the market expanding in the earlier week countries mainly driven by more products being available at lower prices and significant promotional investments by new entrants.

While the generic players have started to capture market share, we have so far been able to grow our absolute volumes. In Canada, our leading tactic is a savings card program, and we've seen good volume retention for both Ozempic and Wegovy in the cash and private insurance channels. Next slide, please. Recently, we launched Wegovy pill in the first IO countries, the U.K. and UAE. This marks an important milestone as we are now able to offer people a weight loss efficacy on par with that of injectable Wegovy in a once-daily easily administrated pill in these countries. In the U.K., the Wegovy pill was made broadly available in early July, becoming the first once-daily oral GLP-1 treatment for weight management. It is estimated that around 20 million adults live with obesity in the U.K. Prior to the launch, around 1.6 million people were treated with obesity medication in this market. Just 3 weeks into the launch, we estimate around 300,000 patients have started on the Wegovy pill.

While it's early days, it appears that the majority of the new patients are GLP-1 treatment naive, suggesting a market expansion. The launch uptake means that our overall GLP 1 obesity market share has increased markedly. When looking at IQV selling data to private providers and pharmacies in July, we've seen an increase in the overall Novo Nordisk obesity market share from around 30% prior to the launch to now 45%. In the UA, we also observed encouraging trends. The Wegovy became available in early June, roughly 1 month after an oral competitor entered. Despite not being the first mover, the Wegovy pill has already captured around 50% market share in the oral segment. We are pleased to see these encouraging uptakes and expect to launch the Wegovy pill in selected countries in the coming quarters, starting with Germany in September. With that, over to you, Martin.

Thank you, Jamey. Please turn to the next slide. Last week, we announced the headline results from So, the first cardiovascular outcome trial investigating [indiscernible] SUS was a large-scale cardiovascular outcome tran with more than 6,300 people enrolled and randomized in a 1:1 ratio to receive once-monthly sinibecumab 15-milligram or placebo on top of standard of care. The eligibility criteria were designed to include patients with established cardiovascular disease, established chronic kidney disease and inflammation as measured by high-sensitivity [indiscernible] protein equal to or above 2-milligram per liter. The primary objective was to demonstrate superiority of once monthly citivecumab versus placebo on top of standard of care to reduce the risk of major adverse cardiovascular events.

Form -- the trial demonstrated robust execution with treatment adherence discontinuation rates consistent with the expectations. Though unexpected findings were observed with respect to dosing treatment exposure or imbalances in standard of care management across treatment groups. While ziltivekimab showed target engagement and inhibition of the ISX pathway as reflected by expected reduction in free IL-6 and HSCRP, respectively, this does not translate into Mace reductions with a hazard ratio of 0.99. From a safety standpoint, the overall rates of adverse events and serious adverse events were similar between those treated with ziltivekimab and those on placebo. Consistent with targeting IL-6 inhibition a higher proportion of people treated with [indiscernible] had serious infections compared to placebo.

Importantly, no difference in all-cause mortality was observed with a hazard ratio of 0.99. While the ZEUS trial did not validate the IL-6 hypothesis in this specific high-risk population, this does not change our strategic commitment to cardiovascular disease. The trial will inform our ongoing cardiovascular research and the development of treatments for the millions of people living with cardiovascular disease. Cardiovascular outcomes trial Artemis and Hermes, which evaluates ziltivekimab in people with acute myocardial infection and heart failure will preserve ejection fraction, respectively. Our plan to continue with results expected during the first half of 2027. Please go to the next slide. Beyond the ZEUS readout, we have had a busy second quarter across all our therapy areas. Starting with obesity, we successfully completed the REDEFINE-9 trial which was a 68-week efficacy and safety trial testing [indiscernible] maintenance doses of 1.0 and 1.7 milligram of each component in people with overweight obesity.

For both lower doses of CagriSema, there was an achievement of superior weight loss compared to placebo. In the trial, CagriSema appeared safe and well tolerated, consistent with the previous CagriSema trials. We expect to share detailed data later this year. We also initiated the CagriSema Phase IIIb trial looking at the higher fixed dose combination of CagriSema with 2.4 milligram of cagintide and 7.2 milligram of semaglutide. The redefined high-dose trial comprises of 2 individual sub studies, one in people with obesity with heart diabetes and other in people with obesity and type 2 diabetes. Each sub study evaluates the body weight reduction with CagriSema high dose compared to calm 2.4 milligram of each component and semaglutide 7.2 milligram alone. We still expect a U.S. decision for CagriSema and obesity at the end of 2026 with the potential launch in 2027. We also initiated the Phase II trial for our triple agonist targeting GLP-1, GIP and Amlin receptors evaluating different dose escalation regimen for up to 39 weeks. The Phase II trial is expected to read out in the second half '27.

Within diabetes, we initiated a Phase II trial for UPT 251 in people living with type 2 diabetes. The trial will investigate the safety, tolerability and efficacy of once-weekly UPT 251 for up to 40 weeks. The trial is expected to read out by the end of 2027. We also completed the open-label head-to-head reimagined for trial investigating CagriSema 2.4 milligram versus teseplatide 15 milligram. When evaluating effects people treated with CagriSema achieved a weight loss of 15.2% and an A1c of 1.9 percentage points, respectively, at 68 weeks. For the dual primary endpoint, CagriSema demonstrated noninferiority versus tesepatide for weight reduction but not for A1C reduction. Looking ahead to the remainder of 26, we are set to deliver a number of important milestones and regulatory achievements. In obesity, we plan to initiate several large stage programs, including oral tenagantide and obesity and [indiscernible] high-dose marking important steps in advancing our next-generation of bet portfolio.

Within obesity-related comorbidities we anticipate Phase III safety results from the [indiscernible] trial of ephroxyfermin in people living with mesh and fibrosis stages F1 to F4. The trial's primary endpoint is safety and tolerability. In that [indiscernible] , we expect to initiate reimagine switch, evaluating the safety and tolerability of switching from [indiscernible] 1.0 milligram and 2.0 milligram of CagriSema. Results are anticipated in the second half of 2017. In addition, we plan to initiate ambition the Phase III development program for Seagate. On regulatory milestones, we continue to anticipate a U.S. regulatory decision for oral semaglutide 25-milligram in type 2 diabetes as well as U.S. and EU regulatory decisions for dense in hemophilia A. We also remain on track to submit etabopivad in both EU and U.S. in the fourth quarter following the positive Hibiscus results announced earlier this year. Taking together these milestones underscore the breadth and the strength of our pipeline as we continue to advance innovative therapies across obesity, diabetes, rare diseases and associated comorbidities. With that, over to you, Karsten.

Thank you, Martin. Please turn to the next slide. In the second quarter of 2026, our adjusted sales increased by 7% at constant exchange rates, reaching DKK 78.5 billion. This was driven by TL volume growth across geographies and a favorable rebate adjustment related to prior periods. The adjusted gross margin was realized at 78.2% compared to 82.7% in Q2 '25, reflecting lower realized prices onetime cost of around DKK 3 billion related to rightsizing of manufacturing capacity agreements, as well as a negative currency impact. This was partially countered by productivity gains and a positive product mix from increased Tier 21 sales.

Adjusted operating profit increased by 11% at constant exchange rates, driven by higher sales and lower cost for the quarter. Through our disciplined cost base approach, we are now ahead of plan to deliver the DKK 8 billion of savings from the company-wide transformation announced back in the third quarter of 2025. which are being reinvested into growth opportunities. At the end of the second quarter, the number of full-time employees was around 6,700, which is a decrease of almost 12,000 employees compared to -- corresponding to roughly a 15% decline compared to 12 months ago. Please go to the next slide. For the first 6 months of 2026, Novo Nordisk has delivered a better-than-expected start to the year. As a result, we have raised our guidance again. The adjusted sales growth is now expected to be 0% to minus 6% at constant exchange rates. The improvement in the outlook is mainly driven by increased expectations for GLP-1 product sales.

The outlook reflects expectations for sales growth within international operations and expectations for sales decline within U.S. operations. In [indiscernible] operations, the outlook is based on current growth trends, including continued volume penetration for GLP-1 treatments and market expansion, mainly within obesity. In addition, the outlook is based on negative impacts from the compound patent expiry of the semaglutide molecule in certain markets. Novo Nordisk continues to roll out the Wegovy product portfolio in more markets during 2026, including the Wegovy pill. In U.S. operations, the outlook is based on current prescription trends for the injectable T1 portfolio intensifying competition as well as negative impact from reduced obesity mitigation coverage in Medicaid. Further lower realized prices linked to investments in market access amplified by the most favorite nations agreement with the U.S. administration is assumed. Novo Nordisk further focuses on expanding access, particularly in the self-pay channel through [indiscernible] Pharmacy and collaborations with Chile health organizations as well as the bridge program in Medicare Part D. uptake related to the launch of the Global in January 2026 is reflected in the outlook based on a range of assumptions as outlined in the company announcements.

Adjusted operating profit is now expected to be 0% to minus 6% at constant exchange rates. The expectation for adjusted operating profit growth primarily reflects the improved sales outlook combined with targeted investments in current and future growth opportunities within R&D and commercial, partly funded by reinvestment of savings from the company-wide transformation in 2025 as well as further optimization initiatives and disciplined resource allocation. Other key modeling considerations for 2026 are shown on the slide. That was the outlook for 2026. Now over to you, Mike.

Thank you, Karsten. Please go to the next slide. While 2026 continues to be a challenging year for Novo Nordisk, it has also been an exciting and an important one. We are encouraged by the first half results and by the progress we have made across several areas compared with the expectations we had at the beginning of the year. At the same time, the year is far from over, and we maintain mindful for the headwinds we are facing in the second half. Our priorities for 2026 remain clear, and there's still significant work ahead of us. As Jamey and Emil explained, we continue to strengthen our competitiveness by expanding our product offerings globally and bringing innovation to many more people.

Our pipeline continues to advance at speed with additional first-in-human dosing and initiation of late-stage clinical trials across multiple therapy areas. And finally, we're progressing ahead of our transformation plan announced last September. Creating greater capacity to invest in future growth opportunities. On behalf of the entire management team, we look forward to discussing these areas in greater depth at our Capital Market Day in September. And with that, let me hand it back to you, Michael.

Thank you, Mike. Next slide, please. With that, we're now ready for the Q&A. We kindly ask all participants to limit her or himself to one or maximum 2 questions, including subquestions. Operator, we're now ready to take the first question.

[Operator Instructions]

And our first question comes from the line of James Quigley from Goldman Sachs.

I've got one on the guidance and one on [indiscernible] trajectory, the guidance, the second half implies around 5% or so negative growth. But can you talk to the dynamics and the headwinds that you have there, which of those headwinds could potentially also move forward into impact growth there. And then secondly, on the ex U.S. rigor trajectory. U.K., you said 300,000 patients in the first 3 weeks or so since launch that compares to $48,000 for the U.S. So how comparable are the launch trajectories for the U.S. versus ex U.S. markets? What have you seen in terms of waiting lists and things like that for the U.K.? And are there any similar metrics or expectations you have for the Germany launch that you've seen with the U.K. launch as well?

Thank you very much, James. First question for Karsten and the second question for Emil.

Yes. James, thanks for the question. In terms of outlook and the balance of logic you're after, the simple version is that we take our current run rate where we delivered 2% growth in the first half. and continue with that run rate and then you factor in 2 factors: 1 being loss of [indiscernible] in a few markets, Canada and Brazil mainly which we see happening here predominantly starting in the second half. And then you take into account the favorable gross-to-net effects we had in Q3 and Q4 last year of combined billion. And if you take that carry forward, then, of course, the comparative effect, we don't carry forward into next year whilst the loss of exclusivity impact will annualize into next year.

On your second question, we, of course, are very encouraged by the U.K. mind you, almost 3 out of 10 obesity patients on a once-weekly GLP-1 and I live in the U.K. but it's still only 1.6 million patients being treated out of 20. So the room for market expansion is tremendous in the U.K. And as you rightly point out, there was a pent-up demand. A lot of patients have been on the sidelines, even more than we could have hoped for, and it just goes to show that injections -- the injection barrier is very real and this uptake is, of course, tremendous. We also believe the fact that we don't have drug-drug interactions allow patients on oral contraceptives on statins, et cetera to start easily on a one-day very efficacious option here.

So we are super encouraged. We are, of course, optimistic on the continued uptake based on what we hear from the [indiscernible] providers and also the media sentiment. In terms of the reader cross to Germany, it is quite a different market, but Germany is also a market that versus a year ago is now driven by Telehealth, more than half of the growth and 1/3 of the market is already sold through Telehealth channels and there is an increasing awareness in the population and an even larger unmet need because treatment rates lower. So the base -- we start from a different base, but we'll use a lot of the same tactics in Germany, and we are bullish on the uptake there as well.

Thank you very much, Al. Thanks, Kash, James.

And our next question comes from the line of Richard Vosser from JPMorgan.

Two questions, please. First question, just on the redefined reimagined for implications, apologies for the launch of Calgary same in diabetes, just thinking about the positioning of the product, given the HbA1c was inferior compared to Mounjaro and of course, the focus in diabetes on blood glucose control. And then the second question, just is on supply. Could you remind us where you are in the ramp-up of the new API manufacturing facilities? What sort of utilization are you at the new plants how quickly can you anticipate being at full capacity? Where are we heading on there in terms of supply?

First question on reimagine for Martin and then the supply question for Karsten.

Yes. Thank you very much, Richard. I'll just remind you that across the [indiscernible] 2 diabetes trials, we have seen A1C lowering between minus 1.8% and 2.3%. So very, very strong placema control in the reimagined was 1.9%. And at the same time, we've seen an almost unprecedented 15% weight loss. Also reminding you that CagriSema obviously the combination of semaglutide that has a very well-established in bit. It's basically the only and in diabetes, it appears to be the strongest CMA risk reduction assets in the field. That carries into CagriSema and the benefits that we've seen on blood pressure on glycemic control on lipid improvements. And what we've also seen in the preclinical space on potential bone preservation, potentially other benefits of the mild biology that calls for a really, really strong proposition, not only in diabetes, obviously, but also in obesity where we've seen a 23% weight loss.

So across the board, we really meet a lot of excitement from investigators but also treating physicians -- looking forward to having yet another new biology with very strong glycemic control weight loss but also other benefits from a combination therapy.

Richard, on your question in terms of API supply from our new facilities, I believe you visited the -- one of the plants in connection with the latest Capital Markets Day in Denmark a couple of years ago. What I'd say is that we have validated the first product in the first finger in the first facility. That's as specific as I can be. So it's progressing very nicely and we are happy with progress. So far, in terms of commercial supply into the marketplace, low utilization, very low utilization from these facilities, which makes us also bullish in terms of being able to supply significant volumes in the years to come, especially the Wegovy pill for ex U.S. rollout.

And our next question comes from the line of Michael Leuchten from Jefferies.

Two questions, please. One for Mike. Just a clarification, Mike, on your BD strategy. I think there was an FT article that suggested you'd be willing to look at larger transactions. And then I think this morning on the media call, you said you more focused on bolt-on acquisitions, just sort of clarifying like what size of potential additions to the portfolio you're looking at? And why you're making that choice?

And then going back to Martin, the reimagined for failure. Can you help me think through what that may or may not mean for nicotine because we keep seeing data points that suggest that adding a novel GLP-1 with an AML doesn't us to 1 plus 1 to equal 2. It's more like 1.5. And I just wonder what that means for a molecular asset that is combining those 2 where you just have less ability to titrate the 2 components up or down? Like how do I think about the ability to get that molecular structure into the right landing zone from an efficacy and tolerability perspective?

Great. First question for Mike on BD and then on Karsten also agent for Martina.

Thanks, Michael. So I don't measure our ambition by the number or the size of the acquisition we make I measured by the quality of innovation we bring to the patients. I've repeatedly have said, Michael, that I'm very proud of our internal R&D and pipeline but no company has a monopoly on good ideas. So what I look right now is what Martin is doing within the areas we are operating and some of the comorbidities of obesity and diabetes. And while getting incredibly proud, I've also said we are in every data room, try and see who else has a better idea? Who else can give us assets that we can bolt on and complement what basically Martin & Co are doing, and that's what we are active on.

The comment to financial times, just for clarity has been, is there 1 day that you can foresee transformation and transformative M&A. And I have said that I'm a person who never starts with a no. So one day maybe, but you have to be in a very different situation that Novo Nordisk has today. for that one day for us to think about it. Today, we are trying to bolt on to what Martin is doing in various areas.

Okay, Mike. And Martin, on...

Yes. Thank you very much, Michael, for that question. So obviously, as we've discussed before, we do not believe that we have seen the final data on [indiscernible] in and of itself as we've previously discussed, there is a need for individualized treatment. We are testing that in what we believe is the right setting in redefine and therefore, both from a weight loss potential and potentially also from a glycemic to potential just with CagriSema, we do believe that we could potentially see even further weight loss and potentially even further placemacontrol.

As you remember from Phase II percentage in obesity, we've seen 24% weight loss in a matter of 6 months treatment. This seems to be a very powerful proposition. I cannot, at this point, speculate whether it's going to be fundamentally different from CagriSema but right now, the indications are both in diabetes and obesity when it comes to [indiscernible] and weight loss, that tenant will be a substantial addition to what we can do in obesity and certainly also in diabetes. Again, I'm looking forward to also show the redefined 9 data, the individualized treatment getting patients to their desired weight loss or their desired target as different doses will also come clearly through redefine 9 and we'll share those data later this year to give you further insights.

And our next question comes from the line of Carsten Lonborg Madsen from Danske Bank.

I think I'll just take one question here, disguised in 2 questions, I guess. The Wegovy U.S. performance, minus 22% in constant exchange rates Jamey, could you try to give us some info on the dynamics you are seeing here in Q2 for [indiscernible] the U.S. market? And also maybe help us understand a little bit the very large discrepancy versus Q1 and also the prescription data that we can see with points to growth, of course, but then there's a pricing component. Should we worry that there's an increasing pricing pressure seen or maybe like-for-like pricing pressure on new channels at lower prices coming on stream?

Thank you very much, Carsten. That's one for you, Jamey.

Yes. I think as we highlighted at the beginning of the year, we were expecting volume growth but continued price pressure. And that's what we've seen. I think you answered the question almost in your question, we did see volume growth with Wegovy injectable, but that was offset by lower realized prices that we anticipated. So no new price dynamic impacting it. It's the price dynamic that we started the year with. [indiscernible] Asian add on?

Yes, and just building on Jamie's comment, what you should also be conscious of carton is that the business mix has changed for Wegovy injectible in the U.S. and actually what Jamie and the team has very successfully pulled off in terms of the brand to get self-pay going. So right now, for the Wegovy injectable in the U.S. self-pays to the tune of 35% of total Wegovy Injectable compared to a year ago where we were around the 10% to 15% range. It's at a different price point, but it's a good way to unlock volume. And then I'd secondly say that we don't see a lot of direct cannibalization from switching to the Wegovyi pill. But of course, indirectly, we don't know how many on Wegovy pill would otherwise have started on the injectable. So it's just important to take that into account when you look at the script trends.

Our next question comes from the line of Michael Nedelcovych from TD Cohen.

I have 2. My first is on the Wegovypill franchise. Novo conducted a Phase III trial of the 50-milligram dose of oral semaglutide that showed even better results than the currently approved 25-milligram dose especially as competition amounts and we see what might be early signs of a potential slowing in momentum in the U.S., would Novo consider filing the 50-milligram dose at any point? That's my first question. And then my second question is on the implications of the ZEUS trial. Its failure amidst the reduction in CRP and IL-6 would seem to suggest that these inflammatory biomarkers are correlates of cardiovascular disease rather than causal factors. To what extent do you agree with that conclusion and in this context, what data serve as a basis for continued enthusiasm around NLRP3 in cardiometabolic disease.

Two questions for Martin, one on see and then the second one on [indiscernible] .

Yes, absolutely. So as you say, we have conducted a 50-milligram start, it showed some really good results on both efficacy and [indiscernible] . As you've clearly seen with the 25 milligram, we've come out with 17% weight loss and the best tolerability profile as far as we can see in the oil space, that is a very competitive offering with [indiscernible] and will actually free more oil assets in our current pipeline and portfolio. We do expect to be able to further leverage the oil space on efficacy, on tolerability and potentially also on comorbidities. And therefore, at this point in time, we do not see a need to launch the 15 milligram.

I think on [indiscernible] , obviously, the jury is still out, you could argue that while you see a reduction in CRP and X and then no improvement in MACE. It is because there is an observation I mean the original idea was there was an observation that patients who have inflammation have higher risk of events. We apparently do not feel the opposite. That can be caused by several reasons, either there is no pharmacological correlate or it was maybe a 2 disease population that was investigated. It could also be that IL-6 in this specific population is too far downstream in terms of the inflammation cascade and ARP 3 are higher up. As you know, the cancers trial showed that NGL 1 bet action introduce substantial CV benefits. So I think it's too early to conclude that inflammation in CV should not be addressed. Actually, we believe the opposite and therefore, you also see us continue the 2 other ZEUS trials. As we've already mentioned, we have currently in the clinic on and we have additional NLRP free assets in our brick pipeline, and we intend to progress those as well. The unmet need is huge and we need to address that.

Our next question comes from the line of Peter Verdult from BNP Paribas.

I'm Peter, BNP Paribas. Two questions, Michael, Karsten a key investor debate is whether 2027 can market return to revenue growth consensus currently flattish for our last check. And I realize Q2 numbers is not before official guidance, but I think it's worth kicking the tires on interest to gauge your level of comfort where consensus sits or your level of optimism about Novo returning to top line growth in '27 given all the various pushes and pulls. And then secondly for Jamey, just can I push you further on the Medicare bridge program. Your competitors being more bullish on the volume inflection potential I think nobody has been trying to keep expectations down, but just what you're seeing at the moment and just to clarify or confirm that the current guidance still bakes in conservative assumptions on the Bridge program volume uplift?

The first question on 27 for Karsten, and then the second question on Bridge for Jamey.

Pete, thanks for that question. And we look forward to guide for 2027 come February next year. So what I can say today talking just in principles around it is we are nicely positioned in a rapidly growing category. So the GLP-1 market is growing close to 40%. When we look at moving annual total. So it's a fast-growing market with a long runway. So that's, of course, a positive. We have laid out the recent dynamics. And actually, we did deliver 7% growth in the second quarter. So don't count us out there yet. And then generally speaking, into next year, then the starting point is always the current run rate and then adjust it for the various factors.

So you start with the current run rate, current script trends and then to call out into next year, I think you should look at CagriSema, where we have regulatory action at the end of this year. for obesity in the U.S. We have [indiscernible] regulatory decision also in the second half of this year. And then you have a loss of [indiscernible] annualization, as I spoke to before, in certain I-O markets. So I think that's as much as I can talk to in terms of run rate into '27, and then we'll come back in February.

Thanks, Karsten. Jamey, on the bridge?

Yes. As it relates to Bridge, firstly, Novo's long advocated for coverage for Medicare Part D patients for best medications. So pleased that we have that now in the form of the pilot program known as Bridge. I think going into July 1, there were questions about the simplicity and ease of the process for beneficiaries. And then secondly, the activation of patients. So a quick comment on the process. The market seems to be learning very quickly. And in terms of identifying eligible patients screening for that eligibility and then ultimately determining based on the prior authorization clinical BMI and comorbidity criteria, that process seems to be going very well. Ease of patients navigating that system with HCPs and pharmacies seems to be going very well. So that's a positive.

In terms of the patient activation, it is still just the first few weeks. But in terms of absolute volume of patients making it through the eligibility screen and the PA criteria and gaining treatment through a paid prescription claim. We're very pleased with the volume so far. Whether or not that is durable and sustainable is yet to be seen. We'll be monitoring that as we continue and progress and we will be focused on gaining our fair share of the prescriptions as well as we move forward.

And our next question comes from the line of Matthew Weston from UBS.

Two questions, please. The first for Martin Zenagamtide is a critical next-gen pipeline driver. I think one of the key observations at ADA for many was that Novo maybe hasn't got the titration right yet to get the optimal balance of efficacy and tolerability but you're still moving forward into Phase III at pace. So given the challenges we all experienced around CagriSema, what assurances can you give investors that Noble will get dosing right? And will we see -- will investors see data prior to the full Phase III readout to reassure us that that's the case.

And then secondly for Jamie, I guess, ultimately, is it the right time to lower the price for higher doses of oral Wegovy?There's a big gap between 149 and 299 for the lower 2 and higher 2 doses momentum seems to be stalling? What can you do about it?

Thank you. First question from Martin on Zenagamtide and the second question is for Jamey.

Yes. Thank you, Matthew. So first and foremost, we've learned a lot from CagriSema. This is a combination of GLP-1 and [indiscernible] and everything that we've learned from CagriSema, we've obviously, as we previously discussed, put into the REDEFINEd-11 trial, which is where we really test the way that we titrate and the way that we dose this biology. And we have, in addition to what we did in the early senegatide studies, not only employed all of our learnings from CagriSema, we've also added an extra titration step, which is why we, from a modeling perspective, we feel quite confident that we will see a section tolerability profile.

In line with what we've seen with, for example, CagriSema,and I'll just remind you that in redefine 1, the same tolerability profile was comparable to that of [indiscernible] quite attractive tolerability profile. Of course, I cannot issue assurances we have to do the data generation, and we'll have to see the Phase III results but based on what we can see at this point, both from CagriSema from our Phase I/II trials and what we've done, we do expect to see a quite attractive tolerability profile combined with that efficacy profile that we also discussed before. And then I'll just remind you, we'll not only have that as a subcutaneous transaction. We also have that as an old offering, meaning that will take a further step up in terms of efficacy when it comes to oral treatment without hopefully compromising on safety and tolerability.

Thank you, Martin. And Jamey, on the Wegovy pill pricing?

Yes. A couple of comments on the titration dynamics that we see. So we do see steady movement to the higher doses of oral Wegovy. We have roughly 30% of prescriptions at the 9- and 25-milligram strength currently. Our preference would be to address consumer concerns about escalating prices as the product is titrated with this subscription model that we introduced just a couple of months ago. We've had good uptake of that. We have 30,000 patients enrolled in the subscription model, 20,000 of them specifically would go the pill patients, and that's continuing to grow. We'll continue to use, what I'll call, more of a targeted surgical solution to that than a universal wholesale change to pricing. So hopefully, that answers your question.

Our next question comes from the line of Graham Parry from Citi.

So just on the rebate adjustments, could you quantify where they sit across the portfolio, particularly epic. And I think on Ozempic U.S. price mix outlook, you've previously been saying around 10% to 15% decline. So on an underlying basis was what you would have been seeing and is that what we should be thinking for the remainder of the year? And then as you look into 2027, how do you think the IRA maximum fare price would impact on that sort of trend on pricing?

And then on U.S. injectable Wegovy, you said there wasn't a shift in pricing dynamics between Q1 to Q2. But if you look at the gap between prescription growth and price, you had a negative price mix effect of about 57%, up from about 40% in Q1. So is that just the cash pay mix that you're seeing? Or is there more pressure on commercial contracts?

Thank you very much. So first question on Ozempic rebates or pricing volume to Jamey.

Yes. In terms of the gross to net adjustments, the $2 billion that we've highlighted. The strongest proportion of that is Ozempic about 3 quarters of the impact is Ozempic gross to net. And then the balance is insulin. So that's the dynamic there. In terms of Wegovy injectable, you're going to see quarter-to-quarter fluctuation in terms of the price volume dynamics. And I think the mix in terms of channel mix, reimbursed versus self-pay, as Karsten mentioned, is also impacting that.

And our next question comes from the line of Kerry Holford from Berenberg.

Sticking on the theme of channel mix. Karsten, I think you said around 35% of that injectable we go demand is now by the cash channel. What proportion of that cash channel demand is ultimately eligible for Medicare bridge? And what we have transferred do you expect in the second half of the year and beyond? And effectively, what kind of price impact should we anticipate as a result of that transition? And then on the pill, it would seem that the demand for some of the lower doses is starting to slow in terms of growth. Just interested in your thoughts on whether this may be a sign that seasonality is going to play a role in the demand of obesity pills. And could you just confirm what the current IQVIA capture rate for the pill.

Thank you, Kerry. Two questions for Jamey, one on Wegovy self-pay injectable and then also on Wegovy pill.

Yes. Thanks, Kerry, for the question. We see a small population minority population of 65 plus in our self-pay environment today. And obviously, we would encourage them to participate in the bridge given the affordability benefit there of the [ 50 ] out-of-pocket co-pay. But it's the vast minority of our self-pay business. And in terms of low dose, 1.5-milligram start. What we do see is many patients start on the 4-milligram strength. So considering new patient starts, we are increasingly looking at both of the low doses to calculate that. We don't see -- and there isn't scientific or epidemiology-based seasonality in this disease state like there is in some others. What there is, is behavioral motivation that waxes and wanes through the year. Obviously, it heightens at the beginning of the year, concurrent with U.S. resolutions, et cetera.

But we can induce motivation through promotional activity. And we will have a heightened presence in the back half of the year here. And Bridge in and of itself is creating activation of patients to buck what ordinarily might be a calendarized view of [indiscernible]

Our final question comes from the line of James Gordon from Barclays.

James Gordon for Barclays. Two questions, please. into what was M&A, which was the on deal size, which you addressed, what are you looking for in terms of deals? I think there were some comments attributed a few weeks ago about maybe interest in things like aesthetics and the more consumer side how do you think about that versus more like physician-led pharma deal making? And is the focus that you deftly want to do obesity? And within obesity, where are you now seeing the biggest unmet needs in a bit given all the things you've already got in the pipeline?

And so look to that in terms of R&D, so some setbacks. And is that partly just because you're operating in tough areas like you're having to build on what's already good therapies. So does that change at all how you think about R&D, what the risk is and other areas that are higher risk now because there's good drugs out there and you maybe want to change a bit how you thought about where you want to be doing trials?

Thank you very much. First question for Mike on BD and focus areas. And then the second one to Martin on R&D.

So James, when we look at obesity, unlike many of our peers, we see this as not a single disease, but multiple conditions with 1 billion people suffering from basically suffering from it differently and needing different solutions. So we start thinking about the patients and then the solutions that we currently actually are building. First, we segment the population into injectable versus orals. Actually, we are more and more ourselves getting surprised how many people are after a pill rather than an injection, frankly speaking. And none of us probably know, but we can start guessing by the end of the decade, what portion of this business is going to be on injectable and on appeal.

We want to make sure that we have both and we are covered on both of these fronts. Then we are seeing more and more, of course, some of the biologies that is predominantly was used to reduce weight, has other benefits. We have seen this with our own semaglutide. And we are seeing it, of course, with a number of other biologies that are coming into this business. Martin just alluded to [indiscernible] But of course, we are seeing it also with GLP-1 and glucagon. Within that, then we are seeing each 1 of those therapy areas or areas basically are closer to us and we understand something the area scientifically, but also perhaps are we able to manufacture it in the same way as we are doing it historically.

And on the commercialization, the same. That will pivot us probably to left and right-hand side of where we are, and we will, of course, elaborate a lot of this more during our Capital Market Day, as we have touched upon. In that search, we then look around already today to see who else active and what is out there to bolt on from a business development point of view, in addition to what we're doing. So that's all I can share with you until now.

Thank you, Mike. Martin, any comments?

Yes. So in general, obviously, there is risk of doing R&D and drug development. I'll just remind you that a couple of months ago, we announced [indiscernible] Phase III data these were among the most groundbreaking in sickle disease that we've seen for many years, and we are aiming for a regulatory submission of that very, very soon. So their success. We've all along called out that [indiscernible] was high risk. There was a question on the correlation between the biomarkers and the actual outcomes and that was the legal phase that had to be tested. We've communicated at FS of around 50% or less because we acknowledge as a general observation, we have a pipeline with disease areas and modalities where we actually can generate a lot of value but with reasonably low risk, but we also have the series and new mode of actions where there is an inferred higher risk.

And by understanding the disease areas, the past physiology, the biology and the pharmacology of course, we can improve the risk profile. But it's actually a good place to be to have that balance between high value, reasonably low risk portfolio projects, but also higher risk, but equally higher-value projects. In that way, we see both successes and obviously, we had to acknowledge there will be some attrition also.

Thank you, Martin. Thank you, James. So this concludes the Q&A session. Thank you for participating, and please feel free to contact Investor Relations regarding any follow-up questions you might have. Thank you very much for dialing in.

This concludes today's conference call. Thank you for participating. You may now disconnect. Speakers, please stand by.

All right. Good evening, and welcome to the 2026 Novo Nordisk Investor Event in connection with the American Diabetes Association's Annual Meeting here in New Orleans. So my name is Michael Novod. I'm heading up the IR team at Novo. And I'm just going to run through a bit of practicalities -- currently not. I just want to throw a bit of a practicalities. So we're going to start with having a short presentation and then also followed by Q&A. And then the event is going to have a duration of 50 minutes before we're going to conclude. And with -- all right, I should also say that we do expect to make forward-looking statements, and they may differ from expectations. So read that just as a reminder. Today's speakers on the stage is our CEO, Mike Doustdar, he's going to give some brief introduction and is also Martin Horsager, our as Vice President, Head of Research and Development; and also Chief Scientific Officer; and then also for the Q&A will also be joined by CartoCusen, our CFO. So with that, Mike.

Thanks very much. So also, I may be have welcome to ADA and to this session. I'll start with the slide that you have seen a number of times. I will not spend too much time on it. But -- we are quite proud that when we walk through the halls of the ADA, actually, this congress is no longer just about diabetes, but obesity, I would say, 10 years ago, we were the only 1 echoing the voice of people suffering from obesity. And today, it is nice to see that so many other companies are with us in that journey. -- connected, of course, to these 2 conditions -- there are a lot of other comorbidities, MASH, CVD, chronic kidney disease. And in all of those, we are a proud owner of assets and build -- we would like to build upon that heritage as we go forward. We also have, of course, our rare disease franchise where I will not get too much into it today. Now this week, we also made an announcement about how we are doing with our pill, which has been 1 of the most talked upon assets of Novo Nordisk and the launches recently. I think at the last quarterly meeting, we talked upon -- we talked about how the field has become the best product launch of within the category of GLP-1 and perhaps within the whole category of launches in U.S. We are quite happy that we announced just a couple of days ago that we have now reached more than 3 million prescriptions. And I have to put that in perspective, we are now in week 22, I believe. It took us 10 weeks or it took us 12 weeks to get to 1 million prescriptions. And in the last subsequent 10 weeks, we have done 2 additional million prescriptions. That's in light of competition having arrived in the latter part. So if that is not acceleration, I don't know what is. I think it's been going very well. And we are also very happy to see that the pill is creating a halo effect on the whole franchises of Wegovy. On the back of the Gobi high dose, the GVHD, of course, the original Wegovy. The appeal is really causing us now have around 60% of the NBRx in the U.S. under the brand Wegovy compared to our competitors. So this is something we are very, very proud of. Then I also thought I shared this slide with you before I pass it to Martin to go in through the details. One of the most questions that I get on the pill is why are you doing so well, especially in the light of competition having arrived because I guess I am speaking on behalf of most of you, that very few had anticipated that. And the reason, I think, is a combination of, of course, the efficacy that you see here, 16.6% and versus 12.4%. That's some 34 percentage difference in efficacy of the pill versus what we are competing with, the tolerability happens to also be at least compared to our competitor better when you compare the number of people that dropped out of our child versus in their trial respective trial? The [ MAC ] and the label of Wegovy is helping a lot. This is a product that's not just reducing weight what is giving you the cardioprotection that Wegovy is synonymous with. So that is also another reason why the physicians are prescribing this medication. The safety profile of it on the back of 50 million patient lives is also something physicians speak to us about. And maybe last but not least, when you compare it to our competitor, is the least restrictive medication, which is the part that most people have ignored and/or did not speak to for maybe good or bad reasons. Yes, I think I'll be the first to say we have 1 restrictions compared to our competitor, and that's -- that you have to wait 30 minutes before you take food with the medication. You take a sip of water and then you wait 30 minutes has not been a problem for millions of patients that are on the pill right now. Meanwhile, against that single restrictions, we can see where the restrictions for my competing peers are. It is quite complicated and restrictive to take the other medication. And that's the fact of it and then that's what the physicians and the patients are trying to, of course, find a way around. And perhaps this combined with good sales and marketing is really the reasons why we feel very comfortable that we are on a good path. We have launched a product now in UAE 2 days ago actually, and early data, and it is really early data, gives me also very good hope that, that will be an equally good launch. And then more of that to come as we go forward with more launches, which we will announce going forward. Now it has been, I think, I'm subjective, but I think it has been a good ADA for us with some 40 different abstracts accepted 100% of the assets that we submitted has been accepted by ADA among which, of course, the products that you see -- we have had 36 presentations and 4 oral presentations covering more than 15 different clinical trials. And Martin will now speak to some of the highlights of those things.

Yes. Thank you very much, Mike. So -- good lord Yes.

Can we turn the volume down? So I'm going to focus, obviously, on you've seen top line data on [ Kagoshima ] type 2 diabetes. I'll remind you, we also did redefine 2, which was -- it is part of the beef program. But today, I'm going to focus on the REIMAGINE program that is the dedicated type 2 diabetes program, a secondary endpoint of weight loss. I'm going to focus on tenant in type 2 diabetes. And then I'm going to show you some details also on [ VBT 251. ] -- the highlights -- all right. So very briefly, Actually, I had to say the summer of [ Huliosenstok and Donana ] tough act to follow. And you probably attended most of you the session that was just finalized. You've seen the data. It is 3 studies basically comprising the spectrum of type diabetes from very early type 2 diabetes in REIMAGINE 1 through advanced tattoo diabetes in REIMAGINE 2 late-stage type 2 diabetes in reimagine free. So when we talk about the very early type 2 diabetes, the average duration of diabetes was actually less than 2 years in that population. The free start is have reasonably similar design. So comparing CagriSema 2.4 milligram to 1 milligram in all of them in all of them also a placebo arm and reimagine to also compare it to the mono component of semaglutide and [ agile ] In all 3 studies, less than 50% female. Obviously, you've seen a couple of times during this ADA. You also have heard us talk about it before. We do know that, that impacts the weight loss observed in the studies that we do because we see bigger weight loss with women that we do with men. We have a mean BMI in the 2 first studies of around 35 in and BMI in the last study of 31. Again, important when you interpret the data. And that basically is reflecting a mean body weight around 100 kilos in the first 2 sides and 90 kilograms in the last -- the weight loss you've seen and REIMAGINE 2 at the highest dose, 14.2 percentage point weight loss with an A1c lowering of 1.9%. And do want to mention, if I placebo control that, it's going to be 2 percentage points, which obviously, in this basin, you've seen other diabetes data being presented at this [ years ADA ] by similar control does actually still matter in type 2 diabetes. Obviously, we want the big way losses, but the first license to operate is good glycemic control. So approximately 2 percentage points lower A1c in this specific study, combined with a 4.2 percentage point weight loss. For consistency, we basically see around the same 14% weight loss in the Re-Imagine 1 and the reimagined free studies and around 2 percentage point lowering in A1C. Obviously, there's a range. It depends on the specific population -- but again, if your placebo-controlled somewhere between 1.6 and 1.8 lowering in A1C. So really, really robust and consistent data. there were a lot of discussions of the tolerability profile of CagriSema. We talked about it. You also saw it today, you see improved glycemic control, superior glycemic control vis-a-vis semaglutide in monotherapy, better weight loss savesmeglutide in monotherapy, but comparable adverse events rates as compared to semaglutide in monotherapy. So better basically get better weight loss, better glycemic control, but with the same safety and tolerability profile. -- and no new safety events occurring in the space of these studies. Just want to point out, we are not ready to do regulatory submission of type 2 diabetes for CagriSema because we are awaiting the cardiovascular outcomes data for basically both the type 2 diabetes, but also the obesity. We're doing that in 1 file called redefine 3 and that will read out next year. What will also happen next is obviously that we do initiate the higher dose of CagriSema. As you've seen, we've successfully established that we can increase the dose of semaglutide in monotherapy to 7.2 milligram without compromising on safety and tolerability as compared to lower doses of semaglutide. We intend to leverage that and initiating higher dose CagriSema studies later this year. .

Turning to [ Zenaganside, ] just reminding you that in obesity in the same time span of the study, approximately 6 months, we saw in obesity percentage point weight loss. Obviously, we expect to see something slightly lower in type 2 diabetes. And specifically, we saw almost 15% weight loss in type 2 diabetes. We do know that there is a little bit of a resistance to weight loss in patients with type 2 diabetes. So it is expected to see a slightly lower weight loss. But as you've also seen during this year's ADA a 15% weight loss in 6 months is quite impressive in type 2 diabetes. In particular, if we combine that with, again, I was about to say almost the usual approximately 1.6 lowering in A1C. Again, this is at 6 months, not in the longer studies. I know that at least 1 of you will ask him to the safety and tolerability profile. And I do want to spend a little bit of time if I can get the slide -- on the withdrawal rate of what we saw with CagriSema. You obviously see the nausea rates, the vomiting rates based on what we've seen during this week 3, it's not a surprising data in a Phase I/II trial. But there has been some concern expressed about the high withdrawal rates, 34% in the highest dose. This is simply because of trial technicalities because with this very powerful biology and an attempt to really push the dose escalation, we basically withdrew patients from the study if they did not want to dose escalate, which basically meant that people who felt that they had already lost more than 20% of their body weight, they did not need to go to the next dose. Not necessarily because they saw side effects but rather because they basically didn't want to lose more weight. They opted to not escalate the dose, which basically meant that they had to exit the trial. So there's a little bit of technicality in interpreting this data. When we look at the overall tolerability profile where we model what we can do in terms of dose titration in Phase III we assess that we will have a safety tolerability profile on [ part with ] CagriSema, which means that is expected to be on par with that of Wegovy. So a really, really strong efficacy profile, both on weight loss glycemic control, but also potentially a very strong safety profile and tolerability profile. We are conducting a quite broad development program, obviously, in obesity as a focus on weight loss. There is also a focus on immediate comorbidities as we see it in [ MAS ] which is sleep apnea and near osteoarthritis focused. So you've seen a combination trial or basket trial from some of our competitors, we've opted to do individualized trials -- so some trials focusing just on the wait loss. Some of the initial trials focusing on sleep at and neat arthritis. And then obviously -- and I think this is important we aim to show the same weight loss as we have shown with the subcutaneous treatment in an oral space will demonstrate that starting with MAS 9, which is our oral [ Senogamtide ] study. it's only 1 study, and that's basically because we aim to have it on the market at the same time as the injection. And we can bridge the safety data and some of the other data from the subcutaneous program to the old programs just like we've done with semaglutide. And that really calls for a very strong offering. Again, I can only quote the data that we have at 6 months. in obesity, 24% weight loss in Diabetes, 15% weight loss and a lowering of [ AT ] of 1.7%. So delivered in both subcutaneous but also an or profile. We'll have a cardiovascular study. It's not the usual free or 4 or 5 [ MEstudieIts ] actually a study focusing on heart failure. We do believe that there's too little focus on the impact of heart failure, both from an augmented lead perspective, but also in terms of what we've seen with semaglutide in that space. So therefore, we pursue that really very focused with [ Ameren. ] And this is an outcome study. It's not a functionality study. It's a true outcome study. And then obviously, we have the type 2 diabetes program as well. UPT 251, super exciting acquisition. You've seen the high-level data. Obviously, I have to call out that in this study testing free doses of actually 4 dose regimen of UPT 251 versus placebo. This is conducted in Chinese patients and in China only that does lead to an expected lower weight loss than what we would see from a global population. We've seen that in our stores, our competitors have as well. Rule of thumb is that you expect an Asian population to maybe lose 2/3 of the weight loss as compared to what you would expect to see in a global population. And therefore, when we do our modeling, just as we've seen for another triagonist during this week 8, we expect to see similar weight loss. So the 19% could translate to what we have seen from our competitors. Of course, we had to show that in Phase III, but really exciting weight loss potential. What is equally exciting is that in the face of that big big weight loss potential, we actually see a safety and tolerability profile that is very, very attractive. So -- sorry, this is the weight loss. I just tend to ramp without looking at the slides. So obviously, a 19% weight loss or 20% weight loss in the highest dose in this population and quite a number or proportion of the patients, 50% of patients reaching more than 20% weight loss in this all Asian population, we expect to see, as I said, substantially more weight loss in a global population comparable to that what we've seen from our competitors.

At the same time, you've seen the data today, those of you who went to the poster, a really, really attractive tolerability profile, very low withdrawal rates even at the highest dose, 0% withdrawal rate due to adverse events. A lot of you have said well, maybe there's also a bias in an old Asian population from that perspective. Just want to say, we've done a number of studies, our competitors have done a number of studies in Asia over the years. There are real also in those populations. So I think this is reflective of a good safety and tolerability profile. And when we look at the actual adverse went, it looks really, really attractive and very competitive. We are currently investigating UBT 251 now in a global population, which basically means that we intend to initiate Phase III in short order. We're not giving the time lines, but aiming to have regulatory submissions and launch around the turn of the stack. Briefly on R&D milestones. Obviously, you heard a lot about CagriSema. You heard a lot about UBT. You heard a lot about Senagemtin. I think for CagriSema, what is next is redefine -- that is the study where we're taking all of the learnings to really look at the weight loss potential of CagriSema. That study will read out in Q1 of next year, which is approximately a time of launch of CagriSema, expecting the U.S. regulatory approval later this year. we will see a continuous presence and initiation of Phase I study in both type 1 and type 2 diabetes that is not shown in this slide, but you will get more details and information on that if you attend Capital Markets Day. In U.S. for diabetes, we expect to see regulatory approval for 25-milligram of Ozempic or Ozempic later this year, which will obviously also be exciting. In rare disease, I just want to call that out. I know it's a diabetes conference, but we expect to see regulatory approval of [ Mint ] in U.S. And obviously, we intend to do the regulatory submission of its evoke were expecting a decision next year. then obviously just advertising a little bit for what is immediately ahead of us in Q3, we expect to see the readout of the [ SUSE ] trial. This is the first of the 3 cardiovascular outcomes trials that we do with ziltivekimab. The [ SHUS ] trial specifically is in patients with established cardiovascular disease, kidney disease and established inflammation. -- and the intent is basically to show improvement on Freepoint MAC with the intervention. It is well established that increased IC or increased inflammation is associated with increased risk of cardiovascular disease. We do know that more than 2 million patients live in U.S. with established cardiovascular disease and increased inflammation and therefore, future unmet need because there is no treatment available. This is driving high levels of mortality, high levels of stroke myocardial infarction and so on. And therefore, if an intervention can improve that the potential is tremendous. What we've seen from [ sitevecumab ] is up to 90% lowering in CRP as a proxy for inflammation in such a population. We've also seen a set and tolerability profile, which is important with NTI 6 treatment that is really attractive. So in Phase II, no increased risk of severe infections no meaningful neutropenia, no meaningful impact on liver or dyslipidemia. So really, really a potentially attractive safety and tolerability profile but also a potential for really impacting outcomes for patients through reduction in cardiovascular events, MACE, that is myocardio infraction, stroke or cardiovascular death. So really firing really also, I had to call out high risk. This would be a first -- and while we obviously await the data with high anticipation, it is a first-in-class, and that carries a risk that you have to take into consideration. But more to come I think with that, we're going to Q&A.

Thank you, Martin. Thank you, Mike. And as I said, we have around 25 minutes for Q&A, and Carsten is also joining us here on stage. Richard?

Richard Vosser, JPMorgan. Just we saw the Career data in diabetes and you went through it slightly. But how are you thinking about that opportunity in diabetes? To imagine 1 data looked quite similar to the readat published just yesterday. So how are you thinking about it? How are the doctors thinking about Amylin versus the use of glucagon in diabetes? .

So I really don't want to talk either good or bad about my competitors. I had to disagree with you that they look similar. So I think you're correct that ratatitide showed a 1.7 percentage point reduction in A1C, but the placebo arm showed 0.8 billion percent reduction. So when you placebo correct, which we have to do a scientist, the reduction is around 1.1, 1.2 percentage points, just 1.1%, 1%. Yes. All right. 1.1. Fair enough. .

And this is to be compared with what we've seen just with Kagem, which is around 1.6 to 1.8 placebo-controlled. So I actually don't agree. I think the weight loss was comparable. But on a simpler control, I think Hapisemma seems to stand out. And I would say the safety and tolerability profile with Cagrisema also appears to be more attractive. Obviously, indirect comparisons, you know my caveats around that. But I don't think I fully buy into the premise of this is comparable between the 2. I actually think in type 2 diabetes care stands up, both on efficacy and safety and tolerability. Great .

Thank you, Martin. Martin Baker from SEB. Just a question on the 2 triagonist. Can you talk a little bit how you position them up against each other also on an indication level, which 1 is -- are they going in Phase III in all indications? Or are there some differences you will look at? And then just into the UBT251io mentioned the 2/3 in China and maybe we should try not to put up the expectations so much for the global readout in Phase II. So that being 30%. But can you talk a little about your expectations for that? And also what kind of dose levels you have used? .

Yes, absolutely. So we're not going into too much detail when we talk about which indication we will pursue. I think your question is super relevant. So we'll not necessarily do what has been done for magnesite reteitide CagriSema for that matter. I think we'll look at really targeting these opportunities to where the biology warrants it. Maybe starting with higher baseline BMIs. As we've already seen, these biologies have really, really big weight loss potential. -- if you have a baseline BMI of 27 or 30 for that matter, you don't need a 25, 30 weight loss. And therefore, we'll probably for both of them be looking at maybe even going towards higher PMIs. When it comes to comorbidities, we'll obviously look at the boats. We know what JP1 does and has the potential to do -- the triangles containing glucagon or addressing the glucagon biology, it makes sense to go into for capital mesh we saw data today with another compound. I don't want to discuss their weight loss and their safety profile, but the data on the liver looked really, really interesting but you also saw a lot of discussions during this weekend on the amylin biology, for example, on both preservation potentially on other benefits and taking a differentiated approach. So we're not necessarily -- or we are not going to pursue the 2 assets for the same indications. We can really really think about what would be the right patient population to address with these biologies individually. Seamus? .

James Fernand Guggenheim. Just 2 quick questions. Martin, I'm just struggling a little bit with the math on the 34% of patients dropping out because they achieved 20% weight loss and then seeing only at the high dose of 14% weight loss as a relative driver from 36%. So just -- I'm trying to figure out what I'm missing there. .

I wasn't giving numbers. I was giving examples on some patients actually felt that they had lost enough weight. It was very clear that A lot of them, obviously, will do due to adverse events. We had not optimized the titration that we'll do in fish. But quite a high number also decided to leave for other reasons, including that they had reached a weight loss that was sufficient for them. don't try to match the number because I was not giving numbers. .

Perfect. And then just in terms of 2 factors, and maybe this is a little bit more of a question for Mike. But in terms of the supply opportunity and the scale at which you'll be able to launch CagriSema, I think folks are definitely interested given the dual chamber pen and some of the perceived complexity there. .

Yes. So it will be a global launch. I think at 1 point or the other, we had said that maybe we will launch the dual chamber for U.S. and dto a co-formulation for the rest of the world. That strategy has changed. We will basically without the co-formulations with the dual chamber be able to launch this globally. So that's what we're pursuing.

Steve?

BNP, 1 for Martin. Just given all the news all of the competing data sets we've seen and issues with fixed versus flexible dosing, placebo dropout patients taking primitive drugs. And just the number of trials we're seeing, just in terms of clinical trial execution for a Phase III programs, Liliano known to be good trial executed in the space. But are we being -- honestly for the wheel, but how much more challenging now as Head of R&D of Novo is it to conduct these trials with all those facts to consider

I would say, not necessarily more challenging, but you have to be more mindful of what you do. For us, these dynamics are not different than when we had the same dialogue in type 2 diabetes 10 years ago, 15 years ago, you saw improvements coming in. And you also saw a drop in other therapies in our cardiovascular outcome studies, we Five years ago, 3 years ago, had dialogue on dropping on SGLT2s and Pan potentially the CV benefit of semaglutide. If you design and the study is correct, then you will be able to take care of that. You've not seen -- I mean, we're doing studies all the time. You've not seen the impact of drop in in our studies, yet it's obviously something that we monitor. It's also something that we dialogue with the investigators and they, in that turn, dialogue with patients on show that we can handle it. Some of it you can potentially also cover from a statistical perspective. I think when it comes to flexible dosing, we have to acknowledge, we took our learnings with CagriSema. Flexible dosing has to be employed. You've also seen some data today where force titration were used and leading to massive dropouts. That's not what you can do specifically from a regulatory perspective. But you have to employ flexible dosing in the right way. So again, we took learnings from CagriSema. We've taken those learnings into the REDEFINE 11. I think you heard me talk about at the quarterly meeting, that we already see the impact of that. And we're taking all of those learnings further into macitenand we'll do that again when we go to the triagonist. So I think from a trial conduct perspective, if you do the right planning and you have the right approach, but there is an art to it, it's not more cumbersome, but you have to be mindful of what to do. .

James?

James Gordon from Barclays. A question on UBT. So I saw the phase -- the earlier Chinese sector, but there wasn't a lot of detail on the tolerability. So can you elaborate a little bit? Is it that you think this could be better on and/or tolerability or more like it's going to be quite similar to Rete? And like was there anything in terms of people having like skin sensitivity or cardiac issues? And then maybe just sticking with BCG, just so we saw the repeat in obesity, how are you thinking that might impact your injectable franchise next year? And how will the picture will be particularly like lower dose refer say, versus AGM, please?

So I think the last question is for Mike or Carsten, will take. All right. Your first question, sorry. Additional details on tolerability. .

Yes. Sorry. So the poster that was shown today was not ours. It was basically shown by the investigators that worked on the study together with United. -- and they decided just to look at the dropout rates. When we look at the data, we can only do modeling transferring the data from Phase II in Chinese [indiscernible] Phase I first in a caucasian population and then into Phase II there we see -- we never plan to see superior over, for example, retest, -- it's the same biology. But we see the potential for parity on weight loss plus/minus. And then we see a tolerability profile that at least in this study and the other data that we have looks maybe more attractive than what we've seen for another triagonist. I mean you saw the dropout data. Obviously, it's a small study, and we have to take that into account Nevertheless, if you look at the actual data, and I've been privileged to those data, it looks quite attractive. Not in the small studies, I mean same-size is not to really make those observations. .

Yes. And James, thanks for your question on the competitor 4-milligram I think the important notion is that if you look at our portfolio today, then with our injectable sema franchise, most recently launched sema high dose, 7.2 in the U.S. market. we have a highly competitive portfolio in terms of efficacy, proven brands, go-to-markets and acknowledgment around all the convinces of that brand. And on top of that, Then, as you know, we launched with the Vigo. So we heard some hints around convenience of compares to play. And there, I think that the Google pill has proven with the uptake Mark showed earlier. -- that if you want convenience, then a daily pill like the Google pill is hard to beat. So -- so we'll welcome competition and look to expand the market. And with our portfolio, we are ready for that combined with CagriSema, which will be approved at that point also. .

Maybe I can add to that also, James, that from what we hear from the patients thereafter the magnitude of the weight loss and tolerability and the speed of the weight loss. So from the data is from our competitor, yes, with 1 titration, you can get to 19% weight loss, but you need to wait 80 weeks to get there. That's very different than, of course, if the situation was after 4 months -- 4 weeks, you titrate and then you get to the 19%. So I think patients don't care so much about 1 or 2 or 3 those changes, but how fast do they get to that percentage weight loss. And then as Karsten touched upon, if you look at the products available right now in the market, ours or even our competitors in a fewer weeks, you get to that level weight loss basically at very similar, if not better tolerability. So that's how I look at it from a patient's angle.

James

Freedom Goldman Sachs. But Two menu-related questions. So firstly, on demicemotide, -- how are you thinking about the doses and the titration scheme for the Phase III. You mentioned that the Phase III will be a new titration scheme. So how how did your modeling give you confidence on that? And are there any other measures as well that you could take to help attenuate the safety profile, the tolerability profile in the Phase III -- and second, we've had a lot on menu biology at the meeting and as more data emerges in the class. How do you think about differentiation between the assets that we've seen data for. So does DAC versus Sara matter? Do you believe these are molecule-specific, co-specific anything on CagriSema versus any game versus Petri versus a loyal inside any views there would be great. Yes.

Absolutely. So on dosing, I mean, we have to go back to what we saw with CagriSema. There are a group of people who can titrate these biologies, GLP1 usable biologies every 4 week as we basically intended, and they had a REDEFINED 1 better, i.e., lower side effects profile as compared to Wegovy 57%. Then there's a group of people who actually got the bigger weight loss more than 25%. And but who also started to go down in those basically because they either lost way too fast or because there's a side of things. That group of people, you should not recommend to titrate every 4 weeks, you have to acknowledge that they are super responders, so they should titrate with lower frequency. And we basically, for convenience, decided every 8 weeks. So we now have employed that in REDEFINE 11. As we already discussed, we can see that work that improves how many patients actually get to the higher doses and stay on those doses with a good safety and tolerability profile. Again, I'm looking at blinded data, I can't see weight loss. -- but I can see how many patients go to the recommended dose. And we are doing that in redefined -- sorry, in the AMaZe program as well. What we are also doing is actually adding an extra dusted, acknowledging that the dose deposePhase I and II were maybe slightly too ambitious. And again, that makes us quite confident that we will see the weight loss potential that we've already discussed in type 2 diabetes also the claim control but with a tolerability profile comparable to that of CagriSema. And then on Emlen biology, I mean, jurist. You've heard me talk a lot about, in particular, when it comes to cardiovascular outcomes. I do not think actually, I think I know that GLP-1 is not just a GLP-type for example, stands hard on CV benefit as compared to other incretin-based therapies I have to assume it must be the same for eminent biology. We've seen 1 asset with a weight loss comparable to agile but will now dose response on the higher doses, whereas we can actually see that if we increase the dose of cagintide, we can get to higher weight losses. .

There's another competitor that have seen a very high weight loss, but where we are a little bit down on what the tolerability profile will look like because at some doses, they saw a really good tolerability profile at others, they looked at tolerability profiles that resembled GLP-1. And you don't want a 19% weight loss if you get the same tolerability profile as the GLP-1 because then it's just for patients another GLP-1. The promise has to be that you get to your desired weight loss with a better tolerability profile. And that is where we see cabrilentide right now stand a little bit out.

big?

Simon Bay from Roshan CoRedborne. Two, if I may, please. Just following up on a couple of earlier questions and starting with James. Are there any differences you'd call out between the receptor affinity across the 3 alumin receptors in calcitonin between grilling Tide and Zengamtite. You answered -- I was going to ask the question about does this actually matter? Do we know? And then just picking back on something that Pete was talking about, particularly in light of some of the data we saw this afternoon on server did. Going forward, is it -- is it practical or ethical to run placebo-controlled obesity studies going forward? Are you good to get your perspectives on that? .

Absolutely. So I I think the jury is still out if it matters the specificity for men versus casitonin. -- they are all slightly different. -- there's also a difference between grind and Seagen side, and that's where I've seen the most data close end. They appear to have the same weight loss potential, the same tolerability potential. Some are saying you want more calcitonin for bone preservation, maybe others are saying, you want more Amlin for better weight loss and better tolerability. I'm not sure we've seen those differences pan out. So what we are doing is basically to ensure that we have a portfolio of Amlin biology that caters to basically both. .

Really good question. I think as long as there's a regulatory requirements, we'll have to continue doing the placebo-controlled studies for better worse, we had to do active comparator for CagriSema with the individual ones we don't mind doing that. Our aim is to take differentiated products to the market. So we've already now shown that CagriSema a step-up Isaismagltypa relied more serves. .

-- all that in Beane. But you're losing market share with Ozempic, why would you not file for Tegsesity? -- given that you have capacity for global loans?

So you meanComandiabetes. -- basically because we need to have the reimagined data -- sorry, redefined free data before we can do the regulatory submission.

Michael? .

Mike Mandekic, TD Cowen. One of your competitors showed some compelling if early data for a once-monthly injectable at this conference. I'm curious if your approach to that effort has evolved at all? Do you think a once-monthly injectable could be a meaningful segment in the PC market? .

So I mean, obviously, we're pretty curious about once monthly. You also saw that we were interested in that specific asset. That being said, I'm not sure that the data were as compelling as we had hoped for, in particular, on the tolerability side, but also a little bit on the efficacy side. I think the efficacy side is a matter of dosing. And maybe they will see a bigger weight loss in Phase III, but they really had to think about their titration because the 1 month tolerability was not as attractive as I would have expected and to give patients something for a once-monthly setting the proposition has to be that it is a very attractive tolerability profile. So we are also pursuing less frequent dosing. Obviously, part of what we just discussed can be mitigated by even longer half as you see us taking once modestly asset into Phase I this year. And we can -- if everything goes right, have those assets potentially in the market around the turn of the decade, to be able to compete in that space in a meaningful way. But again, the tolerability profile has to be better than what we've seen .

Ben?

Ben Jefferies. One for you, Martin, on UBT, -- is this a scenario whereby you can get the SNAP technology involved again and go with the oral route. And perhaps when can we start to see that progressing? And then a really quick 1 for yourself, Mark, I think you made a couple of comments in an interview today talking about potential for aesthetics and longevity. Is that through using the best in Type 2 diabetes portfolio as well? Or is there more interest to diversify beyond these core areas as well?

Yes. So we're going to realize not any peptide lenses sales to the SA technology. That being said, we are obviously pursuing an oral version of UT5. I just want to advertise, we're also doing a tangent as we just discussed, an oral version of an Amlin. And then we have actually a small molecule, which is the CSL inhibitor let's start a Phase I a couple of months ago. .

And I was basically making a reference that the biology is that we are playing around with and have expertise in can do multiple different things, and we will not shy away from pursuing and following the science in those biologies. So that was the reference. .

All right. We have to cut here, but thanks a lot for joining this Novo Nordisk investor event at the ADA of 2026 in New Orleans. Thanks, Mike. Thanks, Martin, and thanks, Carsten. Thanks all for joining. And there's also be couple of minutes afterwards to discuss with management.

Thank you very, very much.

Thank you.

Good day, and thank you for standing by. Welcome to the Q1 2026 Novo Nordisk Earnings Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded.

I would now like to hand the conference over to your first speaker today, Michael Novod, Head of Investor Relations. Please go ahead.

Thank you very much, operator. Welcome to this Novo Nordisk earnings call for the first 3 months of 2026. My name is Michael Novod, I'm the Head of Investor Relations at Novo Nordisk. With me today, I have CEO of Novo Nordisk, Mike Doustdar; EVP, U.S. Operations, Jamey Millar; EVP, International Operations, Emil Kongshoej Larsen; EVP, Research and Development and Chief Scientific Officer, Martin Holst Lange; and Chief Financial Officer, Karsten Knudsen.

All speakers will be available for the Q&A session. Today's call is being webcasted live, and a recording will be made available at our website. The call is scheduled to last 1 hour. Next slide, please. The presentation is structured as outlined on Slide 2. Please note that all sales and operating profit growth statements will be at CER, unless otherwise specified.

Next slide, please. As usual, we need to advise you that this call will contain forward-looking statements. These are subject to risks and uncertainty that could cause actual results to differ materially from expectations. For further information on the risk factors, please see the company announcement for the first 3 months of 2026 and the slides prepared for this presentation.

With that, over to you, Mike, for an update on our strategic milestones in the first quarter of 2026.

Thank you, Michael. Next slide, please. In 2026, Novo Nordisk is focused on driving competitiveness, progressing our pipeline and making focused investments towards growth opportunities while delivering returns. Today, Novo Nordisk is serving more than 45 million people living with obesity and diabetes. Of those, more than 4 million people are using our obesity treatments, which means we are now treating over 50% more people living with obesity compared to just a year ago. We are excited to continue bringing new Wegovy options to patients that includes the Wegovy pill in the U.S. and Wegovy HD, also known as high-dose or 7.2 milligram, which is now approved in the U.S., U.K., European Union and Brazil. It is no secret that the Wegovy pill is off to a record-breaking start in the U.S. Since launching it some 16 weeks ago, we have seen over 1 million people using Wegovy pill.

As the global momentum behind the peptide-based therapies accelerates, Wegovy pill is defining a novel category as the only oral peptide for the treatment of obesity, setting a new benchmark for what patients and physicians can expect. All of this is something we are very proud of, and it highlights our strong innovation and launch capabilities. Within research and development, we continue to advance our pipeline across therapy areas. In the first quarter of 2026, we have had 6 regulatory approvals and more than 10 clinical trials initiations. Martin will dive deeper into all of these exciting accomplishments in a few minutes, along with our expected milestones for the rest of the year.

Novo Nordisk is making strategic investments in growth opportunities to drive our competitiveness and progress our pipeline. In the first quarter of 2026, we have invested about DKK 22 billion in research and development and commercial initiatives. On top of that, we returned nearly DKK 38 billion to our shareholders through dividends and share buybacks. Lastly, we have raised our 2026 guidance, which Karsten will get back to later on. Next slide, please.

In the first 3 months of 2026, adjusted sales decreased by 4%, driven by lower realized prices, partly offset by GLP-1 volume growth and market expansion. U.S. operations decreased 11%, partially offset by international operations, which grew 6%. Our GLP-1 sales in Diabetes decreased by 11%, mainly driven by U.S. operations. Obesity care sales increased 22%, driven by both operating units. International operations grew by 44% and U.S. operations grew by 9%.

With that, handing it to you, Jamey.

Thank you, Mike. Next slide, please. Early this year, Novo Nordisk launched the Wegovy pill in the United States. Wegovy pill delivers weight loss efficacy on par with that of injectable Wegovy in a once-daily easily administered oral tablet. In addition to the weight loss indication, Wegovy pill is the only oral GLP-1 product approved for the reduction of major adverse cardiovascular events, specifically a reduction in cardiovascular death, heart attack and stroke. Furthermore, it is supported by semaglutide's long-standing safety and tolerability profile with around 50 million patient years of real-world experience and does not have drug-to-drug interaction restrictions in its label. Since the launch, we have been focused on use, users and usage. The use of Wegovy pill continues unabated, far outpacing the uptake of any prior GLP-1 drug launch in the United States.

First quarter TRxs were 1.3 million in total. And since launch, we have generated more than 2 million TRxs. We estimate this translates into more than 1 million people treated since launch. For the week ending on April 17, total weekly prescriptions were 207,000. In terms of users, our source of business analysis supports that the Wegovy pill is bringing new health care providers and new patients to Wegovy. In terms of patients, we see close to 80% of Wegovy pill users are GLP-1 treatment-naive patients. We also see patients coming to Wegovy pill from competitor products with limited cannibalization from injectable Wegovy.

Lastly, in terms of usage, we are tracking titration, refills and stay time. While it is early in terms of usage evaluation, we are encouraged by what we see and early trends are consistent with our expectations. We continue to seek improved pull-through of reimbursed volume, leveraging strong standard formulary positions in the commercial segment. By the end of the first quarter, all 3 of the largest PBMs added Wegovy pill at parity with injection on their standard template formularies. This will have an impact on the balance between reimbursed and self-pay volume over time. As expected, the early volume is largely in the self-pay segment. Next slide, please.

Wegovy High-Dose was launched in the U.S. in April in a single-dose device, giving patients and health care providers the opportunity to experience greater weight loss with the Wegovy brand. Based on the step-up trial results, when patients adhered to treatment, the 7.2 milligram dose of semaglutide delivered 20.7% mean weight loss in people with obesity with approximately 1 in 3 people experiencing 25% or greater weight loss. Importantly, despite the higher dose, the rate of discontinuation in the trial due to adverse events is similar to that observed with the 2.4 milligram dose. Wegovy High-Dose has been launched nationwide across all channels with the 3 largest PBMs having added Wegovy High-Dose to their respective standard formularies as a line extension. It is still early days, but we are already seeing users titrate to the 7.2 milligram dose. Next slide, please.

Our recent commercial efforts, including the expansion of Wegovy offerings with the Wegovy pill and Wegovy HD and options for accessing our medicines have driven a notable shift in new-to-brand prescription dynamics in the branded anti-obesity medication space. The Wegovy franchise is now leading on NBRx market share with a share of around 65%.

With that, over to you, Emil.

Thank you, Jamey. Please turn to the next slide. In the first 3 months of 2026, obesity care sales in international operations grew by 44% to DKK 9.2 billion. This was driven by strong volume growth and market expansion, partly offset by lower prices, particularly in China following price reductions after the NRDL listing of a competitor product. Novo Nordisk continues to be volume market leader in international operations with around 55% weekly injectable GLP-1 volume market share. While our market share has been declining over recent quarters, we are starting to see our share growth stabilizing, which indicates that we are gradually seeing the benefit of our efforts to drive competitiveness in the market.

As examples, we are expanding our telehealth partnerships and in some of our largest markets, around 20% of Wegovy sales is coming from telehealth channels. We are also differentiating our GLP-1 portfolio with the U.K. approval of Wegovy 7.2 milligram in a single-dose device and the launches of Ozempic 2.0 milligram. In addition, Novo Nordisk is expecting to launch Wegovy in select markets in the second half of 2026, pending regulatory decision.

With that, over to you, Karsten.

Thank you, Emil. Please turn to the next slide. In the first 3 months of 2026, our reported sales increased by 32%, reaching DKK 96.8 billion. However, as part of our 2025 full year results, we did introduce adjusted metrics to exclude certain exceptional and nonrecurring effects, primarily of noncash nature, including the provision reversal of USD 4.2 billion related to the 340B drug pricing program in the U.S. That means our adjusted sales declined by 4%, driven by lower realized prices, partly offset by GLP-1 volume growth and market expansion across geographies. The adjusted gross margin decreased to 80.6% compared to 83.5% in 2025, reflecting lower realized prices, onetime costs as well as a negative currency impact. This was partially offset by positive product mix from increased GLP-1 sales.

Adjusted operating profit decreased by 6% at CER, reflecting the lower sales and gross profit, combined with continued investments in R&D and commercial activities, including ongoing launches. Through our disciplined cost base approach, we are on track to deliver the DKK 8 billion of savings from the company-wide transformation announced back in the third quarter of 2025, which are being reinvested into growth opportunities. At the end of the first quarter, the number of full-time employees was around 68,000, which is a decrease of almost 10,000 employees compared to 12 months ago. Please turn to the next slide.

Novo Nordisk is off to a good start. And for 2026, adjusted sales growth is now expected to be between minus 4% and minus 12% at CER. The improvement in outlook is mainly driven by increased expectations for GLP-1 product sales. In International Operations, the outlook is based on current growth trends, including continued volume penetration from GLP-1 treatments and market expansion, mainly within obesity and negative impacts from the compound patent expiry of semaglutide molecule in certain markets. In U.S. operations, the outlook is based on current prescription trends for the injectable GLP-1 portfolio, intensifying competition as well as negative impact from reduced obesity medication coverage in Medicaid.

Further lower realized prices linked to investments in market access amplified by the Most-Favored-Nations agreement with the U.S. administration is assumed. Uptake related to the Wegovy pill is reflected in the outlook based on a range of assumptions related here to, such as market penetration, potential negative impact on the growth of the injectable obesity medication category as well as channel mix. Adjusted operating profit growth is now expected to be minus 4% to minus 12% at CER, primarily reflecting the updated sales outlook. We continue our targeted investment in growth opportunities within R&D and commercial, partly funded by reinvestment of savings from the company-wide transformation in 2025 as well as further optimization initiatives and disciplined resource allocation. Our key modeling considerations for 2026 are shown on the slide. That was the outlook for 2026.

Now over to you, Martin.

Thank you, Karsten. Please turn to the next slide. The first quarter was eventful with numerous readouts and regulatory milestones. Within obesity, we recently obtained FDA approval for high-dose semaglutide at 7.2 milligram in the U.S. We have also initiated the 2 pivotal Phase III trials in the zenagamtide development program, AMAZE. In addition, we have initiated Phase III trials to investigate zenagamtide in people with obesity and sleep apnea, in people with obesity and knee osteoarthritis and to investigate how well zenagamtide helps people with obesity in maintaining their weight loss.

Within diabetes, we completed the pivotal Phase III trial, REIMAGINE 1 for CagriSema in people with type 2 diabetes in adequately controlled the diet and exercise. In the trial, CagriSema demonstrated a superior HbA1c reduction of up to 1.8 percentage points and a superior weight loss of up to 13.8%, respectively, at 40 weeks. The detailed results from the REIMAGINE 1, 2, and 3 trials will be presented at the American Diabetes Association Conference in 2026. Lastly, a weekly received FDA approval as the first and only once-weekly long-acting basal insulin for people living with type 2 diabetes. We expect to launch a weekly in the FlexTouch device in the U.S. in the second half of 2026. Please go to the next slide.

Recently, we announced the top line results from the Phase III HIBISCUS study, which evaluated the potential of Etavopivat in sickle cell disease in addition to standard of care. Sickle cell disease is an inherited condition in which red blood cells take on a sickle shape because of abnormal hemoglobin. This alteration leads to blocked blood vessels, poor circulation and episodes of severe pain known as vaso-occlusive crisis or VOCs. The following complications can impact any organ and are often accompanied by anemia and fatigue and may ultimately lead to organ damage and a shortened lifespan. Approximately 8 million individuals worldwide are affected by sickle cell disease. Treatment options remain limited and the unmet need is significant, underscoring urgent need for improved therapies that address both VOCs and hemoglobin response.

Etavopivat is a novel and once-daily orally available small molecule designed to improve red blood cell health via pyruvate kinase-R or PKR activation. Etavopivat was tested in the HIBISCUS trial, a randomized, double-blinded 52-week efficacy and safety trial investigating Etavopivat versus placebo in 385 people aged 12 years or older with sickle cell disease. The co-primary endpoint was annualized VOC rates, reduction and hemoglobin response on top of standard of care. Next slide, please.

Etavopivat successfully met both co-primary endpoints in HIBISCUS, making it the first of its class to meet both co-primary endpoints by substantially reducing VOC events and improving hemoglobin response in sickle cell disease. In the trial, Etavopivat demonstrated a superior reduction in the annualized rate of VOCs by 27% compared to placebo. In addition, time to first VOC event was delayed by around 4 months compared to placebo. In the co-primary endpoint measuring hemoglobin response, Etavopivat demonstrated a superior increase in the proportion of people achieving a hemoglobin response greater than 1 gram per deciliter at week 24 of 48.7% compared to 7.2% with placebo. As an exploratory analysis, Etavopivat also significantly reduced the risk of blood transfusion. In the trial, Etavopivat appeared to be well tolerated with top line safety profile in line with previous Etavopivat trials. Based on the results from the HIBISCUS trial, Novo Nordisk plans to submit the first regulatory approval of Etavopivat in the fourth quarter of 2026. Next slide, please.

Earlier this year, Novo Nordisk and United Laboratories announced the top line results for UBT251 in 2 Chinese Phase 2 trials, one in obesity and one in diabetes, respectively. UBT251 is a long-acting synthetic peptide triple agonist targeting the receptors for GLP-1, GIP and glucagon. In the obesity Phase II trial, the highest mean weight loss observed for people treated with UBT251 was 19.7% after 24 weeks of treatment. In the type 2 diabetes trial, the largest mean A1c reduction with UBT251 was 2.16 percentage points at 24 weeks and the highest mean weight loss observed was 9.8%. In both trials, the safety and tolerability profile of UBT251 appeared to be consistent with tri-agonist-based therapies. Within obesity, Novo Nordisk has initiated a global Phase Ib/IIa trial with results expected in 2027. For type 2 diabetes, Novo Nordisk expects to start a global Phase II trial with UBT251 in second quarter of 2026. Next slide, please.

After a busy quarter, we anticipate an exciting year ahead across all therapy areas. Starting within obesity, we still expect a decision in the U.S. for CagriSema at the end of '26 with a potential launch in '27 around the same time of the REDEFINE 11 top line results. In addition, we expect to initiate a Phase IIIb trial with CagriSema high dose in the second quarter of 2026. Overall, we remain excited about the profile of CagriSema and prospect of launching soon given the strong weight loss profile as well as the broader cardiometabolic effects observed. We also expect to initiate the AMAZE 9 trial investigating oral zenagamtide in people living with obesity in the third quarter and a Phase III trial with cagrilintide high dose in the fourth quarter of 2026.

In the U.S., we anticipate the decision regarding Wegovy FlexTouch that was resubmitted in Q1. In the EU, we expect a decision on Wegovy pill and the single-dose device for injectable Wegovy 7.2 milligram. Within obesity-related comorbidities, we expect Phase III results for efruxifermin in the SYNCHRONY real-world trial in people with metabolic dysfunction-associated steatohepatitis or MASH, with fibrosis stage 1 through 4. The primary endpoint of the trial is safety and tolerability of efruxifermin. Within diabetes, we have initiated the Phase II trial for our tri-agonist targeting GLP-1, GIP and amylin. We also expect to initiate the zenagamtide Phase III development program AMBITION in the fourth quarter of '26.

Within diabetes-associated comorbidities, the first readout of Ziltivekimab from the ZEUS Phase III trial is anticipated in the third quarter of this year. The trial is assessing 3-point MACE relative risk reduction on top of standard of care. Ziltivekimab has the potential to be first-in-class treatment, targeting systemic inflammation in people living with atherosclerotic cardiovascular disease and chronic kidney disease. 2026 is an exciting year in rare disease as well. Besides the HIBISCUS results I just mentioned, we are awaiting regulatory decisions in the U.S. and EU later this year for denecimig, previously known as Mim8 for people living with hemophilia A.

With that, over to you, Michael.

Thank you, Martin. Next slide, please. With that, we're now ready for the Q&A. [Operator Instructions] Operator, we're now ready to take the first question.

[Operator Instructions]

And your first question today comes from the line of Richard Vosser from JPMorgan.

Two questions, please, both on oral Wegovy. You've seen very strong uptake, but there seems to be a bit of a drop-off in the patients going between the 4 mg and the 9 mg doses in terms of titration. So just wanted your views on what might be behind that. Is that the jump in price? Is it tolerability? Or is it weight loss results? And how you're thinking that will impact the stay time of the product and the growth going forward? And one just on supply of oral Wegovy as well. You've referenced launches in a couple of international operations markets. How many markets do you think you can sustain? And generally, how is supply going?

Thank you, Richard. Two questions. One, starting with Jamey and then over to Karsten on supply.

Yes. Thank you for the question. Overall, titration is happening as expected and comparable to what we see with injectable Wegovy. So we're pleased with the progress there. Of course, it's early post launch in the evaluative kind of period of usage. But we also see movement toward the 9 and 25-milligram doses continued uptake on a week-over-week basis.

Great. Thanks, Jamey. And Richard, thanks for the question on supply. The way I'll put it is, while we do not have unlimited supply for the Wegovy pill due to the product design, then despite the fact that we are setting a new record in terms of product uptake in the U.S. market with the Wegovy tablet, we are still able to announce launches in the first markets ex U.S. already this year. So this speaks really to scaling of supply and the inventories we've put in place. And then we play it gradually from here in terms of the pace of international rollout.

Your next question comes from the line of Sachin Jain from Bank of America.

Two again, please. So firstly, I guess, Karsten, on SG&A. It's lowest absolute number for a number of quarters. It feels a little bit odd into a product launch. So should we think of this as a new commercial model with telehealth and this is a base? Or anything to think about the cadence of SG&A through the course of the year? The second one is a broad question around price, maybe for Michael or Jamey and [indiscernible] into your comments around no intention to lower prices and oral price in the sweet spot. I wonder if you could just dig into that a little bit further. Is there no intention to lower come into the 150 or 149 lower oral dose holding? And if oral price is the sweet spot, how do we think about price mix across the business shifting to this lower price bracket? And I guess that trends to higher dose oral pricing, reimbursed pricing and bleeds diabetes pricing.

Thanks, Sachin. First question to Karsten and then second goes to Mike.

Yes. Thanks, Sachin, for this question. So on SG&A in the quarter, first and foremost, it's important to note that we have a one-off, which is favorable in the fact that we are adjusting a legal provision, which has a benefit of, I would say, a notch more than $100 million that favorably impacts the quarter. So one should adjust for that. In terms of continued investment, then I promise you that we have gone pretty much all in, in terms of the Wegovy pill launch and resourcing of that. You've seen the Super Bowl ads, et cetera. And then with the model that we are deploying together with the telehealth partners, then that yields a different scalability in terms of promotional presence between paid versus earned media.

And that has yielded a very, very high share of [ voice ] share in the first quarter. Through the coming quarters, expect us to be disciplined around our spending. We have less employees in the company, which, of course, helps on SG&A. And -- but at the same time, we are truly investing in the growth drivers we have, be that Wegovy HD, the launch products coming up and the Wegovy tablets. So in terms of SG&A ratio, we are in the low 20s for the full year.

So Sachin, I think price is dynamic and element of volume uptake. If you take a look at where we are with our volume uptake, that's why we say we are at the sweet spot. We are seeing a situation where at the current prices, we have had 2 million scripts after 16 weeks, more than 200,000 scripts per week despite competitor having come now more than a week -- more than a month into the game and having more than 1 million patients on our product. So at this point, I would say we have priced this product perfectly correct. We also have said that, of course, it's dynamic because if you look at this in a longer spectrum, then we foresee a situation where volume uptick continues, of course, to continue. And then that would mean that prices have to come down if your ambition is to get to hundreds of millions of patients at one point or the other, at that point, of course, the prices will be very different. But for now, this is the right price.

Your next question comes from the line of Simon Baker, Rothschild & Co.

Two if I may, please, really following on from Sachin's questions. Firstly, on the oral Wegovy, I just wonder in light of the launch and the success of the launch, if you're getting a better handle on this price volume dynamic? And as part of that, what's been your feedback for patients choosing the pill? Is it convenience? Is it efficacy? Or is it cost because it's the cheapest option in the market at the moment? Just some idea on how this price elasticity is evolving. And then secondly, going back to cost, one for Karsten. Not only was SG&A even after the legal adjustment low in the quarter, R&D was as well. So I just wonder if you could give us an idea on the phasing of R&D through the rest of the year.

Great. First question for Jamey and then second question for Karsten.

Yes. I think on price elasticity, as Mike said, the volume uptake and receptivity in the market suggests that we found that sweet spot in terms of price leading to record volumes. In terms of oral attractiveness to consumers and patients, the key decision criteria still is magnitude of weight loss and the Wegovy pill demonstrated 17% weight loss. In addition, the attractiveness of the limited time offer pricing for the initial starting dose brings people to the product as well.

Thanks, Jamey, and thanks, Simon, for the question on R&D cost. As you heard from Martin's introductory comments, then we have a lot going in R&D, and it's a strategic priority for the company to expand our pipeline to drive growth not only for the medium term, but also for the long term. So the R&D ratio in the quarter, yes, is a notch on the low side compared to what we expect for the full year. So expect us to lean in on R&D investment in the coming quarters.

Your next question comes from the line of Peter Verdult from BNP Paribas.

Pete Verdult, BNP. Two questions, one for Martin and one maybe for Jamey as well. Martin, can I just push you for some more info on your next-gen GLP-1? Is it fair to assume that this will be differentiated on dosing frequency? Or do you still believe there is scope within the GLP-1 class to differentiate on efficacy or safety? And then maybe, Jamey, for you, just because you are new to the management team and you bring an outsider perspective inwards. Could you just give us a flavor of what you found when you arrived in your role at Novo and some of the -- a few of the biggest changes you've made since taking the role on?

Thanks, Pete. First question to Martin and then to Jamey.

Yes. I think you've -- thank you for the question, Pete. I think you've heard me talk about before, when we talk about differentiation, we look at efficacy, differentiation, tolerability, dosing frequency and maybe scalability. Let's assume that this one has one or more of these potential traits, but we'll not go further into detail, and you'll have to maybe attend CMD to learn more.

Great. Thanks, Martin. And Jamey, what have you learned?

It's a big question, but a short answer. Firstly, just a lot of opportunity. I think the first quarter milestones, whether it's approvals, clinical data readouts have produced a great environment to make a change in the trajectory of the business, specifically, obviously, Wegovy pill as we're discussing, but also Wegovy high dose, the 7.2 milligram strength really allows us to level the playing field from an efficacy standpoint. So a lot of opportunities and levers to leverage. I think the second thing just in a snapshot, and Mike talks about it often is the opportunity to integrate our thinking across market access, sales, marketing, medical, regulatory in a differentiated way.

Your next question comes from the line of Michael Leuchten from Jefferies.

Two questions as well, please. And linked, Ozempic had a pretty strong first quarter. Can you talk to the price erosion in the U.S. you saw in Q1? And how should that -- or would that look like once the Medicare bridge program kicks in? Would there be collateral damage for Ozempic in diabetes in the second half? And that links to the second question on guidance. So Karsten, you haven't changed the lower end of the range when Q1 came in quite robustly. What's the variables that doesn't allow you to lift that lower end double-digit decline in -- for the rest of the year?

Thanks a lot. Two questions for Karsten.

Yes. Thanks, Michael, for those very relevant questions. So first, in terms of Ozempic and Ozempic performance, then I'd say what we've seen here in the first quarter in the U.S. setting, which is what you're alluding to, is very much a continuation of what we saw towards the end of last year and what the same commentary in connection with full year. So both on volume trending and on pricing, the same, we're looking at these, call it, minus 10% to up to minus 15% price erosion. So really no change there. And that's what we're looking into for the full year. So I really don't want to get into the quarters, but same guidance this year as last year and even the year before on Ozempic U.S. price.

As to guidance and where we are now, the important point on guidance and our thinking behind guidance here at Q1 is that now we're 3 months down the road, and we've seen a number of items actually partially playing our way in terms of the oral script trends. We've got the Wegovy high-dose approval in U.S. We have decided to launch Wegovy tablet ex U.S. in a few select markets. And then we've gotten more info both on competition as well as LOE approvals in IO. So based on that, we're more confident in our outlook. And as a consequence, we parallel shifted both sales and OP ranges by 1 percentage point. So you should see that as increased confidence. And yes, I'm with you that the range is a not wide, but you should take it as a signal of confidence that we lifted the range by 1 percentage point.

Your next question comes from the line of Mike Nedelcovych from TD Cowen.

I have 2. My first is on Ziltivekimab. I'm wondering if you could tell us between ZEUS, HERMES, ARTEMIS and ATHENA, which trial you view as having the largest opportunity? And then my second question is on Wegovy IP in the U.S. I know that you guide to expiration of the semaglutide composition of matter patent as the loss of exclusivity date, but there's almost a decade difference between the drug substance patent and the latest dated patents for Wegovy pill and Wegovy injection. So my question is, does Novo plan to defend that IP?

Thank you, Mike. One question for Martin and one for Karsten.

Yes. Thank you for that. So from an indication and a potential perspective for Ziltivekimab, ZEUS, HERMES and ARTEMIS are the only ones that will lead to potential indications, respectively, in ASCVD, heart failure with preserved ejection fraction and post-myocardial infarction. From a medical perspective, obviously, we have a high level of confidence in the biology. There is a potential of improving outcomes in all of these 3 categories. We still had to flag the high risk. This is first-in-class, and we need to establish not only the efficacy in terms of improved outcomes, but also the safety and tolerability of an anti-IL-6. So we still see this as very, very high potential across those 3 indications, but also high risk until we've seen the first readout.

Thanks, Martin. And Karsten?

Yes. On IP, as you know, Michael, this industry works in the way that we take very significant risks in early investments in R&D with a fairly low probability of success early on. So those big risks and investments in return, we get patent protection for a certain period of time. And that's why when we then get into that period, it's very important for us to defend that patent protection. It's granted by patent authorities in the different geographies. So this is not something that we decide on our own. And when granted, of course, we intend to defend all our patents in court should they be challenged by generics.

Your next question comes from the line of James Gordon from Barclays.

James Gordon from Barclays. Two questions. First question just on long-term semaglutide in general obesity pricing. So I know you've invested tens of billions in CapEx to brew sema very efficiently at scale. But then in India, I think it's at least 8 generics approved and some very low prices, at least for the vial form just $14. So it does look like the generic companies chemically synthesize at very low cost. So your latest thinking about manufacturing efficiency, do you still think like long term with synthesis generics would struggle to match you on price with your different technique? Or do you think we are going to have an order of magnitude for once the patents go in the West, and that does make it tougher for next-generation obesity therapies?

And then the second question was just a follow-up on some of the comments about SG&A, just trying to square it because you did a 47% adjusted EBIT margin. It sounds like with the one-off on legal, it's still mid-40s, but the midpoint of the full year guide is more like 40%. So is it because of lots more R&D? Or is it also like you're allowing for doing a lot more sales and marketing for an ex U.S. oral Wegovy launch? Otherwise, it seems like if you would get to a higher margin.

Thank you, James. Two questions for Karsten, one on sema and manufacturing mode and pricing and then one on SG&A.

Yes. Thanks, James, for those 2 questions. So first of all, first and foremost, on sema manufacturing, based on our [ manu ] process and set up and we believe that we are hypercompetitive in terms of unit cost in producing sema and hypercompetitive in terms of scale also in terms of how much sema we are able to produce and the reach we can do in pretty much at a global scale. What that leads into in pricing in different health care systems and different channels remains to be seen. I think it's important to note that over time, more of this is going to be available in the [ care ] segment with different partners and different go-to-market models. So let's see where pricing pans out, how much pricing can brand recognition and brand loyalty carry compared to generics in this market and consequently, how much price differentiation and price upgrade can we go for next-generation products remains to be seen. I think India is not a good proxy for other markets, to be honest.

Then to your second question on margins, then I would say -- it's important to note that our point of departure is an already very competitive margin if you look at it compared to the rest of our peers in the industry. So being at, call it, 40% operating margin or 40% plus is already very high. So strategically, for us as a company, it's more important for us to invest in future growth more so than short-term margin optimization. So that's why it's important that, of course, we optimize the opportunity we have short and medium term with the assets in the market or coming to the market soon as well as investing in pipeline. So that's the key driver. So yes, we could drive for higher margin, but that's not our strategy and nor the intention. I would though say that we are very disciplined and rational, as I also said in the beginning, with our resources and having less -- almost 10,000 less FTEs today compared to a year ago. So we are really reallocating our resources towards our key growth opportunities. I think that covers the SG&A comments.

Your next question comes from the line of Evan Seigerman from BMO Capital Markets.

First question on the impact of generic semaglutide in Canada. How are you thinking about that as you have contemplated your guidance? Maybe some illustrative kind of concepts around that would be great. And secondarily, on a bigger -- taking a step back, you had some pretty striking data for sickle cell disease. Is rare disease -- I know it's a pillar of the company, but is this an area where you should be leaning in more to complement what you're doing in obesity and diabetes to kind of give investors that next leg of growth?

Thank you, Evan. One for Emil on Canada and then one for Mike on rare disease.

Yes. As you will know, most of you, we now have, of course, 2 approved generics in Canada, slight delay compared to what -- where they could have come in from a regulatory point of view, took some time to get the approvals. Now they're there. It has not made us change our overall guidance at the group level that we will see low double -- single digit, sorry, impact at group level. So we don't guide on country level in terms of impact. But I can tell you, we are very ready and the leading tactic in Canada, that is a savings card that has seen a very good uptake, both for Ozempic and Wegovy. So that gives us a lot of maneuverability as we see how this unfolds. And I think you all know the framework in Canada. After 3 generics, there's a mandated 65% price decline versus our list. So we know sort of the game there, and we are ready to play it, particularly with the savings card. And we have optionality on the second brand as well.

Yes. So Evan, our strategy is to really ensure that we drive growth short, medium and long term. And we will do that with the current products, and we plan also to do that with our pipeline of our products across all therapy areas. I'm incredibly proud and happy of what I have seen with Etavo that comes in a family of a lot of other best-in-class and great rare blood and hematology drugs. So that, of course, is no secret. But all in all, stay tuned. And of course, we'll share with you more and more about our overall strategy. But the main aim is to really make sure we have multiple legs to stand on so we can drive growth short, medium and long term for you guys.

Your next question comes from the line of James Quigley from Goldman Sachs.

I've got 2, please. So first of all, can you talk to what you're seeing in the early stages of the Foundayo launch? What's the latest feedback here from physicians and patients, particularly on how to manage relative food and water interactions, but also in terms of the awareness of the weight loss differential between the 2 products? And are there any patterns or trends in terms of the patients that you -- the patients that are going on each drug? That's number one. And number two, for the AMAZE program, you started 7 Phase III trials on ClinicalTrials.gov. Can you talk to the dosing protocol here in the obesity trials. The primary endpoint is running out to week 84, so taking into account one of the key learnings from the CagriSema program, but how flexible is the dosing in the protocol, particularly given the unpredictability we saw in CagriSema and also before seeing the results of REDEFINE 11?

Thanks, James. First question for Jamey regarding what we see post Foundayo launch and then the second question to Martin on what he can say about AMAZE.

Of course, it's early days, but I think what we see so far is an affirmation of the strength of the Wegovy pill profile. As mentioned before, the #1 decision criteria is efficacy, and we have unsurpassed efficacy with that 17% weight loss with Wegovy pill. We also introduced very quickly an indirect treatment comparison, which is a well-respected health economic population health approach to comparing indirectly studies based on population adjustment in the Phase III trials, and that showed better efficacy with Wegovy pill than the competitor as well as a lower likelihood of discontinuation due to adverse events and specifically GI events. So what we've heard in the market is consistent with the strength of our profile.

Thanks Jamey. Martin?

Thank you for the question. Obviously, very relevant. We did take a lot of learnings from the REDEFINE program, as you know. They were both around the patient population. The need and wish to lose a substantial amount of weight is obviously a key imperative, and we've implemented that starting with REDEFINE 11, but also in the AMAZE program. And then we have adapted the flexible dosing so that we prompt patients more we work or we allow investigators to work more with patients to get them to higher doses while maintaining the flexible nature of trials. We clearly learned also from REDEFINE that approximately 1/3 of patients do need flexible dosing to achieve the full weight loss potential, and we need to allow that as well while helping and guiding the patients.

We implemented that in REDEFINE 11. Without going into too much detail, we can already now see a substantial impact in REDEFINE 11. I haven't seen the weight loss data I had to say, but I'm looking at the titration data and the model seems to work. And we have employed more or less the same algorithm in the AMAZE program. So we are quite confident that we'll help patients really achieve the full weight loss potential of amycretin or zenagamtide.

Your next question comes from the line of Graham Parry from Citigroup.

So on Wegovy pill, could you quantify the total inventory impact on Wegovy pill sales in the quarter? You flagged in the release prelaunch inventory build. Has there been any further inventory increase through the quarter? And do you expect that to run off? Or should we expect further inventory increases in subsequent quarters? And then secondly, a question just on the CagriSema co-formulation, why the decision to terminate? Is that a technical or a commercial decision?

Thank you, Graham. Two questions first for Karsten regarding Wegovy pill inventory and then the second to Martin on the co-formulation.

Yes. Thanks for that question, Graham. So for the Wegovy tablet, we reported around DKK 2.3 billion sales in the first quarter to the tune of $150 million of those were related to what we would call pipeline filling and the pipeline filling covers both the initial inventory build with the wholesalers and in pharmacies, the customary launch orders, if you will. And the second piece is just also the customary inventory build in connection with the brand getting bigger and in this case, very, very fast. So that happens for all products. It's just a question of the pace of the inventory build. It's like we manage inventories in the company in terms of days on hand of inventories, the same way it works with pharmacies and wholesalers in the U.S.

So this is absolutely normal, what we are seeing. And in terms of going forward, then it's also absolutely normal that there will be a certain degree of inventory build in conjunction with the brand continuing to expand so that what you see in terms of when you see IQVIA scripts, then there will be additional sales, especially in the early phases of a product life cycle, which is linked to inventory build across the chain. That happens for all products, and we've seen it for decades.

Very clear. Martin?

Yes. And thank you for the question. As you know, we've always talked to that we are scaling the dual-chamber device of CagriSema to a full-scale launch. So we are very confident in that. We saw the co-formulation as a flexibility or upside -- the way we now think about it is that we have front-loaded and sped up the AMAZE program and the type 2 diabetes program as well as the oral program for zenagamtide. So with full scalability on the dual chamber device combined with anything zenagamtide coming in more or less the same time or even before as the co-formulation could, it really didn't make sense to progress. It was not a technical thing. You heard me talk about last quarter, we did see full bioavailability. So it actually worked. There was just no need from a production perspective to progress it.

Your next question comes from the line of Florent Cespedes from ODDO BHF.

Florent Cespedes from ODDO BHF. Two quick ones, please. First, a follow-up on the GLP-1 franchise in diabetes. I was wondering how could you reenergize the business in the coming years? It will be mainly driven by innovation? And you could maybe give us a little bit more color on the 2 different geographical areas, U.S. and ex U.S. And my second question is for Martin. regarding the tri-agonist, when should we have more visibility on the profile of the 2 products and whether you would -- you intend to decide to keep one or both going forward depending on the profile. So if you could have more color on this point would be great.

Thank you, Florent. Two questions. We'll split the first in 2. So one to Emil on how to drive Ozempic in IO and also to Jamey on driving Ozempic pill in U.S. and then over to you, Martin, afterwards.

Yes. Thanks for the question. We are very much focused on getting back in the game with Ozempic now that we have full supply as of 8, 9 months, and we are seeing already some emerging positive trends in terms of share growth, particularly in U.K. And what will further increase the momentum, we believe, is our 2.0 launch. We've had the first launches in 3 European markets, particularly in Germany. We're seeing very good traction, but also in the Netherlands. In the U.K., it always takes a bit longer with local payers, et cetera, but remain optimistic there as well. You might know that in IO, 2/3 of all patients have already gotten to our 1-milligram dose and many would benefit from uptitrating both in terms of weight and A1c.

If I can maybe add another combo angle here is also that we've actually, in China, launched [ Qyonzo ] which is our once-weekly combination of a GLP-1 and our weekly insulin. And -- or sorry, we will launch it come this summer. We just got the approval, and we have good expectations. We have seen very good traction so far in insulin in China. We own the 2 leading brands, Ryzodeg and Xultophy and also have good traction for our once-weekly insulin in China. So whether it's insulins or it's GLP-1, we still have a strong belief in diabetes across IO.

Thanks, Emil. And Jamey, on U.S. and Ozempic, maybe?

Yes. In the U.S., we'll continue to focus on the efficacy in terms of A1c reduction in type 2 diabetes, but also the holistic benefits in terms of cardiovascular benefits that semaglutide uniquely owns in that space. And then as mentioned, the Ozempic pill, we've just introduced this week, and we think that will bring new life into Ozempic facing pill on the iconic naming and awareness of Ozempic generally.

Thank you. And Martin?

Yes. Thank you very much. So it's important to call out the 2 tri-agonists are 2 different biologies, one combining GLP-1, GIP and Glucagon, the other GLP-1, GIP and amylin. I think based on what we see so far that they both have a substantial potential to introduce weight loss across the board with a good safety and tolerability profile. But they may also contain individual traits that will clearly differentiate them that could be an effect on liver, it could be an effect on bone effectively. And it could also be differentiated weight loss in different subpopulations. So if you take that approach, obviously, it's early days. We intend to progress both. So we understand the full efficacy framework for both biologies, but also the safety and tolerability. And we'll see more insights. We already have Phase II data of UBT251. You've seen the weight loss potential in both obesity and diabetes. It seems to be quite stellar. And obviously, with Phase II data coming in from our internal tri-agonist next year, we'll have better visibility on how to potentially differentiate.

Thank you, Martin. Thank you, Florent. and operator, we'll take the last question.

Your last question for today comes from the line of Carsten Lonborg Madsen from Danske Bank.

I was just interested in hearing your wording on the ex- U.S. oral Wegovy launch. When you launched in the U.S., you are quite clear that this would be a full broad-based sort of very aggressive U.S. launch of oral Wegovy. But what's your sort of commentary on the ex-U.S. launch, including maybe observations on pricing levels outside the U.S. for the Wegovy tablet?

Great. Thank you, Karsten. And that's a question for me. Yes, we are, of course, excited to have the opportunity to launch in selected key markets that lend themselves particularly well to the Wegovy pill in IO, and we see a lot of halo effects from the U.S. already also on our injectable franchise. So we are going to go all in when we get the chance to launch. There will not be any half measures in IO where we launch. But of course, the general play in IO this year, that's the high-dose launches of 7.2 milligram where we see good traction with the messaging already. And of course, when we then bring the device, we have a strong belief that, that will be part of turning around brand sentiment. So that's why we have 20 launches planned, and that's the main play. But of course, it's a nice decision where we get to launch the Wegovy pill.

Thanks, Karsten. And this concludes the Q&A session. Thank you for participating, and please feel free to contact Investor Relations regarding any follow-up questions you might have. Before we close the call, I would like to hand over to you, Mike, for the final remarks.

Thank you, Michael. Please go to the next slide. I'm very satisfied with our announcement today. 2026 is off to an exciting start, but we have much work left to do. So expect continued hard work from all of us in all fronts. This year, we are looking forward to, first and foremost, continuing to drive uptake with new products while providing access to many more patients worldwide. Secondly, progressing our pipeline across the therapy areas and development stages, building innovation from within and through business development. Third, continuing to make this the best organization for our employees and patients we seek our medicine through fast decisions and intentional resource allocation.

And fourthly, strengthening the foundation of Novo Nordisk by sustaining our purposeful direction and thoroughly building partnerships such as the collaborations with OpenAI to help ensure strong positioning not only for this year, but for many more years to come.

Thank you very much. Stay tuned.

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

Good afternoon, everybody. On behalf of the Board, a warm welcome to Novo Nordisk Annual General Meeting of 2026. I'm Lars Rebien Sorensen. I'm the Chair of the Board, and it's my pleasure to welcome you to this Annual General Meeting. For those of you who prefer Danish over English, real-time translation is available here at the Bella center. For those of you that participate online, you can choose the preferred language in the broadcast system. '25 was a profound year of transformation. For decades, Novo Nordisk has flourished in the diabetes market, building our expertise patient by patient and innovation by innovation.

Our entry into obesity, a therapeutic field that we pioneered and shaped threw us into an era of unprecedented growth that frankly even surprised us. The demand we met changed everything. People with obesity are actively seeking our medicines. Self-paying consumers are seeking faster access. And all of this growth shed the global spotlight on everything we do in the company. This extraordinary period has taught us some important lessons. We discovered that people living with obesity face completely different challenges than those living with diabetes. Instead of fear, they often feel shame and stigmatization.

Instead of conventional clinical support, they want discretion. These learnings require entirely different approaches than our traditional physician-focused model, forcing us to rethink the traditional approach to patient care and market access. We need to meet the patients where they are. The competitive landscape has evolved just as dramatically, where we once enjoyed a clear market leadership in obesity, virtually every major pharmaceutical company now recognizes that this is an attractive market.

This competition, while challenging, validates the therapeutic area that we pioneered and drives continued innovation for the patients. We are not intimidated by this new reality, reaping more than a century of working within the area of diabetes, and we have learned how to win even in crowded markets. In response to these market shifts, we have made decisive changes to remain leaders in obesity and diabetes care.

We have focused our strategy on these core therapeutic areas, not as a limitation, but as a recognition that serving the 2 billion people that by 2030 will be living with obesity, overweight and diabetes provides a massive opportunity for growth and impact of the company. Yet shaping the focus also reflects our DNA. Throughout history, we have always succeeded when concentrating our efforts where we make the greatest difference.

In 2025, also marked the important leadership transition. August 7, Mike Doustdar was appointed President and CEO, the only sixth Chief Executive Officer in our 103-year history. I have worked with Mike for most of his more than 30 years at Novo Nordisk. During my tenure as CEO, he joined the executive management team to lead international operations.

I know him as a strong, highly competent leader with a sharp commercial mindset and a very, very competitive edge. Since stepping into the role, he has moved quickly to execute on a number of strategic initiatives and our collaboration has been direct, constructive and aligned with the company's strategic priorities. The most challenging decision in 2025 was the reduction of our workforce, the largest reduction by number in our company's history.

After scaling up rapidly during the period of hyper growth, we recognized that staffing levels had become unsustainable as market dynamics have shifted requiring difficult but necessary actions to simplify the organization to improve the speed of decision-making and reallocate those resources freed up towards growth opportunities within diabetes and obesity. We approach this with a deep respect for those colleagues affected, conducted the process swiftly with dignity, consistent with the way of Novo Nordisk way.

During 2025, we also made changes to the composition of the Board. Following a period of dialogue between the Novo Nordisk Board and the Board of the Novo Nordisk Foundation, different visions of the pace and extent of Board renewal made the extraordinary general meeting necessary to provide clarity on governance. This change reflects our commitment to having the right competencies for the right -- for the reality that we are operating in. And I'm convinced that the reconfigured Board, including the candidates nominated at this meeting, should they be reelected, stands ready to support management in responding rapidly to the changing market conditions.

Equally important, the Board is committed to constructively engage with shareholders so that their perspectives can help us shape the road going forward. As our transformation continues, so does our long-standing commitment to sustainable business practices. The triple bottom line, balancing financial performance with social responsibility and environmental stewardship remains fundamental to our identity.

Long-term value creation requires attention to these broader impacts, and we continue to invest in sustainable practices while setting realistic, achievable targets that we can deliver upon. The year ahead will test our determination and capabilities. We face it with confidence knowing that our renewed focus, strengthened competencies and uncompromising commitment to people with serious chronic conditions positions us well for the challenges and the opportunities ahead. Thank you for your continued trust and support as we write the new next pivotal chapter for Novo Nordisk.

Let me now turn to the introduction of my fellow Board colleagues. Members of the Board of Directors are present at the general meeting sitting up here, all looking nice. In February, November or February, Novo Nordisk conducted an employee election. So I would also like to thank the 4 employee-elected Board members for their work, and I'll get back to the newly elected Board members who will join the Board from today.

Since the Extraordinary General Meeting in November, we have had a good collaboration within the Board, undertaking the task of challenging and supervising and supporting the company and its management with frequent dialogue to ensure alignment. I'd also like to thank the Board members who stepped in during this period for their commitment and willingness to serve. Following today's meeting, we look forward to welcoming even more competencies and perspectives to the Board.

Members of the executive management are also present -- at this general meeting, throughout this past year, we have seen a number of changes within the executive management, most recently with the exciting addition of Jamie Miller, Vice President of our U.S. Operations; and Hong Chow, Executive Vice President, Product and Portfolio Strategy. I am confident that the executive management possesses the right capabilities and competencies to be successful in executing the strategy, and I'm happy to report that the collaboration between the Board and the executive management is characterized by transparency and trust.

Also present in person are Deloitte, our auditors, Sumit Sudan and Lars Siggaard Hansen. And finally, I'd like to inform you that the Board of Directors this year has appointed Anders Orjan Jensen to act as Chair of the General Meeting. Anders is joined on stage, as you can see, by his colleague, Louise Korpela. Louise will be paying attention to the shareholders that are participating virtually.

And I'll now leave it to Anders to take us through the agenda. Thank you.

Thank you very much, Lars, and I'll commence with a few formalities and practical information. First of all, I can confirm that I have reviewed the convening notice and all the material presented ahead of the general meeting, and this information complies with all requirements under the Danish Companies Act and also the Articles of Association. And I can, therefore, conclude that the meeting today is lawfully convened.

Turning to the agenda of the meeting. It contains all the customary items for our Annual General Meeting at Novo Nordisk. And we also have 3 proposals from the Board of Directors, 2 of them relates to renewal of authorizations. And then we have a technical amendment relating to the name of the region where general meetings are held. All of the proposals can be adopted by a simple majority, except those that relate to changes to the articles that require a qualified majority of 2/3.

Also, a quorum needs to be present, meaning that 2/3 of all votes needs to be present in the room. And I can confirm that, that is satisfied and that, therefore, this meeting today can pass final resolutions regarding all items on the agenda. Before we kick off with the agenda, I can mention a few information about attendance here today. A total of 901 have requested admission cards for the meeting today. Of these 645 are shareholders. And just before the meeting here began, there are a little more than 300 present of those 235 shareholders, and I think a few more have joined since.

In addition to those participating here, a large number of shareholders have exercised their right to submit voting instructions ahead of the meeting. That can be done either by proxy or postal vote. In total, 57% of the share capital and 86% of the total number of votes are represented here today. Of all of these votes, 99.9% have actually been submitted in advance by voting instructions. And that also means that we already now can know that all the proposals on the agenda carry sufficient support to be approved in accordance with the Board's recommendations.

That, of course, should not preclude that we, of course, here today can have a good discussion. There can be questions and debate around all the items on the agenda. Now a few practical information regarding the format of the meeting and how to speak and vote. To allow as many shareholders as possible to participate, Novo Nordisk allows shareholders to both participate here but also online via an online application. It is also possible to follow the meeting via webcast.

Novo Nordisk has had this format for quite a few years, so many of you will know all the details. But for those that are new, I'll just give a brief introduction to how to vote and speak here at the meeting. For those that are present here, if you wish to speak, you can make your way up here and register with my colleague, Anna, who sits over here to the left. And please mention your name and which item you want to address, and then I'll give you the name when we get there.

If there is a formal vote, you need to vote using your mobile devices. At the entrance, you received this instruction letter, you can see behind me that has a QR code. If you scan that QR code with your phone, you'll get a link where you can submit your votes. You can see it here, you'll have the options will pop up on the screen. And once you have elected, there will be a green check mark confirming that your vote has been submitted.

For those participating online, you will also be able to submit comments or questions to submit questions, use the QR function on the page, type in your comment and press send. The message will then be received up here. It will be processed and Louise will read them out loud as they arrive, and we have the right agenda item. If there is a formal vote, that will also pop up on the screen, and you can simply click your election. And again, a green checkmark will confirm your vote has been received.

It is possible to change the vote also by pressing the button change vote. If you have any technical problems and then you can call a mobile number available here is +4545-46-0997. For those participating via webcast and just watching, it's not impossible there to submit questions or vote. To ensure we have a focused and efficient meeting, I kindly ask that everybody who takes the stand up here, keep their presentations fairly short and concise and in line with the items on the agenda.

Please also bear in mind that after this meeting, there's a shareholders' meeting where all members of management will actually be present and can answer even more questions. Final comment relates to the language of the meeting here today. It's conducted in English, but it is permitted to ask questions in Danish, but they will be answered in either English or Danish depending on who answers. Now that was a lot of formalities. Thank you for your patience, and let's turn now to the agenda.

As is customary here at Novo Nordisk, the first 3 items will be presented together. This year, the company's CEO, Mike Doustdar, will present the company's report and also the annual report for 2025. Then the Chair of the Board will take the stage to continue the report and also present the proposed allocation of profits. After these presentations, there will be an opportunity to ask questions and comments. So please welcome Mike Doustdar to the podium.

Thank you very much, Anders. Also a big welcome from my side to all of you to this AGM. As Lars said, 2025 was indeed a challenging and a transformational year for Novo Nordisk. It was a year where we had to make a number of very difficult decisions. None of those decisions were more difficult, I would say, for me and for my management team than the one leading to 9,000 individuals leaving the company globally. This was, as Lars mentioned, the highest number of layoffs we've had in the history of the company, I would even probably dare so in the history of Danish corporate history.

Many of those colleagues had been doing well for us. So we don't take decisions like this lightly. But I also say that it was a very important decision we needed to make. We had to make those decisions simply because we wanted to simplify the company, make it faster, but we also needed to take the investments and make sure that R&D is fueled this year. The savings that came out of less number of headcounts through this exercise is right now being poured into our R&D and accelerations of many things that will live for a very long future.

So I'm, in some ways, quite happy that we ended up doing that. Now I do want to use the stage and this moment to thank all of my colleagues who are with us and every day come to the office with their resilience, with their professionality and with their commitment. I also like to thank everyone who left the company for their many years of commitment. And once again, what we did was not an easy decision, but it was to the benefit of the longevity of Novo Nordisk we all love.

If you go to the next slide, please. This is a slide that you have seen over 5 years. We started showing it to you at this event since 2019. If you take a look at the right-hand side, then you see a lot has changed since 2019. Our sales and operating profit has doubled -- we have generated more than DKK 75 billion just from our obesity sales, and we have treated 16 million more patients than just 5 years ago.

This slide shows our annual strategic aspirations or what I would like to call our to-do list for any given year. And this is the version from last year. If you take a look, then you see last year, we delivered 10% sales growth in constant exchange rate. That was on the back of both operating unit, international operations as well as United States delivering growth numbers. We generated 6% growth on profit in constant exchange rate. We spent DKK 8 billion on the transformation I just spoke to. If you would adjust to that, the operating profit growth would have been 13%.

Our obesity continued to be the main growth driver, once again, growing at 31%. We have lost some market share within diabetes, but still have about 1/3 of the diabetes value market share. And 2025 was also a very decent year for growth of rare disease business that has historically been a bit struggling. On the R&D front, we also had some good movements of the pipeline. Semaglutide Phase II study was completed. CagriSema Phase III was completed. Wegovy pill at the end of the year, got an FDA approval. And we acquired a company called Akero and a MASH asset that came with that called efruxifermin, which will be very interesting for our future.

We also submitted a number of approvals that we will benefit from going into this year. Semaglutide 7.2 milligram was submitted for approval. Mim8 in rare disease was submitted and most famously, CagriSema, our next generation of GLP-1 product for obesity and diabetes also was sent for approval last year. Next slide, please. This slide shows the highlights of how we entered into 2026. By now, most of you guys have seen or known that we have launched the oral version of semaglutide, Wegovy pill in U.S., and it has been a crazy good launch, perhaps the best launch pharmaceuticals has ever seen, and we are very proud of that.

In many ways, this launch has set historical first for us. The first antidiabetic -- the anti-obesity pill that got approved to date. The first AOM that is a peptide and not a small molecule, which is quite important. You see on the slide, 16.6% efficacy. That's exactly the same as the injectable Wegovy. It's able to be so effective because it's a peptide in a pill and the only one so far that has been able to do that. It's the first product with such a strong uptake, as I explained.

You don't see the numbers of the prescriptions on the side. We're keeping that as a secret for the upcoming quarterly announcement. You'll get to see that soon. But you could see the projection of these curves, and you could see that 3x -- it was 3x better than what our competitor, Lilly, introduced tirzepatide and some 10x better than our own Wegovy injectable. So this has been a very good uptake. It's also the first time the pill became available not just through the traditional channels, but through all the eHealth providers, all of our partners and some 70,000 pharmacies around U.S. So it has been so far very good.

Next slide, please. As we do continue to launch good products like the Wegovy pill, we also need to expand access and move forward with our pipeline. We have advanced the pipeline as this slide shows quite a bit. We've had the first bullet point achieved actually, semaglutide 7.2 or what we call Wegovy High-Dose was approved by FDA in record time, 53 days. No other product has ever been approved so fast by FDA. So we are very proud of that.

As we go forward, we see that the next big approval will be our CagriSema approval, hopefully towards the end of this year, allowing us to launch that product beginning of next year. Zenagamtide in diabetes and obesity, initiated Phase III. UBT251, a very interesting triple agonist product in both diabetes and obesity have initiated Phase II. Ziltivekimab in CKD and ASCVD Phase III was initiated. And it's going to also be an exciting year for rare disease on the back of, hopefully, Mim8 regulatory approval and the Phase III results of etavopivat becoming available later on this year.

That -- you can go to the next slide, please. That marks the end of item #1 on the agenda. Now I will talk about item #2, which is the presentation and adoption of the statutory annual report for 2025. Our annual report was published on February 4, talking about the financial results of 2025 and obviously, the outlook for '26. If you go to the next slide. In 2025, sales grew, as I mentioned, by 10% in constant exchange rate and operating profit by 6 percentage points also in constant exchange rate.

The cost of goods sold increased by 24%, bringing the margin to 81%. This has been impacted by the acquisition of Catalent, the manufacturing sites as well as costs related to the transformation that I alluded to earlier on. Sales and distribution costs increased by 7% to a large extent, these are the expenditures we do behind our obesity franchises. R&D costs increased by 10%, and that's to progress the pipeline that I a little bit earlier spoke to. And that led to a financial net profit increase of 1 percentage points.

Next slide. Total assets increased by DKK 77 billion to DKK 542 billion during 2025. This increase was due to noncurrent assets due to, a, acquisition of Akero, as I touched upon; and b, our ongoing CapEx expenditures that we're doing, building the factories and so on and so forth. Hereby, we conclude the presentation of the income statement and the balance sheet. So we move on, next slide, please, to 2026.

The guidance for 2026 is that states here on the slide. First and foremost, before I get into it, I'd like to bring to your attention that we have tried to increase transparency. So we will present all of these numbers in adjusted sales and profit at constant exchange rate. This means that the numbers exclude exceptional nonrecurring events. They're primarily of noncash nature, including provision reversals. But that also means that adjusted profit will exclude the impact of 340B and provision reversal that we have done in U.S.

For 2026, as you can see, adjusted sales growth is minus 5% to minus 13% at constant exchange rates. Given the current exchange situation with Danish crowns, we expect that in DKK, the numbers will be some 3 percentage points lower when the year finishes. The same numbers are also expected on the operating profit side, minus 5% to minus 13% in constant exchange rate. The 2026 outlook reflects growth in international operations and degrowth decline in United States. We are assuming a growing GLP-1 market growth.

The GLP-1 market will continue to grow, and Novo Nordisk will continue to capture patients out of that growth. However, this is countered by pressure on our pricing. We've spoken to that earlier during the quarterly results. We see pressure on our prices in U.S. on the back of most favored nation dialogue and discussions with the U.S. administration, adjusting the prices downwards. Prices in the cash channels in U.S. have also furthermore gone down to provide broader access and affordability to patients.

And in the international operations, selected of our markets are going through loss of exclusivity of semaglutide, and that also means prices going down. Price going down on a large business that we have with semaglutide, of course, takes an impact, an immediate impact in this year's results. That is the reason behind the growth, albeit, as I mentioned again, volumes are continuing to grow, and you saw just a glimpse of that with the Wegovy pill slide that I showed you earlier.

Lastly, the positive impact of the gross to net adjustments in U.S. during 2026 are not anticipated to reoccur. Now back to you, Lars, for the proposed capital allocation to shareholders.

Thank you very much, Mike. In 2025, Novo Nordisk returned DKK 53 billion to shareholders through dividends. In August of '25, Novo Nordisk paid an interim dividend of DKK 3.75 per share, and the Board is proposing that the final dividend for 2025 is DKK 7.95 per share, which is to be paid this month. Consequently, the total dividend will be DKK 11.70 per share. The capital allocation principles for Novo Nordisk remains unchanged.

Novo Nordisk focuses on internal growth opportunities and dividend payout ratio of around 50% of net profit. In 2026, we have also initiated a share buyback program up to DKK 15 billion. In line with previous years, an authorization to the Board of Directors to buy back shares is proposed at this General Shareholders' Meeting, and we'll get back to this on a later point in agenda point #8. 1. And with this, back to you, Anders.

Thank you to Mike and Lars. That finalizes the presentation for the first 3 items on the agenda, and we have now a number of speakers that have already registered. The first one is Mark Jessen from ATP. After that, it will be Mikael Bak from Danish Shareholders' Association. We also have a few more. Bjorn Hansen have registered, and then we have a virtual participant with a question as well. But Mark, you are first up.

[Interpreted] Thank you. I'm Mark Jessen. I represent ATP, the pension fund. A number of the Board and management are English. I'll continue in English.

Thank you for the report on the developments during 2025. This has not been a year short of topics to address. It has been a busy year both around and inside Novo Nordisk. And I'll focus on the areas we find most relevant for the company's long-term success. Let me begin with a brief comment on the changes in the Board of Directors. When looking at the developments over the last 2 years, I believe most shareholders will agree that changes were necessary. At the same time, many had hoped for a smoother transition.

We noted the Chairman's recent comment in the media that an earlier EGM would have been a better solution, an assessment we support. We also -- we have also observed a broader public discussion about the role of foundation ownership in Danish companies. Across different kinds of ownership, trust is built through long-term performance, but at risk every day. For many years, we have appreciated the collaboration between several foundations and the stock market, a collaboration that has developed some of our largest local companies.

Turning back to the Novo Nordisk Board of Directors. Today, we are electing well-known members with comprehensive experience in health care, drug development, marketing and finance. Looking ahead, we see potential in value -- potential value in adding further consumer-focused experience as well as additional direct insights from the U.S. market. Despite the bumpy road getting to hear, we believe the future Board can guide Novo Nordisk forward.

On the business side, it is impossible not to acknowledge the strong launch of the Wegovy pill in the U.S. Prescription volumes have already exceeded several analysts' full year expectations. Unfortunately, this positive development has been overshadowed by a disappointing 2026 financial guidance and the recent ReDEFINE 4 trial outcome, which contributed to further share price decline.

As we see it, the stock market is now holding its breath until April. When a competing pill is expected to launch, this moment will offer Novo Nordisk a key opportunity to reinforce confidence in the stock market, particularly if the Wegovy pill maintains a strong market share. Ultimately, this will depend on prescriber behavior. So my first question today is, how do Novo Nordisk intend to secure and sustain prescriber preference for the Wegovy pill in an increasingly competitive market in and outside the U.S.

In the longer term, this market will likely not be a winner takes it all. Patients respond differently to treatments, and they have different needs. While the headline results from the CagriSema ReDEFINE 1 and 4 trials did not meet expectations, market expectations, the pipeline is significantly broader. Trials with high-dose versions, zenagamtide, amylin and triagonists are all in progress, but so are competitor trials.

Until now, the competition has largely centered on weight loss efficacy. We expect to see a more differentiated market in the future where aspects such as tolerability and treatment of comorbidities become increasingly important. We hope Novo Nordisk will compete strongly across these dimensions. So my second question today is, what makes the management confident that the current pipeline will be competitive and preferred by prescribers and patients in the long term?

Finally, stepping a bit further back, many major pharmaceutical companies have successfully expanded into new therapeutic areas beyond their historical core. This has been more challenging for Novo Nordisk. Following last year's reshaping, the strategic focus has become narrowed once again. My last question today is, therefore, -- why has it proven so difficult for Novo Nordisk to take significant steps into new therapeutic areas? And what must change for this to become possible one day in the future. With that, I wish everybody at Novo Nordisk all the best for 2026. And if media reports are correct, around 700,000 Danish shareholders and everybody in here are hoping for a brighter and more stable year ahead. Thank you.

Thank you very much, Michael. So 3 questions. Let me try to take them one by one. The first one, how do we secure the pill in and outside of U.S. I think I showed it on my slide, we have a peptide in a pill. This is really, really important. Usually, when you take a pill, then you have to compromise for efficacy. Pills are weak compared to injections, not in this case. And we have seen firsthand with our injectable business that the magnitude of weight loss matters to people. That's why we have been losing a little bit to our friends at Lilly on the injectable side so far.

While on the pill, the picture is completely reversed. At the same time, our pill has shown in clinical development to be much more tolerable than competition, which is the second reason why people go on these medications. They want products with good tolerability. And then, of course, the phenomenal uptake that we have seen so far and continuing will play for us because we will have tens of thousands of people, if not hundreds of thousands of people by the time competition comes. That will be the testament to how they have been satisfied and that also will help us, of course, make the pill successful.

Now we will not be little to competition. We will prepare and we'll make sure that we're ready. But I think the product is helping us here. And as we do that, we also currently are looking into ex U.S. trying to find out where and how should be our next launches. Stay tuned. You will hear of that as we will make it public.

On the second question, the current pipeline being competitive or not, I think we have some of the best pipelines in the industry. We have, of course, the Wegovy franchises that I just spoke to, our current Wegovy in the market, Wegovy pill, Wegovy High-Dose, which is being launched very, very soon. CagriSema with 23% weight benefits. Today, if it was in the market, it would be one of the more efficacious drugs out there. I'm very excited about that. Zenagamtide, which will come both in oral version as well as an injectable are 2 more assets that are coming soon after that. If you're after losing less weight, but with very, very good tolerability, we have cagrilintide mono as an asset for that.

The last couple of weeks, you have seen results of the UBT251, that's the triple agonist, the 3Gs, glucagon, GLP and GIP, all in one, and we have seen phenomenal Phase II numbers on the back of that. And we haven't even shared all the earlier assets, which in due course, we will make public. So I am more than ever today excited about the speed our pipeline is moving at and the products we will bring to the market, which brings me to the last question on the new therapy areas.

Obesity, diabetes and overweight affects 2 billion people. That's a lot of people out there. Today, we and our competitors combined are providing medications, GLP-1 medications to 20 million 1.9 billion people out there are not having any medication today. With the pipeline I explained, we can get further. But we're not stopping there. We're also trying to see some of the comorbidities associated with these areas. We know that obesity is the leading cause of many other conditions. We're looking into all of those and trying to diversify the company in more and more of those areas as we understand the science and have the manufacturing capability to do so. So more to come. Lars?

Yes. Just a comment from me, short one to ATP. Thank you for providing us with a slightly more balanced view of our company than we have seen recently in the press. And then I can't help you asked about further competencies to be added to the Board in the area of consumer goods. Stay tuned. There will be news towards the end of this meeting.

All right. With that cliffhanger, I think the next one is Michael Back from Danish Shareholders' Association.

Thank you for the floor. And I will do this in English as ATP. Having said that, I had the privilege to interview Mike in [ Falconersalen ] in November last year. And I think we spoke about you practicing Danish. So maybe next year, I'll do this all in Danish. But let me begin, my name is Mikael Bak and representing the private investors on behalf of Danish Shareholders' Association. First of all, thanks to the Chair and the management for the presentation. And I would start out with a remarkable fact, I would say, of course, representing the investor culture in Denmark, more than 680,000, 700,000 Danes are now shareholders in Novo Nordisk according to Euronext.

Think about it, it is amazing. And as I would say to you, it comes with both responsibility, but also opportunities. Responsibility to perform and to communicate in the best possible manner. And on the other hand side, also a unique opportunity to show what strong value creation and shared ownership can do not only for Novo, but for the shareholders, for the Danish and for our nation. I have 3 topics I would like to address today.

First, I would like to focus on research and competition. Over the past year, the narrative around Novo Nordisk has shifted in many ways from being looked at as a market leader to now facing challenges and often criticism from analysts and media. Some of them are here today. We have also seen very strong market reactions to Novo's trials results during the last year. Therefore, my first question. I would like to ask if you, the management, in any way, regret the way that the trials were originally planned.

How can we assure going forward that we see a Novo Nordisk that is managing expectations instead of being hit by them? And with regards to competition, are we looking into a future where we -- where Novo should change the narrative and stop playing against Eli Lilly and instead redefine own strengths, maybe also strengthen pipelines. How do you see this dilemma?

And my second topic, I would like to touch upon leadership and the direction set for the company. Last year, from this stage, I was calling for a potential strengthening of pharma experience in the chairmanship. Now year later, we can conclude that we got. But to be frank, it was maybe not the right sort of the way that we expected it last -- sorry, it's not a criticism. However, we have supported the change from the Danish Shareholders' Association over the years, looking at them as necessary.

But at the same time, we have been clear that the deviation from good governance cannot continue and that it comes with responsibility for you and the company to deliver. So we have not seen the positive developments yet. The share price is struggling. And therefore, to my second topic questions, I would like to ask the management to what extent do you see the current situation still being a result of decisions made in the past before you took over or if it's also, to some extent, something that has happened on your shift, so to say? And what are you then going to do to change it?

And then my last question is directly to you, Mike Doustdar, welcome on board. You have, as you also mentioned in the interview we had with you, a background primarily rooted in field operations rather than in headquarters. We agree that this is and can be indeed a strength leading the company in a new direction. However, it could also raise some concerns. When a CEO inherits an organization and a culture that he has not yet built himself, there is a real risk of becoming absorbed into that existing culture rather than reshaping it.

And in that case, even strong visions can maybe struggle to be fully implemented. This is particularly relevant if and when you are in a situation where a former CEO is now also serving as the Chairman of the Board. So my final question is, over the past 8 months, Mike, have you been able to put in place the backroom staff, the team that you need? Or do you still see this as a continuing process in the years to come? And this maybe also could be a topic for Board meeting discussions. So let me just finish by wishing both the management and also all the employees in Novo Nordisk all the best for the years to come. And on behalf of the more than 680,000 private investors, we support you, so please don't let us down. Thank you.

Thank you very much, Mikael. I have to start by saying we very much welcome the 680,000 shareholders, and I enjoy that day being with you, and they're very dear to us. They are our long-term shareholders that have been with us for a long time. So their satisfaction means a lot to me, my management as well as to the Board. To your questions, trial designs was the first question and if you have learned something from that. I think the quick answer is yes. This is an industry with a very long-term product life cycle management.

What you see we are doing today, you will not see the impact of it basically next quarter or the quarter after. You'll see the impact of our work perhaps a couple of years down the road. The same goes, of course, backwards. It's a long-term business. When I think about the trials, I think I can assure you we have spared no minutes looking into all the details. The whole obesity has changed many people's view, this was not a disease area a few years back. Novo created this. That also means that Novo has made its mistakes of not knowing exactly what the patients want, how the market works. And as much as I think the trial designs were made with fantastic intentions at the time, the knowledge available 3, 4 years ago was very different than the knowledge we have now.

Our job is to capture those learnings and make sure that as we move forward, we don't repeat some of the same, and we design our future trials in different ways. And I think my colleague, Martin Lange, has spoken to that more in details that if you think about REDEFINE 11 as an example, is a trial that we have captured the learnings from the previous REDEFINE studies. And of course, all of this is also being poured into zenagamtide trials, and we will continue improving. On the hindsight, I would say, every company when they do clinical trials and when the results comes back, they go back and say we could have done this a little bit better.

So it's a bit, I would say, unfair to just look at the hindsight. On the issue with regards to Novo focusing on its own strength rather than being obsessed with Lilly, I think you have a very good point. Over the last period, I think we looked at our competitor a bit more than we should. A leader should lead and not basically worry about competition and be obsessed with it.

In Novo Nordisk, we have a long legacy of 100-plus years putting the patient in the center of what we do, not the competition. And I think while we should keep our left eye open up nighttimes for competition, but we need to really think about every decision that we make, the patient centricity element of that and are we serving the patients in a better way. And I can assure you that, that is happening right now.

On the question, is this all the results of the past or not? I think I a little bit alluded to it. I don't want to get into what things we could have done better or not. It is a new area for us, and we're all learning. But I can tell you, we're learning incredibly fast. I am much, much more optimistic today than on the day I got the job I feel that the team around is going incredibly fast.

Today, we are being discussed for some of our shortcomings in the media by our shareholders. I have no doubt that tomorrow will be remembered on how quickly we responded to these challenges. So that's what I will hold myself responsible for. And with regards to the cultural reshaping and if I have the mandate from the Board, the quick answer is yes. We feel very comfortable that we have full alignment to do what we need to do. Thank you.

We have received a question from [ Jens Lan Rasmussen ]. It reads as follows. Given the surplus of more than DKK 100 billion in 2025, was it really necessary to carry out the largest layoff of staff in the history of Denmark? Also, I was told that even staff working on ongoing research projects has been laid off. It seems to me that it would be unwise since preliminary results of such projects will be lost. Can the Board confirm or deny that such projects have been stopped?

[ Jens Rasmussen ] thanks for the question. Cost management is a matter of keeping the right balance between income and cost. So therefore, because of the fact that we had DKK 100 billion in profits cannot allow us to let costs go out of control so that they become unsustainable in the long run when if worse comes to worse, the income starts to fail from the top line. So we cannot manage the company, unfortunately, this way. You could say it should have been managed by avoiding the large recruitment that took place when the company was trying to scale for this unprecedented growth the company was looking into.

However, that's a very, very difficult task when trying to meet infinite demand. Is it correct? Also been stopped researchers have been laid off that are working on projects. Yes, it has occurred. What we try to do in that context is, first of all, we try to take the necessary learnings from these projects and see how we can apply that in other areas. And then we are trying to out-license the assets that we have been trying to develop, but which we deem are not worthy considering funding by Novo Nordisk.

As an example, cell-based therapy is an area where I can remember, it started during my time as CEO as a way of trying to cure diabetes. Hence, it was natural that the company pursued this -- but given the difficulties of ensuring a competitive level of such a project, the lengthy development times, I think many of the shareholders here can remember that I made a prognosis that it was 15 years into the future. We would have cured type 1 diabetes. It is still 15 years into the future. So therefore, the company has now decided to out-license all the activities in the cell-based area. And hopefully, these will find new homes, new companies, new financing so they can be realized. Thanks for the question.

Next speaker will be Frank Hon.

[Interpreted] Thank you very much. My name is Frank Hon. I represent kritiske aktionaerer, critical shareholders. I've been here a number of times. Now the report it says very proudly that last year, the company paid out 50.7% in dividend. That's a higher percentage than during the past 4 years, DKK 53 billion counting the buyback program. Why did you do that? And why continue with such great dividends in 2026, while saying that the company is subject to pressure and very hard competition from other pharma companies.

Novo doesn't need happy shareholders. The shareholders don't contribute anything, not even influenced on the management of the company. I mean that's all the Novo Nordisk Foundation. If was anybody in doubt about that? Well, in that case, look at how the management change took place. You, shareholders, had nothing to do with that. You had no say in the matter. And that foundation has lots of capital. So if Novo at some point, and I don't think it ever would happen, but if Novo should need an injection on the capital, well, the foundation has lots of capital. They doesn't have to go into the market to ask for fresh capital from shareholders. There's no reason whatsoever for the company to be managed based on what shareholders would like. It may be that the stock price on the stock exchange dropped. And so what? What did that matter?

Well, yes, some of us lost money, obviously. But the company moved on. It kept running very nicely. It still creates profits. It develops new products, even though it looks so dramatic on the stock exchange. The company should not be managed based on what the stock exchange thinks of this company, what the company needs is the development of new excellent products to be sold as inexpensively as possible instead of a situation where the people who need our products have to pay a lot of money so that the shareholders can profit.

Why doesn't management focus on what should be the most important thing, the development of good products. That was the idea. That's what it used to be like when all of this was rooted in the insulin production. The theme was we need to produce the best possible medication for those who need our products, but nobody should make money on it. That was the management idea back then. But that's not how it is anymore. So I'll get back. I'd say, let's go back to the roots to the original ideas.

And I think the most important message from a meeting such as this should be we need to develop the company in a good direction, not thinking about making as much money as possible. There's something else which could be done with these billions of kroner instead of paying them out to shareholders might be to reduce the CO2 emission of the company. We all know how important it is for Denmark for the world, for all of us to reduce the quantity of greenhouse gases CO2 -- the company has said it wants to do that, but it increases all the time. Novo's emission of CO2 keeps increasing year after year.

Now for the third year in a row, it increased by 19% in 2025 compared to the preceding year. And that's in complete opposition to what we keep hearing from Novo. Now another critical comment while I'm at it, couldn't we get rid of the of all the scandals in our building sites, construction sites, problems with pay, problems with safety and security on the building side, couldn't we work properly with the trade unions and make sure that the trade union has access to construction sites to make sure that conditions are in order because having the trade union to inspect the construction site is the best possible guarantee, which will protect us against more scandals.

So let's open up instead of just saying, oh, yes, we are talking with the trade union. The trade union should have a real chance of seeing whether what has been agreed is really being adhered to. Now somebody mentioned all the redundancies. Of course, a large company needs to adjust the size of its workforce. There's no doubt about that, but it can be done brutally as it happened or it can be done perhaps over a longer period of time. There's always a certain exchange of stuff and people are hired all the time as well. And last year, people -- new people were hired. So couldn't you have said over time, we need to reduce staff where we don't need as much people instead of just firing people.

I mean, you could have afforded to do it in a different manner instead of just making people redundant as brutally saying, perhaps we try to shift people to other department. It would have been better for the employees. It would have been good for the culture among the employees when you have a company where people are just fired that way. Well, then, of course, it has repercussions on how people feel about their work and their company. It was not done wisely. It could have been done differently. Now to end, I'd like to say Novo should go back to its roots.

[Interpreted] Thank you. Lars will answer this one.

The next speaker after Lars will respond to this. If anybody else wishes to speak, please let us know. We have no further questions online. But if there are no further questions, we'll conclude after Bjorn's questions.

[Interpreted] Thank you to Frank Hon. It's not the first time we meet on these occasions. I'm very pleased that Mr. Frank Hon follows the history of this company and remembers the original declaration of intent, which was emitted when taking over the license from Toronto University for the production of insulin in Denmark without profit. That was noble. But I'm of the opinion, Mr. Hon that if an element of profit had not sneaked into it, we'd have been using the same large syringes, which we used back then to treat patients with insulin, which was unstandardized and unclear, impure. It would have been very, very difficult to obtain modern diabetes treatment as we know it today, which is due to companies competing on improving product quality. But of course, we may have different views on how things would have gone.

Now the question of capital. I think we look at capital in different ways. We see capital as a very important element in the creation of a company. Capital, like employees have a right to be remunerated. And that is why Novo Nordisk at an ongoing basis tries to live up to the requirements and demands of employees for better pay, while we also remunerate our capital, our shareholders with a dividend and hopefully also an increased share price so that everybody is happy.

I tend to agree with Frank Hon in the sense that it is a challenge for the company that we increase our CO2 emissions. I think it's something that we need to look at as a company. We need to look at the balance within our sustainability goals, we see large industrial companies in Denmark and we see entire countries who find it really, really difficult to live up to the very ambitious goals formulated within the past 5 to 8 years.

If you ask me personally as Chairman of the Board, I think that the greatest duty of this company vis-a-vis sustainability is to make sure that patients have access to our products. And if that means that we need to produce larger volumes and maybe even at a slightly lower price to make sure that our products are available for patients in developing countries at the expense of emitting more CO2 because we need to cooperate with producers in other countries or work with factories where we cannot control the use of energy.

Well, then I find it more important to treat more patients. That's the most important thing for us. Now concerning the redundancies, I agree completely with Mr. Frank Hon that it would have been better if we had not placed ourselves in a situation where the number of employees was too large compared to the development of the company. If that had been so, we could have avoided these redundancies. It's always easy when you look back on the past, but it's not as easy when you are in the situation and try to handle it as it develops as the former Board and the former top management did.

But I do think that the colleagues who were made redundant were treated fairly and with dignity as we have always done on previous occasion. Now concerning collective agreements and contract, I agree again with Mr. Frank Hon that, of course, we need to have proper contracts for the work done at Novo Nordisk work sites. I think the problem you referred to as some subcontractors who did not have contracts in place. But I think we have arrived at a point where, of course, we have contracts, and we need to follow up on how our subcontractors work with those contracts and also allowing inspection carried out by trade unions. So I believe we have solved that problem. Thank you very much.

Next speaker is Bjorn Hansen.

[Interpreted] I am Bjorn Hansen. I represent private shareholders. First, a bit of a joyful thing. Novo Nordisk has provided an excellent profit, both in '24 and '25. More than DKK 200 billion, all in all, DKK 200 billion. That's world-class. So that is an excellent result. You must have good employees at all the different locations. And in research, -- your research is expensive. I know it's expensive to develop new products. It cost billions, and you can afford it. So yes, capital is required and the plan for the money is required.

Now conversely, something which is not that good, I think, the price of the share. How can it be that the share price goes down to the existing level, the one that we have now. I don't understand it. When you consider the number of shares, over DKK 2 billion, as a fluctuation of DKK 400 million, DKK 500 million. It's a fluctuation there. So a bit of a reservation there. I don't know how much you spend on artificial intelligence, but it would be interesting to know. Now when I look at Nordnet and Danske Bank and Nordea, they -- with artificial intelligence, they provide different figures, right?

A valuation of DKK 400 million, DKK 500 million -- that's not good, I think, if you're interested in the numbers. So how can these mistakes occur for Novo Nordisk? Who checks that, who verifies that at Novo that they give a correct number of shares? I think the private investors, and I think also ATP is not going to affect them as much as private investors. How can you make deductions for your loss at Novo when the tax authorities have other numbers, who is responsible for reporting these numbers? Does that just happen once a year?

I think the tax authorities have problems. They've established a center in Western Jutland. I think in Esbjerg I think, they put out numbers. I thought what's that? And what year is that? And I thought 2002, what are they talking about? Now we're in '26. And all of a sudden, instead of a deficit that you could deduct instead of that, there was 106,000 profit or gain on this year. I don't know how that happened with the tax authorities.

I believe in Novo Nordisk more than I believe in the tax authorities. And the same with A.P. Moller and other companies such as Coloplast. But I'd like to know who we can address about this question. It is a bit of a problem, I think. You have a new CEO now. I'm sure he can speak Danish soon, maybe he can quite soon after 26 years, I don't know.

But I'd like to hear whether in the U.S. if you know the American market, I only know it from a few years and the connections that I have there at the moment. But isn't it a fact that you can sort of say there is Novo Nordisk in the U.S. and Novo Nordisk in the rest of the world so that there are 2 stock exchanges, 2 places or, let's say, Frankfurt and Copenhagen that you can trade in Danish kroner or in euros where you don't have these big variations because of exchange rates because there's a lot of fluctuation there.

In the U.S., if you still get 52% of your earnings from the U.S., I'm sure Lars Rebien, you know about that. You were the CEO for 17 years, I think, and things were going quite well. It was more transparent back then. It is not now, I think. I also expect to reply in writing in Danish. It's okay also if it's in English because the Norwegians that I know, they can understand the Danish, but a couple of them would like it in English. I wish you all the best going forward, and I'm sure the price of the share will get better. Thank you for your attention.

Thank you, Bjorn Hansen, and it will be Lars responding to these questions.

[Interpreted] Yes, you bet. Bjorn Hansen. Thank you for the questions. I'm not certain I understood all of it, but I'll try to give you a reply to what I think I understood. And I hope that that we can have the talk afterwards perhaps. This thing about the pricing of the share, this is really a special matter is normally, the share price reflects future earning capability in the company. What has happened for Novo Nordisk, you can divide into different areas, I think 3 or 4 years ago, the expectation for the obesity market was very high, high expectations. The market has just opened up. Novo was the first player in this market.

Everybody was excited to see how big that market could get. And now we are further down the road on that journey figuring out how to treat people with obesity, what the challenges are and the overall expectation from this market has been reduced somewhat. So price -- the price -- the share price of the Novo Nordisk share, well, it's because expectations from the market have been somewhat reduced. The second part is our own performance or shortage of it, lack of progress or less fortunate progress of development projects.

And finally, the occurrence of competitors, particularly one big competitor, the Arch enemy, if you like, Eli Lilly from the U.S. that we've always been competing against. But as I mentioned it in my introduction, a number of the biggest companies in the world have entered the market. Obviously, that puts expectations from Novo Nordisk under pressure, thus influencing the share price. I think you mentioned something about artificial intelligence and trading in shares and loss on shares. It was a bit complicated for me, I'm afraid.

At the end of the day, however, trading in shares is an individual matter. If you lose money on a share, I think this is a matter to be solved by the individual person and the tax authorities. I don't think that Novo Nordisk can help you there. The numbers that are in the financial statements are correct. And I'm sure that our auditor, who is present can verify that. There was this thing about whether you could see the U.S. separately and take that to the stock exchange in the U.S. I don't think that's going to be a big advantage.

I mean, our share is being traded on the stock exchange in the U.S. and in Copenhagen. You don't really get any benefit from changing the currency. This is just a conversion factor, isn't it? This is going to make it more difficult for people to always have to convert to the currency that you want to use. So we do believe that the access to capital markets, we do have that at the stock exchange in Copenhagen and the stock exchange in New York, but we do not need to go out and raise money. Thank you for your questions.

We have received one last question from the online participants. It has been received from Henrik Viggo Andersen and will be read aloud in Danish. It reads as follows.

[Interpreted] What does the Board intend to do concerning increasing in this shareholders being less and less satisfied with Novo Nordisk. What is the Board going to do about it?

[Interpreted] Right. Well, there's one easy solution to that one. It would have been a lot easier for me if I chose not to present my candidacy for President for the Chairmanship. But being President of the Novo Nordisk Foundation, it is my damned duty and my responsibility to try to lift part of the responsibility of securing the assets of the Novo Nordisk Foundation. And as part of that, last year, last spring, we found it necessary to step in, in the management and asking for a change of CEO. And then as we could not agree with the Board or the composition of the Board, well, then the Board decided to step back collectively.

And then again, I was asked by the Board of the foundation to take on this job for a brief period of time, trying to protect the assets of the foundation, but also to help protect the interest of minority shareholders. I have stressed several times that this is not a permanent solution, 2 to 3 years, not more than that. And if it turns out that we can find a replacement for me quicker than then we can get back to the desired covenant situation in which we have an independent Chairman and 2 representatives representing the interest of the Novo Nordisk Foundation, and thus getting back to the original solution.

Now it's said that there's -- that shareholders are increasingly unhappy. I'd like to correct that because when I look at the votes for me. Well, I've received personally 42% of the free flow, which means that if you add that to the votes of the foundation, I got 60-plus percent, which is an increase compared to the extraordinary shareholders' meeting. So there is a slight increase. But don't be nervous. I'll be out of your hair as quickly as possible.

Thank you, Lars, and we're getting a bit ahead of ourselves with all of this covered by Item 6. With that, I think we have no further questions from the floor and also no further questions from the online participants to the first 3 items on the agenda. So I'll conclude the debate here and just quickly repeat the resolutions that we need to pass here.

First of all, the oral report is accepted by the meeting. Secondly, we have the approval of the annual report for 2025. If there are no further questions to that, I'll conclude that the report is approved. Then number 3 is the resolution for the distribution of profits. And here, Lars presented the ordinary dividend of DKK 7.95 per share, which adds to the interim dividend already paid out last year. There are no further questions or comments to that, I can also conclude that, that is approved -- it is. Thank you.

That brings us to item 4 and remuneration. The first element is presentation of the remuneration report for 2025. And under Item 5, we have approval of the Board remuneration for '25 and '26. And I'll give the floor to Lars to present the proposals.

Yes. Thank you, Anders. Again, this year, we have published a report on the Board and executive remuneration, which is available on our website. As you can read in the report, the Board remuneration was in line with the remuneration policy as it was approved at the last Annual General Meeting. The slight increase in Board remuneration reflects inflation adjustment to the Board fees. On this background, the Board proposes that the general meeting adopts the actual Board remuneration for 2025. Moreover, the executive remuneration was in line with the remuneration policy approved at the Annual General Meeting.

The Board has reviewed the current remuneration level for the Board in light with the general market developments for Board remuneration as well as the development of Novo Nordisk business and found that there was no need for significant changes. On this background, the Board proposes to adjust the remuneration level for 2026, in line with the general salary inflation and thus increase remuneration with 3% as shown on the slide. With that, back to you, Anders.

Thank you, Lars. So any questions or comments to these proposals? If not, I'll conclude that the remuneration report is approved and also that the proposed remuneration for the Board for '25 and '26 has also been approved. That brings us to the next item on the agenda, which is election of Board members, and we cover that together with Item 6, appointment of auditor. Under the Articles of Association, all Board members are elected for a period of 1 year at a time. And this time, it will also be Lars, who will present or start off by presenting the conclusions from the Board's self-evaluation and also provide a few comments on Board composition, and I'll get back and present the proposals.

Thank you, Anders. Let me start with a few words on the collaboration between the Board members and the composition of the Board. On November 14, Novo Nordisk convened an extraordinary general meeting to elect new Board members to the Board. Throughout the past 4 months, the collaboration within the Board between the Board and CEO, Mike Doustdar and the rest of the executive team has been open, productive and forward-looking.

Each year, the Board conducts a Board evaluation. Various improvement actions were implemented during 2025 in view of the focus areas that were identified in the 2024 Board evaluation as outlined in the 2025 corporate governance report. This included leveraging outside in views, external experts to go deeper into key topics as well as a focus on succession planning and talent engagement. Due to the timing of the 2025 Board evaluation shortly before the Extraordinary General Meeting in November, the result of the questionnaires was shared with the Board with me.

However, the conclusions were drawn that since it is not the same Board that's going to implement any recommendations that these actions were deferred. When recommending candidates to the nomination of the Board takes into consideration the desired competencies and experiences, the performance of the individual Board members, the ambition of diversity and independence. With the proposed candidates, we will continue to fulfill our diversity ambition being at least 2 shareholder-elected members of Nordic nationality, 2 non-Nordic nationality.

We will also continue to fulfill our gender aspiration by being 3 female members and 5 male members, thereby having equal gender balance as per definition in the Corporate Governance code. Diversity among Board members across gender and other dimensions remains a key priority. Back to you, Anders.

So that brings us to the specific proposals. First item is election of Chair. And here, the proposal is to reappoint Lars Rebien Sorensen as Chair. Under Item 6.2, the proposal is to reelect Cees de Jong as Vice Chair. Under Item 6.3, the proposal is to elect Stephan Engels and Britt Meelby Jensen and Kasim Kutay or also to elect 3 new Board members, Helena Saxon, Jan van de Winkel, Ramona Sequeira. And here, I also give the word back to Lars to present these 3 new candidates.

Thank you very much, Anders. The Board proposes election of Helena Saxon as a new Board member. Helena is Swedish nationality and currently a Board professional. Helena started her career in investment banking, which included tenure at Goldman Sachs and Investor AB. Later, she became Chief Financial Officer of Syncron and Hallvarsson company. And most recently, she held the role as Chief Financial Officer of Investor AB, which is a Wallenberg company.

She's been on the Board of SEB Skandinaviska Enskilda Banken and Sobi, which is a small specialized pharmaceutical company and currently sits on the Board of H&M as well as the Stockholm School of Economics. The Board proposes Helena as action as she will add important diverse perspective on board through her extensive executive experience and from her leadership position covering industries in the intersection between finance, pharmaceuticals, fast-moving consumer goods.

You can see Helena's CV on the slide and details are provided in the notice convening for this general meeting. Further to Helena, the Board is proposing election of Jan van de Winkel. Jan is Dutch of Nationality and is Co-Founder of Genmab in which he currently serves as President and CEO. Jan started his career in academic research, having various leadership positions at the Utrecht University before becoming appointed Professor in immunology.

In 1999, Jan co-founded Genmab and became Chief Science Officer of the company before taking over the role as President and CEO in 2010. The Board proposes Jan van de Winkel as he will add significant research and development capabilities to the Board from both the career in academics as well as the current executive career at Genmab. You can see Jan's CV on the slide and more details are provided in the notice convening this general meeting.

Finally, the Board proposes to elect Ramona Sequeira as a Board member. Ramona is a Canadian nationality and is professional Board member. She started her career with Eli Lilly, where she spent more than 20 years in various senior leadership roles across Canada, Europe and United States and most recently held the role as Vice President of Sales and Operations of their U.S. franchise. In 2015, Ramona joined Takeda Pharmaceutical Company Limited, Japanese pharmaceutical company, and she became President of their U.S. business unit and from 2020, also added the responsibility for their global product launch strategy and commercialization.

Ramona currently sits on the Board of Organon, another pharmaceutical company coming from a slaughterhouse in the Netherlands that used to make insulin. Edwards Life Science Corporation as well as the Board of Trustees of the University of Health Network in Toronto. The Board proposes Ramona Sequeira's as she will add significant commercial pharma experience with particular focus on the U.S. marketplace. You can see again here, Ramonas CV on the slide and more details are provided in the notice to this general meeting. And with this, back to you, Anders.

Thank you. And I will just mention here also that the employees of the company has held an election for appointment of employee representatives for the Board here in February. And here are the 4 members that were elected, Elizabeth Christensen, Mette Bojer Jensen were reelected, Semsi Kilic Madsen and Desiree Jantzen Asgreen were elected as new members. These 4 will join the Board after this meeting and will have a tenure of 4 years.

And Lars, I think you mentioned that you had a bit of a surprise to describe.

Yes. And this one is for ATP. We only do it for you. No, no. Next, I would like to announce that the Board has decided to appoint Poul Weihrauch as a Board observer for the year '26, '27 with the intention of nominating him for election as an ordinary Board member at the Annual Meeting next year in 2027. Poul is Danish. He currently serves as CEO of Mars Inc. in the United States, one of the biggest privately held companies in the United States with 150,000 associates.

He serves as a member of Henkel's Shareholder Committee and is a Board member of the Consumer Goods Forum. He spent his entire career in fast-moving consumer goods and in the past 26 years of them with Mars. It's a USD 65 billion U.S.-based business, as I mentioned, with 150,000 employees globally. Mars is a global leader in pet care, veterinary services, quality snacking and food products.

Before becoming CEO in Mars in 2022, Poul held a number of senior leadership positions across different geographies and business segments, including President of Mars Pet Care, Global President of Mars Food, Regional President, Mars Wrigley, Europe, et cetera, et cetera. Poul brings a unique combination of U.S. and global consumer marketing and brand building experience together with senior corporate leadership experience to the Board. He possesses very strong capabilities of applying consumer insights and market analytics to drive product innovation and sharpen the commercial execution to accelerate growth. We are very pleased to welcome Poul as a Board of Server for the coming term, and we'll be looking forward to working with him. This also concludes point #63, and I have to hand it back to you again.

Thank you. And as I mentioned, we'll just cover the auditor election as well. And here, the proposal is to reappoint Deloitte as auditors of the company, and that will be both regarding the financial reporting and sustainability reporting. And Lars mentioned who was here represented by Deloitte earlier in the meeting. So with that, I will open up for questions or comments regarding the candidates that have been described up here. It seems we have no questions from the meeting here. Risa, anybody from online? No. And with that, I think we can conclude and congratulate the candidates with their election.

That brings us to Item 8, which are 3 proposals from the Board of Directors. And 2 of them are customary items for the Annual General Meeting, which is renewals of authorization to repurchase own shares and issue new shares. And there's also a proposal to change the articles with regard to where general meetings are held. Quickly, 8.1 is thus a proposal to extend the existing authorization to acquire up to 10% of the company's shares. That's extended until the next Annual General Meeting in 2027. This authorization is subject to customary limitations. So it can only be acquired a number of shares equal to 10% of the share capital. There's a holding limit of 10% and also a maximum deviation of 10% from the share price at the time of acquisition.

Under Item 8.2, we have a renewal of the existing authorizations to issue new shares. So there are 2 authorizations. One is to issue shares without preemption rights and the other is with preemption right, all limited to a cap of 10% of the existing share capital. And under Item 8.3, a slightly technical change here. But in Denmark, the names of the regions have been changed, the geographic region. So what's been referred to as the capital region of Denmark will now merge into something called region of Eastern Denmark with effect from 1st of January 2027, and we, therefore, have to amend the articles to have the right region mentioned.

So these are the 3 proposals relating to the articles, and I open up for any questions or comments. Nobody in the room, nobody online. So that means we can conclude that all these proposals have been adopted. And that actually concludes the normal items on the agenda. We have under Item 9, any other business. And here, there is a possibility to ask further questions. Nothing can be adopted here. Any last questions? No, and neither online. So I'll give the floor back to Lars to conclude this meeting.

Thanks, Anders Orjan and Louise for sharing this -- today's Annual General Meeting. You've guided us, as usual, with professionalism throughout the meeting. Allow me to close with a few reflections. While 2025 was a tough year for Novo Nordisk and the current outlook for '26 presents its challenges, I remain excited about the year ahead and the long-term prospects of this great company.

First, although 2026 will weigh on our financials, we will expand our patient reach this year with more to come in the coming years, living up to our purpose. Second, we are encouraged by the early uptake, as you have also discussed, the Wegovy pill, the world's first peptide in a pill, and we will continue to communicate the value of this important innovation. Finally, I am pleased that we now have a full Board in place to support Mike and management, and I look forward to a positive impact we can collectively make on the many patients living with serious chronic conditions in the years to come.

I'd also like to thank all shareholders for attending this year's meeting and for your continued support. We greatly value our interactions with shareholders, whether in person or virtually. For these participating -- for those participating persons here at the Bella Center, please exit through the doors in the back of the room where you entered. We will be serving coffee outside. And if you borrowed the headset, please return it on your way out. It is not of much use at home. And please remember to take all your belongings with you. And lastly, for those who've signed up, there is a more informal shareholders' meeting taking place at 5:00 here and where all management will be on the podium to take questions. And with this, I declare the general meeting for close. Thank you.

[Portions of this transcript that are marked [Interpreted] were spoken by an interpreter present on the live call.]

Good day, and thank you for standing by. Welcome to the Novo Nordisk conference call. [Operator Instructions] Please be advised that today's conference is being recorded.

I would now like to turn the conference over to your first speaker today, Michael Novod, Head of Investor Relations. Please go ahead.

Thank you, operator. Good day, and welcome to this Novo Nordisk call regarding the top line results of the REDEFINE 4 Phase III trial. My name is Michael Novod, I'm the Head of Investor Relations at Novo Nordisk. With me today, I have CEO of Novo Nordisk, Mike Doustdar; and EVP, Research and Development and Chief Scientific Officer, Martin Holst Lange. All the speakers will be available for the Q&A session. Please note that this call and Q&A will be related to the top line redefined fall data announced today, and no further details will be discussed. Today's call is being webcasted live, and a recording will be made available on our website. The call is scheduled to last around 30 minutes.

Next slide, please. As usual, we need to advise you that this call will contain forward-looking statements. These are subject to risks and uncertainty that could cause actual results to differ materially from expectations. For further information on the risk factors, please see the company announcement for the full year 2025 and the slides prepared for this presentation.

With that, I will turn it over to Martin.

Thank you, Michael. Next slide, please. REDEFINE 4 was an open-label trial, investigating the efficacy set of CagriSema 2.4 milligram compared to Tirzepatide 15 milligram. The trial was mainly conducted in the U.S.

After incorporating some of the learnings from REDEFINE 1, the study was extended to 84 weeks of treatment, while all other parameters were left unchanged. The primary endpoint for REDEFINE 4 was to confirm non-inferiority of CagriSema 2.4-milligram versus Tirzepatide 15 milligram. The trial included around 800 people with obesity with 1 or more comorbidities. Both treatments were administered once weekly with subcutaneous dosing with the same dosing regimen as in the REDEFINE 1 and REDEFINE 2 Phase III trials.

As Tirzepatide 15-milligram treatment was only commercially available in a pen format, REDEFINE 4 employed an open-label design, in which all investigators and participants were informed of the specific drug administered during the trial. In this trial, CagriSema did not achieve the primary endpoint of non-inferiority of percentage change in body weight relative to Tirzepatide.

Beginning from a mean baseline weight of 140.2 kilograms. If all people adhere to treatment, CagriSema 2.4 milligram achieved a 23% reduction in body weight after 84 weeks. In comparison, Tirzepatide 15 milligrams resulted in a 25.5% weight loss over the same period.

There are many factors that could contribute to the REDEFINE 4 outcome. First, CagriSema performed in line with REDEFINE 1. Surprisingly, the comparator performed unusually well on efficacy compared to what has typically been reported in most previous trials of similar nature. We've noted earlier that not all learnings from REDEFINE 1 to achieve the optimal clinical benefits of CagriSema were implemented into the REDEFINE 4 protocol.

In addition, as I mentioned, REDEFINE 4 was an open-label trial, which has the potential to introduce buyers in favor of a well-established, well-known product when it is compared to an investigational therapy. The safety and tolerability profile of CagriSema was consistent with data from previous REDEFINE clinical trials.

The most commonly reported adverse event in the trial for both CagriSema and Tirzepatide were gastrointestinal-related and were generally mild to moderate in severity. These data further support the added benefit of Cagrilintide offering clinical meaningful effects to what we have shown with Semaglutide biology alone. CagriSema 2.4 milligram was submitted to the FDA for obesity in December 2025 based on the REDEFINE 1 and 2 trials, and we look forward to a decision later this year.

The REDEFINE program for CagriSema continues as we aim to explore the full weight loss potential of these complementary biologies. The REDEFINE 11 trial reached out and is expected during the first half of '27, and we plan to initiate the Phase III trial of a high-dose CagriSema in the second half of 2026.

With that, I will hand it over to you, Mike.

Thank you, Martin. Please turn to the next slide. CagriSema and obesity will allow us to further build upon the Wegovy brand, where we aim to provide patients with multiple treatment options to fit their weight loss and lifestyle needs. Not only does CagriSema provide patients the efficacy, safety and health benefits clinically proven by Semaglutide, including established evidence-based risk reductions across certain cardiovascular, renal and liver diseases but it also improves weight loss with the added benefits of Amylin.

As Martin mentioned, we continue to push the innovation bar with the ongoing and planned Phase III trials for CagriSema and CagriSema High Dose. CagriSema, importantly, built upon our current offerings within the Semaglutide family now with more choices for patients seeking weight loss therapy.

One of those new choices for patients is our Wegovy pill. As you know, we have launched the Wegovy pill in the U.S. as the first and the best-in-class oral GLP-1 with a weight loss close to 17%. And we have shared with all of you how great that launch has been so far.

Another option for patients is the Wegovy High Dose, where we will further maximize the weight loss of Semaglutide all the way up to 21%. Wegovy High Dose is now approved in EU and U.K. and a U.S. decision is expected by the end of Q1. At the same time, Novo Nordisk continues to drive next-generation obesity innovation in our pipeline.

Charging ahead on the next-generation GLP-1 Amylin, Zenagamtide, where we saw up to 24% weight loss after just 36 weeks in Phase II. This product will be available to patients both in forms of injection as well as oral offering.

You should also note that we will leverage all the learnings from the REDEFINE program in the Zenagamtide Phase III AMAZE program, which we just initiated.

Furthermore, we will offer our patients Cagrilintide monotherapy as a potential option for flexible coadministration and a fewer side effects.

And last but not least, we also have 2 exciting triple agonist advancing through the clinics, which have the potential to offer even higher weight loss. We will share more of that in due course.

Now back to you, Michael.

Thank you, Mike. Next slide, please. With that, we are now ready for the Q&A, where I kindly ask all participants to limit her or himself to 1 question, including sub questions. Operator, we're now ready to take the first question.

[Operator Instructions] And your first question today comes from the line of Mike Nedelcovych from TD Cowen.

My question is about your overarching hypothesis about CagriSema. You've reiterated that REDEFINE 11 could reveal CagriSema's full weight loss potential, so I'm assuming there were data points from REDEFINE 4, similar to those from REDEFINE 1, suggesting that efficacy may have been left on the table. Did you once again observe a dichotomy between rapid responders and slow responders, just as an example? And can you confirm whether there was a discrepancy between the arms in REDEFINE 4 in the proportion of patients that reach the target dose?

Thanks, Mike. That's a question for Martin around learnings going into REDEFINE 11.

Yes. Thank you very much, Mike, for that question. We're not going into further detail on the data. But I think it's fair to say that what we've seen in REDEFINE 4 very much resembles what we see in REDEFINE 1, a robust around 23% weight loss and a good safety and tolerability profile.

As we also discussed with REDEFINE 1, and as you pointed out, not all patients reached the full dose potential of CagriSema and therefore potentially not the full weight loss benefit. That is also something that we see in REDEFINE 4. And therefore, we are strongly assuming that there is a further weight loss potential to be had when taking all of these learnings into account. We've done that in REDEFINE 11. And therefore, as we also previously discussed, we couldn't do that, take those learnings into REDEFINE 4. We could do that for REDEFINE 11, and therefore, we had to really guide that the full weight loss potential will be derived from REDEFINE 11.

Great. Next question, please.

Your next question comes from the line of Michael Leuchten from Jefferies.

I'll stick to 1 question. Can you just talk about the non-inferiority margin you applied and how it was derived in REDEFINE 4?

Thank you. And that's a question for Martin as well.

Yes. So again, we're not really going into the data. Of course, we applied the non-inferiority margin. We did not fully achieve that. And therefore, we've seen the data that we have. I think it's important to point out that we see a consistent and robust 23% weight loss with CagriSema, but we also are a little bit surprised about the 25% weight loss that we see with the comparator drug.

Right. Next question, please.

Your next question comes from the line of James Quigley from Goldman Sachs.

Martin, could you speculate on why is that bound data actually look better than they did in the Lilly trials, as you said? What was the flexible protocol not applied to that? And again, following up on the first question, was it 100% of patients just on the 15-milligram dose throughout the trial? And again, the flexible dosing was not applied in this case, is that bound -- what happen there?

Thank you very much, James, for that question. Obviously, we are still investigating the data, but what we can see already now is that -- yes, just to step back, both treatment arms received the same flexible dosing. And while not disclosing the data at this point, it is very clear that more patients reached the 15-milligram dose at some point during the trial for Tirzepatide as compared to CagriSema.

We do believe that, that is largely derived from the open-label nature of this study. We do know, and we've seen that numerous times before that open-label storages drive buyers. In this case, more than 40% of the investigators are previous investigators on the comparator drug. They know the drug well. They have probably prescribed the drug and they feel confident in the drug. We know that drives the buyers, and that's maybe why we have seen these surprisingly good data for the comparator drug.

In part, we probably also had to ascribe this to biology. These data had never been shown before as far as I've seen in previous audits. So obviously, this is the one-off. Obviously, we don't fully appreciate that it happens in our study, but that is what it is.

Thank you, Martin. And the next question, please?

Your next question comes from the line of Peter Verdult from BNP Paribas.

Peter Verdult, BNP. Mike, just 1 for you. Just a simple one, but important. At launch later this year, how are you going to look to actually differentiate CagriSema given the data you have right now? And just kind of squeeze on a very quick one, yes or no question. Any appetite to redo REDEFINE 4 at either a higher dose or with a more forced titration schedule?

Yes. So thanks very much. A couple of things. First of all, you have to go back to how products are sold and they're sold according to their label. So the label that we have is, of course, based on -- not this trial, but the previous 1 and the label that our competitor has also is below basically the CagriSema's similar label. So I think we need to just be aware that there is an abnormality with this trial and how the comparator product has done and that abnormality and the 25% or so that we're talking about is neither in their label nor has it been really seen in their own trials, any other trials, you could even argue that in the real-world evidence. So that I think the market figures that out as we go forward. The clinical experience of the physician and the label trumps anything and everything else when it comes to commercialization. We strongly believe that CagriSema has right now the best weight efficacy than any product currently in the market. So that is a very strong belief.

Now going forward, of course, as I mentioned, we will very quickly and soon release the data from REDEFINE 11 when they're available early next year. Not long after the product is going to be in the market, that will help. But we also have made no secret and I think Martin just alluded to it, that we are designing the CagriSema with the higher dosages of it. So -- and you have seen what happens to Semaglutide when it goes from 2.4 mg to 7.2 mg, and you could do your own modeling what that means. So I'm still incredibly optimistic about CagriSema.

And then when you put it in the context of the Semaglutide molecule where you have basically now current somewhere in the market at some 15%, 16% high dose of sema, which is coming up at 21% and now, of course, sema with Amylin, call it, at least minimum 23% we have shown 2x. That shows the projection. Next to it, of course, is the oral offering at 17%. So I think the brand recognition here and the increased percentages as we're getting more and more is how we're going to treat this product when it comes to the market.

And Martin the consideration.

Appetite -- yes, sorry. Thanks, Mike.

Sorry?

Appetite for doing additional trials like REDEFINE 4.

So obviously, we have to look at the data and understand the data as both Mike and I alluded to, we did believe that we now understand the priority and the optimal way of using this biology in clinical trials. That basically means that we expect to see a potentially higher weight loss with REDEFINE 11, but we're also investigating higher doses. When we see the outcomes of those data, I will not rule out that we would do additional head-to-head studies.

Operator, next question please.

Your next question comes from the line of Harry Sephton from UBS.

Do you have any comments on the relative tolerability profile of the 2 products in the study? And maybe just to touch on CagriSema again, not getting to the high dose as much as Tirzepatide. Could that just be simply a tolerability issue? And in this instance, you have a less well-tolerated product with lower weight loss?

Great question for Martin regarding tolerability.

Yes. Thank you very much. So the tolerability that we see in this trial, both for CagriSema, but also Tirzepatide is in line with what we've seen in previous duties. Obviously, we don't have fully insight into the comparator drug, but very much in line.

That also makes us believe because when I say that more patients at some point reach the highest dose of the comparator drug, doesn't necessarily mean that they stayed on that dose, but they then achieve the weight loss potential with that dose. We do believe that the potential difference in dose levels is more derived from the open-label nature of this trial and the fact that a great number of the investigators were very familiar with the comparator drug rather than any difference in safety and tolerability.

Great. Next question please.

Your next question comes from the line of Emmanuel Papadakis from Deutsche Bank.

Congratulations on the results. I mean maybe a question around longer-term dynamics. CagriSema looks somewhat obsolete now as a competitive upgrade Semaglutide, especially with the 7.2 mg available, as you mentioned, or is there a competitive alternative to Tirzepatide? So what can you do to accelerate Zenagamtide -- excuse me, the new name for Amycretin. And where are your confidence levels that will look a more convincing solution relative to CagriSema?

Thank you, Emmanuel. Question for Mike regarding how we want to optimize and also look at the commercial potential for next generations.

3 Yes. I think Emmanuel to say it's obsolete is quite belittling a fantastic drug in all honesty. Again, when CagriSema will make it to the market early next year as the first Amylin-based product, it will have the best weight loss label than any product marketed at that time. Let's start with that. It will have the best weight loss label than any marketed product at that time.

Then, of course, we basically know that sema high dose has now 21%. Let's take the latest results at CagriSema at 23%, but the CagriSema, the 23% is with the design trial that Martin has now alluded to, and we have multiple times mentioned to you that there is an upside to that when the design of the trial is less flexible, that's the REFINE 11. We'll see what the number is once that trial plans itself.

But we also have said inside CagriSema, what that you have seen in all of these trials, including the REDEFINE 11, there's only 2.4 milligram of Semaglutide. We are starting a trial soon with 7.2 milligrams Semaglutide in that. And then basically, you will see that the life cycle management of CagriSema will pan itself as it is. So that's all on the injectables. It has nothing to do with the pill. The pill is doing phenomenal. I think it's the first and the best-in-class pill that you will see for a very, very long time to come. So that has its own. There is no other pill that has shown -- can get anywhere close to the 17% weight loss, and we have explained that also. It's the only pill that's a peptide. All the other stuff is small molecules. So they have the small molecule efficacy. So that, I think is -- but that's a whole different topic on its own.

Then you're speaking to Zenagamtide, Amycretin, which is the whole next generation of the products were coming after CagriSema, and that will also show its benefits, and we are taking all the learnings, as I mentioned, from these REDEFINE studies into the AMAZE trial studies and then you'll see the benefits of that as well.

And then last but not least, stand still for the results of the triple agonist that we will basically announce in due course. So we have 2 triple agonists, and we are incredibly excited about that as well.

Thank you very much, Mike. And our next question?

Your next question comes from the line of Carsten Lonborg Madsen from Danske Bank.

Yes. So the CagriSema high dose that you will be initiating 2.4 mg, 7.2 mg. What does your internal modeling say about adding 7.2 milligrams similar to Cagrilintide, and why don't you also increase the Cagrilintide dose in that trial?

Thank you very much, Carsten. And the question for Martin on higher dose CagriSema.

Thank you very much, Carsten. I'll not guide exactly what our model says on the weight loss potential. But let's say that it's more than what we've seen with the CagriSema 2.4 milligram plus 2.4 milligram and with a comparable safety and tolerability profile. So clearly, an upside on the efficacy potentially without having to compromise on safety and tolerability. And from that perspective, that is a very attractive offer [ open-label nature ]. We have tested higher doses of Cagrilintide in combination with Semaglutide without seeing added benefits on weight loss. So therefore, based on everything that we know also from the step-up trial, it makes sense to increase the dose of Semaglutide but not necessarily Amycretin -- sorry, Cagrilintide.

SP119072186 Great. Thank you very much, Martin. Operator, the next question, and we have 1 question left.

Your next question comes from the line of Martin Parkhoi from SEB.

Yes. Thank very much. Just on the same type, of course. Last year, you also announced that you drop your duels, your going -- you had Tirzepatide as an actual comparator. Now we see these results today. And I note that if we look at the trials that you so far have on your 19, you use Semaglutide as an action comparator in AMAZE 8. You use Semaglutide as an active comparator. Have you just realized that you cannot eat a Tirzepatide and you're using Semaglutide as the active comparator going forward?

And then just to follow up on the 419, can we talk a little bit about what your goals are with this with respect to are you going for a best-in-class side effect? Or is the weight loss that you're going for in that one?

Thank you, Martin, and 1, 1.5 question to Martin.

Yes. So we obviously will do comparator studies when there is that opportunity. I think clearly, you've heard both me and Mike talk about the open-label nature of REDEFINE 4 and the potential for substantial buyers that is introduced both on the efficacy potentially also on safety and tolerability when reporting on that. So an ability to do head-to-head comparisons with a competitor drug would require the ability to blind. And that, obviously, we are working on as we speak.

Great. Thank you very much, Martin. And with that -- I'm sorry, and this concludes the Q&A session. Thank you for participating, and please feel free to contact Investor Relations regarding any follow-up questions you might have.

Over to you, operator. Thank you.

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

Excellent. So good afternoon, everyone. I'm James Quigley, European pharma analyst here at Goldman Sachs and it's a pleasure to welcome to this fourth quarter results presentation for Novo Nordisk. We've got a pleasure to be joined by Mike Doustdar, CEO; Karsten Knudsen, CFO; and Martin Lange, Chief Scientific Officer. So with that Mike thanks for joining us. Over to you.

Thank you very much for hosting us. I promised that I'll try to go through these slides because I'm sure you've seen this as fast as possible, so we can actually get a lot of questions into the dialogue of the hour that we have. forward-looking statements. This is a slide you have seen for the last 5 years. We'll retire it very soon and give you a new one at the Capital Market Day. It's 1 that we created back in 2019. basically setting some guidance for ourselves what we want to do. Many of the things have happened. Some of it have positively surprised us, some of it negatively, what we are probably most proud of is as a company, we've been more than doubling our sales and profit since this last 5 years, adding DKK 76 billion to our obesity care. Rare diseases where, I would say, many people don't still put into their models enough has been completely revamped compared to 5 years ago and we are super excited about [indiscernible] launch and [indiscernible] launch. And in general, of course, it's an area where we live to the site, but it's getting healthier and healthier and last year grew by some 9%.

And then of course, the sheer number of the people we're treating today is 16 million more than it was back in 2019. So we have 46 million people on our products. If you look at last year, and I know it's long overdue, I will not spend so much time on it. It was a year of, in some way, disappointment when you think about our triple profit warnings, but forecast that initially was given at ended up to be on the high side. We came on the back of a '24 that was incredibly robust. So we made the 2025 forecast and we ended up doing half of what we basically had forecasted. So we did 10% growth on a back of U.S. and IO growth that you see there, 8% in U.S., 14% in international operations. And pretty much all regions did well with maybe the exception of China, we had higher hopes for China.

The main reason for China being below expectation is simply because Wegovy and the obesity is right now moving fast in the eHealth channels in China. And in that channel, you are not allowed to promote a product that's solely for obesity. And we have Wegovy and we are not allowed to sell directly in online channels. Wegovy while our competitor Mounjaro, being a single brand of diabetes and obesity has a bit of an advantage over us. It's something that we're trying to fix, but that's really why China numbers are below it should be.

In general, I would say the obesity market doubled up, and we were able to capture 31% growth out of that. 73% in international operations on the back of a number of new launches that we did on Wegovy and 15% in the U.S. where we are putting a lot of emphasis on the dialogue over the last couple of days to show some data to you is on the Wegovy pill. It has probably so far been one of the best launches that pharma has seen. I speak a little bit cautiously because not because I'm not excited, but because it's early days. It's 1 month into it. But I have to say that in this 1 month, it has blown our own expectation, how well it has done. When you think about why is it doing well?

And I'm sure we're going to have a lot of questions on it as well. Predominantly, it's because what has hurt us on the injectable side is helping us on the pill side. this obesity market now 2 years into deep competitiveness element of it with Lilly as well as compounders has taught Novo Nordisk is first and foremost about the magnitude of weight loss. I think kidney matters, heart matters, liver matters, but not if you are perceived to have a lower weight loss than your competition.

We've painfully realized that with our injectable franchises, but we equally get incredibly convinced that the pill will do well also when competition arrives because it does 16.6% weight loss, while the competition only does 12.4%. And in addition to the weight loss of course, of 16.6%. Then we have the label from Wegovy injection. So the cardiovascular benefits that we have seen with the injection is translated into the pill. And then this actually gives us that extra plus that we need. As of the latest data point they have shared with you, we have some 50,000 prescriptions -- new prescriptions NBRxs in the U.S., that translates to some 170,000 patients having chosen to go in this direction. And that, of course, is super exciting. And just to put that in perspective, today or the latest data point in U.S. shows no other brand, including those of our competitor is having more NBRxs than the Wegovy brand has. So that's really good. But again, just the first month. And our job, of course, is to continue that as we go forward. And we'll get into that dialogue how we plan to do that as we go forward.

I think it's you or to Karsten? [indiscernible]

Also, yes, you can do it too. I'm going to do it fast also. So it drives innovation is obviously what we continuously have to do. there's a lot of competition out there and having the broadest but also the deepest pipeline in the special diabetes and obesity, but also our other therapy areas is what we do in R&D. 2026 is going to be a really exciting year in diabetes and obesity. I am not going through everything. Lot of readouts, lot of initiations across cagilincide, semaglutide, [indiscernible] and 2 tri-agonists, One being a GLP-1/GIP glucagon, which is an external acquisition, one being the internal GLP-1/GIP amlyn analog. That's really exciting.

And again, a lot of readouts, a lot of initiation, a lot of regulatory decisions across the board. In our comorbidity space, we'll see the first readout of sincedecumab, our anti-L6. The [indiscernible] trial will read out in second half of this year. It's rarely mentioned these days, but high risk, We had to acknowledge it's a first, but also really, really high potential if the data comes out with good efficacy, good safety and tolerability. And then finally, obviously, regulatory approval of [indiscernible] in U.S., in Europe for treatment of hemophilia A with and without antibodies. And the Phase III readout of itabopivat, which is for sickle cell disease, again, a novelty for us. But in this space of huge unmet need, very, very high potential as well. So a lot of interesting things happening in 2026.

Indeed, there is -- and when we look at capital allocation, that's also happening in 2026. Just looking backwards on 2025. So as you've seen, we delivered DKK 100 billion in net profit for the year 2025 and we actually managed to convert that into almost DKK 120 billion in cash from operations. So our cash conversion is really strong. The way we deployed our capital or allocate our capital is DKK 60 billion in what we call CapEx. So that's construction of manufacturing capacity. Then we spent -- sorry, DKK 30 billion on BD/M&A. The bulk of that is linked to the Akero transaction for MASH [indiscernible]. And then we paid out dividends DKK 53 billion related to 2025. So with the dividend that is being proposed at the upcoming AGM will have increased our dividend per share for 30 consecutive years. So a very consistent approach, 50% payout ratio. Looking into 2025, we'll continue to invest in the business, invest in growth, both on the CapEx side coming down the mountain of CapEx.

So we're finalizing our facilities, with attractive assets, we will continue to invest in BD pending that we have attractive assets. And then on cash return to shareholders, consistent approach to dividends you should expect. And then we initiated a share buyback program of [ DKK 15 billion ] just started this week. In terms of outlook for the year, we are guiding between minus 5% and minus 3% on the top line. It's driven by certain extraordinary effects, including LOE in international operations in specific markets. impact from MFN in the U.S. as well as declining prices, mainly in the U.S. linked to a higher proportion of cash business as well as rate enhancements on the insured side. Of course, we continue to drive volume, and we are looking into volume growth and more patients being on Novo products in 2026.

However, the price effect outweighs that. Then with this time around, we have guided in adjusted measures. And the reason why we did that change is due to the fact that here in the first quarter of '26 we have a provision reversal, so a favorable outcome of the so-called 340B rebate provision. So we will have a positive one-off accounting noncash impact in the first quarter of $4.2 billion. So of course, it's not fair to look at the underlying business performance when we have such an effect in our numbers, and that's why we have adjusted measures, both on top line sales as well as on operating profit.

So that concludes the presentation. And now we are over to Q&A, which Michael Novod has promised to facilitate.

Thanks, Karsten. So let's start the Q&A. There's plenty of time and let's start with the host. James?

James Quigley from Goldman Sachs. So first question for me is on the Wegovy launch. So the launch has been very strong, as you said, on the initial scripts. But can you talk to any metrics that you have on current levels of awareness in the U.S., you highlighted your Super Bowl ad, but how much support are you putting behind the product in terms of TV advertising to raise awareness? And how much of a multiple effect are you seeing with partnerships from your telehealth and pharmacy collaboration? And also would be interested to your initial expectations for stay-time demographics and expected trends you're seeing from prelaunch marketing as well as the early stage of launch?

Well, there was a lot of -- one question? So we have gone really all in and here's the Super Bowl ad. But I didn't mention if you would walk into Boston or New York Central Station over the last weekend, you would see probably no other ads than Wegovy pill ad. And I literally mean no other ads than Wegovy pill ad. And we're doing it with our partners, I would say, We have decided that this has the right price point at $149, and we need to really make sure quite quickly we get to high numbers for a couple of reasons.

One is because it's important for us to basically use their first-mover advantage and demonstrate on the back of real patient data that this 30-minute dosing flexibility that our competition is speaking to, is a nonissue. I could tell people it's a nonissue, but why should people believe me, when thousands of people say it's not an issue. It's a very different one. We have 1.5 million people in [indiscernible] that never complain about that. And the 170,000 today also are not complaining about that. And then we will, of course, actually prove that and document that as we go forward before we get competition to really make sure that the world knows when you have seriously differentiated weight loss profile.

On the back of CV benefits, then than like many other medications, all pilot medication, it's okay that you just take the pill and then take a shower and then go downstairs and have your breakfast. And so that's -- I think the more patients initially they're better, and I'm super excited about it. I'm also super excited that many of these patients are new patients. 88% of them, as I have mentioned in the call, are buying the 1.5 milligram dose which, in many ways, is good for us. One, because, of course, we're really expanding the market. But two, price-wise, there's only upside because my lowest dose is the lowest price. So no matter how you look at this, there is a plus in this notion than not. And these patients, of course, will titrate up to a higher dose. To make sure that this continues, we will continue putting a lot of efforts behind it financially. I will not get into the numbers for competitive reasons. But I can tell you that there is a good reason why it has been the best launch ever. We are really putting the best effort behind it together with our partners. I think the sheer number of the partners have been critical joining in at the very beginning.

Matt?

It's Matt Weston from UBS. Can I ask about price? Because I think people are really struggling to triangulate your guidance and price comments. So Lilly was very clear on its call yesterday that they anticipated mid-teens price declines in the market, offset by volume growth. So would you agree with that mid-teens view as an overall price pressure in the U.S. market? Or is there something different happening in the Novo portfolio, whether it's a greater shift to cash or an incremental rebate to insurers to try and keep Wegovy going that means that you have a different price outlook than your biggest competitor.

Yes. So I'll take that one. Thanks, Matt, for that one. It's not for me to comment on Lilly's guidance and guidance metrics. I think what we've been out saying is that pricing is coming down, both for [indiscernible] in diabetes. So we see a continuation of the declining prices for GLP-1s in diabetes, mainly Ozempic. So historically, we've been talking about underlying minus 10 million to 15 million. So that has been kind of the directional guidance. No changes to that. And in obesity, the key point is that the factors we are looking into is rate enhancement in the insured channel mix, i.e., more towards cash and then an MFN impact in terms that both in sales cash pricing, but also Medicaid and Medicare Part D pricing. So if you put all that together, on I would say the Wegovy injectable, then you come to a quite substantial price reduction for the Wegovy injectable than for the oral that we only have a starter price, so we don't have anything in the comparator.

So our -- the decline that we are implicitly guiding for in our U.S. business being, say, in the teens, that is price driven. So I think that's as close as I get it. We're not guiding specifically on price and volume as our competitor.

Pete?

Pete Verdult at BNP. Just 2 questions. Just on Wegovy pill, Mike. Beyond the U.S., I mean Lilly said yesterday, they filed orfor in 40 countries. Could you remind us -- sorry to be on the spot, where you are in your filing strategy for Wegovy pill outside the U.S.? And then secondly, I understand completely that Wegovy pill is your route to salvation. So you've had about 1,000 questions on that in the last 4 hours. So just a different question on Ozempic. We've seen these scripts. We all know it's gentle decline. Is there anything that can be done there? Or is that just the sort of the situation in the U.S., there will continue to be a general decline as you focus all your efforts on Wegovy pill and Wegovy.

Yes. So under registration and regulatory approvals, we have made it quite open, Pete, that we have filed for regulatory approval of the pill in EU and U.K. And when we say that, we don't go ahead and count the number of the countries that are inside European Union, If I was playing the catch-up game and needed some positive news, I probably would say not the EU, but turned it into whatever number of countries that it may be and add 1 or 2 to it. We do know that the process for registration in many of the emerging markets is that you need to have the FDA approval and/or EMEA approval and you use the standard file of those to go to emerging market and get regulatory approval. We know that it's not possible that you basically get parallel registration in Philippine before you have either EMEA or FDA approval. So that I leave for you to kind of read the law and know where the numbers come from. And then for Lilly to perhaps explain that a little bit more in detail.

On the Ozempic element, I would say there a couple of things. Now it's kind of not a secret anymore. If you read the news the last 3 days, there's been articles saying Novo Nordisk is launching Ozempic pill and then that's going to happen. So we are going to actually revitalize a bit of a Ozempic brand around bringing rebases in a different way, let's call it that, into the market. And that you will see this year. Then Emil, who's sitting in the back responsible for international operations, will also tell you that we are moving much faster than before with Ozempic 2.0 in a number of his markets. And we did not do some of those activities before last year. also partially because of supply situation, I have to say.

And now we actually have our hands more open. But on the diabetes part where I think rightfully, a number of you are a bit worried that diabetes has gone down a bit while growth of growth is coming from obesity. I also will say that we have the best insulin in the world, the weekly insulin in the world, and we only have it in 3 markets today. And we didn't again go behind that and launch it in more because we've been busy managing whatever. And I think now it's a good to open up some of those books and then see what else can we do with our diabetes franchise. And all of that, I think, is in the planning.

Richard?

Richard Vosser, JPMorgan. Maybe a couple of questions on international operations. Just thinking about the LOE that you've highlighted, the 5%. I think when we talk to Sandoz and others, there may be some delays there. So just your thoughts on that competition and what you're baking in. And then secondly, in IO, Mounjaro had, I think, very large numbers in international operations yesterday. So just your thoughts on the competition there, maybe last time over speaking, the U.K. you were fighting back. How are you thinking about the rollout of injectable Wegovy and you mentioned the 7.2. In other markets, what sort of growth can we see there?

Very good point. I would say the way the guidance is created for us and probably for Lilly and the other pharma companies is that we take our best guestimates internally for our budgets, at any point of time, then we get it approved by the Board and then eventually a month later, we come and introduce it to you with our upside and downside sheet. When we do that, then we use data that is usually from a month or so before just for no other reason. And in that context, then you learn things along and then we internally, of course, adjust for those with our so-called latest estimates. And quarter-by-quarter, we also let you know where we are up and down. If you just take that as a guiding principle for all companies, Then I would say that I am hearing today more possible upside along the line that Sandoz is speaking to. They did not talk to that a month or 2 ago, but we're moving into it I would say, I'm hopeful that there will be maybe some delays here and there.

And then we can, of course, see some benefits on that on our own targets and what we have announced to you. On the other hand, I've also noticed that the preference share of Wegovy versus Mounjaro or Zepbound in U.S. has a bigger spillover effect to the rest of the world due to social media. Brits and Colombians like go to the same YouTube and learn from the same digital opinion leaders that are based in U.S. And in the U.S., everyone thinks that tirzepatide is a better product slowly as they launch into my neck of the world also they're benefiting, I would say, from that. So we are adjusting to that as we go along, albeit not giving up, and we do hope that with the launch of 7.2 in U.S. initially, we will actually have that spillover effect into the rest of the world and benefiting from it. But we need to see it and it has a delay impact, I would say, that we need to calculate on it.

I think the 7.2 is really, really important for us. besides the financials and what have you, because we fundamentally in our company feel this is being unfairly treated that people have forgotten about those mechanisms of medications and that you actually dose a product higher, you get more out of it. And we just stopped at 2.4 and now we need to bring the 7.2. And then, of course, our hope is that people will make the judgment that now that the weight loss magnitude is on par, should I cheer about the kidney and the heart and the liver that 1 asset has woven and the other 1 not yet and slowly change that.

But the preference share, I think, you know the data as good as I in U.S. is anywhere between -- from 10 patients 7 or 8 go to my competitor. And basically, 2 on a good day 3 comes to me. That we do -- I strongly believe we're going to try to change that. but it will not overnight become 50-50. We have to do this properly. We have to kind of tell people and then let the people tell each other. And that's why I think there's a bit of a delay on it. We share our plans with you. But there is, unfortunately, a bit of a wait and trust me later element into this for no better reason than what I'm explaining.

Sachin?

Sachin Jain, Bank of America. Two questions, please. If I go back on pricing. It's more of a midterm question how do you think about price elasticity sort of price for volume midterm. So you obviously take it down to $150, let's unlock the market. how do you think about $150 in being a floor and what work have you done to say, going to 7,500 unlocking volume? And then how do you think about, as you see data through this year as to whether they titrate up and dose or not your willingness to lower the higher dose oral $299 and even the injectable $349 given you're seeing this demand at the lower price? Just trying to get a sense of we've had a big price reset, how do I think about that from here? And then the second question is for you, Karsten, margins. Obviously, you're guiding to flat margins despite aggressive top line. So just if you could give us some moving parts as to where the savings are coming given the big investment we're obviously talking about in SG&A.

So Sachin, I hope you don't wish that in a large fora like this, with broadcast is also happening, I will give you my whole list of pricing policy for what you call it, for the products. I do -- I'll give you 1 part of the answer, which might resonate well with you. Price is an important element of how much volume gets untangled in this business, no doubt about it. We first saw that with the compounders. The reason, basically, people were picking up a compounding knockoff products was not because they don't want to original. It's because they couldn't afford the original. And we saw how much and how fast they have been able to penetrate. So that was, I think, one, of course, learning element for us. But if you just compare the launch of the Wegovy pill to previous launches where the price level were very different, and you can dig out the prices and then actually see the numbers.

The 170,000 that I spoke to or the 50,000 NBRxs that I'm speaking to. If you take a look at that, that's 15x more than the first month of Wegovy injectable launch at the higher -- of course, much higher price than it was. And still, you can see this is a better business case. at 149 and 15x more than Wegovy was. You could also come back a little bit closer. Wegovy was the first launch, can come closer to the Zepbound launch, And they did actually better than Wegovy, considerably better. And this launch is 2x better than the first month of Zepbound launch.

So part of it, of course, is the molecule and efficacy and what have you. But if it was purely efficacy, people will not go to the compounders. If it was purely efficacy, people will not move and people will still buy Mounjaro because it has higher than 16.6%. So price is a big element of all of this as well. And we believe with what we have announced that it's worth the short-term pain because the volumes were easily bypass it. Again, I have publicized and you know the math better than anyone else that you have to price double the volume, you breakeven. If I didn't think that you have to price and you do much, much better than doubling the volume, we would not go in this direction.

The reason we do is because we strongly believe that there -- and Karsten will now talk to the margin, they strongly believe that there is good business in doing that. But we have also said that you have or we have to see this as an investment that we make short term, the price reduction because medium term, basically, all of this will pan out with the volume increases. And then the question is when is medium-term starting? Medium term started first of January this year with the pill. It comes week by week by week. because all the scripts that I need in doubling, tripling, quadrupling the volumes will not come on the first day that the price goes down. But the question is also, is the margin okay? And do we make money off of this and what have you?

Thanks, Mike. So on margin and resourcing, then you're right, Sachin that when you have a top line decline, which is price driven, that's brutal on a margin in a high mark business. So logically speaking, intuitively, operating profit should be declining much faster than [indiscernible]. The simple version of why that's not the case is, first of all, we have a couple of more discretionary items that we have restructuring costs in '25 that makes for an easier comparator, which are partially being offset by Akero running cost in '26 but it's still a net benefit in this equation on fee development. And the second piece is super disciplined resourcing. So we have been cutting a number of budgets across the company. but it's not like a green harvester. So we are stepping up budgets for our top priorities, for instance, in R&D. So the MA program and some of the key R&D priorities. But in many departments, we are running with lower buckets this year than we did last year. So financial discipline, combined with these 2 discretionary factors.

Rajesh?

Rajesh Kumar from HSBC. Just a clarification on that margin point, and this is not my question because you're talking obviously, you put in a lot of capacity that goes into assets under construction, that depreciation is kicking in. So that's fixed cost, which is going up. And you have done a bunch of head count reduction, you're telling budgets are coming down. So if the pricing, say, commercial channel pricing next year steps down and has a similar effect this year and generic [indiscernible] delay that comes next year. Would that still be true for '27. I know you're not giving the '27 guidance. Just mechanistically, would be helpful to think through. The question I have is a simple one. Thank you very much for explaining how the guidance is constructed, what is the process I'm pretty sure you would have figured out costs and knowing you a week before where the guidance would be. So why was it released a night before? What was the process that you went through that you could not release it when you knew that you were going to be significantly below consensus?

Yes. Two questions for me. So the first question, correct. The math is if prices go down, it hurts on the margin, everything else equal. But when you run a business, then everything is not equal. So of course, the triggers to offset. Logically, we will also have with CapEx coming down, the CapEx flow through into the P&L that we've seen in prior years. So with lower absolute CapEx, we would have a benefit there. And then, of course, we'll be very rational around how we resource the company. It's important to note that it's not -- we don't start with the margin and then we gear everything from there. We start with our top priorities in terms of driving top line and then the execution across the value chain, including R&D, to create value for our shareholders, both the short, medium and long term. So that's the first question.

For the second question around release of timing, what we are looking at, and it's something that we diligently spend a lot of time on, and there are many scenarios in terms of exactly how is the year going to pan out. So we work in a number of scenarios and the number of assumptions and then also getting the latest data in terms of January performance both on the overall, but also on our other major brands and how we started the year in international operations. So getting more data on, agreeing on assumptions and then the reason we came the night before, was that then it's our Board of Directors that approves our guidance based on a very comprehensive work through. And then since we are materially away from expectations in the market, we have to go out immediately. So then we cannot wait for the next morning as is customary and which we would have done if we were closer to consensus. So that's why we came out after the Board. And we had a very thorough assessment around when it's the right point in time when we have enough evidence and a sufficient understanding of scenarios to decide on exactly where do we put our guidance and the associated interest.

[indiscernible]

No, no. Can I actually -- can I try to articulate that what happened last year to us was a great learning that this obesity market is more dynamic than at least we had felt or no. So typically, all the budget formations and the budget approvals that happens internally between me and my direct reports actually at the end of last year was moved to this year. was moved this year. And the reason was we actually -- it's moving and it's changing so much. And a small little change on the level of business that we have is considerable. So we have had a lot of dialogue during the month of January, both with Emil, who heads International Operations; and Dave in understanding exactly what is happening, not least with regards to the these news are going in and out on a daily basis, frankly speaking, leading into what Karsten said the night before or the same day actually, that we made the announcement. And then once we've kind of figured out, okay, this is where we feel comfortable about it, that this is where we feel is the latest information and now we have to soon go to the market. We've had our Board meeting. where then the Board actually listened all our pluses and the minuses. They also understand the elasticity of all of this, then they sign off on the numbers that you have basically been communicated.

[indiscernible] At the moment, if you look at how the [indiscernible]. So I'm assuming there was 1 view which was closer to what Lilly are saying. One is what you came out here or no?

The growth rates are different. The growth rates are different because our dynamics are right now different. They have a situation where they have a lot of tailwind in with regards to the preference of their injectable. This is, to a large extent, what's happening with this injectable market. And by the way, when I talked about 7 to 8, well, 7 or 8, it makes a big difference that they take versus the 1 -- 2 or 3 that I take. These are big differences. I think what is really happening is that we -- in terms of prices, the world dynamic is not so much different. We will not -- as Karsten said, go into the details of the pricing, like our colleagues are going into. But I would say prices those are public information, and it's not that they're night and day different. What is really different is the volume uptake that we had a huge volume uptake in '24. We had substantially less of that in '25 versus Lilly and then '26 is a bit of a question mark. So come back to 7.2 we talked about. .

I tell you why I feel a patient should go on semaglutide 7.2 milligram. What do I know today is it's going to be 5 or 4 or 3 on a given Monday, I don't. We have to have our dialogues and discussions and then put the needle somewhere and hold hands on it.

James?

James Gordon from Barclays. Two questions, please. One -- so the oral Wegovy launched really a key highlight. But what's the duration of the opportunity? Because I think in the annual report, the European pattern is '31, U.S. '32 but is that like a work in progress? Or is this just a 5-year opportunity? Do you think you're going to get much longer IP on it? Or is it the same LOE that you're already going to have a problem with? And then the other question was just M&A, I've heard comments about doing -- willingness to do a big obesity deal. But do you -- how do you balance that with maybe doing some of that diversifies you? Because it seems like obesity as well, every big pharma company is trying to buy something. And so assets look quite expensive. How do you think about maybe we don't get in a bidding war with other people versus like a diversification?