Eli Lilly and Company (LLY) Earnings Call Transcript & Summary

Okay. Let's get underway here for the Lilly session, one of the most highly anticipated. And we're so appreciative of the entire Lilly team that's here, Lauren Zierke from Investor Relations, who's always a stalwart and manages so much for the schedule here. My name is Chris Shibutani. I'm a member of the Goldman Sachs healthcare research team, cover large pharmaceuticals. Super pleased to have Patrik Jonsson here with us. Patrik, perhaps a little bit less of -- not quite the household name that he will be after this talk, head of the diabetes, the obesity business, very much President of the USA pharma aspect of things. Tell us a little bit about yourselves first so that we can make sure that we have the right lens to interpret carefully every eye twitch word, nuance, adjective, acceptor. Who are you?

Thank you very much, Chris. Swede by origin. Having served Eli Lilly and company for more than 3 decades, most of my time spent outside the U.S. Led our business in Scandinavia, Italy, Eastern Europe, and prior to coming to the U.S., our Japan business, which is the second biggest affiliate in the world for us outside the U.S. Having been here for the last 5 years, I've led our biomedicine business, our immunology business, and now since late last year, our business in diabetes and obesity and also the Lilly USA over the last 3.5 years. So that's short about me.

Excellent. It's a unique opportunity. I think so much of the science risk is still evolving but is kind of -- we've come to a clear inflection point, obviously. And we're thinking about commercialization. We've got to make the doughnuts, manufacturing, so many issues here to address. What did you feel was the most important sort of set of objectives for yourselves near and intermediate term as you assume this role? You were put in this hot seat essentially last fall, right? And I always think about Lilly's management team as having tremendous bench depth. People are well trained. They stayed through the organization. They filter through. So what do you task yourself with delivering?

I think, first and foremost, it's a super exciting time. And I think the cards we have in our hands right now are probably as good as they possibly can be. So for me, it's number one, making sure that we continue the very successful introduction of Mounjaro for people with type 2 diabetes. We just launched Zepbound for chronic weight management on obesity 6 months ago. So that's just the start, and we have started in the U.S. and a few selected markets outside of the U.S. That is really the top priority. But beyond that, I think when we look at the pipeline, we have 2 really exciting medicines in Phase III: orforglipron, which is an oral GLP-1 RA; and we have also retatrutide, which is adding the pharmacology of glucagon. So I think those are both in Phase III, super exciting. And I think that really brings a lot of promise for the future. And lastly, working with my colleagues in development and in research to just ensure that we have a next wave of truly innovative medicines. And we just announced earlier this year that we're entering into Phase III with lepodisiran for LP(a). So launch the assets we currently have in the market just evolving the launch readiness for our current Phase III assets and then securing that the earlier-stage pipeline is progressing and meeting current unmet medical needs.

So a lot of tasks ahead here. We're at this juncture particularly for the stock where people are watching very closely whether you can make the product. Demand, obviously, very significant. Difficult to size, and we could have a whole separate parlor debate over that. Supply has been the rate-limiting factor here. A year ago, I sat here with Anat, CFO, and she's off to some exciting ventures. And I think folks have a lot of confidence that there's going to be another stellar person who's going to sit in the role. But this is a window of opportunity because she was always very precise in her vocabulary about saying what would happen. How are you doing in terms of the manufacturing supply to meet this demand? Maybe give us a sense to reaffirm or not some element of time lines because I think there was a raised guidance, but some of that general delivery guidance didn't change. So it feels as if the tail has kind of come through. So is the head going to keep on moving forward? Just talk about the supply dynamic.

Very happy to, Chris. First, if you look at the demand we are facing now, it's precedented. We have a huge, huge unmet medical need when it comes to obesity. We're estimating 110 million people in the U.S. suffering from obesity, 650 million outside of the U.S. So I think just if you look at the combined capacity of us and the competition, that's really hard to meet with injectables only. Having said that, we are leaning in fully in terms of expanding our manufacturing capacity. We have announced since 2020 investments above $18 billion in manufacturing alone. We are building several sites in parallel. We just announced, I think, 2 weeks ago, but we are increasing the investments in our new facility in Lebanon, in North Indiana to above $9 billion. We started production in our first site in North Carolina in the research triangle last year. We are foreseeing that the second site will start production towards the end of this year with supply in the marketplace in the beginning of 2025. We broke grounds in Alzey in Germany, I think, 2 months ago for another facility there, and we announced one in Limerick in Ireland last year. And just a few weeks ago, we also announced the acquisition of a new site in Wisconsin that will start production towards the end of 2025. And on top of that, we have also enhanced our current manufacturing side to make sure that we can increase supply. So I think all of that combined, I think, installed on us and all of us in the executive committee, we have a lot of confidence when it comes to the outlook for 2024. We raised guidance, and we also made a commitment to at least increase the amount of salable products with at least 1.5x the amount of salable products the second half of 2023. And I think we have seen some good signs. Just last week, we had the FDA to remove both Zepbound and Mounjaro 5 milligram and 12.5 milligram from the shortage list. So I think we are seeing the light at the end of the tunnel there. Having said that, I think it's realistic to expect that there will be times when demand continue to outpace supply. But we are also getting better in monitoring the demand patterns in the marketplace to make sure that we can protect patients that are currently in treatment.

And there was a little bit of shift in the language that was used. It was a year ago, they were talking about capacity. And as a therapeutics person, I think it gets very vague when we think about square footage manufacturing facilities and all of these. They're certainly not white elephants. They're going to be galvanizing production facilities the world has never seen in Wisconsin and every elsewhere. But then the vocabulary changed to salable doses. What's a salable dose? Just so that we're all level set on what the denominator is because there could be a couple of saleable doses in a single one of these clever pens, right?

Yes. First and foremost, the move was, to a large extent, based upon feedback from investors and other stakeholders. We used the capacity language because we made a commitment. Back at the end of '22, we said, okay, we are going to double our production capacity in 2023. And we did that. But we got a lot of questions. Okay. What does it mean with increasing capacity? What does it really mean in terms of supply? And I think we realized that capacity -- production lags capacity, and we moved to the language of saleable doses. And that takes into account our saleable doses of incretins. It takes into account our saleable doses of the [ Irma ] the auto-injector that we mainly supply in the U.S. and equipment outside the U.S. as well.

So I think one of the sentinel debates is about market size, units times price. We've talked a little bit about the units on the delivery component. Let's talk a little bit about pricing and dynamics there in terms of the market being a net revenue dimension. Catch us up a little bit with the sort of net pricing dynamic that we're seeing, particularly for Zepbound, where we had the tirzepatide molecule already out there for diabetes in terms of thinking about this initial -- really, we're just in the second full quarter of the launch here at this stage of the game. And I think there's a desire to get more comfort around when we're going to be able to see those numbers together. But it involves a lot of calculus on the price side. So maybe that's the backdrop, which I've overcomplicated, but coverage and then where you're seeing that going beyond the private commercial insurance and then also out-of-pocket pay.

Yes. You know what, if we look upon where we are today, I think we have made tremendous progress in terms of access. And we announced at the first quarter earnings call that as of April 1, we have already 67% commercial access. And I don't think I've ever experienced having a commercial access at the level of close to 70% 4 months after launch. So I think we are very pleased there. We will continue to make progress, and we will do that in a very disciplined way as we have done for Mounjaro. But it's a second component when it comes to anti-obesity medications. So it's not sufficient to only gain commercial access with the PBMs. We also need to get to employers opting in. And that is not one reliable source when it comes to employee opt-in, but it's estimated to be around 50% today. And we are assuming that wherever employees have opted in to competitive products, by default, Zepbound will be listed as well. So I think in terms of employer opt-in, that is going to increase. And I think we are receiving very positive feedback from employees as well and the desire to reimburse anti-obesity medications. But I think it's realistic to assume that the employer opt-in will not just be a step-based increase as you see with PBM coverage. This is going to be a gradual increase over time. And particularly for employers, I think it's important to share the net cost benefit of covering the anti-obesity medications. So they need to better understand, okay, what are the benefits here of protecting for comorbidities, reducing other medications, seeing a lower level of absentees, and we see a trend in that favor among employees as well. The third piece would be Medicare. Medicare today doesn't reimburse anti-obesity medications. There are 2 parts. One part is TROA, the Treat and Reduce Obesity Act. And that has been reintroduced this year and with bipartisan support. So I think from our lens, it's not a matter of will TROA be approved. It's a matter of when and to what extent. And we also see some positive movements there with federal employees now being covered. The second part in Medicare is actually through outcome indications. And CMS announced back in April that they will reimburse secondary prevention cardiovascular disease with the competitive product, semaglutide. And we also take that as a big confidence for getting our obstructive sleep apnea indication reimbursed in Medicare whenever it gets approved. So I would say a lot of positive movements in the commercial space, employer opt-in as well as in Medicare and progress in Medicaid as well. In terms of net pricing per se, you're not -- I think regardless of which disease area. Net pricing -- and we don't provide details by product, but net pricing always decreases with time of access. So I think we are still in the very early phase of the launch of Zepbound, the second full quarter as you referred to. And we are currently launching with a KwikPen in markets outside of the U.S. So I think it's realistic to see, but the net price will decline over time with increased access. That's just the common formula being applied.

Yes, that's kind of rules for the road. We're certainly seeing that in other sort of therapeutic categories like immunology, where expanded indications. Love to sort of say it's a pipeline within a product. But as you're getting the label expansion for cardiovascular benefit, OSA, et cetera, we would expect to see the expanded indication set also to pressure the net pricing as a logical path is what you're saying?

I think particularly, the outcome indications will help granting Medicare patients' access to anti-obesity medications. I think we have said publicly you're not -- when you look at anti-obesity medications, I think you should expect the pricing headwind along the lines that you normally see for the average portfolio, which is low to mid-single digit over the coming years. But I think that's probably as much as I can go into details in terms of pricing.

Philosophically, when orals come in -- we'll talk a little bit about the pipeline product orforglipron, which is the gold standard so far in terms of data. But when orals come along, I think there's an immediate broad sense that there could be a potential democratization of the availability, certainly, perhaps not as tricky to make. And so supply might be less part of the rate-limiting calculus. What about pricing with orals?

I share your excitement on orforglipron. I think it's super interesting to have an oral formulation that actually has demonstrated in Phase II weight loss along the lines of the best GLP being semaglutide, not at the level of tirzepatide, but at the level of semaglutide and obviously with no food or water restrictions. So I think that's mainly an opportunity to scale. You remember the amount of patients I referred to in the U.S., the amount of patients outside of the U.S. You need a good oral medicine to really reach all of those patients. It's premature to talk about pricing for orfo. It's a small molecule but in the range of less complex and complex small molecules. This is probably in the range of the more complex small molecules, but we have been engaged in manufacturing on this one since 2018. So I think when we have read out the orfo data Phase III next year and assuming it looks as good as we are anticipating, I think our manufacturing colleagues are ready to supply orfo across the globe.

But then returning to the original premise of my question, pricing for oral therapeutics, how would you see that comparing with the injectables, assuming that we have comparable but perhaps not as blue chip of responses you get with tirzepatide?

Chris, I would probably not dig more into the pricing question yet. I think it's a good second try. But I think many factors play as well as the overall market dynamics. So I think there is some work to do in that space, and I look forward to share much more when we get closer to launch.

Okay. Very good. Joe, Lauren, good training. Excellent. One of the aspects that we're seeing is maybe a little bit of out-of-pocket paying, not just in the U.S. but internationally. And my sense is that it's a little bit more than we would have thought. Where has it been lately steady stating at?

Yes, you are right. We see more out-of-pocket i.e., paying the full list price for Zepbound than we have seen for Mounjaro. There are probably good reasons of that. First and foremost, Mounjaro went more less full access. So there is full coverage for Mounjaro, very close to. And with Zepbound, as we discussed earlier, access is good, but it's not 100% yet. And secondly, we have a big patient group as well in Medicare that actually will have to pay full list price based upon how the regulations are defined. So there is unfortunately no other options for those. So when we look at Q1 data, because that's the only data we have so far, I would say we have the mid-single digit of patients paying full list price out of pocket in the U.S., which compares to low single digit for Mounjaro's type 2 diabetes. Outside the U.S., I think we will see different archetypes of markets. We are just about to launch in the European market. And there, we are very often talking about a single payer system for reimbursement. So I'm not sure yet to what extent we will see out of pocket in Europe. But then you have, on the other hand, a market like Brazil, which is a huge out-of-pocket market. And we have seen that, for example, with Saxenda. So I think we would expect to see a similar pattern for our anti-obesity medications as has been seen with the competition. And maybe we have an even higher willingness to pay, taking into account the data, the amount of weight loss and some other benefits of tirzepatide versus the competitive products.

To ask another question about the Medicare related, we've certainly seen a very effective strategy. And certainly when the outcomes study SELECT semaglutide read out positively, we certainly saw stocks on both of the leading parties benefit here. The FDA would be specific about updating the label for Wegovy. And what are you seeing at the actual interface of the payers? Are they willing to be as we see the read across? And I would imagine that amongst customers and the clinicians, there's maybe a broader acknowledgment that it's not just specific to semaglutide. Particularly at the payers, how picky are they being?

No, we were very pleased to see the readout of the SELECT trial. And I think that was very much what we anticipated with weight loss. We would expect to see those cardiometabolic benefits. And I think across the different stakeholders, I think they expect to see at least the same, if not more, with tirzepatide. We are reading out the CV outcome study for diabetes likely in 2025. It's an event-driven trial. It's hard to give a specific timing, and we have a morbidity/mortality outcome trial in obesity reading out most likely in '27. That's also event driven in both primary and secondary prevention. So I think those benefits are expected to be seen with the tirzepatide as well and taking into account that the weight loss is significantly higher with tirzepatide and semaglutide but probably higher expectations there as well. But the most important point is that CMS announced that they will cover outcome indications in Medicare. So I think this opens up the Medicare population to get access to anti-obesity medications, and we expect something similar with our approval of obstructive sleep apnea. We would expect something similar for the heart failure indication, but it's reading out later on this year and later on for the morbidity/mortality outcome data as well.

Market size, units times price and the, X, Y, Z, axis is duration of use. What's the latest you guys are saying in terms of what your belief is of how long patients will stay on these therapies in obesity?

In obesity, it's harder to say because we launched 6 months ago. And even when you look at the competition, I think they have experienced similar supply challenges as we have done. So it's really hard to look into reliable adherence data here. What we hear from patients is that there is a strong desire to stay on treatment. I think compared to many other chronic medications, here you experience the benefits firsthand. So if you are an obese or suffering from obesity and you suddenly have a weight loss of 20%, 21%, 22%, that's really life changing. And I think all of the data we have seen so far confirms that for a huge majority of patients, they will need to stay on treatment because obesity is a chronic disease. So we are expecting to see a relatively long duration of treatment for obesity. It's not going to be finite, but we expect it to be longer than you normally see. Have in mind that for other chronic diseases such as heart failure, whenever you go above an adherence of 12 months, it's considered good. It's bad for outcome, but that's reality. So we foresee a longer duration of treatment here with Zepbound.

And I think Lilly as a house has commented that the GLP-1s in the diabetes indication has historically had kind of median duration of use that kind of settles out at kind of 15 months. Would that be your expectation? Do you see something on par? Or are we just getting better at using these and patients more motivated, so could it be longer? Or is there a reason why it'd be less?

Yes, we saw 15 to 18 months in type 2 diabetes. That's correct. I actually think we need to aim significantly higher. And I think there is, at the patient level, a mechanism here because if you stop your treatment, you're seeing the benefits of getting down to a BMI of 27 or 28 or whatever it might be. And we saw in our study that when some people was designed, you could continue with your tirzepatide medication or go on placebo. If you went on placebo after treatment, you increase your weight with 15% quite rapidly, while if you continue tirzepatide treatment, you had a continued decline in this study of 7%. If you have experienced a benefit and you rapidly regain, I think patients will rapidly try to get back on treatment. And I think there is an educational need here that we and the competition needs to take the lead on to make sure that patients don't go on and off because we don't know the impact of that in terms of the body composition. But I think we should expect and aim for significantly higher adherence for the sake of patient outcome.

Let's talk a little bit about selling. There's an effort LillyDirect that is now part of the strategy. Quantify this a little bit for us and then give us a sense for how good a job third-party payers are -- third-party aggregators of data are in terms of helping us spike that jelly bean and figuring out what the quarterly number is going to be.

Yes. LillyDirect was actually an idea we gave birth to approximately a year ago. And we just realized that patients, regardless of the disease area, it's a very cumbersome journey for them. So we asked ourselves, what can we do to reduce friction for patients with focus on the U.S. to start with? That's what gave birth to LillyDirect. And we launched it back in early January this year. It has never been attended to be a new revenue stream for the company but just a way of making sure that the patient journey gets better. And it's not here to disrupt the current ecosystem but just to provide a better consumer experience. One of the benefits of LillyDirect is that all of the co-pay assistance programs, et cetera, will by default applied. So that's nothing that the patient has to be concerned about. It has been live now for almost 2 quarters. I think we are very pleased with how it has been received in the marketplace. If you look at the total TRx -- total number of prescriptions that go through LillyDirect so far, in terms of TRx, it's not high. It's probably low single digits so far. But in terms of new prescriptions, it's increasing. So I think LillyDirect is gaining in popularity. It hasn't been perfect yet, but we are working to enhance it, having more partners. And we will most likely add other disease areas and medicines as well over time and other services for patients. In terms of how well third parties are capturing this, I don't think IQVIA is tracking it in the weekly data sets. But my understanding is that they have the formula in place, and I think they get very close to the reality. So I don't think there is a huge gap when we look at what we believe is their estimate and where we are, but a great start. And also importantly, the consumer experience is better than in the current normal system.

Let's dig in the pipeline here. Body composition is part of the ecosystem to debate about muscle sparing, muscle loss, et cetera. You have an asset bimagrumab through the Versanis acquisition, Phase II primary completion, mid-year. Tell us if we're going to hear anything and then also your general thoughts about some -- having a product that has attention to this notion of body composition.

Yes. You're right. We acquired Versanis, and there was a Phase II study started, but we didn't design. And you are right in terms of the primary completion as well. It's announced to be mid this year. I don't think you should necessarily expect us to release anything based upon the primary completion for a couple of reasons. Number one, we don't define this study to be material for Lilly. It's semaglutide, a competitive product, versus IV of bimagrumab. If we would proceed, we would do a combination of a subcu in -- with both medicines. Secondly, even if the primary completion is mid this year, but it's a 24-week extension of this study as well. And after 24 weeks extension, there is a 32 weeks withdrawal extension as well. So I would say you shouldn't necessarily see us releasing the data. If we see what we expect to see, we are likely going to proceed with a combination study with tirzepatide, and that would probably be the time at the latest we would share something. The muscle mass loss, we know that regardless of how you are losing weight, if it's bariatric surgery, it's diet or it's a medicine like a [ GIB ] clip, there will be a piece of seen muscle loss as well. And I think ratio is normally defined as 25% to 40% of the loss is muscle loss. So that has always been seen. We -- but nevertheless, the ratio in terms of fat and muscle is actually improving after treatment. So I think that's important to have in mind. For us, it would probably be just to be able to tailor treatments to different patient groups. And we are thinking particularly of the elderly where muscle loss could be more of the negative or people with sarcopenic obesity. So those are pretty much the patient groups we currently have in mind. But I think we will be more informed when we have seen the full readout of the Phase II with the primary completion this summer.

Yes. It almost makes me wonder what the endpoint be, whether it be an efficacy measure or on the adverse event side of the column. You could look at it from so many different ways theoretically. Let's attack another pipeline aspect. We mentioned it earlier, orforglipron on the oral side. And here, I think people are feeling quite confident and speak to your confidence in the level of derisking here because we know that with orals, when I mentioned the potential democratization, safety and safety, very important. And it seems as if you guys have that modicum of confidence needed to begin to go into thinking about scaling up production even beyond where you are clinically. So make us feel comfortable about orforglipron.

I think anything is entirely derisked. That's the reality of the business we are in. With Phase II, we felt very confident progressing into Phase III. We have an independent safety monitor group that looks at it today on a regular basis. There have been no signals. But of course, at the end of the day, we need to wait the full readout of the Phase III. But based upon everything we have seen so far, we have a high degree of confidence in orforglipron, and it's from a different backbone compared to the [indiscernible] compounds. So I think that's important to have in mind as well. But we will see the full readout in 2025 of all the orforglipron Phase III trials [Audio Gap] time when it's entirely derisked. Well, it's the first -- the first one is coming in April 2025, and the full readout will be done prior to the end of 2025. And that includes head-to-head trials. So we're going head-to-head in type 2 diabetes. We have orforglipron versus Farxiga and Rybelsus. So I think it's going to be a very comprehensive package that we are reading out next year.

Okay. Let's go [Audio Gap] which often gets thrown into a conversation in the same paragraph when we're starting talking about the adjacency that is liver complications, NASH, MASH, when we think about mechanistic benefit. Bring us up to date with where we are with GGG and where you see it going.

Yes. GGG, I think what excites us here is the addition of a glucagon pharmacology. And what we saw in Phase II is that it's bringing incremental benefits on top of tirzepatide. First, it's the magnitude of weight loss when we are very close to the level that you see with bariatric surgeries. We are talking about weight loss at 25%, 26%. But it's not only the magnitude of weight loss. It's also the consistency of weight loss because what we saw with retatrutide, it's actually about 100% of patients responded to retatrutide and demonstrating a weight loss of at least 5%. So I think that consistency of response is a very important factor as well. And on top of that, you have the lowering of lipids. You have the lowering of liver fats. And you have the hypertension piece or the blood pressure piece as well. So there is increased cardiometabolic protection and potentially some benefits from a renal perspective as well. So we are super excited about retatrutide as well. It doesn't read out until 2026, but it's just around the corner. Time flies here, conducting a basket trial with [Audio Gap] That's the anchor indication. But we're also studying osteoarthritis and obstructive sleep apnea, and we have also initiated an outcome study with retatrutide, and in parallel, studying type 2 diabetes. So this could be how we really raise the bar in the treatment of obesity beyond the revolutionary change [Audio Gap]

The bar has been raised. The bar is -- let's talk about additional mechanisms. And certainly, if the market is any indication, market capitalization has been afforded to excitement in the absence of data, just the expression of enthusiastic emotion around what we're seeing so far kind of things. So let's talk about 2 mechanisms that have generated that kind of enthusiasm by investors. One would be amylin. Talk about what you have there and your thoughts there. We're going to be watching your face for expressions.

Yes. We have 2 assets in that space. The first one is a long-acting amylin receptor agonist LAARA. And now we have already started Phase II studies with LAARA, and we are considering LAARA or the amylin for both -- in co-formulations. We have engineered all of our peptides here for potential co-formulation with tirzepatide or retatrutide if we would like to, but we're also studying it in monotherapy. I think there are a couple of aspects that excites us with amylin. The first one is that you could potentially see even more waste loss in the type 2 diabetes population with amylin than we have seen with, for example, tirzepatide. And the second one could be on the gastrointestinal side effects side. SO those are 2 areas that we are quite interested in. And besides LAARA, we have another one, DACRA, which is a dual amylin calcitonin receptor agonist. That one is, for us, also exciting, but we haven't started Phase II of that one yet. But we see it as an opportunity for optionality in that space. And there is DACRA now in Phase III development. But we are probably more excited about LAARA than the DACRA for the time being at least.

And any other mechanism would be GIP to agonize or antagonize, what say thou?

GIP agonist or antagonist, well, I think that debate has been quite heated over the last 2 months. We feel very confident that GIP agonist is working. And we have done a small Phase I study on a pure GIP agonist on our own, and we saw the effect that we expected. We have also a long-acting GIP that has been demonstrating weight loss as well as a decline of fasting glucose. So I think those are really strong evidence for GIP agonist. I think there is probably more to demonstrate in terms of GP antagonist. I think those are data and answers that I think many are looking to, okay, what does GIP antagonist actually do in terms of long-term cardiovascular safety, bone, cardiometabolic health overall as well as insulin sensitivity, HbA1C. So I think there are a lot of questions to be answered in terms of GIP antagonist, while I think GIP agonist has been quite well demonstrated to induce both weight loss and reducing fasting glucose levels.

I like your expression using has been quite heated because your team has been part of the flame throwing, but that's part of why we love the sport. So one other adjacency here. I was kind of hoping with this 4:00 fireside chat that we'd literally be synchronously with the AdCom, and then I'd be swatting your phone out of your hand as your team is trying to scroll through the vote. But obviously, all of the drama has already played out. So congratulations to the Lilly team. But this actually sets up a potential sibling rivalry because we have like [indiscernible] and then [indiscernible]. But hey, we have GLP-1s. Isn't that going to solve for Alzheimer's?

We know that others have initiated the trials with GLP in Alzheimer's disease. If it works, we don't necessarily believe it's going to be an impact on the disease itself. We believe it's going to be an impact on underlying conditions such as obesity and type 2 diabetes. If you can improve the outcome, particularly vascular health, we believe that's going to have an impact on the cognitive decline because you will reduce, for example, the number of strokes. And we know that strokes will accelerate decline of cognitive functions. That's our current hypothesis. But of course, we are closely [Audio Gap] everything that is going on also in the Alzheimer space.

The unmet need is...

I'm more excited about the outcome of the ad board today on donanemab. So I think we are super excited to work closely together with the FDA to finally get donanemab to patients that are suffering from Alzheimer's disease. And I think that's hopefully quite nearby right now.

Definitely scaling some of the most significant unmet needs. So thank you to Lilly for joining us and for Patrik for being a good sport. I hope to see you again next year.

Thank you very much.

Thank you.

Thank you.