Sanofi (SAN) Earnings Call Transcript & Summary

Excellent. So welcome, everybody. I'm James Quigley from Goldman Sachs. I'm the European pharma analyst, and it's a pleasure to welcome you all to this session with Sanofi. We're joined today by the Head of Specialty Care, Brian Foard. Brian, thank you for joining us.

My pleasure.

And just to kick it off, could you just give a quick overview of your role at Sanofi, what you're sort of responsible for and what your goals are for the Specialty division?

Yes. So I run the Specialty Care business unit. So as you know, we have -- previously had 4. Recently, with the recent sale of our Consumer Health Opella, we now have 3. So General Medicines, Vaccines and Specialty Care. So I run our Specialty Care business unit, which is basically made up of immunology, oncology, neurology and rare diseases. And I think as we've shared before, we're in a really interesting space these days where we have significant growth drivers of the organization fit within Specialty Care. So things, of course, like dupilumab, as we've said, that would have double-digit CAGR growth from '23 through 2030, delivering around EUR 22 billion by that 2030 time frame. And then we've got other assets that we've recently launched like ALTUVIIIO, recently Qfitlia. We've got SARCLISA that's growing and continuing to expand its indications from an oncology and multiple myeloma standpoint. So it's really a growth story for us across each of those areas, including even neurology, where we're expecting our kind of reentrant into the MS space with the upcoming launch of tolebrutinib. So for us, Specialty Care is all about across those therapeutic areas, delivering really meaningful and transformative therapies for this patient population and driving really meaningful growth for the company. So a lot of work to do in that -- in those statements.

Yes. Lots to cover. Before getting there, I'm going to do the sort of the mandatory tariffs question. Again, I understand this isn't quite your sort of area. But in terms of from what you've seen so far in terms of the tariffs and from the internal discussions that you guys are having at Sanofi, what could be -- what could the impact be to your business?

Yes. I think overall, what we've said as an organization is we just don't know yet what the tariffs will actually be. So I think there's still more questions than there are answers to what that could actually mean. That said, we've scenario planned like every other organization. We've already made some preparations for what could be some mitigation strategies. Overall, the impact, we believe, will be manageable for us as an organization. But again, I still think that there is a lot more questions to be answered first and foremost. And today, we just remain focused on the more you can innovate, the more you can bring innovative therapies in the marketplace, you'll find ways to manage through whatever the tariff situation is.

Got it. Perfect. And then mandatory question number two, most favored nations pricing. Again, this is a potential impact to your business. How are you thinking about the implication? What do you know in terms of -- or what can you tell us in terms of the exposure -- potential exposure here with -- whether it's Medicare channel and on the differential between U.S. and ex U.S. pricing across your key franchises?

Yes. I think this one has less answers than the tariffs one does. This one is still a really developing topic. And so there's -- I just read an article yesterday that was written up that the kind of scenario plan, what could be various different most favored nation types of approaches and what could be the impacts to the industry. I think like anything else, we're scenario planning as well. We just don't have a lot of answers to this particular point. I'd just remind everybody that at least for us today, as we sit here, we have -- by and large the bulk of our business remains commercial in the U.S. So we have a little less exposure to the government-based business in the U.S. Of course, we've operated the same way everybody else has as the way to which the current world works around launching drugs outside of the U.S. as well. And I think you have varying degrees of differences from country to country outside of the U.S. as well. So I think we'll see how this conversation develops, but we feel like we're in a good position as well as it relates to the most favored nation discussion also, but still more to come.

Got it. Perfect. And then obviously, we had the bank panel earlier today talking about M&A in the industry. So Sanofi has been fairly acquisitive over the last couple of months. So can you talk through some of those recent acquisitions, what they add to your business and why they are attractive value-added for Sanofi?

Yes, yes. I think we've been very consistent, I think, in reference to our capital allocation. First and foremost, we always think about how do we invest internally in advancing innovation internally, but we're always going to be looking for external opportunities. And we've been, I think, very consistent about how we will deploy capital for the types of opportunities. So if you just look at -- maybe I'll just speak to the kind of the last 3 that we've done recently. So Dren Bio, obviously. So a B-cell depleting therapy. This could be something that could potentially have the promise of potentially resetting the immune system. You talk about durable effect or disease remission almost, in some cases, is the promise of something like that. In immunology, that's something very exciting. The Vigil deal that we recently did, obviously, with the TREM2, an opportunity there maybe from an Alzheimer's disease. I mean this is an area of neurodegenerative diseases. I mean you talk about 6 million patients potentially today up to 13 million by 2050. I mean this is a growing area that's going to require really innovative therapies, and this makes sense for us from a neurology standpoint. Previous one made sense for us from certainly an immunology standpoint. And then the recent deal with Blueprint, still not a finalized deal yet. So we still have time to try and finalize that deal. But if you look at that one, that was one where much of that fit, who we are as an organization, so much of the rare disease experience that we have of finding patients, getting them appropriately diagnosed. But then the immunology side of things, the call points in a lot of these patients, it's a highly symptomatic disease. And they tend to present themselves, these patients -- the ISM patients tend to present themselves at allergists, dermatologists and gastroenterologists. So for us, it really helps us to accelerate our build for our next-gen immunology portfolio, things like amlitelimab, lunsekimig, our TL1A with duvakitug, brivekimig, each of these assets that would come into the future. So it just helps us accelerate our strategy. So we'll continue to look at capital allocation in that way and be consistent as we can, obviously, with our strategy.

Excellent. So moving on to some of the growth drivers. So obviously, as you mentioned, DUPIXENT, the guidance implies sort of EUR 22 billion peak sales before the patent expiry. So we've recently had the COPD launch. If you can talk us through what are the key metrics you're tracking in COPD. There was a slide in one of the slide decks that showed in asthma GP was resonating well, with pulmonologists as well. So what are you tracking? How is it going versus expectations?

Yes. Again, another good question. I think first point I always like to clarify is that because we've been on this journey before when we had given away point of even DUPIXENT at EUR 10 billion at one point, individuals said, oh, well, you're going to be EUR 10 billion peak. And so I just want to clarify. The guidance that we had given was we believe the drug will grow at a double-digit CAGR rate from kind of that '23 to 2030 time frame [indiscernible] euro drug by 2030, not necessarily our peak sales but by that particular time frame. So we'll continue to update that as we go. But we're 7 indications deep now. And so my comment to your COPD question is we're 7 indications deep now in the U.S. with the most recent approval in CSU, and COPD was the indication before that. And it's kind of funny. We're very fortunate that, that science has continued to read out, and we continue to be able to expand the patient population. But COPD was the one that we launched just before CSU. And that one was one where we already were in the pulmonologist offices, and the pulmonologists had already had a good experience with DUPIXENT in asthma. And so we were already set up nicely, I think, to go into that particular space. Now it's a very different patient population, 65-plus, a sicker patient population, a lot of comorbidities with this patient population. So that's why we had shared we felt like the -- we would see a lot of that growth start to really take off in 2025, and we've been very pleased we've actually seen that happening this year. So we've actually seen that it's delivering exactly as we anticipated. And we -- one of -- the #1 metric we look at is patients on therapy. And so we've actually -- this has been our -- we've -- it's been our fastest indication as far as achieving coverage, both from a Medicare and from a private marketplace standpoint. And it's been our second-fastest indication as far as growth of patients on therapy. So again, it's still relatively early days, but we're very pleased with how COPD is progressing and also the impact that it's had positively on asthma as well.

Yes. Perfect. And how are you thinking about how the biologics COPD market will play out? We mentioned that a number of the competitors are also present in the asthma space as well. So is your base case that this will be a cut and paste for the asthma market? Or are there other sort of factors we need to consider in terms of the way the market shakes out?

I think there's some difference -- there are some similarities and there are some big differences. I think there are some similarities in the thing -- I think that as you go all the way back and you really think about asthma before there were biologics, as the biologics come into the marketplace, they're added on top of background therapies. And so you're looking for efficacy on top of what patients are already on. So that's very similar in COPD. So these COPD patients are the most severe. So kind of like asthma, also similar, GINA 5 patients. We're talking about the GOLD E patients, the really most severe patients. They're on the highest doses of double and triple therapies, and they're still exacerbating. So those are the similarities so far, I think, as far as patient goes. There's exacerbation elements and there's also lung function elements. I think those are all pretty big similarities. The big differences are, if you think about the patient population, asthma patient population skews a little younger. They tend to be a little healthier population in spite of, obviously, their asthma. COPD skews older and they tend to be a bit sicker with more comorbidities. And I think the other big difference is when you see exacerbations really take off in COPD, there's a higher probability that they're going to re-exacerbate and potentially be readmitted into the hospital. So urgency to get these patients treated is probably a little more urgent, even though the patients are a little -- and probably for good reasons, patients are a bit sicker. So that makes a lot of sense. So I think there's similarities and there's differences. I think the marketplace though will be a really meaningful marketplace. It's going to require different mechanisms of action in the future. And the bar to raise as far as improving efficacy over time, there's still a long way to go. DUPIXENT is very effective, but you're reducing exacerbations annually by about 30% to 34% depending on the 2 different trials that we had. And asthma, you're much higher than that today. So I think the future is going to require new mechanisms. We're advancing, as you know, lunsekimig as well, which is an IL-13 TSLP, into that space also. So I think there's lots of room for innovation in COPD.

Perfect. And then you mentioned CSU as well approved in April this year. So what are your expectations for that market? Clearly, there's -- XOLAIR is approved there. There's a lot of competition coming down the road in terms of remibrutinib and a number of other assets that are also in development for CSU. So what are your expectations?

It's the next indication for us. So we're excited about it. I mean it's -- we had articulated the epidemiology of that in the U.S. alone is -- it's relatively similar to COPD as far as patient population goes, as far as size of the patient population, very different disease state because it presents -- the patients present in multiple different physician types, allergists as well as dermatologists. But if you think about it, XOLAIR has really been the only therapy in that particular space for quite some time. So now having another safe and effective therapy in the space, I think, is going to be meaningful for both the dermatology community as well as the allergist community. So we're excited about it. And again, it's our seventh indication now. So it's a big base of business, and it helps us grow on top of that. But I think it will be a meaningful, and already the feedback we've heard from physicians is it's meaningful to have another option now that they really have had very few options for a very long time.

Got it. And then in the initial indication, atopic dermatitis, obviously, still growing. The competition is helping to build out the market as well. But when you look at how competition is launching, we've got NEMLUVIO. We've got lebrikizumab and a number of others in the oral space as well. How concerned are you that the competition is coming? And what are your -- how are you thinking about how that market is going to evolve?

Yes. I think we've publicly said many times before, in a disease state like atopic dermatitis, competition coming in is quite good because awareness of new treatment options -- I mean when you have a bio penetration that's still today around 14% in atopic dermatitis, and we're nearly 8 years in with DUPIXENT, that shows you that there's a lot of opportunity for growth of the marketplace, of more patients being treated with these advanced therapies. So not worried about that. I think it's actually good for the marketplace. And it's good to have other options. I think having new mechanisms of action in a disease state like -- that is as heterogeneous as atopic dermatitis is, is going to be really meaningful. So as we've said before, I think DUPIXENT will continue to grow kind of until its last day, and atopic dermatitis is an area that's going to continue to help with that growth. And then, of course, we've got other assets that things like amlitelimab, which we're really excited about that new mechanism of action that could be meaningful as well in a disease state like atopic dermatitis. So I think new MOAs and new competitors coming into the marketplace is actually good.

Got it. Perfect. I think I'll move on from GP to the hemophilia portfolio as well. And I think ALTUVIIIO has been a very, very strong launch, as we were discussing this morning. So when you think about the market in hemophilia, you have the Factor VIII market and you have the bispecific market sort of broadly how it's shaking out. Within that, Factor VIII market, how much share do you think you can gain?

We haven't really talked about it as far as how much share we think we can actually take. I mean it's -- what we've seen so far is that a big part of that market was really factor driven. I think you and I -- it's funny, you and I were talking about this at one point earlier today. And the marketplace was largely kind of used to the factor marketplace. And we saw that you bring in a differentiated asset like HEMLIBRA that came into the marketplace and really disrupted that marketplace a bit with a convenience story. And they did an incredible job of that. And I think what we did -- what we've seen with ALTUVIIIO is it was really about staying focused on what the patient needs were. And what we -- was crystal clear was patients were looking for a higher degree of protection, a higher level of efficacy, if you will. And when we were able to deliver that even though it was a factor of therapy, in a once-weekly type of dosing, what you've seen is that we've actually taken very meaningful share in the marketplace. Now about 2/3 of our business is actually coming from competitors, as we've said. About 1/3 of it is coming from our own. We had Eloctate that was in the space, and about 10% of that is actually coming from HEMLIBRA. So what we've seen is the switches are coming from both factors as well as HEMLIBRA. And so I think -- we obviously are going to continue to grow. We've actually said that this year, we believe the drug will be a blockbuster, blockbuster plus this year. And in the future, I think primarily, we'll continue to take share from the factor marketplace, which is still relatively big and a bit from HEMLIBRA.

Perfect. And then the recent approval of fitusiran or Qfitlia. Now Paul has previously said this is one of the most underappreciated assets that you have in the portfolio with blockbuster potential. We're only half of that in our model. So how are the launch preparations going? Where could Qfitlia wrong fit in the treatment paradigm? And why am I wrong?

Why are you wrong? No, this one is also exciting because I think if you look at the space, to have -- if you look at, first and foremost, what our label got, we really have probably the broadest label approval in this space, heme A, heme B, with or without inhibitors. And actually, to look at -- you can have as few as 6 doses per year to bring you to -- or to have efficacy for these patient populations. The lowest treatment burden really in the space. And so I think we have -- there's a lot of features to this particular product that I think are going to be really meaningful to both physicians, or we've already heard this actually from the community, both from a physician and a patient standpoint. There are patients out there, and there are physicians out there that really see this as a nice fit. I think first and foremost, we're going to see inroads in the heme B space because this is a space that really lacks that type of option at all. And then, of course, we've already heard positive signs as well in the heme A space as well because it's of the treatment burden side of things. The other thing that I think is really interesting about this one that probably is underappreciated is that it comes with a diagnostic. And as you think about those antithrombin levels, it allows you to really customize the dosing and the treatment for the patient based upon the outcome that they're having in their antithrombin levels. And so it's a little bit more of a precision medicine type of approach per patient. And we're seeing that the physician community so far has really latched onto that. They like that side of things. And so again, it's early days. We said that this would be probably a little bit of a slower ramp because you have the diagnostic piece of it and physicians will have to get used to that side of things. But we definitely think it's going to be a meaningful therapy in both the heme A and heme B space.

Perfect. And then moving to the neuroscience portfolio topic. You mentioned you're currently with the FDA. Some questions we get on this are along the lines of black box warning or the likely black box warning that could come for hepatotoxicity. Now when you think about the launch and you think about Aubagio, which also had a black box warning, and also Lemtrada that you've launched, which again had a REMS program, how concerned are you about that being on the label? Is it a worry at all? Or is it -- you've been here before with other assets?

Well, I think the space, I mean, just as you mentioned -- first, always -- you always think about the community, I think, more than anything else, both patients as well as the physician community, and say, are they used to this? And I think you rattled it off a couple, but there's many more drugs in that space that actually have some sort of monitoring required. So the physician community is used to this. The patient community is used to this. So that's kind of point number one. I think point number two is given the differentiation of something like tolebrutinib, the potential, and we still are under the review process, but the potential to be the first in therapy to treat this kind of secondary progressive patient population, the physicians and the patient community are both excited about that. And so I think you just got to make sure that the outcomes are what you expect. And so for me, from a monitoring standpoint, that's not necessarily a bad thing at all. I think it just is one of the things that you learn in your clinical trial programs that this is something that you're going to need to do to make sure that the patients get the outcome that you're expecting. And so our experience with previous programs allows us to design one that not only delivers against making sure the patient has a great outcome but also one that actually creates the least amount of resistance for physicians to try a new therapy like tolebrutinib.

Perfect. And then -- and how are you thinking about the initial launch? So obviously, there's an element of SPMS being difficult to diagnose. So in terms of increasing that diagnosis and getting awareness out there, and that may suggest a steadier launch. On the other hand are a number of patients out there who already have been diagnosed with SPMS and reliance on other therapies, which haven't necessarily shown a benefit. So is there -- or is it steady ramp? Or is it somewhere in between?

I think that's hard to know at this particular point. I think the way that I've talked about this is that all of the data and where we are even in the review process just further confirms our longer-term ambition for this asset of we've kind of created this class of drugs that will be in that kind of EUR 2 billion to EUR 5 billion range. And that's as we see tolebrutinib, it's squarely in that range, if you will. Now how quickly we get there, I think, is going to be the question is -- all the questions that you're asking is how quickly, I think, can we change the conversation from event driven, like we've talked about before in the past, to more of a disability side of things because this is where you've really seen that. When you really think about the patient population, that is one of their #1 -- no, it is their #1 concern, is the progression of their disability. And for us, this is going to be a really meaningful change in how we believe the HCPs and patients even talk about their disease. So I think with that, that tends to take a little bit more time, but the ambition that we have for the drug overall is stronger than ever.

Got it. And how has KOL feedback evolved on tolebrutinib? If I go back about a year or so, talking to physicians at medical conferences, the BTK assets as a class didn't really -- there wasn't a lot of enthusiasm. And I think largely, obviously, the data in RMS has maybe impacted that. So when you speak to doctors now, when you speak to the prescribing physicians, what are they saying in terms of the profile given that they've seen part of the data?

Yes. Maybe I'll break it into 2 things. What we saw back then when we were having the conversations -- and a lot of our learnings were led by our engagement with the external community. I mean a lot of the physicians were saying they were the ones where we got a lot of the insights, quite frankly, about the patients where they said, patients were coming in and they have clean scans. But they were complaining about, hey, I feel a little less stable than what I once did or I'm more tired than what I once was. And there's a few of these things that they would say, and the physicians really couldn't put their finger on, yes, but you're your scans are clear. So -- and what they believe is there's kind of the -- there's a smoldering inflammation or smoldering MS, if you will. And so what was really funny is that conversation was really led by them and started to take off. And then they were hopeful that you could have a mechanism or mechanisms in the future that could really help around this patient population that they were really struggling with. They were controlled, if you will, on current therapies, but they were still having this progression of disability, if you will. And so it kind of started with that, I would say, more than it did, here's a drug that we think it does this. And then as the data read out, I think, for tolebrutinib, of course, first and foremost, being brain penetrant, being differentiated in that way and then, of course, delivering the results because we have the most comprehensive MS program of any of the BTKs. So I think it was -- the confidence started to then increase of, hey, we might have an asset here that actually could deliver against the problem that we were talking to you about. So we still have a lot of work to do. I think that's the job that we have to do as we get out there and launch it. But I'd say the sentiment is very different than it was 2 years ago. There's much greater excitement.

Perfect. And then thinking into the PBMS side of things. So firstly, obviously, what we've seen across the BTK inhibitor trials is, as you say, disability progression benefits, whereas relapse rates haven't been -- haven't outperformed Aubagio. So to what extent is that a positive read to the PBMS trial, number one? And then number two, Roche's fenebrutinib is going head-to-head versus OCREVUS in their PPMS trial. Does that matter from a commercial point of view? If, for example, we get a year down the line, 2 years down the line, both assets in the market, one has better than OCREVUS and one doesn't, does that matter?

I think it's a couple of things. I think the first thing for us that gave us confidence, and I think to answer your second question that will matter the most, is having the indication in secondary and then primary as well. I think having both of those and starting in secondary and then moving into primary progressive, if, in fact, it's positive in primary progressive. I think being successful in secondary gave us a bit more confidence that it might work in primary progressive. So that was a little bit more of the confidence builder. But I think that also links to what will matter, I think, a bit more in the community and even with payers will be, okay, do you have a secondary and a primary progressive indication because it's obviously broader. And obviously, you continue to prove proof points that you have both a safe and effective drug. I think those are things that really matter. I think it's great that you see other therapies out there, BTKis going out there and generating these other proof points because I think that will be positive for the class actually as well.

Got it. Perfect. We've got about 10 minutes left. I'll move on to the pipeline. Itepekimab data read out recently. Is there any update yet in terms of what's going on in the 2 different trials or 2 trials designed in a similar way? One showed clear benefit as you'd expect with the Phase II results, and -- but the other one didn't. So any updates there? And what's the time line from here in terms of learning more on AERIFY-2?

Yes. I think the second one is -- well, second one is a little harder to answer because I think there's still work to do before we can really speak to kind of what the next -- what the time lines will actually be. I think in the first part, Houman, so our Head of R&D, has been out there. Regeneron, I think, has also spoken about this as well, was -- first immediately was looking at the data and then starting to understand, okay, well, second trial looks a bit interesting even after the 24 weeks because it looked completely normal to 24 weeks and then something strange happened in 24 weeks. And so I think that requires us -- we have a responsibility, I think, across the alliance, both companies, to dig deeper into that and see if we can better understand, is there any hypothesis as to the why because it is -- we have to admit, it's a bit strange. Both companies having a lot of experience in doing clinical trials, both companies really saying that it's kind of the first time we've seen something that's that specifically different. There's already some building hypothesis as to why that may have been. But before we go any further, I think with any type of public disclosures of that, we want to make sure that we have stronger data to support it. And I think the next step from that is, once you have that, is to start to have conversations with the regulatory bodies and say, okay, well, based upon what we believe might have happened, what is -- what could be a path? Is there a path? And what would that require? And I think following those 2 steps, then we would communicate with the external community about what we plan to do. So hard to put a time line on that, to be fair. But just trust and know that we'll be -- both companies will be doing it as quick as humanly possible.

Understood. Amlitelimab is the next one. A few questions on this one. So I think in investors' minds, this has to work in order for the sort of the Sanofi R&D rebuild story to have credibility. But what's the view internally in terms of is amlitelimab a must-have? Or is it, I mean, the sort of portfolio in immunology approach sort of offsets that?

Yes, that's a tough question because if I say we've got a broad portfolio, I might get said, as people might say, oh, you don't care about amlitelimab as much or he said he didn't care about amlitelimab as much. Or if I say, no, no, it really matters, people say, oh, he's really [indiscernible]. So look, I think that we're in a very strong position today where we have so many -- I mean, look at already what we've talked about and we have a lot more to talk about. We're in such a strong position because we have in our hands incredible assets that are growing. We're a growth story. Many of them recently launched. Several of them soon to launch. And then we've got so many readouts that are actually coming. And so I'd say in the grand scheme of things, this is -- yes, it's absolutely -- it's an important readout, but it's part of a broader story. It is not the story. It's part of a broader story. But is it an important readout? Absolutely, it's an important readout for us. If you look at the way in which we've designed it, I mean, I think if you look at this mechanism, first and foremost, we believe the mechanism is a really meaningful mechanism. We believe the ligand approach is the most strategic approach to the OX40 class because you had the best balance of efficacy and safety. And then if you look at the robust development program that we've designed around it, we've given ourselves a whole host of areas to really differentiate this asset in the atopic dermatitis space. So I think we've shown with the steps that we've taken that it's an important asset, but I'd say our story is even broader. It's definitely not a one-asset story.

Got it. And then with COAST 1 recruitment seems to have gone pretty quickly, so should we expect data for atopic derm by the end of the year, number one? And then number two, what are you hoping for in terms of a target product profile? Is it Dupixent-like efficacy but 3 months in the administration? Is that the bar? Or does it have to be better in terms of efficacy from where you're looking to position it in the market?

Yes. So a couple of things. So we've said H2 for the updates. Of course, it's recruited well. So we'll, of course, update the community as soon as we have the data. But H2 is what we've communicated. So I always take a step back as it relates to -- when I get this question because I get this question a lot. I would take a step back and basically say, you first have to think about the therapeutic areas. So if you think about atopic dermatitis, it's an incredibly heterogenous disease state. Today, it still really lacks very differentiated mechanisms of action. Of course, DUPIXENT has been extremely successful, and we've said this before. It will continue to grow into its last day, and it will continue to grow in atopic dermatitis. And every time a new entrant comes into atopic dermatitis, the market grows, much like what we saw in psoriasis. So I think this is going to be no different. As this new mechanism of action comes into the marketplace, you're going to see the market grow. So what do I have to see? I think, number one, I'm expecting to see a new mechanism of action that has a scientific rationale for why it could be important in atopic dermatitis. And because we believe OX40-Ligand is a broader target than even the current targets on the market, if you will, from a biologics standpoint. It's broader than the IL-13s alone. It's broader than Dupixent, and it's broader than the IL-31. Not as broad as the JAK, of course, but it's broader than the current biologics. So it has a strong scientific rationale on why it might work across a broader patient population or a broad patient population. So new mechanism of actions, strong scientific rationale as to why it might work. And then you need to look for areas of differentiation. So it's got to be safe, got to be effective. And then from an efficacy standpoint, there are areas there that you can really dial that up a little bit. So meaningful durable efficacy up to 3 months, that would be really meaningful in the space. Combination efficacy in combination with topical therapies, even working in patients that are inadequate responders to previous advanced therapies, so JAKs or previous biologics, and we've got all of these in our trial. So we've developed a way in which it should deliver a profile that could be very meaningful into the atopic dermatitis space.

Got it. Perfect. I just wanted to also touch on duvakitug, TL1A. You've seen some encouraging data in both UC and Crohn's, but you're a little bit behind the other companies looking to develop this asset. So how are you thinking about the sort of commercial opportunity here? And is there any sort of analogs, any other areas where you've seen this sort of situation before where you have a sort of third-to-market asset but has potentially better efficacy? What would you sort of point to as an analog there?

It's a little harder with analog. I have to think about that. But maybe I'll tell you the way in which we've thought about this because we looked at this class for a little while. We thought that this class is going to be really an interesting class of the TL1A target, if you will. And what we've seen, as you've seen obviously in our data in really early stages of it, is you could be really looking at best in -- certainly best-in-class cross-trial comparison now but best-in-class type of efficacy but maybe even best disease type of efficacy. I mean this is early data, but first and foremost, across Crohn's and UC, these are 2 meaningful places we wanted to land at first because we thought that was really important. Now as it relates to the opportunity there, I mean, if you think about the disease state of UC quite specifically, this is an area where you see extreme amounts of switching because these patients actually reach a durable effect, and then the effect starts to wane. And so we're also looking at actually could you have -- it looks like you could have a bit more of a durable effect actually with the TL1A class. So first and foremost, I think those anchor indications before we moved on to what might be next, we wanted to make sure we landed a differentiated profile there. And we're working with our partners, Teva, to make sure that we do that now. And then the thinking is we're working across the alliance there with Teva to think about where else could you take this asset. So stay tuned for where we're committing to there. But I'm not so concerned about being a little later as long as you can deliver a differentiated profile, which we think we can.

Perfect. We've got about a minute left. So one of the key debate really for Sanofi is potentially EUR 22 billion that you need to offset from the pipeline to sort of promote growth on into the longer term. Only really EUR 12 billion of that in terms of -- or half of that is the profitability you need to replace. So in a minute, how -- what is your sort of viewpoint at the moment in terms of the building blocks to replace that? And is the goal EUR 12 billion or EUR 22 billion in terms of sales you want to replace?

Only a minute for that question.

A bit of a half one, sorry.

No. I mean we've been thinking about this for a long time. And so I think the answer to your question -- the short answer to the question is it's going to have to be -- we've been thinking about replacing the whole even though you only have to replace half. So we've been thinking about how do you replace the whole. And it's going to have to be a multifactorial approach. It's not a 1-drug or a 2-drug or a 1-indication or 2-indication type of approach. It is doing exactly what we're doing, right? You stack up really innovative assets across the entire immunology portfolio. Some of them are going to be in similar indications. Some of them are going to be in completely new indications. Some of them are going to be alliance products like itepekimab. Some are going to be non-alliance products. Some of them might be in heme A and heme B, as we've just talked about actually as well. So -- and certainly, in neurology. So some of the recent deals that we've even done with Vigil or Dren Bio, these are the types of things that we're thinking about that actually could help us in the future really offset the pending LOA of Dupixent, which is not until after the end of the decade, as we know. So it's a holistic approach to it, and it's -- and we've been thinking about it for quite some time.

Perfect. Brian, thank you for your time, and thank you for traveling down to Miami to speak with us.

Thank you so much. Appreciate it. Thanks.