Novo Nordisk A S (NOVO-B) Q1 2026 Earnings Call Transcript

Welcome to this Novo Nordisk earnings call for the first three months of 2026. My name is Michael Novart, and I'm the Head of Investor Relations at Novo Nordisk. With me today, I have CEO of Novo Nordisk, Mike Duster, EVP U.S. Operations, Jamie Millar, EVP International Operations, Emil Kongshoy Larsen, EVP Research and Development and Chief Scientific Officer, Martin Holtz-Lange, and Chief Financial Officer, Karsten Munknusen. 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 one hour. Next slide, please. The presentation is structured as outlined on slide two. 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 risk 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 three months of 2026 and the SLER 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, NovoNordis is focused on driving competitiveness, progressing our pipeline, and making focused investments towards growth opportunities while delivering returns. Today, NovoNordis 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 Vigovi options to patients. That includes the Vigovi pill in the U.S. and Vigovi HD, also known as high dose or 7.2 mg, which is now approved in the U.S., UK, European Union, and Brazil. It is no secret that the Vigovipil 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 Vigovipil. As the global momentum behind the peptide-based therapies accelerates, Vigovipil 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 six 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 22 billion Danish crowns in research and development and commercial initiatives. On top of that, we return nearly 38 billion DKK 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 three months of 2026, adjusted sales decreased by 4%, driven by lower realized prices, partly offset by GOP-1 volume growth and market expansion. U.S. operations decreased 11%, partially offset by international operations, which grew 6%. Our GOP-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, Jamie.

Thank you, Mike. Next slide, please. Early this year, Nova Nordisk launched the Wugovi pill in the United States. Wagovi Pill delivers weight loss efficacy on par with that of injectable Wagovi in a once-daily, easily-administered oral tablet. In addition to the weight loss indication, Wagovi 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 longstanding 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 Wagovi 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 17th, total weekly prescriptions were 207,000. In terms of users, our source of business analysis supports that the Wagovi pill is bringing new healthcare providers and new patients to Wagovi. In terms of patients, we see close to 80% of Wagovi pill users are GLP-1 treatment-naive patients. We also see patients coming to Wagovi pill from competitor products with limited cannibalization from injectable Wagovi. 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 three of the largest PBMs added Wagovi 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. Wagovi high-dose was launched in the U.S. in April in a single-dose device, giving patients and healthcare providers the opportunity to experience greater weight loss with the Wagovi 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 one in three 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. Wugovi high dose has been launched nationwide across all channels, with the three largest PBMs having added Wagovi 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 Wagovi offerings with the Wagovi pill and Wagovi 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 Wagovi franchise is now leading on NBRX market share, with a share of around 65%. With that, over to you, Emil.

Thank you, Jamie. Please turn to the next slide. In the first three months of 2026, Obesity care sales in international operations grew by 44% to 9.2 billion Danish kroner. 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 Vigoi sales is coming from telehealth channels. We are also differentiating our GLP-1 portfolio with the UK approval of Vigori 7.2 mg in a single-dose device and the launches of a SEMPIC 2.0 mg. In addition, Novonautics is expecting to launch Vigori pill in select markets in the second half of 2026, pending regulatory decision. With that, over to you, Kar.

Thank you, Emil. Please turn to the next slide. In the first three months of 2026, our reported sales increased by 32%, reaching $96.8 billion. As part of our 2025 full-year results, we did introduce adjusted metrics to exclude certain exceptional and non-recurring effects, primarily of non-cash nature, including the provision reversal of $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, one-time 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-based approach, we are on track to deliver the 8 billion Danish krona 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. Gnorsk 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 its national 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 pattern expiry of semaglutide molecules in certain markets. In U.S. operations, the outlook is based on current prescription trends for the injectable GL4-1 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 favorite nations' agreements with the U.S. administration, is assumed. Uptake related to the Vigobi pill is reflected in the outlook based on a range of assumptions related here too, such as market penetration, potential negative impact on the growth of the injectable obesity medication category, as well as Genomex. 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 education. Our key modeling considerations for 2026 are shown on the slides. 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 led. Within obesity, we recently obtained FDA approval for high-dose semaglutide at 7.2 milligrams in the U.S. We have also initiated the two pivotal phase-free trials in the Senegamtide Development Program and MACE. In addition, we have initiated phase-free trials to investigate Senegamtide in people with obesity and sleep apnea, in people with obesity and knee osteoarthritis, and to investigate how well Senegamtide helps people with obesity in maintaining their weight loss. Within diabetes, we completed the pivotal phase 3 trial, Reimagine 1, for caracosemma in people with type 2 diabetes and adequately controlled the diet and exercise. In the trial, CAG Resemma 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 reimagined 1, 2, and 3 trials will be presented at the American Diabetes Associated 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 3 Hibiscus study, which evaluated the potential of etibopibate 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 BOCs. disease. 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 a 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. It's a VOPIVAT is a novel and once daily orally available small molecule designed to improve red blood cell health via pyruvate kinase R or PKR activation. It's a VOPIVAT was tested in the Hibiscus trial, a randomized double-blinded 52-week efficacy and safety trial investigating IsevoPivet versus placebo in 385 people aged 12 years or older with sickle cell disease. The co-primary endpoint was annualized BOT rates, reduction, and hemoglobin response on top of standard of care. Next slide, please. IsevoPivet 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, ITEVOPEVAT 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 four months compared to placebo. In the co-primary endpoint measuring hemoglobin response, it's a VOPA that demonstrated a superior increase in the proportion of people achieving a hemoglobin response greater than one gram per deciliter at week 24 of 48.7% compared to 7.2% with placebo. As an exploratory analysis, ETAVO-PIVAT also significantly reduced the risk of blood transfusion. In the trial, ETAVO-PIVAT appeared to be well tolerated with top-line safety profile in line with previous ETAVO-PIVAT trials. Based on the results from the Obstiscus trial, Novonautis plans to submit the first regulatory approval of ETAVO-PIVAT in the fourth quarter of 2026. Next slide, please. Earlier this year, Nova Nordisk and United Laboratories announced the top-line results for UBT251 in two Chinese Phase II 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 2 trial, the highest mean weight loss observed for people treated with UBT-251 was 19.7 percent after 24 weeks of treatment. In the type 2 diabetes trial, the largest mean A1C reduction with UBT-251 was 2.16 percentage points at 24 weeks, and the highest mean weight loss observed was 9.8%. In both trials, the safety and solubility profile of UPT251 appeared to be consistent with tri-agonist-based therapies. Within obesity, Novo Nordisk Health initiated a global Phase 1b-2a trial, with results expected in 2017. 27. For type 2 diabetes, Novonorski expect to start a global phase 2 trial with UPG 251 in second quarter of 2026. Next slide, please. After a busy quarter, we anticipate an exciting year ahead across all therapy areas. Starting with an obesity, we still expect a decision in the U.S. for kakrasimma at the end of 26, with a potential launch in 27 around the same time of the redefined 11 top-line results. In addition, we expect to initiate a Phase 3b trial with Cagrosemma high-dose in the second quarter of 2026. Overall, we remain excited about the profile of Cagrosemma 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 AMASIN-9 trial investigating oral senagamtide in people living with obesity in the third quarter, and a phase-free trial with cagrelentide high-dose in the fourth quarter of 2026. In the U.S., we anticipate the decision regarding Wegoi FlexTouch that was resubmitted in Q1. In the EU, we expect the decision on Wegoi pill, and the single-dose device for injectable Wegoi 7.2 mg. Within obesity-related comorbidities, we expect Phase III results for ephroxyfermin in a synchrony real-world trial in people with metabolic dysfunction associated with STH or MASH, with fibrosis stage 1-4. The primary endpoint of the trial is safety and tolerability of ephroxyfermin. Within diabetes, we have initiated the phase 2 trial for our tri-agonist targeting GLP-1, GIP, and amylin. We also expect to initiate the Senegatide phase 3 development program Ambition in the fourth quarter of 26. Within diabetes-associated comorbidities, the first readout of citibakimab from the SUSE phase 3 trial is anticipated in the third quarter this year. The trial is assessing 3.5 relative risk reduction on top of standard of care. Siltivecamab 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 denesimic, previously known as MIMATE, for people living with haemophilia. With that, over to you, Martin.

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

Thank you. To ask a question, you will need to press star 1 and 1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1 and 1 again. We will now take the first question. And your first question today comes from the line of Richard Fosser from JPMorgan. Please go ahead.

Thanks for taking my question. Two questions, please, both on Aura or Govi. 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 agobi 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? Thanks very much.

Thank you, Richard. Two questions, one starting with Jamie and then over to Carsten on supply.

Yes, thank you for the question. Overall, titration is happening as expected and comparable to what we see with injectable. Vigovi, 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.

Thanks, Jamie. And Richard, thanks for the question on supply. The way I'll put it is, while we do not have unlimited supply for the Vigovi 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 Vigovi tablet, we're 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.

Thanks, Jamie. Thanks, Carson. Thanks, Richard. Next question, please.

Thank you. Your next question comes from the line of Sachin Jain from Bank of America. Please go ahead.

Thank you for asking my questions to you again, please. So firstly, I guess Carson on SG&A. It's the lowest absolute number for a number of quarters. 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's a broad question around price, maybe from Mike or Jamie, and two media interview comments around no intention to lower prices and oral price at the sweet spot. So one of you could just dig into that a little bit further is that no intention to lower a comment for 150, 149, lower oral dose holding. And if oral price is a sweet spot, how do we think about price mix across the business shifting to this lower price bracket? And I guess that, you know, trends to higher dose oral pricing, reimbursed pricing, any bleeped diabetes pricing.

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

Yeah, thanks, Sachin, for this question. So on SDNA 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 a 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 Vigobi pill launch and resourcing of that. You've seen the Super Bowl ads, et cetera. And then with the model that we're deploying together with the telehealth partners, that yields a different scalability in terms of promotional presence between paid versus earned media. And that has yielded a very high share of voice share in the first quarter. Through the coming quarters, expect us to be disciplined around our spending. We are less employees in the company, which, of course, helps on SG&A. But at the same time, we are truly investing in the growth drivers. We have Vigov HD, the launch products coming up, and the Vigov tablet. So in terms of SG&A ratio, we're in the low 20s for the full year.

Thanks, Karsten. Good. So Sachin, I think price is dynamic and an 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 month into the game, and having more than a million patients on our product. So at this point, I would say we have prices 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 optics 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. Thanks, Mike. Thanks, Atchun. Next question, please.

Thank you. Your next question comes from the line of Simon Baker, Rothschild & Co. Please go ahead.

Thank you very much for taking my questions. Two, if I may, please, really following off from Sachin's questions. Firstly, on the all-will-we-go-vie, 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 Carsten. 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. Thanks so much.

Great. First question for Jamie, and then second question for Carsten.

Yeah, I think on price elasticity, as Mike said, the volume uptake and receptivity in the market suggests that we've 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 Wigobi 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, Jamie. 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, yeah, it's 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.

Very clear. Thanks, Carsten. Next question, please.

Thank you. Your next question comes from the line of Peter Fadult from BNP Paribas. Please go ahead.

Yeah, thanks, Peter Fadult from BNP. Two questions, one for Martin and one maybe for Jamie as well. Martin, can I just push you for some more info on your next-gen GLP-1? Is it fair to assume 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, Jamie, for you, just because you are new to the management team and you bring an outsider's perspective inwards, could you just give us a flavor of what you found when you arrived in your role at Novo and a few of the biggest changes you've made since taking the role on? thank you thank you first question to martin and then to jamie yeah i think you've heard thank you for the for the question pete um i think you've heard me talk about before when we talk about differentiation we look at efficacy differentiation tolerability uh dosing frequency and and maybe scalability um let's assume that this one uh 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 to learn more Great.

Thanks, Martin. And Jamie, 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, Wagovi pill, as we're discussing, but also Wagovi 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. Great. Thank you, Jamie.

Thanks, Pete. Next question, please.

Thank you. Your next question comes from the line of Michael Loyston from Jefferies. Please go ahead.

Thank you. Two questions as well, please, and linked. Zempic 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 ZAMPIC in diabetes in the second half? And that links to the second question on guidance. So, Carsten, 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 for the rest of the year?

Thanks a lot. Two questions for Carsten.

Thanks, Michael, for those very relevant questions. In terms of USIMPIC and USIMPIC performance, then I'd say what we've seen here in the first quarter in the US setting, which is what you're alluding to, is very much a continuation of what we saw towards the end of last year and 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 US 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 three months down the road and we've seen a number of items actually partially playing our way in terms of the oil script trends. We've got the Vigobi high-dose approval in the U.S. We've decided to launch Vigobi Tablet X-U.S. in a few select markets. And then we've gotten more info both on competition as well as LOE approvals in I.O. So based on that, we're more confident in our outlook. And as a consequence, we parallel shifted both the sales and OP ranges by one percentage point. So you should see that as increased confidence. And yes, I'm with you that the range is a notch wide, but you should take it as a signal of confidence that we lifted the range by one percentage point.

Great. Thank you, Karsten. Thank you, Michael. Next question, please.

Thank you. Your next question comes from the line of Mike Nidalkalvich from TD Cowan. Please go ahead.

Thank you for the question. I have two. My first is on Zilti Zecumab. 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 Ligovi 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 Wegovi pill and Wegovi injection. So my question is, does Novo plan to defend that IP? Thank you.

Thank you, Mike. One question for Martin and one for Karsten.

Yeah, thank you for that. So from an indication and a potential perspective for Sylphie Vekamet, Zeus, Hermes, and Artemis are the only ones that will lead to potential indications, respectively in AACVD. Heart failure will preserve the injection 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 three categories. We still have to flag high risk this is first in class and and we need to establish not only the only the efficacy in terms of improved outcomes but also of the the safety and solubility of an anti-IL-6 so we still see this as very very high potential across those three indications but also high risk until we've seen the first regard.

Thanks, Martin.

And Carsten?

Yeah, 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 fairly low probability of success early on. So those big risks and investments in return, we get the 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.

Thank you, Carsten. Thanks, Mike. And next question, please.

Thank you. Your next question comes from the line of James Gordon from Barclays. Please go ahead.

Hello, James Gordon from Barclays. Thanks for taking two questions. The last question was just on long-term semaglutite in general obesity pricing. So I know you've invested tens of billions in CapEx to brew semaglutite very efficiently at scale. But then in India, I think it's at least eight generics approved and some very low prices, at least for the vial form, just $4,000. So it does look like the generic companies can 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 unique? Or do you think we are going to have an order of magnitude for once the patterns 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 illegal, it's still mid-40, but the midpoint of the four-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 load more sales and marketing for an ex-US or a Wigobi launch? Otherwise, it seems like you would get to a higher margin.

Thank you, James. Two questions for Carsten, one on SEMA and manufacturing mode and pricing, and then one on SG&A.

Thanks, James, for those two questions. So first and foremost on SEMA manufacturing, based on our process and setup, we believe that we are hyper-competitive in terms of unit cost in producing SEMA and hyper-competitive in terms of scale, also in terms of how much SIMA we're able to produce and the reach we can do pretty much at a global scale. What that leads into in pricing in different healthcare 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 cash 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 a 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 a higher margin, but that's not our strategy 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 almost 10,000 less FTs 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 Commons.

Very clear, Carsten. Thank you very much. And thanks, James. Next question, James.

Thank you. If your next question comes from the line of Evan Weigerman from BMO Capital Markets, please go ahead.

Thank you so much for taking my question. First question on the impact of generic semaglutide in Canada. How are you thinking about that as you have contemplated your guidance? Maybe some, you know, illustrative kind of concepts around that would be great. And secondarily, on a bigger, you know, taking a step back, you've 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 so much thank you evan uh one for emil on canada and then one for mike on radishes yeah as as you will know most of you we now have of course two 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 their approvals now they're there it has not made us change our overall guidance at the group level, that we will see low single-digit 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 OSEMPIC and Bigowi. 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 three 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 a savings card. And we have optionality on a second brand as well.

Thanks, Mie. 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.

Great. Thank you, Mike. Very clear. Thanks, Evan. Next question, please.

Thank you. Your next question comes from the line of James Quigley from Goldman Sachs. Please go ahead.

Great. Thank you for taking my question. I've got two, please. So, first of all, can you talk to what you're seeing in the early stages of the Foundero 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 two products? And are there any patterns or trends in terms of the patients that are going on each drug? That's number one. On at number two, for the AMAZE program, you started seven phase three trials on clinicaldrials.gov. Can you talk to the dosing protocol here in the obesity trials? The primary endpoint is running out until 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 Jamie regarding what we see post Fondeo launch and then the second question to Martin and what he can say about MACE.

Of course it's early days but I think what we see so far is an affirmation of the strength of the Wagovi pill profile. As mentioned before the number one decision criteria is efficacy and we have you know unsurpassed efficacy with that 17% weight loss with 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 three trials.

And that showed better efficacy with Wagovi 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 with the strength of our profile thanks jimmy and martin yeah uh thank you for the question obviously very relevant we did take a lot of learnings from from the redefine program as you know um they were both around the patient population the need and wish to lose a substantial amount of weight is obviously a imperative and we've implemented that starting with redefine 11 but also in the image program and then we've 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 one third 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 I haven't seen the weight loss data, I have to say, but I'm looking at the hydration data, and the model seems to work, and we have employed more or less the same algorithm in the AMH program. So we're quite confident that we'll help patients really achieve the full weight loss potential of emicretin or senagantide.

Thank you, Martin. And thanks, James. Next question, please.

Thank you. Your next question comes from the line of Graham Parry from Citigroup. Please go ahead.

Great. Thanks for taking my questions. So Omegovie pill, can you quantify the total inventory impact Omegovie pill sales in the quarter? you flanked in the release pre-launch 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 Kagrisemma co-formulation. Why the decision is to terminate? Is that a technical or a commercial decision?

Thank you, Graham. Two questions. First for Carsten regarding the go-go pill inventory and then the second to Martin on the co-formulation.

Yeah, thanks for that question, Graham. So for the Vigobi tablet, we reported around 2.3 billion GKK 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 built with the wholesalers and in pharmacies, the customary launch orders, if you will. And the second piece is just also the customary inventory built in connection with a 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 built. 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're seeing. And in terms of going forward, then it's also absolutely normal that there will be a certain degree of inventory built 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 lifecycle which is linked to inventory built across the chain that happens for all products and we've seen it for decades. Martin?

Thank you for the question. As you know we've always talked to that we are scaling the dual chamber device of Kanko Sema to a full scale launch so we are very confident in that we saw the co-formulation as a flexibility upside. The way we now think about it is that we have front loaded and sped up the EMAs program and the type 2 diabetes program as well as the oral program for Senagantide. So with full scalability on the dual-shaper device combined with anything Seneganta coming in more or less the same time or even before as the co-formulation could, it really didn't make sense. 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.

Thank you, Martin. Thank you, Graham. And next question, please.

Thank you. Your next question comes from the line of Florence Espedes from Odo BHS. Please go ahead.

Good afternoon. Florence Espedes from Odo BHS. Thank you very much for taking my questions. Two quick ones, please. First, a follow-up on the GLT1 franchise in diabetes. I was wondering how could you re-energize the business in the coming years? It would be mainly driven by innovation, and it could maybe give us a little bit more color on the two different geographical areas, U.S. and ex-U.S. And my second question for Martin, regarding a trip agonist, when should we have more visibility on the profile of the two products, and whether you intend to decide to keep one or both going forward, depending on the profile. So if we could have more color on this point, it would be great. Thank you.

Thank you, Florent. Two questions. We'll split the first in two. So one to Emil on how to drive OSEMPIC in IO and also to Jamie on driving OSEMPIC PIL in US and then over to you, Martin, afterwards.

Yeah, thanks for the question. We are very much focused on getting back in the game with OSEMPIC now that we have full supply as of eight, nine months. And we are seeing already some emerging positive trends in terms of share growth, particularly in Ukraine. And what will further increase the momentum, we believe, is our 2.0 launch. We've had the first launches in three European markets, particularly in Germany. We're seeing very good traction, but also in the Netherlands. In the UK, it always takes a bit longer with local payers, etc., but remain optimistic there as well. You might know that in IO, two-thirds of all patients have already gotten to our one milligram dose, and many would benefit from uptitrating both in terms of weight and A1C. If I can maybe add another combo angle here, it's also that we've actually in China launched Qunso, which is our once-weekly combination of a GLP-1 and our weekly insulin. Also, 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 two leading brands, Rise, so they can solidify, and also have good traction for our once-weekly insulin in China. So whether it's insulin or it's GLP-1, we still have a strong belief in diabetes across Iowa. Great. Thanks, Emil. And Jamie, on U.S. and Osimbing Pill, maybe?

Yeah, in the U.S., we'll continue to focus on the efficacy in terms of A1C reduction and 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 breathe new life into Ozempic, basing a pill on the iconic naming and awareness of Ozempic generally. Thank you. And Martin?

Yeah, thank you very much. So it's important to quote out, the two triathletes are two different biologists, one combining GFP1, GIP, and glucagon, the other GFP1, GIP, and amylin. I think based on what we see so far, they both have a substantial potential to introduce weight loss across the board with a good safety and solubility profile, but they may also contain individual traits that will clearly differentiate them that could be on effect on liver, it could be on effect on bone respectively 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 biologists but also the safety and solubility and we'll see more insights. We already have phase 2 data of UBT251. You've seen the weight loss potential in both obesity and diabetes, it seems to be quite stellar. And obviously, with the two data coming in from our internal triagonist next year, we'll have better visibility on how to potentially differentiate.

Great. Thank you, Martin. Thank you, Florian. And operator, we'll take the last question.

Thank you. Your last question for today comes from the line of Carsten Lomberg-Madsen from Danske Bank. Please go ahead.

Thank you very much. I was just interested in hearing your wording on the ex-U.S. Oral Vigovie launch. When you launched in the U.S., you were quite clear that this would be a full, broad-based, sort of very aggressive U.S. launch of Oral Vigovie.

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 Vigovie tab? thank you great thank you Carsten and the question for me yeah yeah we are of course excited to have the opportunity to launch in selected key markets that lend themselves particularly well to the Vigoe pill in IO and we see a lot of halo effects from the from the US already also on our injectable franchise so so we are we are you're going to go all in when we get the chance to launch there will not be any half measures in in IO where we launched but of course the general play in io this year that's the high dose launches of 7.2 where we see good traction with the messaging already and and of course when we then bring the device we have a strong belief that that will that will be part of turning around brand sentiments so that's where we have 20 launches planned and that's the main play but of course it's a it's a nice addition where we get to launch the Vigo appeal great very clear thank you you meet.

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, Michael, 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.