It gives me great pleasure to spend time, and all of us to spend time, with Julie Brown, CFO of GSK today. I have got a few prepared questions we are going to go through, and then we are going to open up to the floor for questions. Or if you would prefer to submit your questions via the Pigeonhole, I can look at those via the iPad. Without further ado, Julie, thank you ever so much. The first question, I was going to just talk about the new CEO. Could you just talk a little bit about the changes Luke is making to speed up and improve the quality of investment decisions at the company?
Yeah, sure. Good morning, everybody. Nice to see you. Yeah. Luke has become the CEO from the beginning of the year, and he was an internal candidate, so he knows GSK well. He has worked with GSK for a long time. What he did from the very beginning was, his focus was really on three priorities. The first one was all about accelerating R&D. The second one was to fuel the launches, a nd the third one was simplification. What he has done in those early stages is he set up a group that was called the Strategic Portfolio Review Group, and they met every two weeks with the people who run the programs. So effectively de-layered by going directly to the people who were running the program, and looked at how we could accelerate the major assets or the prioritized assets within R&D.
At the same time, we also set up another group, which was looking at how we could simplify the way we run the business, how we could use technology and AI to simplify the business. The benefit then of the two coming together was we said we want to accelerate R&D, we want to fund the launches, but we do not want to change the operating profit profile of the company. So we needed to find the funding through the second group's work running in parallel with the first group around accelerating R&D and those assets. And the benefit has been, and we announced a major change program just recently at the end of July. So we were targeting almost GBP 2 billion of savings, GBP 1.9 billion of savings, the majority could then be reinvested in the pipeline.
It means that we have got 20 phase III starts this year from 10. We started off at 10, and we have now got 20 phase III starts, across seven assets and around 18 indications. So this is really showing that GSK is changing into a more asset-rich company. The other point was we decided to allow part of those savings to drop through to the margin, in the period when we lose HIV dolutegravir patent protection, which is 2028- 2030. So we have now said during that period, the margin will be stable to improving. So net-net, there has been a big change program running in the first six months together with, of course, not to mention the biggest deal we have done for quite a long time, which was the Nuvalent deal, which was a $10 billion deal, just over a $10 billion deal. Yeah. So it has been a busy six months since he started.
Actually, sticking with that phrase of the company keeping busy, could you just share a few thoughts on the long-term improvements with regards to R&D that GSK expects to be driven by moving a lot of the U.K.-based R&D to Cambridge, U.K., to the bio campus?
Yes. So we decided to move. For those of you that do not know, we are currently in Stevenage, and we have been in Stevenage for quite a long period. We took the decision to move to Cambridge, essentially because you have a total biotech ecosystem in Cambridge. You have access to some of the most prominent hospitals in the U.K., like Addenbrooke's, and you have over 400 biotech organizations built out of there, together with, obviously, the university. So it creates this ecosystem that our scientists can then work in so that we will have new labs, new state-of-the-art facilities to really motivate those scientists to do their best work.
They will be interacting all the time with either the hospital or university all on the doorstep, which we believe will make a difference and really energize the organization. Similarly, we work very closely with academic centers in the U.S., and the benefit is you can shorten the period from research into translational medicine into the clinic, and that is the whole ethos of what has driven the change. Yeah.
Just expanding a little bit on those relationships with East Coast institutions. So it is your sense that hopefully the ability to forge those academic relationships on the East Coast of the U.S. will get stronger with the move to Cambridge as well?
Yes, absolutely. Both in the U.K., in the U.S., but also very importantly, increasingly, we've built additional capability in terms of BD to access BD opportunities in China. I would say these are the key focal points, U.K., Cambridge, East Coast of the U.S., together with some biotechs in California. You've seen us do deals with those. And very importantly, also China. We've done very significant deals there with two major companies, Hengrui in respiratory and Hansoh in oncology. That deal scouting capability and those relationships and proximity mean you can get quicker from research into commercial.
I'm just going to switch to HIV for a minute as well. Could we just talk a little bit about the advantages that GSK sees with shifting to the longer-acting therapies and away from the tablets, and what that might mean for share shifts in U.S. HIV mid to long term?
Yes, of course. With regard to HIV, we have got a very strong franchise with dolutegravir. We've been pursuing long-acting therapies for the simple reason that patients prefer longer-acting therapies in HIV. It means that instead of having a daily oral tablet that reminds them that they've got HIV every day, and they stand the risk of viral breakthrough if they forget a tablet, and then they can pass HIV onto somebody else. The benefit is with a long-acting injectable, is that they are protected for the course of the duration of that injection. At the moment, we've got two months on the market, which means the person's got to have an injection six times a year. So we've got two months on the market, and we are the leader in terms of HIV treatment for long-acting injectables.
It's probably important to say that an integrase inhibitor is at the core of this, and we're the only company with integrase inhibitor at the core of HIV long-acting therapies. Now, to Justin's point, we are moving increasingly from once every two months to once every four months. That is a big transformation because it means the person goes in three times a year, usually coincides with their testing for sexually transmitted diseases, so it fits with that. We're anticipating having the final readout of that in 2027 and the launch in 2028. So that's basically three times a year. Then the next stage is to move to basically lasting for six months, long-acting injectables for six months, which is twice a year. So that's a big step forward. Treatment is the most value opportunity, and it's 90% of the market in HIV, so it's a large component.
This is where we are in the leadership in terms of when we will bring those products to launch. To the point about the patient, when we have done a study, we did a SOLAR study. 90% of patients prefer long-acting injectables to orals. It is because of this lack of stigma. It is no need for a reminder to take their medication, and it is the assurance of protection. From the physician point of view, we did a study called LATITUDE, which was again comparing daily orals with long-acting injectables. Again, the data monitoring committee stopped it early because the data was so compelling that people were more protected with long-acting injectables. This is the big change that is going on now and will continue to go on as we launch longer-acting therapies in HIV.
That is super great. Could we just talk a little bit about that 2031 patent expiry for that long-acting HIV molecule and why GSK does not see that as a material headwind?
Yeah. CABENUVA. If I step back, the treatment solution will always be a combination of two products. With regard to the product we have got on the market for treatment, you have got a combination of CABENUVA and rilpivirine. That means you have got the treatment, you have got the integrase and the capsid. Putting the two together. In terms of the patent estate, CABENUVA is a single asset. The new chemical entity patent expires in 2031, which is what Justin is referring to. There is the prospect as you put combination products together, CABENUVA with rilpivirine or the next generation of assets, the patent estate will go for longer.
We have got applications with the patent office to take us to 2035, beyond that, 2040s. We are not concerned about the patent situation because we have got all these applications pending. The newer assets, which is the six-monthly treatment, would be VH-184, VH-499. That patent estate would be brand new. This is why as we convert the business and we are leaders in treatment, this is where you feel assured about the future of HIV.
Brilliant. Thank you.
Yeah.
So switching onto oncology, you kindly mentioned Nuvalent a few moments ago, but could you just delve a little bit more into the rationale for that transaction and the impact and, in terms of other niches where GSK is confident it could win in oncology, and why?
Yes, of course. We did a lot of work on the Nuvalent acquisition, as you can imagine. It was a big deal for GSK, and we had studied it for a long time. For those of you that are not so familiar with it's a precision oncology company. Rather than being a single asset, which a lot of our deals have been single assets, this actually brings with it two major assets, very late-phase assets who are late phase III, together with a phase I. What Nuvalent did, being a precision oncology company-
Right.
...is they were looking for opportunities in non-small cell lung cancer, which is one of the largest cancer markets, to be able to make changes so that therapies that were efficacious but had tolerability issues, they could amend the product so that it could address that tolerability problem. This is essentially what we did, what we were looking for. The first one was neladalkib, which has actually got its PDUFA date already in November this year, so very soon. The other product was zidesamtinib. This is ALK and ROS1 treatment for non-small cell lung cancer. This has also been approved early by the U.S. FDA. The PDUFA date was actually in two months, but it was approved in July, so it's come early. So now we're in the process of launching zidesamtinib, and neladalkib comes in just a few months.
Both of these assets are tackling the genes that cause tumor replication, but they are doing so in an efficacious way, but with far less side effects. Some of the competitor products have some limited use because of the side effects, the side effect profile. When you think about the patient in this case, in non-small cell lung cancer with ALK and ROS1, they are typically quite young. They are 40- 50 years old, typically women, non-smokers. This is a big innovation, and we are excited about the launch and then the next stage, which is the neladalkib product that is coming shortly.
Super.
Yeah.
Are there other niches within oncology you would talk to where blood cancer possibly where GSK also thinks it can generate outsized returns as well?
Yes, no question. There are a few products to pull out in this regard. We have got BLENREP, which is already on the market, for multiple myeloma. Again, BLENREP had fantastic data behind it. It can be used in the community, which is 70% of the U.S. market. But the data is basically it halves the risk of death, and it triples progression-free survival. So there is this astounding data in an oncology field. The second two to draw your attention to would be the two ADCs, antibody-drug conjugates. We have got B7-H4, which is for gynecological indications, endometrial as well as ovarian. Then we have also got B7-H3, which will first go into two major tumor types, small cell lung cancer and also prostate.
But the beauty of B7-H3 is it is actually a pipeline within a product, and the opportunity to take this into multiple tumor types gives a very significant commercial opportunity. Then the final one just to draw to your attention is velzatinib, and this one is basically for gastrointestinal stromal tumors. There we see this as a second-line opportunity with first-line trials ongoing. So coming into, again, a market. This is one of our features. We will look for opportunities where the market is not satisfied, either through efficacy or tolerability. This is another example of that.
Great. Thank you.
I am going to change gears to vaccines, if that is okay.
Yes, of course.
Could we talk a little bit about SHINGRIX potential, both U.S. and ex-U.S. lifecycle management for coming in?
Sure. SHINGRIX, for those of you that don't know, I'm not sure, in terms of the audience, but SHINGRIX is a great asset. It's a vaccine, obviously, for shingles. It's got an astounding amount of data behind it and exposure to a huge number of patients already, people already, I should say, because it's a vaccine. The data for SHINGRIX was phenomenal in terms of almost an 80% efficacy rate. The longevity was 6-11 years, majority 11-8 years. So once you have SHINGRIX, it protects you for that period of time. The U.S. is obviously the major market. The U.S., it's all about the level of penetration that you can achieve, how many people in the U.S. population are vaccinated.
The good news is we've been growing that penetration level, and we're now up to around 45% penetration of people in the U.S., and we're now into the category of harder to reach. So we're anticipating getting an additional 2-4 percentage points of penetration in the U.S. market each year is where we're tracking at the moment. The second part of the world is obviously, you've got Europe International, and part of that is China. With regard to the rest of world markets, the top 12 markets in the rest of the world, the penetration level is still low, is still 12%. You compare that where we are in the U.S., there's a big difference. So it just shows the opportunity to penetrate more. Our European growth of SHINGRIX, as you probably saw from Q1 and Q2, has been very strong.
It's been way into the double digits, and we've had very good success in the private market and the public market in a number of Scandinavian countries in the first half of this year. So we're penetrating further and further when it comes to the opportunity for SHINGRIX. The final major market, of course, China. Again, we had phenomenal efficacy data in the Chinese population with 100% efficacy of the SHINGRIX vaccine, and we're working with a partner, Zhifei. It's private pay in China, so depending on the situation of the Chinese economy depends on the rollout. So we're working with Zhifei, who's a phenomenal partner. Just responding to the macro situation that we find in China at the moment. Net, SHINGRIX, we've guided more than a GBP 4 billion asset. I think in the first quarter it was around already a GBP 1 billion.
So it's doing incredibly well. I should answer the second part of your question, which was MACE and dementia. So what we found through observational studies is that, and we believe it may be the adjuvant component of SHINGRIX, that it potentially reduces the degree of inflammation people experience when they get shingles. That means there's a potential benefit in terms of cardiovascular events, together with dementia. So what we've decided to do is to do studies in terms of dementia, but then we're running, we've initiated a major trial for MACE.
This is one of the assets we decided to accelerate for cardiovascular events, for SHINGRIX, where we're doing trials now that should lead, if successful, to an extension of the FDA label. Which could be very compelling, because through the observational work we have seen, we have seen the potential for between 30% and 40% reduction in the risk of events such as cardiovascular events. This is a major, this is one of the targeted areas that we came up with as part of the work that we referred to at the beginning.
Sure. Brilliant, thank you.
Yeah.
Just going back to the U.S. for a minute, in terms of what seems to be a bit still of an anti-vax environment that we have.
Yeah.
If you would agree, and just any thoughts you might have about how that potentially becomes a tailwind mid to long term?
Yes. This is a very topical question. Unfortunately, what we find is that if vaccination levels drop because of public policy or sometimes commentary, unfortunately, the rate of illness increases because people are more susceptible to the disease, whatever that might be. We have seen that with MMR vaccinations, and we saw sad situations happening with measles and young children dying as a consequence. Not only is it better for people, but it is also better for the healthcare system because the U.S. spend around GBP 9 billion a year on vaccine-preventable diseases, and around 80% of that is adults that could have been protected from the disease that they then got that cost them and the healthcare system a lot of money. What we find is when, as I mentioned, when it drops, it then comes back again because people need it.
Actually parents, our MMR business was really, really strong at the beginning of the year because people were worried about measles incidents. Net-net, what we do believe is this will go in cycles. We believe it will come back at some point. We continue to invest in vaccines. We have just taken mRNA for flu, which is obviously going to compete with high dose, into the market, into the clinic. We are behind it, we will stay behind it, and we expect the commentary and the rhetoric to start to change-
Thank you.
...based on scientific evidence.
Yeah. Got it.
Yeah.
I'm going to change tack to lung diseases now or respiratory. Could you talk a little bit about Exdensur that you've just launched and the competitive differentiation that that product has?
Yes, absolutely. Exdensur, which we used to call depemokimab.
Yeah.
Exdensur's the brand name, and this is a big innovation. The reason, it's an IL-5, it's in the IL-5 category. We've already got a product on the market for an IL-5 for respiratory disorders, which is NUCALA. The big benefit of Exdensur is the dosing. Instead of having medication once a month or, in some cases, once every two weeks or once every two months, Exdensur runs for, it's one injection once every six months. So it's very compelling because for somebody who's suffering from asthma, they can basically have two injections a year and be protected from exacerbations. Now you may say, "Why is that so important?" The reason it's important is because, each exacerbation injures the lung function. So you want to avoid, for the patient point of view, you want to avoid the exacerbation. The other thing is, exacerbations can frequently lead to hospitalization.
And again, that is cost for the patient, cost for the healthcare system. Exdensur has very strong data. So there is a 72% reduction in exacerbations that result in hospitalization. That is a phenomenal piece of data and extremely competitive. The other opportunity with Exdensur is there are very few people on biologics in asthma, in serious asthma. There is only 1/3 , about 30% of people are actually taking biologics, which means there is a golden opportunity to encourage those people to go. So the bio-naive market opportunity is significant. We call bio-naive. So net-net, I think this is a golden opportunity because people also, the 30% that do have biologics, there is quite a high dropout rate. We think that is because they feel protected, they feel safe, then they stop taking the monthly therapy, then they exacerbate, which then does exactly what I said.
So the longer you can keep the therapy, the better, and this is six months. We launched it earlier in the year. We got the approval in December last year in the U.S. We have got approval now across a range of countries. The key with the U.S. market, especially for a six-month therapy, is you need the J-code, because it takes away the risk for the physician of holding six-monthly treatments without being sure of reimbursement. The J-code gives access to reimbursement. That came in just a couple of months ago. So this next Q3 results, Q4 results, Q1 the following year, will give a much better line of sight in terms of how this is performing.
Super. Thank you. I am going to change tack to liver diseases, if that is okay. Could you just spend a few minutes explaining why the company is confident that in what seems to be a very high unmet need market the company will be able to lead there?
Yes, I think in terms of liver diseases, there are a number of assets to pull through. bepirovirsen is probably the first one to call out. bepirovirsen just recently had one key opinion leader called it totally transformational data to be able to support the launch. The product called bepirovirsen has now got fast track designation or SENKU in Japan, fast track designation in the majority of major countries across the world. That is because of the power of this data. People with hepatitis B, go on, if not treated, to develop liver disease. In China in particular, it is a major issue because there is a lot of stigma associated with hepatitis B. They have regular testing similar to the way HIV is seen in the West. It is a major issue.
The data we got was basically that, and this is revolutionary, 19% of patients, bepirovirsen offers a functional cure for hepatitis B. It means they take six months of therapy, and then they are effectively cured, which is groundbreaking, because otherwise they will be taking daily tablets which are not tolerable. Then we found an additional percentage of patients also have a benefit from reduced surface antigen, which means there is less chance of going on to develop cirrhosis or liver cancer. This is a major innovation. Around 50% of people have a chance to either be functionally cured, which means they do not need to take therapy thereafter, or they can have surface antigens reduced, which has a medical benefit. This is a major, I cannot stress how important, a major innovation. Like I say, we have now just got approval just over the last few weeks in Japan.
Sure.
In terms of commercial potential, for those who are interested in the financials, there are essentially three markets that will make up three quarters of the business, and that is the U.S., China, because of the incidence level, and Japan are the major three markets. Coming behind that, we have got products for sclerotic liver disease, earlier in development, but again, products that we are accelerating efavirenz, etc . We are accelerating them considerably as part of this program so that we can bring them to the market earlier. Yeah.
Brilliant. Thank you. Can we just circle back to margins a little bit more?
Yes.
Could you possibly just expand on the moving parts we need to think about going through those HIV tablet patent expiries 2028- 2029 and 2028- 2030, and the mitigating factors and the reinvestment and the GBP 1.9 billion would be very helpful.
Yes, of course. When I first joined GSK, I went out and did investor listening sessions, and people quite often fed back that they were concerned about the dolutegravir patent expiry. There was uncertainty at that point as to when it was actually going to have an impact, and we clarified that it would be between 2028 and 2030, with the majority impact between 2029 and 2030, which is when the U.S. patents go. As you know, we are protecting the dolutegravir business ourselves by introducing long-acting HIV injectables with longer patent estate, as we talked about with Justin. So that's all underway. In addition, we are pivoting our business more and more to specialty, which brings with it margin benefits because the SG&A associated with specialty products is so much lower than it would be if you were dealing with other parts of the range.
Net net, what we see is that we will be able to hold the margin stable through the dolutegravir period, which is 2028- 2030. And we made that commitment about three years ago, and we're holding that commitment, and we're confident of being able to do it. Now, what we decided to do with the change program that we announced at the end of July, which is a GBP 1.9 billion savings program, we decided the majority will go towards investing in those assets, like 20 phase III starts, seven major assets, 18 indications. We will invest in that. But an element of it, we will also drop through to the margin in that period of 2028- 2030. And that means our margin through that period will now be stable to improving. People have asked me why is it stable to improving?
Because depending on how the pipeline's performing, it will determine whether we put more priority towards investment. But it will be at least stable, and we have the option, or choice, to have it as improving. So that's sort of given people, I think, a reassurance through that period, and I'm pleased to say that consensus expectations over that period have now risen-
Sure.
...as a consequence from where they were before.
Brilliant.
Yeah.
I'm going to ask last one of my questions, and thank you very much. We've now got five questions in the pigeonhole, so thank you for that, and we can have more. Last one from me before going to the pigeonhole would be on M&A. Could you just share some thoughts about, it's been a very busy period for the company, your ability to sustain the rate of activity which sort of started in 2022. Then just a few thoughts on how, as an organization with M&A, you guard against sort of biting off more than you can chew.
Yeah. It's a very good question. I think R&D pipelines increasingly are built through very good sourcing of internal and external. You've got to have both. You've definitely got to have both. Therefore, we've got very strong teams scouting for the right opportunities in different parts of the world, as we talked about U.S., Europe, certainly the U.S., and very much now China. Increasingly in China. To Justin's point about we've done a lot this year. We've done with 35 pharma, we've unwraped these two deals were around GBP 1 billion- GBP 2 billion. Then we also did Nuvalent, which was a GBP 10.5 billion deal, but it was GBP 7 billion net, because they had cash in sterling. It took our leverage level to just less than 2x net debt to EBITDA, so it was a fairly significant deal.
We are very committed to a strong investment-grade balance sheet. We will maintain a strong investment-grade balance sheet because we want our investors' money to stay totally safe. You can see that what we've done recently is we funded ourselves to do the acceleration of R&D and bring in these assets, in fact. We committed as part of the Nuvalent deal, that it is immediately sales accretive because the assets are launching now. It is operating profit accretive next year. It is EPS accretive in 2029.
So you can see that we are generating income cash ourselves to be able to offset the headwinds associated with doing this. Net-net, I am very comfortable we won't bite off more than we can chew. We hold that balance sheet dear to our hearts, as well as looking for the best assets, as well as exercising capital discipline inside our organization to generate savings to fund what we are doing. Yeah, you can feel assured about that.
Brilliant. Thank you. I am going to go to the questions from the audience now.
Okay.
If that is okay. First one is very high level. It is sort of your view on what stock markets are probably getting wrong about the company. Any thoughts you might have there?
Yeah. That's a great question.
Yeah.
Yeah.
Start with the easy one.
Yeah. I think in pharmaceuticals I spent most of my life in pharmaceuticals. I had six years in a consumer goods product, but most of my life in pharmaceuticals. It takes a while in pharma. Things don't happen overnight. Cycles in industries vary hugely. And in our industry, you have to prove that things have changed. And you prove it only with two ways, really. You prove it with data readouts, usually phase III data readouts. And you prove it with commercial execution once the product is on the market. And that is really the way. But that takes a long time because when lead times, cycle times are long. And I think, obviously, GSK was a conglomerate. It had a consumer healthcare business. It only became a pure-play biopharmaceutical business in 2022, so not that long, as you mentioned.
It just means that we have got to prove to the market that we have changed and that we're different. And we're doing it. Because if we take consensus, I know some of the buy side models are different and they're higher, but the consensus models for our sales by 2031, we guided more than GBP 40 billion, and we guided a margin stable. Consensus earlier on, the sales were GBP 33 billion, GBP 7 billion adrift, and the margin was down to 25%. So GBP 5 billion significantly adrift. And what we've been able to do over time, I think, through data readouts. You don't win everything.
No.
Everything in this industry, if you are doing better than 60% in phase III probability of success, it is pretty good results.
Yes.
We have had a lot more than that. If you can prove these points as time goes on, then the market starts to believe in the matter. Consensus has now moved. We have not got all the figures in, but the consensus has now moved from what was around GBP 33 billion up to around GBP 37 billion. Either close to or on GBP 37 billion . The margin consensus we were just talking about this earlier, Justin. Our margin through that dolutegravir period has now moved to around 30%, 31%. It is a big change from where we were. We have just got to prove it. We recognize that. We have got to get the data readouts. We have got to get bepirovirsen on the market. We have got to get the commercial success of these assets. That is what will prove the day.
Super.
Yeah.
Thank you. I have got one on HIV now. How confident is GSK in switch rates from tablet dolutegravir-based therapies to long-acting with regards to cushioning the revenue losses, and how dependent is that vision on the launch of the twice-yearly injection?
Yes. It is a very good question. We are very encouraged by what is happening already with the switch from oral to long-acting. The SOLAR data, 90% of patients are preferring it, which is phenomenal. We have now already, even though we are only on the market a number of years with APRETUDE and CABENUVA, which are the long-acting. You take it six times a year. It lasts for two months. We have now got over 30% of our business in the U.S. is already transferred to long-acting injectables, which shows when you are only dosing people three times a year and twice a year, this is going to be a major breakthrough for them because that, again, will be very supportive. The point about dependence on the six-monthly or twice a year b ecause we own treatment and we are taking patients from two months to four months to six months. We own it.
Yeah.
We own treatment. There is a big competitor out there that has moved into prevention. They have got a six-month prevention way forward. They have not got treatment yet. This gives us the advantage. This is why we are confident that we will navigate the dolutegravir patent expiry.
Brilliant. Thank you.
Yeah.
Another one on HIV. Thank you. Are there any concerns over availability of nearby clinics to administer the HIV injections in the U.S.?
This is a great question.
Not mine.
It's a great question. Whoever came up with this one, it's a great question. This has been a constraint. It's undoubtedly a constraint. There would be more throughput of injections if clinics had more capacity in the U.S. They have been building capacity, and we've engaged in training and nurse support for the training, etc. , to enable there to be a higher level of throughput. The benefit is, in moving from every two months to every four months, basically you can deliver twice the amount of therapy. Obviously six months you can increase it further again. But even just focusing on going to four months, where we're expecting the launch for treatment to be 2028 and for prevention for 2027, you're already doubling the capacity in the United States. Which again, is a big factor supporting the commercial strength through that period.
Sure.
Yeah.
Okay.
Yeah. You're in the hands of-
Yeah.
...healthcare providers, and we can't change that. We just have to try and influence the benefits of the therapy. Yeah.
Thank you. A follow-on question would then be, could you talk about the margin structure for HIV long-acting injectables versus HIV tablets?
Yes. The margin structures in HIV are healthy. They are very healthy. It is a very profitable business. It is a very specialized cell as well, so the SG&A component is relatively low. The gross margin, obviously oral's gross margins are very healthy. You have then got the move, and we have already made the move to CABENUVA and cabotegravir and rilpivirine, the combination. The rilpivirine component of that comes from Janssen, and therefore you have got a pay-away that is going to Janssen. So there is some pressure on the gross margin from the CABENUVA-rilpivirine combination. The longer-term solution, which is the six months, this is where the combination of the two assets, it is basically an integrase inhibitor, 184, and it is a capsid 499, and they are both GSK assets. This is where the margin structure improves again.
Okay.
So yeah, it will vary.
Sure.
There is nothing simple-
No.
...about explaining anything in HIV, but it will vary as we go through these different cycles of products. The most important message is we can assure you of profitability through a loss of exclusivity of the franchise, and that we have next-generation assets coming through the pipeline. We lead in 90% of the market, which is treatment.
Good. Thank you.
An oncology one now, if that is okay. Certainly, when I chatted to Nina at the CMD, she talked about, I think even now, that returns on R&D in oncology are one of the highest in the company, if not the highest, despite the scale of the company there. Could you talk a little bit about how sustainable that would be going forwards? Would all of these pipeline products coming through in oncology, would that allow oncology to still remain, from an R&D return perspective, the leading segment within the company?
Yes. Oncology returns, obviously we have been in an investment phase in oncology for quite a number of years now, since we did the Tesaro deal, essentially. We have been very much in an investment phase. The beauty of oncology is once you get a product onto the market, and we are expecting to have a number of products onto the market now through this next five years. The economics, the payback is phenomenal. They are very high gross margin. They are often orphan drug status. It is another benefit of zidesamtinib and neladalkib from Nuvalent, both orphan drug status. Means you are more immune to MFN and IRA, etc .
The margins are healthy at the growth level, and because it is a very specialized cell, you are dealing with specific oncologists in a specific field. The SG&A is relatively low, so hence you do get a very good ROI. The issue occurs in oncology is if you are not getting the products through to the market, and then you are investing heavily, but you are not getting them through. But we are now on a trend of getting these products approved and onto the market.
Brilliant.
Yeah.
Thank you.
Yeah.
Another one on China with regards to the M&A, and how confident is the company that it can continue to replicate the success that we have already seen so far, as you alluded to with Hengrui and Hansoh?
Yeah. We're very confident. The relationship with Hansoh and Hengrui is very strong. There was a big meeting even with them last week, actually. They are exceptional at identifying products, identifying unmet medical need, identifying tolerability challenges, and modifying the asset accordingly to meet that need. Therefore, we're delighted with the collaboration we've had with them. They're also, in parallel, producing their own data in Chinese patients. They retain rights to Chinese territories, and we have the rights to the rest of the world, which obviously gives us a big opportunity.
It's a good partnership, and we can run in parallel. B7-H4 is a great example. They've had very strong data in endometrial and ovarian cancer. We've been publishing progression-free survival data in the low 60s and the high 60% range, respectively. The two companies together, both producing data in different parts of the world with different patient populations. It's a very strong collaboration, and we will continue to do that. With Hengrui, we struck a respiratory collaboration recently that gives us access to the lead asset together with another 11 assets behind it. Yeah.
Going to the other end of the scale, you, of course, would've seen the speculation of AstraZeneca and Bristol Myers Squibb.
Yes.
We'd love to get your thoughts on why that is not something that GSK needs to entertain with regards to large consolidation.
Yes. It was an interesting time at the beginning of August. I think obviously, there was a lot of commentary in the press and obviously a lot of commentary from shareholders at the time. The commentary and analyst reports on it as well, the pros and cons of mega-mergers. There was a period, I was part of the team that put Astra and Zeneca together. There was a time when it made a lot of sense, and I was on the Roche board, around the time we sealed the final deal with Genentech. There was a time when it made a lot of sense. I think there are benefits of scale, but then now the majority of big pharmas are sizable scale. When the mergers were occurring before, companies were a lot smaller. I think the scale is there.
You need a certain scale to be able to compete in pharmaceuticals. I think the majority of the top 20 or so have got that level of scale. There is always, whenever you do a major merger of that sort of size, you've always got some element of disruption to R&D. You've kind of got to weigh those two factors up. You've also got to navigate when the patent expiry is occurring and how you get through them, because every company faces these patent expiries. I can't comment on what AstraZeneca do and don't do. For GSK, we are focused on now integrating Nuvalent and driving those assets forward, launching them successfully, accelerating that pipeline. Like I say, 20 phase IIIs, we've never had that level before. It's been six and seven a year. We got 20. This is what we're driving for-
Sure.
...focused on our business.
Good. Brilliant. Thank you. Going back to the accelerated growth program and the GBP 1.9 billion of SG&A that could get reinvested. Are there any particular assets or pipeline milestones you would like the audience to think about with regards to, this is a really promising asset, and that's going to need a lot of reinvestment to maximize the NPV? Any sort of few you would call out there, or is it a bit too early to go there?
In terms of SG&A or just general investment?
I think more a case of just-
General.
Are there situations with certain drugs where actually it could be a situation where that merits another five phase III trials, so quite a certain chunk of that GBP 1.9 billion is going to get reinvested as opposed to dropping down, which might mean the margin pressure might be a little bit more.
Yeah.
Or is it too early to talk about that?
Yeah. We focus the attention of the GBP 1.9 billion around, there were seven major assets and 18 additional indications. It was interesting that of the 18 indications, 11 are oncology.
Yeah.
That brings you back to where. If we take B7-H3 as an example of that, we refer to it as a pipeline within a product, which is unusual. We are going first with small cell lung cancer and platinum-resistant prostate. There are multiple other tumors that could follow this. You saw with JEMPERLI. JEMPERLI first went into endometrial. We just had a very positive readout for rectal cancer. Phase II was 100% efficacy. We are going into head and neck with JEMPERLI. Probably oncology areas would be the areas you would target doing simultaneous pursuit of solid tumors. I think that would be probably the area I would call out. You also can go into first line more quickly following second line. Again, it is an area, oncology, I would call out.
Good. Thank you.
There are some respiratory elements as well that I would also continue to look for. As we get readouts in the respiratory field and hepatology field, you want to invest behind the success. Yeah.
I hope this one doesn't come across as a curveball.
I ask this question at the end of every kind of meeting like this. Are there any particular issues that we've not discussed that would keep you awake at night?
I think we've been very comprehensive, I think. I think all your questions and the ones from the audience have been really strong. But there's nothing actually that keeps me awake at night. I sleep really well.
Yeah. Good.
Which I have to in this job. I sleep really well, because I don't get much sleep, actually. But I just think we're so focused on making the most of the company. We're focused on being able to get that valuation to where we believe it should be. I think we're a very good buy at the moment, that's for sure. We're focused on bringing these assets to the market and to the patients who need them the most. You just listen to one of these patient stories, like Neladalkib. Relatively young, mostly female non-smokers hit with non-small cell lung cancer with a gene expression that causes the cancer to replicate quickly. The treatment on the market, which is probably the best at the moment, causes sometimes psychosis, weight gain. They've now got, or they will have, a new opportunity to take something that doesn't do that.
It's major.
Brilliant. We've got 15 seconds left, so I think we'll end it there. Julie, thank you all-
Thank you
So for your time. Really appreciate it. Thank you.
Thank you.