AstraZeneca Q4 2024 Earnings Call Transcript

Quartr
Provided by Quartr
February 6, 2025

There are 21 speakers on the call.

Operator

Good morning to those joining from The UK and The U. S. Good afternoon to those in Central Europe and good evening to those listening in Asia. Welcome, ladies and gentlemen, to AstraZeneca's Full Year and Q4 twenty twenty four Results Conference Call for investors and analysts. Before I hand over to AstraZeneca, I'd like to read the Safe Harbor statement.

Operator

The company intends to utilize the Safe Harbor provisions of The United States Private Securities Litigation Reform Act of 1995. Participants on this call may make forward looking statements with respect to the operations and financial performance of AstraZeneca. Although we believe our expectations are based on reasonable assumptions, by their very nature, forward looking statements involve risks and uncertainties and may be influenced by factors that could cause actual results to differ materially from those expressed or implied by these forward looking statements. Any forward looking statements made on this call reflect the knowledge and information available at the time of this call. The company undertakes no obligation to update forward looking statements.

Operator

Please also carefully review the forward looking statements disclaimer in the slide deck that accompanies this meeting. For those joining remotely, there will be an opportunity to ask questions after today's presentations. Please use the raise a hand feature to indicate you wish to ask a question at any time during the call. And for those attending in person, roaming microphones will be available to ask questions during the Q and A. After the presentation, you'll be invited to raise your hand in the air and we will bring the microphone to you.

Operator

When you receive the microphone, please state your name and organization.

Speaker 1

Thank you, Andy. Welcome, everybody. It's great to see you all here today. 2024 was a very strong year for our company. I would say a very, very amazing year, I have to say, with total revenue up 21% and core EPS up 19%, as you can see here, a clear illustration of the strong underlying momentum of our company.

Speaker 1

I've also listed here 14% on core OpEx to show that we continue to work on leverage with a lower growth of our expenses relative to the growth of our total revenue. We also delivered important pipeline advancements with nine high value pivotal trials readouts in 2024. Combined, these trials represent over $5,000,000,000 in non risk adjusted PQR revenue. We had, of course, more readouts than those nine, but those are the most high value readouts we had last year. At our Investor Day in May, we communicated our ambition to deliver 20 new medicines by 02/1930.

Speaker 1

And I'm pleased to report that we have eight new medicines approved to date, including the recent approval of Datto Way, which was previously called Datro DXD earlier this year. So if you move to the next slide, we continue to benefit from our broad based, diverse portfolio of products and diverse geography, And we have strong growth across all our CLP areas, as you can see here, and our key geographies in 2024. In the year ahead, we anticipate sustained demand for our innovative medicines and our growth across geographies. In our results announcement, we provided an update on ongoing investigations in China. We've received a notification from the Shenzhen City customs office regarding suspected unpaid importation taxes totaling $900,000 which, to the best of our knowledge, relates to Infinci and Imjudo.

Speaker 1

So if actually AstraZeneca was found liable, a fine of between one to five times the amount of voided import duties could have to be paid by AstraZeneca. We are continuing to cooperate with the government towards resolution of those investigations. I'm pleased to have Ishkra, we call her Super Ishkra, joining us today in her new role as Head of International. I would now like to invite Ishkra to share early perspectives on her new jobs and in particular, China. Over to you, Iskra.

Speaker 2

Thank you, Pascal. No pressure with a nickname. I'm very honored to have assumed responsibilities in the international region that, as you all know, combines China emerging markets as well as Australia and New Zealand. Initially when I started in my new role, my focus was really in how best to support our colleagues in China at an unsettling time for them. And I have been really truly impressed by their continued effort and passion to deliver on the values and our purpose.

Speaker 2

And I have a real strong confidence in the leadership that we have in place in China. China revenues last year had increased by 15% throughout the first nine months and overall year 2024 growth is 11% because of the quarter four decline of 3%. It is very important to note that that decline was primarily driven by year end hospital ordering dynamic, which affected few products, specifically Tagris and ForCiga, as well as demand for our respiratory products that is lower given the mild start of the winter. And while we do expect some headwinds specifically driven by VVP inclusion for our several medicines, we do expect the growth in China will continue and especially in the longer term, we see a strong opportunity and we are fully committed to continue growing in China. If I think about emerging markets more broadly, I think you all know that we have been building our presence and capabilities for many years, accelerating our regulatory approvals and also doing our best to broaden our equitable access and we have seen strong growth over the past several years and we do expect that growth to continue.

Speaker 2

In 2024, overall emerging market growth was at 22%. The unmet need across the emerging market is unprecedented or enormous. I mean, if you look at any therapy area, but specifically if you look at the areas where we work, just to give you one example, in emerging markets, it's estimated that one point eight million people will be diagnosed with lung cancer. That represents actually seventy percent of the overall lung cancer diagnosis in the globe. The substantial unmet need coupled with the increased investment in the healthcare as well as increased willingness to pay for the healthcare gives us an opportunity to deliver and sustain and significant growth going forward.

Speaker 2

Thank you. Please advance on the next slide and I will give floor back to Pascal.

Speaker 1

Thank you, Ishkra. So as you heard from Ishkra, there is enormous opportunities in the emerging markets, not only in China but also outside of China, and Ishra knows the region very well. So we'll definitely have a big impact on our future growth, and we look forward to resolving the issues that we've been facing in China, of course. 2025 marks the beginning of an unprecedented catalyst rich period for our company. We have talked about it before.

Speaker 1

We're looking forward to the results of high value trial readouts this year for several of our existing medicines, including HER2, LATROE, IMFINZI, Bres3 and Fasenra. And importantly, we also anticipate the first Phase III data for seven NMEs, seven, including camizestram and baxrostat, two medicines which each have a potential to generate more than $5,000,000,000 in peak revenue. The value of our pipeline has been increasing steadily. And as Adna communicated earlier this year, we now have more than 99 late stage trials underway with an average non risk adjusted peak year revenue per trial of $1,000,000,000 Looking only at the anticipated readouts in 2025 shown here, taken together, this represents over $15,000,000,000 in non risk adjusted PQR revenue potential. And that's why we have said a few times, by the end of this year, early twenty twenty six, everybody will have a good sense as to our chances to get to the €80,000,000,000 You'll see the momentum that we have in our company, plus you will see the outcomes of those trials.

Speaker 1

With that, please advance to the next slide, and we'll hand over to Arhat now, who will take you through our financials.

Speaker 3

Thank you, Pascal, and good morning, everyone. As usual, I will start with our reported P and L. Next slide, please. As Pascal highlighted, our company delivered very strong performance in 2024. Total revenue grew by 25% in the fourth quarter with full year revenues up 21%, exceeding our twice updated guidance range of high teens percentage increase.

Speaker 3

Product sales grew by 19% in the full year, driven by strong underlying demand for our medicines across regions. Alliance revenue increased by 55%, reflecting growing demand for HER2 and TESTpire in regions where our partners booked product sales. Collaboration revenue increased by 54%, driven primarily by a $600,000,000 Lynparza sales milestone recognized in the fourth quarter as well as smaller sales milestones for Bifortis and Kosilugo. Next slide, please. This is our core P and L.

Speaker 3

Our core product sales gross margin in 2024 was 81.2%, in line with our indication for a slight decrease compared to full year 2023. Core operating expense increased by 14% in 2024, well below the top line growth of 21%. Core R and D expense increased by 19% and consistent with our prior commentary, as a percentage of total revenue, core R and D expense was towards the upper end of the low 20s percentage range. This increase supported multiple new trial starts, including Phase II trial starts for our weight management portfolio and the acceleration of our cell therapy programs. It also reflects costs following the closure of several business development transactions in 2024.

Speaker 3

Core SG and A costs increased by 11%, reflecting continued investments behind launching brands. SG and A decreased to 28% of total revenue on a full year basis. Other operating income declined significantly as we booked more than $700,000,000 in 2023 relating to the update of the contractual agreement on Befortis as well as $250,000,000 relating to The U. S. Divestment of Pulmicort.

Speaker 3

Core EPS of $8.21 represents 19% growth, placing us at the top end of our full year guidance. Next slide, please. Our net cash flow from operating activities increased by $1,500,000,000 in 2024. CapEx of $2,200,000,000 was broadly in line with the indication of a 50% projected increase over 2023. This includes both tangible and software related intangible assets.

Speaker 3

We completed a number of business development transactions in 2024, including the acquisition of AMOLED, ICOSAVAX and Fusion and incurred total debt payments close to $7,000,000,000 We anticipate deal payments relating to past transactions of approximately $3,000,000,000 in 2025. Net debt increased by $2,100,000,000 to $24,600,000,000 which is a level we are comfortable with. Given the growth in our EBITDA, our current net debt to EBITDA ratio stands at 1.5 times. We increased the full year 2024 dividend to $3.1 per share and announced this morning that we intend to increase our full year 2025 dividend to $3.2 Today, we issued guidance for 2025 and expect total revenue to increase by a high single digit percentage and core EPS to increase by low double digit percentage. We anticipate our strong growth momentum to continue in 2025, more than offsetting the headwinds that we've previously indicated.

Speaker 3

These dynamics also adversely impact our product sales gross margin and we anticipate an incremental 60 to 70 basis points decline driven by the net effect of the IRA in The U. S, the anticipated inclusion in BBP of Forciga, Lynparza in China as well as the growth of our partnered products that have lower gross margins. Operating leverage remains a priority for our company. We continue to anticipate SG and A cost to grow at a slower pace than revenue. We are beginning to see benefits from the redeployment of our global footprint and continue to optimize our commercial investments across key disease areas to support new launches.

Speaker 3

R and D expenses are expected to remain in the low 20s percentage range of total revenue. Our full year guidance is as usual at constant exchange rates. Based on average January 2025 rates, we anticipate a low single digit adverse FX impact on total revenue and a mid single digit adverse impact on core EPS. The recent strengthening of the U. S.

Speaker 3

Dollar also affects our core operating margin percentage and we estimate an adverse impact of roughly 20 basis points in 2025 based on average January 2025 FX rates compared to average rates for full year 2024 and roughly 50 basis points if compared to average FX rates in first quarter twenty twenty four. Please turn to the next slide. In 2025, we expect expenditure on tangible and software related intangible assets to increase by approximately 50%, driven by manufacturing expansion projects and investments in systems and technology that will support our long term growth ambitions. Today, we have a diverse and resilient supply chain with 26 production facilities in 16 countries that affords us optionality and agility while addressing global demand for our medicines. The increased manufacturing investments we are making include investment into next generation capabilities for both small molecules and large molecules, as well as transformative technologies such as ADCs, cell therapies and oligonucleotides globally.

Speaker 3

Already in progress are a new end to end ADC manufacturing site in Singapore, a cell therapy manufacturing site in Rockville, Maryland and an API facility in Dublin, Ireland and a site in Qingdao, China for inhaled therapies. In November, we also announced several investments in The U. S, including a specialty manufacturing facility in Texas. All of these are multi year projects that illustrate how we are supporting our growing pipeline, including potential drivers of growth post 02/1930. Lastly, we are upgrading our data and ERP systems to set the data foundation to support our growth and enable us to more fully leverage innovation in AI and make our business more efficient.

Speaker 3

With that, please turn to the next slide and I will hand over to Dave who will take you through the oncology performance.

Speaker 4

Thank you very much, Aradna. Next slide please. So in 2024, oncology delivered total revenues of $22,400,000,000 which was an impressive increase of 24 with key medicines surpassing new multi blockbuster milestones with Tagrisso achieving over $6,500,000,000 LYNPARZA over $3,000,000,000 in product sales Imfinzi and Imjudo combined approaching $5,000,000,000 Calquinsine and HER2 achieving over $3,000,000,000 and almost $2,000,000,000 in full year revenues respectively. This strong growth really does signal clear progress on our mission to deliver medicines with potential to transform outcomes for patients globally. Turning now to fourth quarter performance for our key medicines, Tagrisso global revenues grew 21% reflecting strong growth across all indications, partly offset by the customary fourth quarter ordering dynamics that you heard about earlier in China.

Speaker 4

In the frontline setting, Tagrisso achieved over 75% market share globally with close to 85% market share in The U. S. We continue to make steady gains in the adjuvant setting with Adora and saw encouraging early launch uptake for LoRa in early stage unresectable lung cancer. Calquent's total revenues increased 20% in the fourth quarter, driven by sustained BTK inhibitor leadership in the frontline CLL setting and continued international expansion in the face of pretty fierce competition. In the fourth quarter, Imfinzi and Imjudo delivered 1828% growth respectively, reflecting continued demand across lung and liver cancer in The U.

Speaker 4

S. As well as accelerating adoption of Topaz in Himalayan Europe. As expected, we saw continued impact on established rest of world revenues following the two mandatory price reductions in Japan that took effect in 2024. Lynparza achieved global sales of over $3,000,000,000 in 2024, triggering receipt of a $600,000,000 milestone payment in the fourth quarter, which was recorded in collaboration revenue. As the established standard of care across HER2 positive and HER2 low metastatic breast cancer and HER2 delivered total revenue growth of 54% in the fourth quarter, partly offset by stock compensation following recent NRDL listings in China for Destiny Bresto three and Destiny Bresto four.

Speaker 4

Last week, we received FDA approval and NCCN guideline inclusion for Destiny Bresto six, which will further drive adoption in the ultra low setting. TRUCEAP delivered $163,000,000 in fourth quarter revenues, which partially benefited from stocking following the launch of the blister packs in The U. S. And I'm pleased to report TRUCEAP is now the market leader in the second line biomarker altered patient population. We received a number of landmark regulatory approvals since third quarter results, including U.

Speaker 4

S. And Japan approvals for DATRAWAY and HR positive HER2 negative breast cancer, U. S. Approval for CALQUENCE and Mantle cell lymphoma, Imfinzi and limited stage small cell lung cancer and European approval for Tagrisso in early stage unresectable lung cancer. And finally, we received priority review designations for DATRAWAY and late line eGFR positive lung cancer based on the TROPION LUNG05 study and INFINSI and muscle invasive bladder cancer signaling the potential value of our rapidly advancing oncology pipeline.

Speaker 4

Next slide please. So coming off this remarkable year of growth, we see continued momentum for our oncology medicines in 2025, particularly Tagrisso and HER2 and INFINSI despite the incremental impact from Part D redesign and the anticipated inclusion of Lynparza in VBP Batch 11 in China. Tagrisso is positioned to remain the market leader in frontline eGFR mutated non small cell lung cancer and we expect continued expansion of Adora and Laura in early stage disease in the year ahead. Longer term combination trials are designed to reinforce Tagrisso as the backbone TKI, addressing late line MET driven disease resistance with Saffron and Savanna and investigating novel ADC combinations with Tropion Lung fourteen and fifteen. For HER2, we anticipate new international launches for HER2 positive and HER2 low breast cancer as well as further expansion from Destiny Breast six to drive growth over the course of this year.

Speaker 4

Moreover, the HER2 positive breast cancer trials reading out this year represent the next meaningful leg of growth for HER2. On INFINSI following positive Phase three readouts in lung and bladder last year, we anticipate Adriatic, Aegean and Niagara launches to initiate the next wave of INFINSI growth bolstered by continued adoption of Himalaya and liver cancer. And beyond '25, we expect bladder and GI to unlock further expansion for Infinzean and Imjudo. We expect Calquence to remain the leading BTK inhibitor in frontline CLL supported by accelerating volume over the balance of the year. However, we do anticipate gross to net pressure both from Part D redesign and where we've taken contracting decisions to secure preferred formulary access in The United States.

Speaker 4

We expect meaningful demand growth upon the approval of Amplify, which will allow us to grow into the finite therapy segment, which represents nearly half of the CLL frontline market today. And finally for TRUCEAP, our most recently launched medicine, we see continued market leadership in the core second line biomarker altered population. We're set to deliver another year of strong growth, which is supported by continued global demand for our medicines as well as meaningful indication expansion opportunities. And with that, please advance to the next slide and I will hand it over to Susan to cover R and D.

Speaker 5

Thank you, Dave. So 2025 is shaping up to be a very exciting year across our oncology pipeline. We look to maximize the reach of our innovative medicines across lung, breast, GI and bladder cancers and present additional data for some of our transformative technologies, including our IO bispecifics, ADCs and T cell engagers. In the second half of twenty twenty five, we plan to announce the high level results from the Phase III AVANZAAR study of DATEOWAY in combination with Imphyse and platinum chemotherapy in patients with first line non small cell lung cancer. EVANSAR will be the first of five Phase III trials in frontline non small cell lung cancer to read out and has potential to not only confirm combination efficacy with IO, but also serve as the first prospective validation of the TROP2 QCS NMR biomarker.

Speaker 5

Importantly, we recently amended the primary endpoint to focus on the non squamous population and to look at the benefit in both TROP-two positive non squamous and the broader non squamous population, which we believe increases the probability of the trial's success. Additionally, we expect results from the TROPIUM BERSTO2 trial of DATEOWAY in triple negative breast cancer in the first half of this year. In 2025, INHER2 will move into earlier lines of treatment for HER2 positive breast cancer. Destiny Breast nine aims to bring in HER2 to the first line metastatic setting with both monotherapy and pertuzumab combination options. Destiny Breast five and HER2 11 are the first two readouts for HER2 in the early breast cancer setting where the opportunity for cure is even higher.

Speaker 5

Our Imphyse bladder and gastric programs continue to advance with readouts for Volga which builds on Niagara, the combination of emfortinab vedotin and Imphyse plusminus Imjudo in patients with muscle invasive bladder cancer, with Potomac in non muscle invasive bladder cancer and with Matterhorn in gastric cancer. Together, these trials represent meaningful new opportunities for DATRAWAY, INHER2 and Imphyse as we look to expand the reach of these transformative medicines. This year, we'll also report Phase III results from a very promising NME in our pipeline, camisestrant, which has potential to be the best in class next generation oral SERD. As a complete estrogen receptor antagonist, camisestrant not only binds to the receptor inhibiting transcriptional activity, but it also induces degradation of the receptor itself. In contrast, aromatase inhibitors only reduce production of the ligand estrogen, reducing ligand driven transcriptional activity but leaving the estrogen receptor in place.

Speaker 5

This dual action of camisestrin gives us confidence that it can provide greater benefit to patients than aromatase inhibitors regardless of ESR1 mutation status. Our confidence is supported by the data from the Phase II SURRENA2 trial, where we saw a similar median progression free survival of six to eight months with camisestrant regardless of ESR1 status and a benefit over fulvestrant in head to head data with a hazard ratio of zero point five eight in the ITT population and zero point three three in the ESR1 mutant population. These data, taken together with the low discontinuation rates, low rates of GI toxicities which can be bothersome to patients and the ability to combine Camizestrant with all three major CDK4six inhibitors, These together drive our confidence across the SIRENA and CAMBIA studies. SIRENA six is the first Phase III trial to read out and investigates switching the endocrine partner of any CDK4six inhibitor from an aromatase inhibitor to camisestrant on emergence of an ESR1 mutation during first line treatment. The goal of Sirena six is to extend the duration of benefit in first line.

Speaker 5

ESR1 mutations are treatments acquired with low prevalence at the time of metastatic diagnosis, around five percent, increasing to around forty percent at the time of disease progression at the end of first line treatment. SIRENA6 addresses the pool of patients currently on first line aromatase inhibitor plus CDK4six inhibitor treatment who have these emerging ESR1 mutations without disease progression on clinical scan. And we estimate this to be around thirty percent of all endocrine sensitive first line patients. While Sirena six focuses on these first line patients that have emergence of ESR1 mutations, Sirena four targets the broader first line population. Those patients with newly diagnosed hormone receptor positive endocrine sensitive metastatic breast cancer and investigates upfront combination of camisestrant and palbaciclib.

Speaker 5

Similarly, we have two ongoing adjuvant trials, Cambria one, which looks as a switch strategy to extend treatment after two to five years of endocrine therapy with or without a CDK4six inhibitor and Cambria2, which investigates the upfront combination of camisestrant with or without abemaciclin. We look forward to updating you on our camisestrant clinical program, which is designed to support our ambition to establish this new endocrine therapy as a backbone in hormone receptor positive HER2 negative breast cancer. Finally, we continue to progress our transformative technologies into Phase III. We now have nine ongoing Phase III's for our IO bispecifics and plan to share early data for combinations of rilbicostomig with DATRAWAY and INHER2 later this year. Last year, we progressed AZD0901, our claudine eighteen point two ADC, into Phase three.

Speaker 5

And this year, we plan to advance our B7H4 targeted ADC with our proprietary linker TOPO1 payload, Puxitatou Gsambratican, otherwise known as PSAM, if you find Puxitatouke difficult to pronounce, right, into a Phase III trial in endometrial cancer. In addition, we recently initiated the SOUNDTRACK F1 trial, our first Phase III trial for the CD19 CD3 T cell engager AZD0486 in follicular lymphoma. These transformative technologies help support delivery of sustained growth beyond 02/1930. And with that, please advance to the next slide, and I'll pass over to Ruud to cover Biopharmaceuticals performance.

Speaker 6

Thank you so much, Susan. Our Biopharmaceuticals medicines saw another very strong year of performance in 2024, with total revenue growing 21% to $21,900,000,000 In the fourth quarter, biopharmaceuticals growth was 24%. R and I grew by 28%, an impressive performance despite softer demand in China due to the mild starts to the winter season for respiratory viruses. CVRM grew 17% with strong VASIKA growth of 22%, which was partly offset by year end hospital budget dynamics in China. Alongside Fasenra and Symbicort, Despyr became the third blockbuster medicine in our respiratory portfolio with over $1,000,000,000 in combined global in market sales.

Speaker 6

Soon, we can expect to see a fourth blockbuster on that list as BreastTree delivered over $250,000,000 in revenue in the fourth quarter. Given strong global demand and increased production capacity for BayFortis, we recorded a sales related milestone payment of $111,000,000 in the fourth quarter. The launch of WAYNEUWA and ATTR polyneuropathy is progressing very well, and we are excited about the longer term opportunity in the broader ATTR cardiomyopathy indication. And following the commercial launch of AirSupra early last year, we have seen impressive volume growth and we continue to work on broadening the access for patients. Next slide please.

Speaker 6

We look forward to another year of strong performance in 2025, despite the anticipated Berlinta loss of exclusivity and the potential VBP inclusion for Farxiga and roxadustat. Outside of China, we expect to see further growth for Farxiga due to the continued market leadership in the fast growing SGLT2 class and see potential for increased adoption with millions of patients still not receiving guideline directed therapy. Lokelma surpassed $500,000,000 in total revenue last year, and there's a growing body of evidence showing that Lokelma can help CKD and heart failure patients with hyperkalemia, while maintaining guideline directed therapy. We expect continued growth with further adoption and longer duration of treatment due to demonstrated real world clinical benefits. Breastory has grown rapidly in the last two years and has gained over two thirds of the market in China, where COPD is a leading cause of death.

Speaker 6

We anticipate continued growth in China following the recent addition of COPD to the country's national public health program. Our biological respiratory medicines have a strong competitive position in the growing market. Biological penetration in asthma remains relatively low with potential for sustained long term growth. And the COPD Biological market is still immature. In 2025, we anticipate continued growth from our biologic portfolio in asthma and we're looking forward to the upcoming Resolute Phase III readout for Fasenra in COPD.

Speaker 6

Finally, SAVNELO has steadily gained share among systemic lupus erythematosus patients treated with intravenous infusions and remains the leading IV biologic in several markets. Subcutaneous biologics represent more than half of the market for SLE today. The ongoing TULIP SC trial is studying a subcutaneous formulation of Safranelol and has the potential to open a new market opportunity. Our biopharmaceuticals portfolio is posed for continued growth in 2025 and I will now hand over to Sharon to discuss the latest developments from the biopharmaceuticals pipeline. Next slide please.

Speaker 7

Thanks, Ruud. So 2024 was an exciting year in biopharma. And in 2025, the momentum continues as we rapidly advance both indication expansion and NME pipeline opportunities. In Respiratory and Immunology, we are building an industry leading portfolio in asthma and COPD with the opportunity to expand our presence in these diseases where high unmet medical need remains with key indication expansion opportunities this year as well as NMEs in late stage development. Starting with Bresdree, our triple combination inhaler already approved in COPD, we have the opportunity to improve care for people suffering from uncontrolled asthma with a new treatment option.

Speaker 7

In the Phase III CALOS and LOGOS trials, RESTRI has the potential to demonstrate asthma control by improved lung function versus current dual combination ICSLABA treatment, and we look forward to these data readouts in the first half of this year. Fasenra, our IL-five monoclonal antibody represents another meaningful opportunity to expand our reach beyond severe eosinophilic asthma and EGPA into COPD with the Phase III RESOLUTE trial. Characterized by airway blockage and long term respiratory symptoms, COPD remains the third leading cause of death globally. Many patients are not well managed and remain at risk of exacerbations that increase the risk of hospitalization and mortality. With our strong foundation in biologics, we are seeking to address a broad spectrum of this highly complex and heterogeneous disease through differentiated mechanisms of action to address the underlying inflammatory pathways that may trigger COPD.

Speaker 7

As a key contributor to inflammation, eosinophils are potent effector cells that are believed to play a role in COPD. The Phase III RESOLUTE trial for Fasenra addresses a population with eosinophilic COPD with baseline blood eosinophils of 300 or above, which represents about thirty percent of the market. To further broaden our reach in COPD, we look forward to initiating a Phase III TESFIRE trial later this year in patients with eosinophils greater than 150. And lastly, with our IL-thirty three monoclonal antibody tozeracumab, we look forward to the results from our Phase III Luna program next year, which is targeting a COPD population irrespective of eosinophil levels and smoking status. Toceracumab received FDA Fast Track designation at the end of twenty twenty four, emphasizing the high unmet medical need for this disease.

Speaker 7

With a robust pipeline of differentiated mechanisms, we have an opportunity to transform outcomes in COPD. Now turning your focus to the right hand side of the slide. In CVRM, we eagerly await the first Phase three data from Baxtrastat, our novel aldosterone synthase inhibitor. Both as a monotherapy and in combination with dapagliflozin, Baxtrastat represents a multi blockbuster opportunity across areas where patients urgently need new options. In the second half of this year, we will see data from the Phase III Bax HTN trial assessing Baxtrastat as a monotherapy in uncontrolled or resistant hypertension.

Speaker 7

We have already seen encouraging blood pressure reduction in Phase II. The PK profile supports twenty four hour systolic blood pressure control, which we are looking to confirm in the Bax24 trial also reading out in the second half of twenty twenty five. The Phase III combination trial of baxtrastat with dapagliflozin, VEX DUO Arctic for those living with kidney disease and high blood pressure was also initiated this past year. This reinforces our unique ability for multi mechanism combinations to address interrelated diseases across our CVRM portfolio. Lastly, as we continue to build the next wave of transformative medicines in CVRM, I am excited to share that we have recently completed the Phase 2b pursuit trial for AZD-seven eighty, our oral PCSK9 inhibitor, and we look forward to sharing the data at the American College of Cardiology Annual Meeting next month.

Speaker 7

With that, please move to the next slide and I will hand over to Mark to cover our rare disease portfolio.

Speaker 8

Thank you, Sharon. And next slide, please. The rare disease delivered total revenue of $8,800,000,000 in 2024, up 16% year over year, driven by an increased patient demand and launches in new markets. Total revenue growth included a 2% benefit from a sales milestone for Coselugo received in the fourth quarter. In the quarter, PILTOMIRIS grew 33%, driven by neurology indications with the vast majority of growth coming from generalized Myasthena Gravis patients who are naive to branded treatments.

Speaker 8

Outside of emerging markets, SOLIDRIS revenues continued to decline due to the successful conversion to Ultomiris, some competition and in Europe biosimilar pressure. As a reminder, we expect biosimilars to enter The U. S. Market in March of this year. Beyond the complement, Strensiq and COSILOGO grew 3797% respectively, driven by continued patient demand, new launches and a favorable tender order timing in emerging markets.

Speaker 8

2024 was another year of double digit growth for rare disease medicine and we see momentum continuing in 2025. Can I advance to the next slide? Liltomiris continue to grow, driven primarily by neurology indications, including patients who are new to branded medicine and SOLIRIS switch patients, as well as further market expansion. We indicated peak yourselves for Ultomiris to be above $5,000,000,000 with contribution from both existing and new indication opportunities including ACTTMA, CSA AKI and IGAN. For Strinsic, we anticipate further adoption supported by new hypophosphatasia guidelines, which have led to an increased disease awareness, diagnosis rates and accelerated new patient starts.

Speaker 8

As we continue to launch Strensiq in new market globally, we are focused on disease education, which prepare markets ahead of the next generation Espin Sofaz ALFA launch. Patient demand and geographic expansion continue to drive COSILOGO growth in pediatric patients with NF1PN And following the positive Phase III trial results in adult with NF1PN, we expect COMET to drive growth beyond 2025. We are well placed to deliver another year of strong growth, supported by global demand for rare disease medicine as well as meaningful indication expansion opportunities. Please advance to the next slide. We anticipate 2025 to be a catalyst rich year, unlocking the next wave of innovative rare disease medicine.

Speaker 8

We expect five Phase III readouts across multiple indications, four of which for new molecular entities. Following Phase II data, we believe enaboparatide, a PTH receptor agonist, has the potential to normalize serum calcium levels, decrease urinary calcium and preserve bone mineral density, all clinical priorities of hypoparathyroidism. Novel depleter on selamimab has been developed to remove toxic light chain amyloid fibrils that accumulate in the heart and kidneys. In light chain amyloidosis, these fibrils cause systemic and progressive organ damage, hospitalization and high mortality when accumulated. Espinformatase alpha or next generation enzyme replacement therapy is being studied in a broad hypophosphatasia population.

Speaker 8

With an improved profile, which allows for lower dosing and lower frequency, it has the potential to address six times the patient population versus Stransick. Third generation C5 inhibitor, gefirilumab, a VHH that allows for weekly subcutaneous administration has a potential to expand our reach in Myasthena Gravis to treat an earlier and broader population. And lastly, in for Ultomiris, initiative TMA, the product has a potential to address life threatening complication of stem cell transplant and represent the first indication expansion opportunity for Ultomiris beyond the SOLARIS label. These trials combined represent a significant peak year revenue potential, marking a meaningful contribution to the rare disease portfolio. And with this, I will hand over to Pascan.

Speaker 1

Thank you, Marc, and I will try to conclude quickly so we can move to the Q and A session. Next slide, please. So as you can see here, we are making very important step toward the achievement of our strategic ambitions, in particular the $80,000,000,000 sales in 02/1930, and we are progressing high value readouts that will unlock further growth. So if we move to the next slide, this is an important slide because it really shows that the investments we are making and of course, those investments create R and D budget expansion, but those are investments that are not only supporting the growth of our existing and late stage portfolio, but we're also building capabilities and capacity with potentially transformative technologies shown here. Our goal is to be a growth company until 02/1930, but also beyond 02/1930 and anticipate today what will shape the future of medicine and how we will actually continue to grow despite patent expiries that may happen post 02/1930.

Speaker 1

And with this, I'm really pleased to report that we're making very good progress in all of these areas with multiple pivotal trials planned or initiated for our ADCs, our bispecifics and most recently our CAR T and RT cell engager programs. These transformative technologies have the potential to drive sustained growth beyond 20 Next slide, please. We continue to make progress against all the ambitions outlined at our Investor Day in May 2024. We set our sights on $80,000,000,000 in total revenue by 02/1930. As we communicated at the Investor Day.

Speaker 1

By the end of this year, early twenty twenty six latest, we'll have a very good idea as to whether this ambition can be achieved. We're also working hard to drive operating leverage throughout our company, and we continue to make good progress towards achieving our ambition for mid-30s operating margin in 2026. And finally, and most importantly, we have actually delivered eight new medicines toward our goal of '20 by 02/1930, and that demonstrates our ability as a team to deliver life changing medicines for patients globally. Please move to the next slide. As Andy mentioned at the start of the call, please limit the number of questions you ask to allow others a fair chance to participate.

Speaker 1

I must say this is what I say each time, but I'm never very successful with that one. But for those online, please use the raise hand function on Zoom. And with that, let's move to the first question. Thank you. Let's start with this table and we go around the table and move to the next table.

Speaker 1

Yes, James, maybe you can start.

Speaker 9

Thanks for taking the question. James Gordon from JPMorgan. I'll stick to one theme, which will be China. So a couple of questions on China. So one would be, so revenue is down 3% in Q4, but how did it evolve during the quarter?

Speaker 9

So what did it look like before there was the investigation on November 5 versus afterwards? And more recently, like the start of this year, are things getting better or worse in China? Also on China, so for 2025, so you've given us a group guide, but what does that assume for China? And I can see we've got Lynparza and probably Fazig of VBP. So should we assume that China is going to decline overall, not just because of the investigation, but also VBP, but EM overall still grows?

Speaker 9

How to think about that? And then just finally on China. So I think there have been investigations going for some time, but I'm not seeing any provision for a fine or other penalty in your disclosures. So how should we read that? Does that mean you don't think there is likelihood that you're going to have to pay something material?

Speaker 9

Or is it just you wouldn't provision for it at this time? When would you have to ever provision for something?

Speaker 1

Thank you, James. So let me start with the last question. And then for the business development and business growth, I'll ask Ishrad to comment and maybe I'll have to reflect the guidance question. So we actually disclose things as we learn about this investigation. And the important piece is that we disclose anything that we believe will have a potential liability dimension.

Speaker 1

We disclosed this in our release and you could, I would like to refer you to this and look at it. So if you look at these things in turn, first of all, the illegal importation, we've communicated $900,000 of avoided import duties to the best of our ability, to the best of our knowledge, as we said, it relates to Infinze and Imjudo. The fine that could be associated with that if AstraZeneca is found liable for it, it would be one to five times the amount of avoided import duties, so five times maximum five times the 900,000. Now it is possible that an HER2, for instance, will be affected as well because those products the products that are affected are essentially products that were approved in Hong Kong, not yet approved on the Mainland, and there is a limited period of time during which patients actually can totally legally go to Hong Kong and get their medicines. But of course, some people found the opportunity here to take this product from Hong Kong and deliver them to the patients on the Mainland and that is illegal.

Speaker 1

Patients can go get their medicines. Other people are not allowed to do the transportation, if you want, of those medicines to patients. So we know and HER2, of course, had a period of time when it was approved in Hong Kong, not on the Mainland. So that could be another one. But again, the turnover associated with 132 was a bit bigger than Infiniti, but it's not going to be massively bigger.

Speaker 1

So that's the illegal importation case. And that's basically what we know in terms of the so called fraud case. Again, just like to remind you, we disclosed in the litigation section anything that could have a liability dimension for the company. Now some of you would like to, I'm sure, understand better the sort of individual responsibility, corporate responsibility, legal aspects as it relates to a forecast like this. My best advice is to suggest that you contact one of the Magic Circle firms here in London to get advice, independent advice from them.

Speaker 1

Make sure you ask a firm

Speaker 2

that has

Speaker 1

an affiliate in China or partner in China that has a license to comment on Chinese laws because global firms are not allowed to comment on Chinese laws. So if you want a precise, reliable answer, you have to get it from someone who has a license in China. So ask them and you'll get, I believe, a very clear answer to that question. And that's really the most we can actually talk about this case. If I go back to your first question, James, the sales in Q at the end of last year in Q4, I mean, when people, when hospitals manage their inventory, manage their budgets, they start doing this in November, December.

Speaker 1

So that's what we saw and that's what typically you see. But the biggest thing is that to keep in mind is that the impact was very much our respiratory products. And into January, we see, I think, a pretty good trend, but of course, the respiratory products are still affected. Yvesco, over to you and then maybe Aradna.

Speaker 2

Thanks, Pascal. Thanks for the question. So I think as Pascal mentioned, I mean, there is not much to read in the dynamic of quarter four because it's really you will see the same trend in the respiratory products given the mild winter. And it's interesting to look at because of the mild winter, clearly, you have a lower level of the flu infections that drives lower rate of the hospitalization. And particularly in China, those products, Pulmicort in particular, are really used for the hospitalization and exacerbation.

Speaker 2

And if you look at the overall inhaled market, you will also see the significant slowdown in growth. Quarter four, growth of the inhaled market was 9% versus 23% in quarter three. So I would argue that's a very clear dynamic that you can see throughout the quarter. As you know, the winter is back and the flu infections in China are quite up. So you would argue that you may expect the respiratory portfolio performing as expected as normal in the quarter one.

Speaker 2

I think the second mentioned dynamic was the hospital capping. And I think it's you see the similar trend. I would argue the same trend as you saw it last year for the top 10 brands in the listed in the hospitals in China. The only difference is that this year that effect was a bit bigger because more hospitals were introducing the hospital capping, trying to manage their budgets and the pressure at the end of the year. But overall, it's looking in 2025, obviously, early days, but you do expect the portfolio to continue to grow.

Speaker 2

We have a few good news in the start of the year with Enhear two being included in NRDL with eight other renewals in NRDL and regulatory approvals of the two new indications for Tagrisso and Lynparza. So despite the headwinds that we expect from BBT inclusion in ForCIGA, Lynparza and roxadustat, we do expect the rest of the portfolio to continue to grow.

Speaker 1

The biggest headwind really is VBP for 2025. Ishmael, maybe you wanted to say a little bit about the team where they are at. I think it's important to get a sense for potential momentum into 2025, but also our interactions with the medical community in China.

Speaker 2

Yes. I just spent four, five weeks in Shanghai, and I was really impressed on one side with, as I mentioned in my remarks, on the commitment and of the team. Equally, I was impressed that it was unsettling moment in November and December, but I was really impressed how with the stability that we introduced in December and the clear focus on what the team needs to do that both in the office and underground are very much focused and keen to continue doing what we do best and that is delivering our innovative medicines to the patients in China. And I think the message of the company commitment and our belief that our strategy in China is the right one, that we believe in our ability to deliver for patients, but equally to use a growing innovation in China for China and for global is very much lended very well internally as well as externally. I think from my external interactions with many different stakeholders there, I think it's also clear that our partners and stakeholders in China are willing and happy that we will continue to invest and partner with them in order to bring innovations together.

Speaker 3

Sure. So on the guidance, obviously, the China is included in our guidance. We do assume growth from our underlying brands as well as the NRDL inclusions that Iskor talked about. But at the same time, there is headwind from VBP, again, three large products obviously being included in VBP this year, as well as some disruption from some of the ongoing investigation and team stability and so forth.

Speaker 1

Thanks, Alana.

Speaker 10

Thank you. Luisa Hector from Berenberg. I have just one more on China and then some on the outlook. So for China, can you then confirm if there have been no notable changes in your market shares for Key Drugs in China? And then for the outlook, perhaps just to quantify, if you can, the Part D impact for 2025 redesign.

Speaker 10

I think I only heard mention of Calquence from Dave, but perhaps other products to be aware of. And, Aradna, you mentioned billion of deal related payments. I'm just curious whether you can provide any color on the components. And should we assume that the majority of those come essentially with success, so pipeline success, sales success?

Speaker 1

Thank you, Roussaint. I can see that I'm totally failing once more. Three questions at a time. So should we start, Ishra, with you and then Dave you cover?

Speaker 2

So quick response on the market share. As I mentioned, in Hill market is I mean, the whole market obviously slowed down. So clearly, you will not see many any major difference in market share. With Forciga, you will see some difference and there is some decline in the end of the year. And the reason is that the hospital capping that I mentioned really applies only for the 10 top performing brands.

Speaker 2

Clearly, as you know, Forsea GA is competing with many different SGLT2 generics in the China market. So in the December due to the capping, you will see some decline. We saw the same trend, as I mentioned, last year, and we would expect that to bounce back.

Speaker 1

But net net for important products like Tagrisso, etcetera, so far we have seen no impact. Of course, we looked at that because market share is the best way to actually assess whether you are impacted. I mean, the market moves up and down. We see no impact at all, yes. Early days and so far, we only have hospital data.

Speaker 1

We need retail data. It takes more time to get there, but it's very encouraging to see our market share actually not moving differently from what we would expect. Have you covered Part D?

Speaker 4

Yes, please. So I think the first point, Louisa, on Part D is that the IRA we've continually said we think is manageable. It's part of guidance. It's in our outlook. So it's built in.

Speaker 4

So why do we think it's manageable? Well, first and foremost, it predominantly affects our oral oncology portfolio. There is some biopharmaceuticals and rare disease impact. But in terms of where we see the greatest impact, it's on oral oncolytics. There is a downside pressure of the increased manufacturer liability that now is happening in terms of picking up what was previously catastrophic.

Speaker 4

But there is a partial offset and we saw that happening in 02/2004 from improved adherence and compliance on medicines and also lower free drug utilization and that volume is directly a result of improved patient affordability. And so that's the first dynamic for manageable. I think the five, right. So Tagrisso, we have continued opportunities Adora, Laura, Flora II, Infinzi, Himalaya, Adriatic, Caspian, Niagara and HER2, DB06, DB04, DB03 and TrueCap, those are all in hand. And so it allows us to be able to work through the headwind that we're getting in from IRA and that's why it's included within our outlook.

Speaker 3

So just to build on Dave's point, the guidance, especially the gross margin guidance that I provided in terms of 60 to 70 basis points, that does include the net effect of the IRA. Again, we haven't given an absolute quantification, but that as well as the BPP, as well as some of the impact on biosimilars, that's included in the gross margin indication. As it relates to the $3,000,000,000 for past deal related payments, yes, most of them are success based, but success could not necessarily be Phase III. We get out some of them have already happened with Daichi, for example, but it could also be progression events. So when a product moves into Phase two or into Phase three, so which is also success based because obviously we won't move them into the next phase if we weren't confident.

Speaker 3

So yes, all of those related to some of it is Daichi, but also Cincor, again, if Baxter stat reads are positive, again, the CD19, CD3. So it's a multitude of smaller payments that are all progression or success based.

Speaker 1

Just since we talked about Pardee, keep in mind that basically the headwinds we have in 2025 are, of course, IRA. Two is VBP China, we mentioned it. Another couple of smaller ones, Berlin Tapadont expiry and the usual, maybe more intense this year, cottage industry of price cuts and rebates and whatever in Europe. But the momentum in the portfolio and in the new indications we hope to launch certainly will continue to support our growth and move through these challenges in 'twenty five.

Speaker 5

Joe Walton from UBS. A couple of clarifications, I think. Eradna, I didn't catch what you said about the gross margin impact for 2025. Could you just tell us again what you're expecting to happen there? You spoke very quickly.

Speaker 5

And is that something that we should continue to see through into 'twenty six as well? Or is it just a onetime impact? And just to go back to Part D again, if we can, you say you are you already seeing increased adherence? In 2024, the payment levels were lower, but they aren't as low as they're going to be in 2025. So are you anticipating a further improvement in adherence?

Speaker 5

And is there any chance of things being even better in the first quarter because of the all you can eat buffet that you get if you pay your 2,000 across the year rather than have to pay a big lump sum in January. So just whether we should be seeing anything in the short term?

Speaker 3

[SPEAKER UNIDENTIFIED COMPANY REPRESENTATIVE:] So I'll address the gross margin point. So the indication is more around the so I said 60 to 70 basis points impact on gross margins. And a lot of that comes from the Part Ds, the net effect of the Part D payments. If you want to think about it, again, it's not a gross to net discount, but it does affect what you pay off of your you know, revenue base. So that's included in there.

Speaker 3

When I say VBP, again, VBP, when you get your price for VBP and their stock compensation and so forth, it affects your price, right? It doesn't affect necessarily your volume. There's some impact on volume, but you hope that once there's a reset on volume, obviously, generics will take some share and then you'll start going from there, which is what we've seen in other VBP situations. So again, that impacts your gross margin because your price is basically reset. I talked a little bit about, Pascal said, a whole bunch of other price actions, which you see in Europe and other countries.

Speaker 3

Solaris biosimilar is another example, right, where we have been transitioning more and more of the market to Ultomiris. Again, Ultomiris is at a 30% lower price than Solaris'. So as more market shifts to LOTEMIRIS, again, it's slightly different slightly lower gross margin than SOLIRIS. So it's all of those factors that and again, I don't think they are one time factors, but that's sort of what we expect to point to. Dave?

Speaker 4

Thanks, Surabha. Joe, so yes, in 2024, in the oral oncology portfolio, we saw both a reduction in free goods as well as an improvement in adherence or we sometimes we talk about that as abandonment rates. And that came as a result of the co pay cap being set at $3,300 last year. Now obviously we didn't have the liability that we needed to pay for within that. So 2024 was a year where the co pay was capped, but there wasn't the 20% liability.

Speaker 4

The payment structure was still as it existed before. And so that's one of the things that changes within 2025. But I think that very importantly, we've had this as an opportunity to help our reimbursement teams and our account managers engage with U. S. Customers to understand how they can work together to create education around the new opportunities to be able to think about where charitable programs need to be used, where they might not need to be used and to be able to have an understanding how the benefit design has changed.

Speaker 4

And I think that as there's education around that, that that's one of the things that's resulting in patients being able to be on medicines that are not through charitable foundations. And then the charitable foundations are able to have more money available to them because of the co pay caps to be able to serve more patients. So it has really been, I think, in many respects, a real improvement in terms of affordability resulting in higher volume on the medicines. And I do expect that we'll see that continue into this year, probably not to the same degree of the bump that we saw when we went from uncapped to 33 and now 33 to 2,000.

Speaker 1

Can we move to another table? We mentioned

Speaker 3

the secondary effects if they're we're seeing in the commercial.

Speaker 4

No, we're not seeing secondary effects into the commercial.

Speaker 1

Sachin, we moved to this table and we'll get in Israel. Yes. We will

Speaker 11

then move there. Sachin, Jane, Bank of America. Given it's a pipeline here, I'd still do two pipeline questions on the two assets you called out on the slide. So the first one, I guess, is for Ruud on Bax. Of the greater than billion peak, how much is in the resistant hypertension opportunity we're getting this year?

Speaker 11

And I wonder if you could just give us some feedback. If you deliver the data as per Phase II, what's your physician feedback on adoption of this therapy in a heavily genericized market? The third, fourth line agent is the commonest pushback I get. And then the second question is on the CERD. I think investors are generally very confident in Serena six because of the mutant population, but there's been lower confidence in frontline, lower mutation incidents.

Speaker 11

So wondered if you could just touch on the hypotheses that make you confident you touched on in biology, but some of the other stuff we hear from physicians potentially delaying ESO mutations, endocrine sensitivity or combination therapies. Just wondered if you could touch on other hypotheses that make you confident.

Speaker 1

Thanks, Sachin. It's nice to move to growth opportunities away from headwinds. So, Rod and Susan, maybe? Yes, let me take the first one. So the Bextrostat is the combination

Speaker 6

of the mono component as well as the combination of Bextrastat and Fasig or dapagliflozin. So that's one. As you can imagine, this will be a crucial year for Bextrastat and we are doing an enormous amount of market research. And it is clear that the higher met medical need is very clearly resonating with cardiologists and physicians in internal medicine. I think the big challenge is going to be the GPs because a lot of those patients are undiagnosed or are not well treated in the first line.

Speaker 6

And so we're working very hard in order to find a way in order to educate the first line moving forward as well. But there is no doubt that this new class of medicine, this new way of treating resistant and uncontrolled hypertension is resonating very well with the Specialty Care group of physicians. Before we move to Serge, let me just add that if you look at

Speaker 1

kidney disease, which is a total epidemic in the world, eight hundred million people have kidney disease today and it's growing. Forty percent of those patients have kidney disease from hypertension, forty percent from diabetes and the rest is a few other reasons, but forty percent of these patients. Now if they develop kidney diseases because they have hypertension that is not properly treated and their blood pressure is not controlled, And so we believe that an agent that helps bring those patients to blood pressure control and also potentially affects aldosterone because we believe that the effects of aldosterone, negative deleterious effect of aldosterone on the kidney, the heart are totally underestimated. So if you affect aldosterone in your control blood, you really have a very positive effect on kidney disease in particular. So the third question Susan, do you want to cover the SIR?

Speaker 5

Thanks for the question. So again, the data that has been seen for the current SIRs have been in later line trials to date where the proportion of patients that are truly endocrine sensitive is lower. And I think that's why you've seen the benefit concentrated in the ESR1 mutants. Just as a reminder, and as I said, we saw activity in the overall population with a hazard ratio of 0.58 versus fulvestrant, which is the currently available SIRD. But we know that fulvestrant doesn't maximally degrade the estrogen receptor.

Speaker 5

As a reminder, when you go into the first line in Sarena four, the comparator is with an aromatase inhibitor that doesn't degrade the receptor at all. And that's why we think you're going to have activity in the ESR, wild type. And again, that builds on that hazard ratio of 0.58 overall. It wasn't just in the ESR1 mutants that we saw activity. And then we've enriched the patient population in SIRENA4 for patients that are likely to be more endocrine sensitive.

Speaker 5

So in addition to them being first line, which obviously enriches for endocrine sensitivity, they had to have adjuvant endocrine therapy of more than two years without progression. So again, those patients that progress rapidly are the less endocrine sensitive. You had to have a treatment free interval of more than twelve months since completion of adjuvant therapy without progression unless they've had tamoxifen. And I think those features that we've enriched for were carefully chosen in order to maximize the probability of technical success for Sirena four as well as for Sirena six.

Speaker 11

Sorry. The BAX, peak cell split mono versus combo, just to get an idea of how you think about the mono opportunity this year?

Speaker 6

So sorry, Sochi, mono versus

Speaker 11

The grades of billion. Do you have a split of that mono versus combo? The study this year is obviously the mono.

Speaker 6

Yes, we haven't disclosed that, Sochi. And this is a relatively highly competitive field, these two competitors. So we have said that there's substantial on both sides, but we haven't given the split.

Speaker 12

Mattias Siglum, Handelsbanken. So two questions for Sharon, please. So first on the ongoing Phase II investigating use of the oral GLP-one. So I'm curious to hear how confident your the twenty six week duration of therapy for the primary endpoint is enough to meet the recently revised FDA guidelines? And if you could talk about enrollment pace in those studies?

Speaker 12

And then secondly, for the oral P6K9 with Phase IIb data and our confirmed RACE to see in March, Help me frame expectations of LDL reductions once the abstract from HCC is out and perhaps talk about timelines to a Phase III start and perhaps remind me how you win over Merck's oral peptide and has Phase III trials leading out later this year. Thanks so much.

Speaker 7

Sure. I love those questions. So thank you. Your first one was about AZD-five thousand and four. That's our oral GLP-one.

Speaker 7

We've been very public about the progress of that. We released the data at Obesity Week in November of last year. This is a true small molecule. We are envisioning this as a molecule that we are developing both as a monotherapy and in combination with other small molecules already in our portfolio. I mention that because we are moving beyond short term weight loss targets and really thinking about the interconnectedness of cardiovascular, renal and metabolic disease.

Speaker 7

So the first step is our two Phase 2b studies, one for patients with obesity or who are overweight and one for patients with Type two diabetes. Those are the VISTA and APACUS studies, both are enrolling well and we are on track for the timelines that we previously mentioned. So I'll move on then and speak about our oral PCSK9, which was your second question. This is AZD-seven eighty. So we have completed the Phase I data and we released those last year.

Speaker 7

And in those data, we showed that we were able to reduce LDL at 50% on top of statins, seventy eight percent from baseline. We have just completed the Phase IIb study, PERSUIT. We will be releasing those data next month, so hold your breath. But I would expect to share a story that is broadly in line with our Phase one data. How do we differentiate this molecule from other PCSK9s?

Speaker 7

Well, unlike some of them, it's orally bioavailable. Unlike the other orally bioavailable molecule, it is a true small molecule. It doesn't require a permeability enhancer and it doesn't require fasting. There is no food effect associated with this. So it is well suited to use as a monotherapy, but also potentially in combination with other molecules in our portfolio because it is a small molecule, such as the one that I just mentioned, ACD-five thousand and four, again addressing the interconnectedness of cardiovascular, renal and metabolic disease.

Speaker 7

So it has a favorable PK profile. It sets us up well for success. And it lines up in a portfolio of small molecules that really allows us to address interrelated disease.

Speaker 1

Thanks, Sean. Maybe much as, I mean, differentiation is one thing, but the, I think, the most important part is to create this market for PCSK9. And two companies doing this is far better than only one. If you think of PCSK9, they're fantastic drugs. Problem is they're injectable and expensive.

Speaker 1

So in The U. S, you can sort of get them, but in Europe, in most countries, you have to have an event to be able to get a PCSK9 reimbursed and the steps are complicated. You have to have a recommendation from a cardiologist. Often, you have to get approval from the payer before you can get it. If you move to a knowledge and that is easy to take and then priced at the appropriate level, you can definitely expand the access to these very important medicines.

Speaker 1

And then you can go into the emerging markets where also the needs are enormous. So I think really expanding this PCSK9 market is going to be a very fundamental priority for our commercial organization.

Speaker 13

Yes. Richard Parks from BNP Paribas Exane. I've got one for Susan and one for Ruud. Firstly, for Susan, you're obviously making a push into next generation PD-one bispecific. You don't, as far as I'm aware, have a VEGF in development currently, but you do have a digit where I think confidence in that target has been damaged by recent data.

Speaker 13

So in terms of VEGF, is that something you would address through partnerships and do combination studies with Datto DXD? Or would you develop something internally? And can you talk about your confidence on TIGIT still and the bispecific? Then the second one is for Ruud. You specifically talked about continued growth in the Asthma Biologics franchise, but you do have GSK coming with a six monthly dapamokimab in the relatively near future.

Speaker 13

So can you talk about that competitive threat and how you manage to how you plan to manage that?

Speaker 5

Okay. So again, we presented data from the ARTEM ID01 study at the World Congress on Lung Cancer for rilvigostimic in non small cell lung cancer. And again, we focused the development of this asset on the higher end of the PD L1 expressing agent, which is the area where I think the data are most encouraging for the TIGIT mechanism. If you just come back to those data, if you look at the PD L1 greater than fifty percent, actually, we had a sixty two percent response rate in that population and a median PFS of more than ten months, which is actually with all the caveats of cross trial comparisons and small sample sizes as a health warning, that's in the same range as the other bispecifics, including the ivanecimab data. What we also have is in the one percent to forty nine percent patient population, again, encouraging data with that asset compared to what you'd expect with a PD-one agent alone.

Speaker 5

And importantly, because it's an Fc silent molecule, it's good combinability with chemotherapy with good safety and low discontinuation rate, I think, may have contributed to some of the failures with combination data that we've seen with other molecules. We do have some Phase II trials ongoing for combinations with VEGF targeted combinations, for example, in our HCC and gastric studies as well. The good news is that we've got good safety for combination of rubugastemerg with that agent. And I think where the VEGF mechanism has also shown on its own that there's activity, that is the place where you're probably most likely to see the interaction between both an IO and a VEGF mechanism. So I think there's opportunity for us to build on the backbone of Wilburgosti make with some combinations with VEGF directed agents.

Speaker 5

And that's something that we're obviously we'll be looking at as well beyond the HCC and the gastric studies that we've already got ongoing.

Speaker 1

Thanks, Sudeen, Alban? Shall I

Speaker 6

take the second one? So first of all, I think the market opportunity in itself is still very, very substantial. The biopeneration of Biologics in the ESMA segment on average is only 20%. So clearly, there's a substantial room for further improvement there. Secondly, based on our own Fasenra, which is a two month injection, we know that yes, it is important from a convenience perspective, but the endgame is always efficacy.

Speaker 6

It's very important that physicians, but certainly patients, feel the efficacy is the most important piece. And the reason that Fasenra has performed so well in the severe uncontrolled asthma segment is that the efficacy is very high and the level of satisfaction is very high. So in that sense, competition is not bad. But I think the bar in order to move Fasenra away from the market leadership we currently are having in the NTR5, I think is very high. Equally, of course, we have an unprecedented possibility in China.

Speaker 6

We will get Fasenra hopefully later this year in NardL. We're clearly the market leader in China from a respiratory perspective. So in that sense, we're very bullish regarding the outlook of Fasenra moving forward, despite potential more competition.

Speaker 1

Thank you, Arud. Let's move to Steve Scala online. Steve, over to you. Can you hear us?

Speaker 14

Yes. Thank you so much. Two questions. First, regarding Tagrisso, is your confidence in the outlook predicated on growth in adjuvant or do you think Tagrisso will remain dominant in first line or perhaps both? And has the first line outlook been influenced by the Mariposa OS data?

Speaker 14

So that's the first question. Second question is the fact that this duty has been assessed against AstraZeneca in China suggesting corporate Astra has been implicated in the investigation. Previously Astra was not part of the investigation. So if it's now part of it, what are the implications of that? Thank you.

Speaker 1

So

Speaker 4

Steve, thanks for the question. On the first part of your Tagrisso question, we saw in 2024 very nice growth in Adora, LoRa where we've launched it, but also a really strong launch to FLORA2. And I'll note that FLORA2, we've launched now in 65 markets across the globe. So we've had an opportunity to really get out and be able to tell the Tagrisso backbone story and then also the opportunity to be able to get some combination in FLORA2. As we look at the impact that Mariposa is having, certainly the overall survival that has been shared as high level results is something that anything at a year of overall survival I think is catching attention of the community.

Speaker 4

With that said, based on the data that the community saw at ELCC in 2024 for FLORA two where we saw really very, very competitive FLORA two landmark survival rates of eighty percent at twenty four months, sixty four percent at thirty six months. I think that there's a general expectation that FLORA two is also moving in absolutely the right direction in this regard. And the utilization that we're hearing is for Mariposa is a lot in second line and actually quite a lot of trial, but not repeat use. And the only last thing that I'd just say, let me take this opportunity. In my prepared remarks, I had mentioned that the market share was 85% in The U.

Speaker 4

S. And I should have said that that was in Japan. So that was something that I had said. The global frontline eGFR market share is 75%. That's inclusive of The U.

Speaker 4

S. And in Japan, it's higher at 85%. That's just something I wanted to correct.

Speaker 1

Thanks, David. The second question, Steve, is relatively straightforward. As I said before, a notice has been sent to the Prosecutor's Office. If AstraZeneca is found liable, The Chinese law is very, very clear. The implication is very clear, which is the company has to repay the import duties, so $900000.0.900000 dollars to be repaid, plus a fine that is one to five times the amount of import duties.

Speaker 1

So it could be 0.9 plus 0.9 or it could be 0.9 plus 4,500,000.0. That's the implication and it's very, very clearly defined by Chinese law. Andy, you will tell me when we have to run out. We have to stop because I know some of you have to go to another meetings.

Speaker 15

Hi, Emily Phil from Barclays II in oncology. Firstly, on DATRAWAY, a great label from a safety perspective with Novoxx warning relative to the other TROAK2 ADC. Do you expect that to hold for a potential approval in non small cell lung cancer? And then another question on the third, we will be seeing the all comers results from the competitor Giridestrant this year. I was just wondering if you could help us understand why some of the molecular advantages of camazestrant over the competitor molecule?

Speaker 1

Suzanne?

Speaker 5

Yes, sure. So obviously, we're still in discussions with regulatory authorities about the filing for GACOE in the EGFR mutant lung cancer setting. But we did publish the safety data that's the basis of that filing earlier. So you can look at the adverse event profile that is there. And I think in the EGFR mutant population, that's in line with the current label that you've got in the breast cancer setting.

Speaker 5

So we obviously have to wait for the final label, assuming that the rest of the filing goes well. In terms of the chemisestrant molecule, I think we've got a very good potency. We've got very good linear PK. We've got very good drug drug clean profile with all of the combination partners that we're looking to combine with, including all of the CDK4-6s. The safety profile that we're seeing with Kamizestrant leads to an extremely low discontinuation rate, very low rates of these GI side effects, which I think is important, particularly when you go into the earlier lines of therapy.

Speaker 5

People want to stay on drug for a long period of time. So I think the overall profile that we have with this drug is really looking best in class from my perspective. Obviously, we've got to have the trial readouts first, and then we can happily discuss the actual profile that we've seen in the Phase III trials. But at this point, we're confident.

Speaker 16

Simon Beg from Redburn Atlantic. Two quick ones, if I may. Just going back to Rullivogasterbig. Susan, could you give us your updated thoughts, and you did touch on this, on the scope for TIGIT as a target beyond non small cell lung cancer based on what you now know? And then one for Ishkran Emerging Markets.

Speaker 16

The growth ex China looked very good. I mean, if you could give us some highlights of sort of country by country where you are seeing that growth.

Speaker 5

Okay. Thank you. So for Wilburgostemayk, obviously, we've in addition to the lung cancer indications with TROPION LUNG10 in combination with DATEOWAY and the ARTEMIDE LUNG02 and LUNG03 trials in combination with chemotherapy, we've got the ARTEMIDE BILERY one study, which builds on the TOPAZ data that we had with divalumab in biliary tract cancer but takes it into the adjuvant therapy. That's, I think I would say that the investigators are very enthusiastic about. And then the next piece in terms of the expansion is clearly building on the combinations that we've already got with Dachau Way.

Speaker 5

There's also good combination capability within HER2 and then with the other ADCs that we've got coming through the portfolio, I think there'll be significant opportunity. We are focused on those patient populations where TIGIT is likely to be more beneficial, but that has been seen in indications also like gastric cancer, for example, and in HCC cancer, where you would expect activity from the TIGIT mechanism of action beyond what you see with PD-one.

Speaker 2

So if you look at the emerging markets outside of China, as you mentioned, I mean, growth is quite impressive. It's another strong year of growth of 32%. And the emerging markets, if you exclude China, actually represents up to 13% of the global revenues. And we are very confident and positive in the further growth in the emerging market. And therefore, the answer to your question is very difficult because we actually see the super strong double digit growth across Latin America, Asia, Middle East and Africa areas.

Speaker 2

And we do see the good reasons and the good many growth drivers to see that continue. And I think one important point is that across the emerging markets, we are actually launching our brands a bit later than when comparing with U. S. And Europe. So So if you think about that, I mean, the products are like breast free or like and here too are still to get the full maximum and full leverage across the international region.

Speaker 2

So despite the headwinds that we will always see, as Pascal mentioned, a bit of the pricing or the exchange rate, I do believe that underlying growth across all areas in emerging markets is to be continuous, across all therapy areas as well.

Speaker 1

I mean, I think it's important to just to add to this, it's important to remember the population is there. The global population lives outside The U. S. And Europe, I mean, most of the population. And many of these countries are becoming richer.

Speaker 1

Their economies are developing. More funds can be allocated to health care. And we have the portfolio of products that address most of the pricing needs, medical needs in many of those countries. The other thing we've done is we've accelerated the approval of new products. In the past, these countries were sort of priority three, of course, U.

Speaker 1

S, Europe First, and we had a long delay between the launch in Europe or U. S. And the launch in those countries. We've accelerated this. The team has done an amazing job.

Speaker 1

And so we're bringing those medicines to all these countries much faster than before. So there's really good reasons to believe that we will continue to grow. And in many, not all, but many of these countries, we don't experience the impact of patent expiries like we have in The U. S. Or Europe because those products are sort of sold as a brand.

Speaker 1

Lower price but less exposure to patent expiries, and you just compete with generics as opposed to losing it all when you lose Patent Protection.

Speaker 17

Yes. Erika, Vergos, Stifel. Two questions. First, we do appreciate that your top priority is on top line growth, both short and longer term. But my question is on margin development.

Speaker 17

We were probably expecting margin to end at around 32% in 'twenty four percent and ended just above 31%. So your reiterated commitment to reach mid-30s by 'twenty six percent, which is the gap by around 400 basis points over the next couple of years. Given the current guidance for 'twenty five percent, it looks like the leverage will be quite minimal this year, so it leads a lot into 2026. So how should we think about this development? Are we right in assuming that mid-30s means 35?

Speaker 17

Or could that be a broader range? And would you be comfortable reaching 34% or just to give kind of sense also for consensus adjustment? And the second question is on Airsupra. If I remember correctly, it was supposed to be a multi block buzzer in the end and you were probably more bullish than consensus and the start is relatively soft and we haven't seen much of an improvement in even the fourth quarter. So there was a lot of development around free sampling and probably for mill reaccess.

Speaker 17

Is it getting better moving into 'twenty five? And should we expect a significant improvement on the product in 'twenty five?

Speaker 1

Arnaud and then maybe over.

Speaker 3

Sure. So we do expect to see operating margin expansion this year. So if you look at our guide for revenue and EPS and you can extrapolate sort of what the operating margin could be. So there is clearly an expansion between '24 and '25. I also mentioned in my prepared remarks the impact that FX has, and again, that was not obviously the case in 'twenty four, but when you look at where the currencies have moved, particularly in the last two, three months, that does have an impact of, as I mentioned, 20 basis points in on our margins for this year and 50 basis points if you compare it to the first quarter twenty twenty four rates.

Speaker 3

Other than that, I would say, me and all the entire executive team is very much committed to achieving that mid-30s operating profit. So mid-30s is 34% to 36%, which is always what we have signaled. And we have a number of initiatives, whether it's optimizing our commercial footprint, seeing where we do work. So you've probably seen the hubs we've opened in Mississauga and Barcelona and Bangalore and other places, again, taking advantage of work we're doing. We're also doing a lot of process improvements, whether it's in regulatory filings and so forth.

Speaker 3

So there are a whole bunch of different initiatives that are happening across the company on driving productivity while still supporting obviously a very large and growing portfolio.

Speaker 1

Thanks, Fahrut, Batuuk at the Assupra.

Speaker 6

Yes, quickly. First of all, I'm still very excited about Assupra. First of all, we see an enormous volume over 300,000 scripts in one year. But equally, and that's also the challenge in the spirit of transparency, one out of two scripts are not fulfilled at the pharmacy level because still of access issues. This is a very highly general sized market.

Speaker 6

And clearly it's much more difficult than we expected in order to get traction because albuterol, fentanyl has a very, very low price. And we don't want to compromise at this stage of the game too much our price. We want to sell it based on the clinical features of Air Supra. The other big piece of excitement is that we have published well, this is the high level results of the Batura data, which further expand the potential of using sutra in the mild asthma segment. And last but not least, more than 65,000 physicians in The United States have already prescribed SUPRAS.

Speaker 6

So it's all about access. We're making good progress. For the January 1, we have now roughly a coverage of sixty percent of commercial lives. We have secured one very large Part D access. So it will take some time.

Speaker 6

The good news is of inhaled therapies, the detail is very long. You see it yourself is the performance of Symbicort. So we are very committed in order to capture this opportunity moving forward, and we are working very hard on the access situation.

Speaker 1

I mean, you know that when you launch a new product, access is always something that takes time, even more so here because of the reason Roud described. But we're making good progress. And the important piece, I think, is Batura, the study that Roud mentioned, because fundamentally, you've got to convince managed care of the economic value of reimbursing these products when they have, of course, generic a butyrrole that they can offer patients. And Batura data will suddenly be a very important tool in convincing them of the cost effectiveness of reimbursing a Supra. The clinical data are very, very striking.

Speaker 16

Thanks, Pascal. It's Justin from Bernstein. I've got one for Mark on Azimfitase. Just if you wanted to share any thoughts on the cost of goods versus Strensiq? And the second one for Aradna, just if you could possibly give any kind of color on CapEx after 2025?

Speaker 8

So in short, the cost of goods for Synchronyce is way under that of Stransig. And our ambition is to be able to reach out to six times the number of patients as we do for SandSig, not only for a cost of good reason, but also because we are also going to address the adult population and a much wider regional expansion. So, the cost of good is only one factor. In this, the development the clinical development plan in both pediatric and adult is important. And the regional expansion where today, strength is still relatively limited to a certain number of countries.

Speaker 8

And we are expanding year after year. But with Xfinity Sverters Alpha, this expansion will be much easier and much wider.

Speaker 3

As it relates to CapEx,

Speaker 2

I think a good way

Speaker 3

to think about sort of from a forward standpoint would be that these are all multiyear projects. So some of them we started last year or the year before, so like the API facility, the cell therapy we started last year, the ADC we will start this year, Qingnow has started last year. So you should expect that these go for at least four or five years, the same with the ERP project. And so this would be a good level for the next several years. Again, if there are new projects started, for example, if we have great success with the GLP-one or something, then we'd announce those separately.

Speaker 3

But this is a good way to think that these are multiyear projects.

Speaker 1

Thank you. It was good you asked a question about FIM Photest because I think this product is underestimated. Potential, we said, is quite substantial. There's no competition, the stability will be good, the unmet need is important and large. So we believe it is going to be a very important product, not only for Alexion, but for AstraZeneca.

Speaker 1

Should I take maybe the last question online, Andy, and then close so we sorry? Oh, there's tumor in the room. Sorry, I missed that.

Speaker 18

It's Rajen Sharma from Goldman Sachs. First question, just to follow-up on the oral PCSK9, actually. Do you think that you need a cardiovascular outcomes trial or a positive one to get meaningful uptake? And what would be kind of your thoughts around initiating that trial, particularly thinking that you might need one for the oral GLP-one as well? And then the second question was just on Avanzar and potential filing strategy there.

Speaker 18

Assuming that it's positive on PFS, do you think that will be enough for a condition on approval?

Speaker 7

Sure. So I'll jump in and answer the question on the oral PCSK9. I appreciate the question. Recognize that we are just now completing Phase II and planning for our pivotal study. We're not going to comment today on what our plans are for outcomes trials.

Speaker 7

We have been public about our expectation for the need for outcomes trials in oral GLP-one. And it's a little early to comment on what we plan to do for AZD00780. But thanks for the question.

Speaker 5

And in terms of PFS as an endpoint in first line on small cell lung cancer, there have been approvals with full approvals based on PFS. In general, the regulatory agencies are going to want to see a positive trend in OS and reasonable maturity of the endpoints.

Speaker 9

So those are just things to consider.

Speaker 19

One question. I appreciate you've got a twenty-thirty target of $80,000,000,000 revenue and that's more of an organic number. If we look at your balance sheet, you will start generating more capacity to redeploy capital. What are your therapeutic area capital allocation, Iris? I mean, appreciate oncology has been very attractive for you.

Speaker 19

And when we started, Digit suddenly was very interesting and people are now asking if veg is more interesting. So are there therapy areas where you think it's getting a bit more difficult to find incremental opportunities or you're still excited about equal amount of capital in all three areas?

Speaker 1

Yes, it's a great question. The exciting part of our industry at this point is, so the scary part, I must say, is that, I mean, the innovation is incredible and the speed of replacement of technology is incredible. And that's why I believe, I continue to believe that being focused on a few key CRP areas and building competence, building expertise is fundamental because you actually understand much better what are the promising new technologies or products that are emerging and how you develop them, how you commercialize them, and you have an end to end understanding of a specific therapy area. So our approach is really to continue to focus on oncology, respiratory disease, cardiovascular disease, immunology. We want to address it through a few products we are working on, but also cell therapy we believe could be a very important angle to treat some of these immune diseases and of course, finally, rare diseases.

Speaker 1

But we will continue to stay focused on this and build access to new technologies. We've talked about ADC, T cell engagers, cell therapy, bispecifics, hydro pharmaceuticals. There's a whole range of technologies that have emerged in the last few years And actually, there's reason to believe it will continue to happen. And it's actually fantastic, fantastic for patients, for medicine, fantastic for us to participate in this, bring those medicines to patients. The reason I was saying it's scary is that it actually keeps us all on our toes, really.

Speaker 1

We have to make sure we actually scan the horizon constantly and we don't get caught with something that is coming from left field that actually replaces our products. I mean, you see it yourself, I mean, products coming out of the woodwork and really transforming the treatment of an indication. So maybe I'll take the online one and then we'll let you go. Gonzalo Danske Bank, do you want to go ahead?

Speaker 20

Yes, can you hear me? Can you hear me, guys?

Speaker 1

Yes, go ahead.

Speaker 20

Okay, great. Yes, thank you for taking my questions Gonzalo Diaz from Danske Bank. Two questions, one on DASA away. And what type of launch do you expect in the TROPON BRS one setting? Did you see a broad potential in the population?

Speaker 20

I'm asking this because now DATO BRS six for Enelto will come one line earlier. So I was wondering how fair is the assume some patients will go through ADT sequencing, so in HER2 followed by Datto? And the second question on baxosostat, not in hypertension, but in primary aldosterone organism. How big do you think this opportunity is for the drug? I mean, there is potentially Phase II coming soon.

Speaker 20

I was wondering what type of patients would benefit from Vaxostrac in that indication? Thank you.

Speaker 1

So there yes. Did you get it? Yes. Okay. Because the line is not very, very good.

Speaker 1

But to you

Speaker 4

Gonzalo, I'm pretty sure that you're asking basically a TBO1 market size and market opportunity question. So if that's not the question you're asking, I'm going to answer that anyway. So as we take a look at this, I mean, I think that what we're certainly seeing here is that the size of the market, G7, about thirty five thousand fourth line plus hormone receptor positive HER2 negative patients, right. So that's the patient population that we're talking about here that's addressable. And so it's after ET, after chemotherapy.

Speaker 4

And I think TB01 really complements DBO4, which is transforming the HER2 landscape, right? So the first part of this is that now with TB01 at the lowest IHC scores, you've got an option to be able to treat with TB01. But then as DBO6 starts to expand into the earlier treatment segment, there's a portion of the population also that in later lines will have seen an ET and a chemotherapy in the form of an ADC that could also be considered for utilization here. So I think that you've got an opportunity particularly in the null space and then also potentially in the HER2 low space, but HER2 low more likely being kind of after they've seen an ADC upfront. And I just would lastly say all of this is part of a strategy in breast cancer to really make sure that there's an option for all patients presenting, right, camazestrant to replace backbone ET, TRUCEAP to continue to have an opportunity in patients who can benefit from ER drive, multiple ADCs to replace chemotherapies within this space and it's a comprehensive breast program that we've put together.

Speaker 1

Thanks, David.

Speaker 6

Yes, let me take the second one. So this is a very difficult area in that sense that it is highly under diagnosed. The expectation is that five percent to eight percent of patients suffering from hypertension have this disease. The reason we are so excited about it is that physicians came proactively to us in order to do a study in this patient population because there's an incredible high medical needs. So

Speaker 1

once again,

Speaker 6

as a ballpark figure, five percent to eight percent of the anti hypertensive patients are suffering from this disease.

Speaker 1

Thank you. So let me thank you all for your great questions and your interest in our company and wish you a good rest of the day. Thank you very much.

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Earnings Conference Call
AstraZeneca Q4 2024
00:00 / 00:00