Graham Parry: Great. Thanks for taking my question. So it’s on Pluvicto. So the number in the quarter was a drop off quarter-on-quarter, I think you said in Q3 that you’d actually seen about a 50% increase in patient starts. But also there was an offsetting factor here of sicker patients not getting the sort of the last two doses. So I was just helpless with the dynamics why that increase in patients you saw in Q3 didn’t translate into a higher sales number in Q4? And then on sites, I think you’d said 300. So how many are you targeting for 2024 and given your supply unconstrained is this actually now the rate limiting step to getting to the multi-billion number that you’ve talked about for the vision indication? Thank you.
Vas Narasimhan: Yes. Thanks, Graham. So on Pluvicto in quarter four, we saw a steady rebuild, but I think we did not see yet the full replenishment of the base of patients given that we still had supply constraints into the August — well July-August timeline. And so, over the course of quarter four we saw more patients getting on therapy, which then, of course, gives us the four to six doses on those patients, which we build that base. I would also say during the holiday period for these — we did see less as we were expecting in the Christmas period and Thanksgiving period these patients tend not to want to have the therapy given the radiation can lead to — it does lead to restriction and being around children and other loved ones.
So I think those dynamics did play a role. But we did see growth in new patient starts in Q4 versus Q3. But the growth was not I think as strong as maybe what the external world predicted. We had tried to guide in quarter three to the expectation that we would be to a rounded billion, which is exactly where we are at the nine $980 million mark. But perhaps we should have been more clear on our outlook and expectation. All of that said, we, of course, can track this on a daily basis and we see strong growth and demand, strong overall dynamics. We continue to expect to see robust quarter-on-quarter growth for Plovicto over the course of this year getting us back towards that multi-billion dollar outlook that we’ve guided to in the vision population.
Graham Parry: And centers?
Vas Narasimhan: And center. Sorry. Yes. So our goal is to get to 500 plus centers and we’re expanding now rapidly. I think centers are probably one constraint. And then I think the other in terms of the growth and so we expect to have [indiscernible] centers of a steady clip over the course of this year. And then we also are encouraging physicians now that supply is unconstrained to treat earlier. So therefore the average number of patients moves more towards six doses per patient, which will certainly be our goal over the course of the year. I think both of those dynamics will fuel growth for this brand over the course of 2024. Thank you. Next question operator.
Operator: Thank you. Your next question comes from the line of John Priestner from JP Morgan. Please go ahead.
John Priestner: Hi. Thanks very much for taking my question. So you said that the 2024 guidance includes the impact of generics, which we assume is for kind of Promacta and also to Tasigna. So what are the — what are your thinking behind the actual timings of those generic entries? And also you also said that the 2024 guidance could be somewhat prudent. So what are some of the key kind of levers that you could execute on to kind of exceed that guidance? Thank you.
Vas Narasimhan: Yes. Thanks, John. So there’s three generic entries we would expect over the course of the year. But we’re not in a position I think to provide specific guidance on when these entries would happen given the, I think, unpredictability, both in terms of our own goals to defend our IP, as well as supply for some of these parties. The three would be Promacta and Tasigna, as you noted, as well as Sandostatin LAR, where there is now an approved generic, but no product in the market. We, of course, would provide updates when these would enter over the course of this year. But, I think this is our current forecast and we’ll see, of course, how things evolve. Now, in terms of our full year performance, Harry, in terms of the prudent guidance?
Harry Kirsch: Yes. John, thank you very much. I mean, we will not say when — we assume, right, it’s all for financial forecast assumptions. Of course, we do appropriately defend our IP when possible. Of course, on Sandostatin LAR, there is no IP anymore. It’s more about the ability of the generic producer to produce. It’s a very difficult to produce product. On the other hand, we have basically distributed these three potential entries for forecast purposes over the quarters. There’s a bit of a generic portfolio play, if you will. And now, if all of them will come a bit later, then we may have an upside to our guidance. So, that’s what we meant with that. And, of course, overall, we do assume that our key growth drivers continue to perform very well.
But, it’s a bit difficult with these three different generics to make assumptions. And so, we do them in a prudent way. And there could be changes to this if either one competitor cannot produce or we have some upside on the LOE and patent defense, if you will, on the other two.
John Priestner: Very clear. Thank you.
Vas Narasimhan: Next question, operator.
Operator: Thank you. Your next question comes from the line of Tim Anderson, Wolfe Research. Please go ahead.
Tim Anderson: Thank you. On Cosentyx, a question on pricing and market access dynamics in 2024, just in the U.S. with multisource about similar to [Humira] (ph) on the market now, albeit only for six to seven months. Are you seeing any access tightening in 2024 such as more step edits given indication overlap? And if not in 2024, then do you think it might tighten in 2025? And then also on this topic, just the level of U.S. net price erosion in 2024 relative to what it was last year?
Vas Narasimhan: Yes. Thanks, Tim. In terms of Cosentyx, we actually feel pretty good about overall the access environment for 2024. We’ve had modest growth to net shifts overall for the brand, and we have a broader access in some of the major accounts versus what we’ve had in the past. We haven’t seen any, let’s call it, increased impact from biosimilar Ianalumab. We think this is mostly because we’re contracting within the IL-17A class. And given our track record in the class and large position, that’s enabling us to manage the overall access environment successfully. Have not seen, to my knowledge, any increase in step edits either with respect to Cosentyx access. Now, I think looking forward, obviously always difficult to predict.
I think some of the tailwinds we have going for us is the new indications in hidradenitis, which, of course, at least for now, we’re only one of a few medicines that have that indication, which gives us strength in terms of formula and negotiation. Hopefully, some of the other indications come through as well. Separate from that as well, for Cosentyx, we’ve launched in the IV setting as well. And that’s also another, I think, important growth driver for this medicine over the coming years. So overall, I think pretty stable position for Cosentyx, at least for 2024. And of course, as we understand better, 2025 and beyond, we’ll keep everybody updated. Moving to next question. Thanks, Tim.
Operator: Thank you. Your next question comes from the line of Simon Baker, Redburn. Please go ahead.
Simon Baker: Thank you for taking my question. And it’s another one on Cosentyx. I wonder if you could give us your thoughts on the expectation of the uptake for Cosentyx in HS. I’ve had some clients suggesting it’s slower than expected, given the quality of the profile and the paucity of the competition [Technical Difficulty] How do you see the potential and the uptake there over the course of the next year or so? Thanks so much.
