And what is happening is because the administration costs and the paperwork around the co-pay, we’re just seeing the structural shift of physicians just saying that the patient looked a lot easier if you just go next door with the pharmacy and get your shop there. And so that shift has happened. We have actually recovered some ground in terms of growth in terms of penetration in the centers beyond the two core ones, the three core ones we had. But we are pushing against this tide, which is just much easier for everyone if they go next door. Now the challenge is when they go next door in quarter one, the pharmacists are very clear in terms of the market research. Their priority is flu RSV, so a little bit of a victim of our own success there and COVID.
In quarter two, we expect that, obviously, as we move to the summer months, they’re all signaling very strongly, that they expect to move Shingrix up, and we’ve actually seen that in terms of stocking levels in pharmacies. Wholesaler levels are stable, but we’ve seen the pharmacist start to build the stock up. So when we see that there’s clearly an expectation of a shift to start vaccinating those patients there. So that’s encouraging. I think I’ve covered everything.
Emma Walmsley: Yes. Anything you want to say on the Arexvy penetration?
Luke Miels: Yes. Yes, sorry. I mean I think our strategy has been very clear, which has been to concentrate on the comorbid individuals, and we have outstanding market research there showing the intent of pharmacists and doctors to discuss this with patients and vaccinate them. And when you look at the number one reason someone recommends Arexvy its efficacy and its efficacy in these populations. But we’re very much in the early days. But that initial penetration, the bulk of that is those high-risk informed individuals that have gone in there. I don’t have the exact percentages in front of me, but yes, it’s about 80% of those people are comorbid older individuals. So there’s 65-plus where there’s a lot less than that 60-plus. And of course, if we can get the 50 to 59 comorbid, that’s a nice growth opportunity for us because they’re just as aware of their risk as is their physician with these poly comorbid individuals.
Emma Walmsley: And that’s another 15 million Americans in the at-risk comorbids for 50 to 59 which is an exciting prospect. Okay, next question, please.
Nick Stone: Now we’re going to come to UBS and Jo Walton. So, Jo over to you, please.
Emma Walmsley: Hi, Jo.
Nick Stone: Jo looks like you are on mute.
Jo Walton: Apologies. I have three quick ones, please, or two related. Just if you could tell us a little bit more about AMP Cap. Trelegy did extremely well. Can you confirm that there’s no bleed across in terms of rebates, et cetera, that is going to impact that and that, that is continued. I wonder if you could also just talk about Zantac litigation. We’ve now had one case that has gone to trials where you have previously been settling and you haven’t settled that one. And we now see lots of potential cases and a Sargon set of cases coming out in California. I am just wondering if there’s any timeframe or any update as to when you might be able to resolve this situation.
Emma Walmsley: Okay. Well, I’ll come to Luke in a second on AMP Cap and rebates off the back of another quarter of absolutely fantastic dynamics for Trelegy. But let me make some comments on Zantac for everybody on the call. I mean, first of all, we remain very confident in our position and continue to defend the science and the facts very vigorously. Obviously, you know that since 2019, there have been 16 independent studies that have been categoric in showing no causal link between ranitidine and cancer and the extensive review to the FDA and the EMA as well. Now obviously, Jo and others, you would not expect me to comment on the specifics of our legal strategy and especially with ongoing and current cases. But I do want to also emphasize and remind everyone that the upcoming Daubert hearing is purely a question of visibility of evidence.
Absolutely nothing whatsoever to do with any judgment on liability. And we are very focused on, as I say, defending our position vigorously. And in the meantime, this team and the whole organization is really all about delivering on our operating performance, our momentum for growth and continuing to invest for growth as well in line with our capital allocation priorities. So that’s as much comment as I’m going to make on Zantac today. Luke, would you like to come back to AMP Cap?
Luke Miels: Yes. Thanks, Emma. Jo, I mean, Trelegy is really quite separate from AMP Cap. I mean, the drivers there are the momentum around the GOLD guideline changes, commercial execution, and we have a very strong team in the U.S. A very simple messaging there. I mean we have around 64% of those patients who are on triple therapy with COPD and about 67% with asthma in the U.S. So very strong penetration there, and you’ve still got a sizable proportion of individuals who are not responding to treatment. So between 40% and 60% of patients still exacerbate depending on which numbers you look at, which is good for Trelegy and could be very good for Nucala and depemokimab long-term. In terms of AMP Cap, I mean, the numbers that we’ve given in the past are still the same.
We had a 150 million effect at the end of 2023. If you look at broader exposure for the rest of 2024, it’s still around 550 million. I mean, I think to be fair, we did better than we were expecting in quarter one. Some of the strategies that we had commercially did exceed our own expectations, which is always nice we prefer that than the other way around. But – and that there will be a countermove to those. And so I don’t think we’re going to see the full effect until we’re talking at the half year results for the total AMP Cap exposure. And then just back on the China question, Nick has just told me that it is about 20% for Shingrix sales will be in Q1 and then 60% to 80% in half 1 if you’re on phasing of that 400.
Emma Walmsley: Next question, please.
Nick Stone: Our next question from Steve Scala. So, Steve over to you.
