2024-06-10 Eli Lilly and Company (LLY) Goldman Sachs 45th Annual Global Healthcare Conference

Eli Lilly and Company (NYSE:LLY) Goldman Sachs 45th Annual Global Healthcare Conference June 10, 2024 4:00 PM ET

Eli Lilly and Company (NYSE: LLY) 高盛第 45 届全球医疗保健大会 2024 年 6 月 10 日下午 4:00 ET

Company Participants 公司参与者

Patrik Jonsson - Executive Vice President, President of Lilly Diabetes and Obesity and Lilly USA

帕特里克·约翰森 - 执行副总裁，莉莉糖尿病和肥胖事业部总裁，莉莉美国公司总裁

Conference Call Participants

电话会议参与者

Chris Shibutani - Goldman Sachs

克里斯·渋谷 - 高盛

Chris Shibutani 克里斯·渋谷

Okay, let's get underway here for the Lilly session. One of the most and highly anticipated and we're so appreciative of the entire Lilly team that's here. Lauren Zierki from Investor Relations is always a stalwart and manages so much with the schedule here. My name is Chris Shibutani, I'm a member of the Goldman Sachs Healthcare Research Team that cover the large pharmaceuticals. Super pleased to have Patrick Jonsson here with us.

好的，让我们开始莉莉公司的会议。这是最受期待的之一，我们非常感谢在场的整个莉莉团队。投资者关系部门的 Lauren Zierki 一直是坚定不移的，管理着这里的许多事务。我的名字是 Chris Shibutani，我是高盛医疗保健研究团队的成员，负责覆盖大型制药公司。非常高兴有 Patrick Jonsson 与我们在一起。

Question-and-Answer Session

问答环节

Q - Chris Shibutani Q - 克里斯·渋谷谷

Patrick, 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, et cetera, who are you?

帕特里克，也许稍微少了一点 - 在这次谈话之后，他将成为一个家喻户晓的名字，糖尿病和肥胖业务的负责人，非常重要的是美国制药方面的总裁，首先告诉我们一些关于你自己的事情，这样我们就可以确保我们有正确的视角来仔细解释每一个眼睑跳动、每个词、每个细微差别、形容词等等，你是谁？

Patrik Jonsson 帕特里克·约翰森

Thank you very much, Chris. Swed by origin having served Eli Lilly and Company for more than three decades. Most of my time spent outside the US, led our business in Scandinavia, Italy, Eastern Europe, and prior to coming to the US, our Japan business, which is the second-biggest affiliate in the world for us outside the US. Having been here for the last five 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.

非常感谢，克里斯。瑞典人，曾在礼来公司工作超过三十年。大部分时间在美国以外度过，领导我们在斯堪的纳维亚、意大利、东欧的业务，以及在来美国之前，领导我们在日本的业务，这是我们在美国以外的第二大分支机构。在过去的五年里，我领导了我们的生物医学业务，我们的免疫学业务，以及自去年底以来，我们的糖尿病和肥胖业务，以及在过去的 3.5 年里领导了礼来美国业务，这就是关于我的简短介绍。

Chris Shibutani 克里斯·渋谷

Excellent. It's a unique opportunity. I think so much of the science risk is still evolving, but has kind of -- we've come to a clear inflection point, obviously, and we're thinking about commercialization. We've got to make the donuts 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 is having tremendous bench depth. People are well-trained. They stay through the organization. They filter through. So what do you task yourself with delivering?

很好。这是一个独特的机会。我认为科学风险仍在不断发展，但已经有了明显的拐点，显然，我们正在考虑商业化。我们必须制造甜甜圈，有很多问题需要解决。在您担任这一角色时，您认为自己在近期和中期最重要的一系列目标是什么？去年秋天，您基本上被安排在这个热座位上，对吗？我一直认为 Lilly 的管理团队具有巨大的替补深度。人们接受良好培训。他们留在组织中。他们通过筛选。那么，您给自己设定了什么任务？

A - Patrik Jonsson

Well, 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 it 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 six months ago. So that's just the start and we have started in the U.S. and a few selected markets outside of U.S. that is really the top priority.

嗯，我认为首先，这是一个非常令人兴奋的时刻，我认为我们现在手中的牌可能是尽可能好的。所以对我来说，首要任务是确保我们继续为 2 型糖尿病患者成功推出 Mounjaro。我们仅在六个月前推出了用于肥胖慢性体重管理的 Zepbound。这只是一个开始，我们已经在美国和美国以外的一些选择市场开始了，这确实是最重要的事情。

But beyond that, I think when we look at the pipeline, we have two really exciting medicines in Phase 3, Orforglipron, which is an oral GLP-1RA, and we have also, Retatrutide, which is adding the pharmacology of glucagon. So I think those are both in Phase 3, super exciting and I think that really brings a lot of promise for the future.

但除此之外，我认为当我们看到管道时，我们有两种非常令人兴奋的药物处于第 3 阶段，Orforglipron，这是一种口服 GLP-1RA，我们还有 Retatrutide，它添加了胰高血糖素的药理作用。所以我认为这两种药物都处于第 3 阶段，非常令人兴奋，我认为这确实为未来带来了很多希望。

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 3 with lepodisiran for Lp(a). So I launched the assets we currently have in the market, just evolving the launch readiness for our current Phase 3 assets and then securing that the early-stage pipeline is progressing and meeting current unmet medical needs.

最后，与我的发展和研究同事合作，确保我们拥有一波真正创新的药物。我们在今年早些时候宣布，我们正在与 lepodisiran 进入第 3 阶段，用于 Lp(a)。因此，我推出了我们目前在市场上拥有的资产，不断发展我们目前第 3 阶段资产的推出准备工作，然后确保早期阶段的管道正在进展并满足当前未满足的医疗需求。

Chris Shibutani 克里斯·渋谷

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?

所以这里有很多任务要做。我们现在正处于这个关键时刻，特别是对于股票，人们正在密切关注你是否能生产出产品。需求显然非常大，很难估量，我们可能需要就此展开一场完全独立的辩论。供应一直是这里的限制因素。一年前，我和首席财务官 Anat 坐在这里，她已经踏上了一些令人兴奋的冒险，我认为大家对于将有另一位杰出人士接任这个职位充满信心，但这是一个机遇之窗，因为她总是非常准确地用她的措辞来说明会发生什么，你在制造供应方面的表现如何以满足这种需求？

Maybe give us a sense to reaffirm or not some element of timelines, because I think there was 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.

也许给我们一些时间线的要素来确认或否定一些元素，因为我认为已经提出了指导意见，但一些一般交付指导并没有改变。所以感觉好像尾巴已经过去了，那么头部会继续向前移动吗？只是谈谈供应动态。

Patrik Jonsson 帕特里克·约翰森

Very happy to, Chris. First, if you look at the demand we are facing now, it's unprecedented. We have a huge, huge unmet medical need when it comes to obesity. We are estimating 110 million people in the US suffering from obesity, 650 million outside the US. 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 two weeks ago, that we are increasing the investments in our new facility in Lebanon in North Indiana to above $9 billion.

非常高兴，克里斯。首先，如果您看一下我们目前面临的需求，这是前所未有的。在肥胖问题上，我们面临着巨大的医疗需求缺口。我们估计美国有 1.1 亿人患有肥胖症，在美国以外有 6.5 亿人。因此，我认为仅仅依靠注射剂，我们和竞争对手的综合能力是很难满足的。话虽如此，我们正在全力扩大制造能力。自 2020 年以来，我们宣布单单在制造方面的投资超过 180 亿美元。我们正在同时建设多个工厂。就在两周前，我们刚刚宣布，我们将增加对我们在印第安纳州北部黎巴嫩的新工厂的投资，超过 90 亿美元。

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 two 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.

我们去年在北卡罗来纳州的研究三角地区的第一个工厂开始生产。我们预计第二个工厂将于今年年底开始生产，并在 2025 年初投放市场供应。我们大约两个月前在德国的阿尔策动工，为那里的另一个设施，我们去年宣布在爱尔兰的利默里克设立一个工厂，就在几周前，我们还宣布收购了威斯康星州的一个新工厂，该工厂将于 2025 年年底开始生产。

And on top of that, we have also enhanced our current manufacturing site to make sure that we can increase supply. So I think all of that combined, I think, installed both Anat and all of us in the Executive Committee, we have a lot of confidence when it comes to the outlook for 2024.

除此之外，我们还加强了目前的制造基地，以确保我们能够增加供应。因此，我认为所有这些结合在一起，我认为，安娜特和我们所有人在执行委员会中，对 2024 年的前景有很大的信心。

We raised guidance and we also made a commitment to at least increase the amount of saleable products with at least 1.5 times the amount of saleable products in 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.

我们提高了指导，并承诺至少增加可销售产品的数量，至少为 2023 年下半年可销售产品数量的 1.5 倍。我认为我们已经看到了一些好的迹象。就在上周，我们让 FDA 将 Zepbound 和 Mounjaro 的 5 毫克和 12.5 毫克从短缺清单中移除。因此，我认为我们看到了隧道尽头的曙光。话虽如此，我认为现实的情况是，需求持续超过供应的时候会有，但我们也在更好地监控市场需求模式，以确保我们可以保护目前正在接受治疗的患者。

Chris Shibutani 克里斯·渋谷

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, things get 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 elsewhere, but then the vocabulary change to salable doses. What's the salable dose just so that we're all level-set on what the denominator is because there could be a couple of salable doses in a single one of these clever pans, right?

语言使用上有一点变化。一年前，他们谈论的是产能，作为一个治疗学专业人士，当我们考虑到生产设施的面积和所有这些时，事情变得非常模糊，它们肯定不是无用之物，它们将成为世界上从未见过的加工生产设施，但后来词汇变成了可销售剂量。什么是可销售剂量，这样我们就都明白分母是什么了，因为在这些聪明的平底锅中可能有几个可销售剂量，对吧？

Patrik Jonsson 帕特里克·约翰森

Yeah. 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 2022, we said, okay, we are going to double our production capacity in 2023 and we did that. But we got a lot of question, okay, what does it mean with increasing capacity? What does it really mean in terms of supply?

是的。首先，这一举措在很大程度上是基于投资者和其他利益相关者的反馈，我们使用了产能语言，因为我们在 2022 年底做出了承诺，我们说，好的，我们将在 2023 年将我们的生产能力翻倍，我们做到了。但是我们收到了很多问题，好的，增加产能意味着什么？从供应方面来说，这到底意味着什么？

And I think we realized that capacity -- production lags capacity and we move to the language of salable doses, and that takes into account our salable doses of incretins, it takes into account our salable doses of the IRMA, the auto-injector that we mainly supply in the U.S. and the KwikPen outside of U.S. as well.

我认为我们意识到产能——生产滞后于产能，我们转向可销售剂量的语言，这考虑了我们的可销售的肠促素剂量，考虑了我们的可销售的 IRMA 剂量，我们主要在美国供应的自动注射器，以及在美国以外供应的 KwikPen。

Chris Shibutani 克里斯·渋谷

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, in particular 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 is 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 over complicated, but coverage and then where you're seeing that going beyond the private commercial insurance and then also out-of-pocket pay.

因此，我认为其中一个关键辩论是关于市场规模，单位乘以价格，我们已经稍微谈到了交付组件上的单位，让我们稍微谈一下定价和市场的动态，以及市场作为净收入维度的情况。让我们稍微了解一下我们正在看到的净定价动态，特别是对于已经在糖尿病领域推出了替瑞普肽分子的 Zepbound。就这个阶段而言，我们真的只是在推出的第二个完整季度，我认为人们渴望更加确定我们何时能够看到这些数字，但这涉及到价格方面的许多计算。也许这就是背景，我可能把它搞得太复杂了，但覆盖范围以及您看到的私人商业保险以及个人支付之外的情况。

Patrik Jonsson 帕特里克·约翰森

Yeah. 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% four 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.

是的。如果我们看看我们今天所处的位置，我认为我们在获取方面取得了巨大进展，并且我们在第一季度收益电话会议上宣布，截至 4 月 1 日，我们已经有 67%的商业获取。我从未经历过在上市后四个月就达到接近 70%的商业获取水平。所以我认为我们在这方面非常满意。我们将继续取得进展，并且我们将像我们为 Mounjaro 所做的那样以非常有纪律的方式进行。

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 opting but it's estimated to be around 50% today. And we are assuming that whenever employees have opted in, to competitive products, by default, Zepbound will be listed as well.

但这是抗肥胖药物的第二个组成部分。因此，仅仅与 PBMs 获得商业准入是不够的。我们还需要让雇主选择加入，这在员工选择方面并不是一个可靠的来源，但据估计今天大约有 50%。我们假设每当员工选择了竞争产品时，默认情况下，Zepbound 也会被列入。

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 benefits of covering the anti-obesity medications, so I need to better understand, okay, what are the benefits here of protecting for comorbidities, reducing other medications, seeing a low-level of absentees, and we see a trend in that favor among employees as well.

所以我认为在雇主选择方面，这将增加，我认为我们也收到了员工非常积极的反馈，他们也希望报销抗肥胖药物。但我认为可以合理地假设雇主选择不仅仅是像 PBM 覆盖那样的逐步增加。这将是一个随着时间逐渐增加的过程，特别是对于雇主来说，我认为重要的是分享覆盖抗肥胖药物的净成本收益，所以我需要更好地了解，好的，这里保护合并症、减少其他药物、减少缺勤率的好处是什么，我们也看到员工中这种趋势的偏好。

The third piece would be Medicare, and Medicare today doesn't reimburse anti-obesity medications, but two paths. One path is TROA, the Treat and Reduce Obesity Act, and that has been reintroduced this year 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 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.

第三个部分将是医疗保险，而当今的医疗保险并不报销抗肥胖药物，但有两种途径。一种途径是 TROA，即治疗和减少肥胖法案，今年以跨党派支持重新提出。因此，我认为从我们的角度来看，问题不在于 TROA 是否会获批准，而在于何时以及在何种程度上。我们还看到联邦雇员现在也有一些积极的动向。医疗保险中的第二部分实际上是通过结果指标。CMS 在四月份宣布，他们将通过竞争产品塞马鲁胰肽二次预防心血管疾病，并且我们也将其视为在医疗保险中获得我们的阻塞性睡眠呼吸暂停指标报销的重要信心，无论何时它获得批准。

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 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.

因此，我想说，在商业领域有很多积极的动向，雇主选择加入，以及在医疗保险和医疗补助方面也有进展。就净定价本身而言，无论是哪个疾病领域，净定价都会随着时间的推移而下降。我认为我们仍处于泽普邦（Zepbound）推出的早期阶段，正如您所提到的第二个完整季度，我们目前正在美国以外的市场推出快捷笔（KwikPen）。因此，我认为随着增加的获取，净价格随时间会下降是现实的。这只是应用的常见公式。

Chris Shibutani 克里斯·渋谷

Yeah, 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?

是的，这在某种程度上是道路规则。我们当然在其他治疗类别中看到了这一点，比如免疫学，在那里扩大适应症喜欢说这是产品内的一个管道，但随着您获得心血管益处、OSA 等标签扩展，我们预计会看到扩大适应症集也会增加对净定价的压力，这是您在说什么吗？

Patrik Jonsson 帕特里克·约翰森

I think particularly, the outcome indications will help granting Medicare patients access to anti-obesity medications. I think we have said publicly, when you look at anti-obesity medications, I think you should expect a 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.

我认为特别是，结果指标将有助于让医疗保险患者获得使用抗肥胖药物的机会。我认为我们已经公开表示，当您考虑抗肥胖药物时，您应该预期在未来几年内会出现价格上涨的情况，这与您通常看到的平均投资组合相符，即低至中等个位数，但我认为这可能是我在定价方面能提供的最详细信息了。

Chris Shibutani 克里斯·渋谷

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?

从哲学角度来看，当口服药物出现时，我们将稍微谈一下管道产品 orforglipron，就数据而言，这是迄今为止的黄金标准，但当口服药物出现时，我认为人们立即产生了一种广泛的感觉，即可供性可能会民主化，当然也许不像制造那么棘手，因此供应可能不再是速率限制的一部分，那么口服药物的定价呢？

Patrik Jonsson 帕特里克·约翰森

I share your excitement on orforglipron. I think it's a super interesting to have an oral formulation that actually has demonstrated in Phase 2 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, we have 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 the US, you need a good oral medicine to really reach all of those patients.

我对 orforglipron 感到兴奋。我认为拥有口服制剂是非常有趣的，实际上已经在 2 期临床试验中展示了类似最佳 GLP（糖肽样肽-1）药物 semaglutide 的减重效果，虽然不及 tirzepatide，但与 semaglutide 相当。显然，我们没有食物或饮水限制。因此，我认为这主要是一个扩大规模的机会。你还记得我在美国提到的患者数量，以及美国以外的患者数量，你需要一种良好的口服药物才能真正覆盖所有这些患者。

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 readout the orfo data Phase 3 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.

谈论 orfo 的定价为时尚早。这是一种小分子，但在不太复杂和复杂小分子的范围内，这可能处于更复杂小分子的范围内，但我们自 2018 年以来一直在进行这种制造，所以我认为当我们在明年读取 orfo 数据第 3 阶段并且假设它看起来像我们预期的那样好时，我认为我们的制造同事已经准备好在全球范围内供应 orfo。

Chris Shibutani 克里斯·渋谷

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

但是回到我问题的最初前提，口服治疗的定价，您认为与注射剂相比如何？假设我们有可比的，但也许不像替瑞普肽那样蓝筹股的反应

Patrik Jonsson 帕特里克·约翰森

Chris, I would probably not dig more into the pricing question. Yes, I think it's a good second try. But I think for many factors playing in as well as the overall market dynamics, so I think very some work to do in that space and I look forward to sharing much more when we get closer to launch.

克里斯，我可能不会再深入探讨定价问题。是的，我认为这是一个不错的第二次尝试。但我认为有许多因素在起作用，以及整体市场动态，所以我认为在这个领域还有很多工作要做，我期待在我们接近发布时分享更多信息。

Chris Shibutani 克里斯·渋谷

Okay, very good, Joe, Lauren, good training. Excellent work. One of the aspects that we're seeing is maybe a little bit of out-of-pocket thing, not just in the US, 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?

好的，非常好，乔，劳伦，训练得很好。出色的工作。我们看到的一个方面可能是一点点的自费，不仅仅在美国，在国际上也是如此，我的感觉是这可能比我们想象的要多一点，最近它在哪里，保持稳定状态，是吗？

Patrik Jonsson 帕特里克·约翰森

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 for that. First and foremost, Mounjaro, we have more or 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 for list price, but based upon how the regulations are defined, there is unfortunately no other options of 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 of Type 2 diabetes.

是的，你说得对。我们看到更多的自费支出，即为 Zepbound 支付全价，而不像我们为 Mounjaro 所见的那样。这可能有很好的原因。首先，Mounjaro，我们有更多或更少的全面访问。因此，Mounjaro 有全面的覆盖，非常接近，而且正如我们之前讨论的那样，对于 Zepbound，访问是良好的，但还没有达到 100%。其次，我们在 Medicare 中也有一个庞大的患者群体，实际上将不得不支付全价，但根据规定的定义，不幸的是，没有其他选择。因此，当我们查看 Q1 数据时，因为那是我们目前唯一拥有的数据，我会说，在美国，有中等个位数的患者自费支付全价，与 Mounjaro 2 型糖尿病的低个位数相比。

Outside the US, 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.

在美国以外，我认为我们将看到不同类型的市场。我们正准备在欧洲市场推出产品，在那里我们经常谈论单一支付方案进行报销。所以我还不确定在欧洲会有多少自费支出。但另一方面，像巴西这样的市场是一个巨大的自费市场，我们已经看到例如 Saxenda。

So I think we would expect to see similar pattern for our anti-obesity medications as has been seen with the competition and maybe with an even a higher willingness to pay taking into account the data, the amount of weight loss, and some other benefits of tirzepatide versus the competitive products.

因此，我认为我们预计我们的抗肥胖药物会出现类似的模式，就像竞争对手所看到的那样，甚至可能会更愿意支付，考虑到数据、体重减轻的数量以及 Tirzepatide 相对竞争产品的一些其他好处。

Chris Shibutani 克里斯·渋谷

To ask another question about the Medicare-related, we've certainly seen a very effective strategy, and certainly, when the outcomes study SELECT for semaglutide readout 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, but particularly at the payers, how picky are they being?

关于与医疗保险相关的另一个问题，我们确实看到了一种非常有效的策略，当 semaglutide 的结果研究 SELECT 呈现积极时，我们确实看到了两家主要公司的股票受益。FDA 将具体更新 Wegovy 的标签，您在付款方的实际接口上看到了什么？他们是否愿意像我们看到的那样进行跨产品研究？我想象中，在客户和临床医生中可能会更广泛地认识到这不仅仅是针对 semaglutide，而是特别针对付款方，他们有多挑剔？

Patrik Jonsson 帕特里克·约翰森

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 CVOT 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 mobility-mortality outcome trial in obesity reading out most likely in '27, that's also event-driven in both primary and secondary prevention.

我们非常高兴看到 SELECT 试验的结果，并且我认为这正是我们预期的。随着体重减轻，我们预计会看到心脏代谢益处。我认为在不同的利益相关者之间，他们至少期望看到与替瑞普肽相同甚至更多的效果，我们预计将在 2025 年公布糖尿病的 CVOT 结果研究。这是一个事件驱动的试验。很难给出具体的时间，我们还有一个关于肥胖的运动死亡结果试验，最有可能在 2027 年公布，这也是一个既有初级又有次级预防的事件驱动试验。

So I think those benefits are expected to be seen with 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 for 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 that is reading out later on this year and later on for the mobility-mortality outcome data as well.

因此，我认为这些好处预计在替瑞普肽中也会得到体现，考虑到替瑞普肽和塞麦格列汀的体重减轻显著更高，但可能也有更高的期望。但最重要的一点是 CMS 宣布他们将覆盖医疗保险中的结果指标。因此，我认为这为医疗保险人群获得抗肥胖药物提供了机会，我们期望在我们批准阻塞性睡眠呼吸暂停时也会有类似情况。我们期望今年晚些时候公布的心力衰竭指标以及后续的活动能力-死亡率结果数据也会有类似情况。

Chris Shibutani 克里斯·渋谷

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?

市场规模，单位乘以价格，X、Y、Z 轴是使用持续时间，就肥胖症患者在这些疗法上将会停留多长时间，您们目前的看法是什么？

Patrik Jonsson 帕特里克·约翰森

In obesity, it's harder to say because we launched six 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 first-hand. 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.

在肥胖症中，很难说因为我们是六个月前推出的，即使看竞争对手，我认为他们也遇到了与我们类似的供应挑战，所以很难查看可靠的依从数据。我们从患者那里听到的是他们强烈希望继续治疗。我认为与许多其他慢性药物相比，在这里你首先亲身体验到好处。因此，如果您是肥胖症患者或患有肥胖症，突然体重减轻了 20％、21％、22％，那真的是改变生活。

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.

我认为迄今为止我们看到的所有数据都证实，对于绝大多数患者来说，他们需要继续接受治疗，因为肥胖是一种慢性疾病。因此，我们预计肥胖的治疗将需要相对较长的时间。它不会是有限的，但我们预计会比通常看到的时间更长。请记住，对于其他慢性疾病，如心力衰竭，一旦超过 12 个月的依从性，就被认为是良好的。这对结果不利，但这是现实。因此，我们预见在这里使用 Zepbound 会有更长的治疗持续时间。

Chris Shibutani 克里斯·渋谷

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 to 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 be less?

我认为，莉莉作为一个公司已经评论说，糖尿病适应症中的 GLP-1 类药物在历史上的使用持续时间大致稳定在 15 个月左右，您是否期望看到类似的情况，或者我们只是在更好地使用这些药物，患者更有动力，因此可能会使用更长时间，或者是有其他原因导致使用时间更短？

Patrik Jonsson 帕特里克·约翰森

I -- yes, we saw 15 months 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 have seen 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.

是的，我们在 2 型糖尿病患者中看到了 15 个月至 18 个月的情况，这是正确的。我实际上认为我们需要更高的目标，我认为在患者层面存在一个机制，因为如果您停止治疗，您已经看到了将 BMI 降至 27 或 28 或其他数值的好处，我们在研究中看到，当一些人——设计时您可以继续使用替雷帕肽药物或服用安慰剂。

If you went on placebo, after treatment, you increased your weight with 15% quite rapidly, while if you continued tirzepatide treatment, you had a continued decline in this study of 7%. If you have experienced the 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 an aim for significantly higher adherence for the sake of patient outcome.

如果您服用安慰剂，在治疗后，您的体重会迅速增加 15％，而如果您继续使用替瑞巴肽治疗，您在这项研究中的体重会持续下降 7％。如果您已经体验到好处，然后迅速恢复，我认为患者会迅速尝试重新接受治疗。我认为这里存在教育需求，我们和竞争对手需要带头确保患者不会断断续续地接受治疗，因为我们不知道这对身体构成的影响，但我认为我们应该期望为了患者的结果而努力实现更高的依从性。

Chris Shibutani 克里斯·渋谷

Let's talk a little about selling. There is 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?

让我们稍微谈谈销售。现在战略的一部分是一项努力，LillyDirect。请为我们稍微量化一下，然后告诉我们第三方支付者在帮助我们提高销售并弄清楚季度数字方面做得有多好 - 第三方数据聚合者的工作如何？

Patrik Jonsson 帕特里克·约翰森

Yeah, 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 folks in the US 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.

是的，LillyDirect 实际上是我们大约一年前提出的一个想法，我们意识到无论患病领域如何，对患者来说都是非常繁琐的旅程。所以我们问自己，我们能做些什么来减少美国患者的摩擦？这就是 LillyDirect 的诞生原因。我们在今年一月初推出了它。它从未被视为公司的新收入来源，而只是确保患者旅程变得更好的一种方式。它并不是为了打破当前的生态系统，而只是为了提供更好的消费者体验。

One of the benefits of LillyDirect is that all of the co-pay assistance programs, et cetera, will by default be applied. So that's nothing that the patient has to be concerned about. It has been live now for almost two quarters. I think we are very pleased with how it has been received in the marketplace. If you look at the total TRx, the 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.

LillyDirect 的一个好处是所有的共付援助计划等都会默认应用。因此，患者无需担心这些。它现在已经上线将近两个季度了。我认为我们对市场上对它的接受程度感到非常满意。如果你看一下总 TRx，到目前为止通过 LillyDirect 的处方总数，在 TRx 方面，它并不高，到目前为止可能只有个位数。

But in terms of new prescriptions, it's increasing. So I think LillyDirect is gaining a popularity, and 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 time and other services for patients.

但就新处方而言，它正在增加。因此，我认为 LillyDirect 正在变得受欢迎，虽然还不完美，但我们正在努力改进，增加更多合作伙伴，随着时间的推移，我们很可能会添加其他疾病领域和药物，以及为患者提供更多服务。

In terms of how well third parties are capturing this, I don't think IQVIA is tracking it in the weekly datasets, 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 our estimate and where we are, but a great start. And most importantly, the consumer experience is better than in the current normal system.

就第三方机构如何捕捉这一点而言，我认为 IQVIA 没有在每周数据集中追踪，但我理解他们已经制定了公式，我认为他们非常接近现实。因此，当我们看到我们认为是我们的估计和我们所在位置时，我认为差距并不大，这是一个很好的开始。最重要的是，消费者体验比当前正常系统更好。

Chris Shibutani 克里斯·渋谷

Let's dig into pipeline here. Body composition, it's part of the ecosystem to debate about muscle sparing, muscle loss, et cetera, you have an asset, bimagrumab, through the Versanis acquisition, Phase 2 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.

让我们深入研究这里的管道。身体组成，这是生态系统中讨论肌肉保留、肌肉流失等问题的一部分，您拥有一项资产，即通过 Versanis 收购获得的 bimagrumab，第 2 阶段主要完成，年中，告诉我们是否会听到任何消息，以及您对拥有关注身体组成概念的产品的一般想法。

Patrik Jonsson 帕特里克·约翰森

Yes, you're right. We acquired Versanis and that was a Phase 2 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 with both medicines.

是的，你说得对。我们收购了 Versanis，这是一个第 2 阶段研究的开始，但我们并没有设计。你说得对，在主要完成方面，它宣布将在今年年中。我认为你不应该期望我们基于主要完成发布任何东西，有几个原因。首先，我们不认为这项研究对 Lilly 来说是重要的。这是 semaglutide 与 bimagrumab 的静脉竞争产品。如果我们继续进行，我们将结合皮下注射使用这两种药物。

Secondly, even if a primary completion is mid this year, there is a 24-week extension of this study as well. And after the 24-week extension, there is a 32-week 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 will probably be the time at the latest, we would share something.

其次，即使今年中期完成初步研究，该研究还将延长 24 周。在这 24 周延长之后，还将有 32 周的撤回延长。因此，我想说的是，你不一定会看到我们发布数据。如果我们看到了我们期望看到的结果，我们很可能会继续进行与替瑞帕肽的联合研究，那可能是我们最迟分享信息的时间点。

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 GIP/GLP, that will be a piece of thin 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.

肌肉质量的流失，我们知道无论您如何减肥，无论是通过肥胖手术、饮食或者是类似 GIP/GLP 的药物，都会伴随着一定比例的肌肉流失。我认为通常将这个比例定义为 25%至 40%的流失是肌肉流失。这一直以来都是已知的。然而，在治疗后，脂肪和肌肉的比例实际上是在改善的，所以我认为这一点很重要。

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 2 with the primary completion this summer.

对我们来说，可能只是能够根据不同的患者群体量身定制治疗方案，我们特别考虑的是老年人群，肌肉流失可能更为负面，或者是患有肌少肥胖症的人群，这些基本上是我们目前考虑的患者群体。但我认为当我们在今年夏天看到第 2 阶段的完整结果时，我们会得到更多信息。

Chris Shibutani 克里斯·渋谷

Yes, and 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, what I mentioned, the potential democratization, safety, 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 orfoglipron.

是的，这几乎让我想知道终点是什么，无论是疗效测量还是不良事件方面，你可以从理论上以很多不同的方式来看待它。让我们攻击另一个我们之前提到的管道方面，或福格利普隆，从口服方面来看，在这里，我认为人们感到相当自信，并表达对这里降低风险水平的信心，因为我们知道口服药物，我提到的潜在民主化，安全性，安全性和安全性，非常重要，而且似乎你们已经具备了开始考虑扩大生产规模的信心所需的最低限度，甚至超越你们目前的临床水平，所以让我们对福格利普隆感到舒适。

Patrik Jonsson 帕特里克·约翰森

I think anything is entirely derisked [Technical Difficulty] that's the reality of the business we are in [Technical Difficulty] Phase 2, we felt very confident progressing into Phase 3. We have an independent safety monitor group [Technical Difficulty] that looks at the data on a regular basis [Technical Difficulty]. There have been no signals. But of course, at the end of the day, we need to wait the full readout of the Phase 3, but based upon everything we have seen so far, we have a high degree of confidence in orfoglipron, and it's from a different backbone compared to the fighter compound. So I think that's important to have in mind as well. But we will see the full readout in 2025 of all the orfoglipron Phase 3 trials with a time when it's entirely de-risked.

我认为任何事情都是完全降低风险的[技术困难]这就是我们所处业务的现实[技术困难]第 2 阶段，我们非常有信心进入第 3 阶段。我们有一个独立的安全监控组[技术困难]定期查看数据。没有任何信号。但当然，最终，我们需要等待第 3 阶段的完整结果，但基于我们迄今所见的一切，我们对 orfoglipron 有很高的信心，它与战斗化合物相比来自不同的骨干。所以我认为这也很重要。但我们将在 2025 年看到 orfoglipron 第 3 阶段试验的完整结果，那时它将完全降低风险。

[Technical Difficulty] 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 with orfoglipron versus both, Farxiga and Rybelsus. So I think it's going to be a very comprehensive package that we are reading out next year.

[技术困难]嗯，这是第一个--第一个将于 2025 年 4 月推出，全面的结果将在 2025 年底之前完成，其中包括头对头试验。因此，我们将在 2 型糖尿病中进行奥福格利普隆与法西加和瑞贝勒斯的头对头比较。因此，我认为我们明年将公布的内容将是非常全面的。

Chris Shibutani 克里斯·渋谷

Okay. Let's go [Technical Difficulty] which often gets thrown into a conversation in the same paragraph and we're starting talking about the adjacency that is the 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?

好的。让我们继续讨论在同一段落中经常被提及的[技术困难]，我们开始谈论的是与肝脏并发症相关的邻近性，NASH/MASH，当我们考虑到机械性益处时，带领我们了解 GGG 目前的进展，以及您认为它将走向何方？

Patrik Jonsson 帕特里克·约翰森

Yes, GGG, I think what excites us here is the addition of a glucagon pharmacology, and what we saw in Phase 2 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 is 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.

是的，GGG，我认为让我们兴奋的是葡萄糖素药理的添加，我们在 2 期研究中看到的是它在提瑞帕肽的基础上带来了增量益处。首先，是体重减轻的幅度。当我们非常接近你在胃肠手术中看到的水平时，我们谈论的是体重减轻 25％，26％，但不仅仅是体重减轻的幅度，还有体重减轻的一致性。因为我们看到的是雷他曲肽实际上有大约 100％的患者对雷他曲肽做出了反应，并展示了至少 5％的体重减轻。所以我认为反应的一致性也是一个非常重要的因素。

And on top of that, you have the lowering of lipids, you have the lowering of liver fat, and you have the hypertension piece -- 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 readout until 2026, but it's just around the corner time [Technical Difficulty] conducting basket trial with [Technical Difficulty] as we 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.

而且，您还有降低脂质、降低肝脂肪以及降低高血压的部分——血压部分，因此心脏代谢保护增加，可能还有一些肾脏方面的好处。因此，我们对 retatrutide 也感到非常兴奋。它要到 2026 年才能公布结果，但我们正在进行篮子试验，以[Technical Difficulty]作为锚定指标，但我们也在研究骨关节炎和阻塞性睡眠呼吸暂停，并且我们还启动了一项关于 retatrutide 的结果研究，并同时研究 2 型糖尿病。因此，这可能是我们如何真正提高肥胖治疗水平，超越革命性变革。

Chris Shibutani 克里斯·渋谷

The bar has been raised, the bar is [Technical Difficulty] 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 two 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.

这个标准已经提高了，标准是[技术困难]让我们谈谈额外的机制，当然，如果市场是任何指标，市值已经被赋予了数据缺失的兴奋，只是围绕我们目前看到的事物表达热情情绪。所以让我们谈谈两种机制，这些机制已经引起投资者的热情。其中之一将是 Amylin，谈谈你在那里的看法。我们将密切关注您的表情。

Patrik Jonsson 帕特里克·约翰森

Yeah. We have two assets in that space. The first one is a long-acting Amylin receptor agonist, Elora, and we have already started Phase 2 studies with Elora, and thus we are considering Elora 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 starting 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 weight loss in the Type 2 diabetes population with Amylin than we have seen with, for example, tirzepatide.

是的。我们在这个领域有两个资产。第一个是长效 Amylin 受体激动剂 Elora，我们已经开始了 Elora 的 2 期研究，因此我们正在考虑 Elora 或 Amylin 用于联合配方。我们已经对所有的肽类进行了工程处理，以便与 tirzepatide 或 retatrutide 进行潜在的联合配方，但我们也开始了单药治疗。我认为 Amylin 让我们兴奋的几个方面。第一个是你可能会在 2 型糖尿病人群中看到比我们看到的例如 tirzepatide 更多的体重减轻。

And the second one could be on the gastrointestinal side effects side. So those are two areas that we are quite interested in. And besides Elora, we have another one, DACRA, which is a dual amylin calcitonin receptor agonist, and that one is for us also exciting, but we haven't started Phase 2 of that one yet, but we see it as an opportunity for optionality in that space, and -- but there is DACRA now in Phase 3 development, but we are probably more excited about Elora than the DACRA and for the time being at least.

第二个可能是关于胃肠道副作用方面的。所以这两个领域是我们非常感兴趣的。除了 Elora 之外，我们还有另一个叫做 DACRA 的药物，它是一种双淀粉样钙化素受体激动剂，对我们来说也很令人兴奋，但我们还没有开始该药物的第二阶段，但我们认为这是一个在这个领域有选择性的机会，但是 DACRA 目前正在进行第三阶段的开发，但我们可能对 Elora 比 DACRA 更感兴奋，至少目前是这样。

Chris Shibutani 克里斯·渋谷

Then the other mechanism would be GIP to agonize or antagonize what say though.

另一个机制可能是胰高血糖素（GIP）对所说的进行激动或拮抗。

Patrik Jonsson 帕特里克·约翰森

GIP agonist more antagonist, well, I think that debate has been quite heated over the last two months. We feel very confident that the GIP agonist is working and we have done a small Phase 1 study on a pure GIP agonist on our own and we saw the effect that we expected. We have also long-acting GIP that has been demonstrating weight loss as well as decline of fasting glucose. I think those are really strong evidence for GIP agonists. I think there is probably more to demonstrate in terms of GIP antagonists.

GIP 激动剂更拮抗剂，嗯，我认为在过去的两个月里，这场辩论已经非常激烈了。我们非常有信心 GIP 激动剂正在发挥作用，我们已经自行进行了一项小规模的纯 GIP 激动剂的第 1 期研究，看到了我们预期的效果。我们还有长效 GIP，已经显示出减重以及空腹血糖下降的效果。我认为这些都是 GIP 激动剂非常有力的证据。我认为在 GIP 拮抗剂方面可能还有更多需要证明的地方。

And I think those are data and answers that I think many are looking to, okay, what does GIP antagonists actually do in terms of long-term cardiovascular safety, bone, cardiometabolic health overall, as well as insulin sensitivity, HBA1c, so I think a lot of questions to be answered in terms of GIP antagonists while I think GIP agonists has been quite well demonstrated to induce both weight loss and reducing fasting glucose levels.

我认为这些数据和答案是许多人正在寻找的，好的，关于 GIP 拮抗剂在长期心血管安全性、骨骼、心脏代谢健康以及胰岛素敏感性、HBA1c 方面实际上起到了什么作用，所以我认为在 GIP 拮抗剂方面有很多问题需要回答，而我认为 GIP 激动剂已经被很好地证明可以引起体重减轻和降低空腹血糖水平。

Chris Shibutani 克里斯·渋谷

I liked 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 this sport. So one other adjacency here, I was kind of hoping with this 4 o'clock fireside chat that we 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 end of vote, but obviously, all 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 DMAB and then [Indiscernible], hey, we have GLP-1s, isn't that going to solve for Alzheimer's?

我喜欢你用“已经相当激烈”这个表达，因为你的团队一直都是火焰喷射的一部分，但这也是我们热爱这项运动的原因之一。所以在这里还有一个相邻的问题，我有点希望在这次下午 4 点的篝火聊天中，我们可以与 AdCom 同步，然后当你的团队试图浏览投票结果时，我会把你手中的手机打掉，但显然，所有的戏剧已经上演完毕，所以祝贺 Lilly 团队。但这实际上设定了一个潜在的兄弟姐妹竞争，因为我们有 DMAB 和[不可辨识]，嘿，我们有 GLP-1，这难道不会解决阿尔茨海默病吗？

Patrik Jonsson 帕特里克·约翰森

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 there, particularly vascular health, we believe that's going to have an impact on the cognitive decline because it will reduce, for example, the number of strokes, and we know that strokes will accelerate the decline of cognitive functions, so that's our current hypothesis. But of course, we are closely [Technical Difficulty] everything that is going on also in the Alzheimer's space.

我们知道其他人已经开始在阿尔茨海默病中使用 GLP 进行试验。如果它有效，我们并不一定认为它会对疾病本身产生影响。我们相信它会对潜在疾病条件产生影响，比如肥胖和 2 型糖尿病。如果你能改善那里的结果，特别是血管健康，我们相信这将对认知衰退产生影响，因为它将减少，例如，中风的次数，我们知道中风会加速认知功能的衰退，所以这是我们目前的假设。当然，我们也密切关注阿尔茨海默病领域中正在发生的一切。

Chris Shibutani 克里斯·渋谷

The unmet need is…

未满足的需求是..

Patrik Jonsson 帕特里克·约翰森

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 who are suffering from Alzheimer's disease, and I think that's hopefully quite nearby right now.

我对今天有关多那莫的广告委员会的结果感到更加兴奋，因此我认为我们非常期待与 FDA 密切合作，最终让患有阿尔茨海默病的患者获得多那莫，我认为这一切希望很快就会实现。

Chris Shibutani 克里斯·渋谷

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

绝对满足了一些最重要的未满足需求。因此，感谢 Lilly 加入我们，感谢 Patrick 表现得很好。希望明年再见。

Patrik Jonsson 帕特里克·约翰森

Thank you very much, Chris.

非常感谢你，克里斯。

Chris Shibutani 克里斯·渋谷

Thank you. 谢谢。

Patrik Jonsson 帕特里克·约翰森

Thank you. 谢谢。

2024-06-10 Eli Lilly and Company (LLY) Goldman Sachs 45th Annual Global Healthcare Conference

2024-06-10 Eli Lilly and Company (LLY) Goldman Sachs 45th Annual Global Healthcare Conference

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