Good afternoon. A big pleasure to be back here in London and to present a very good set of results for the last year. It's also a pleasure to have two new colleagues today with me, Bill Anderson and Michael Heuer, who will present for the first time our divisional year-end results. Before we get started, I'd just like to make two logistics comments. One is, unlike last year, we will not have breakout sessions after the presentations. We'll have a five-minute break to rearrange the setup here, but all of you can stay in this room then for a combined longer Q&A session. Don't run away after the presentations. Secondly, for those who join us via webcast, you can submit questions by webcast, or also call in by telephone. Good. With that, let me go right into the results.
You have seen sales up by 7%, core EPS actually up by 19%. Even if we exclude the U.S. tax reform impact, still 8%, slightly ahead of the sales growth. With this, we foresee a dividend increase to CHF 8.70. Both pharma and diagnostics up by 7%. Pharma, as you will see in a moment, very much driven by the new product portfolio. Diagnostics, again, strong growth above the market, very much driven by the main business area, centralized diagnostics. Again here, the immuno diagnostics business, which has grown double digits. You see a good momentum in terms of sales and very much driven, again, by our new medicines such as OCREVUS, Hemlibra, and the new cancer indications or products we have launched more recently.
More specifically here, what you can see is CHF 1.2 billion impact due to the entry of biosimilars, and this is primarily Europe, of course, for MabThera and for Herceptin. On the other hand, CHF 3.2 billion of new sales for the newly launched medicines. Clearly, overcompensating the decline which we have due to the more mature portfolio. On an operating profit level, you can see 9% growth, so we could slightly improve our margins. Core EPS, again, 19%, as I've said, and also a continued strong free cash flow. Now, let me shift to the portfolio. I'd like to start with the number of Breakthrough Therapy Designations because it is an indicator for the quality of the portfolio.
Last year, again, we had six new Breakthrough Therapy Designations, and we started off this year with a very important Breakthrough Therapy Designation for KADCYLA, which opens up a new segment for us in the adjuvant setting. Bill will certainly cover that. I mention that because even more so now than ever, the differentiation of the medicines, the benefits which you bring to patients, that's really what matters. That is what will separate the winners and losers in this industry. It does not only provide you with the chance to replace existing medicines and get to market share positions. Importantly, it gives you the pricing power with payers if you bring true medical benefit. What we have also seen is that authorities around the world start to differentiate on the regulatory process.
If you come with something which is innovative, where they give you a Breakthrough Therapy Designation or a priority review, timelines are actually very fast. On the other hand, if it's a less differentiated medicine, you quickly run into timing issues. The quality of the portfolio is really what makes the difference in the future. Now still, we are proud to also have a high number of new medicines. We are at a record now with 16 new molecular entities in late-stage development. You've seen a rich clinical news flow over 2018. I won't go into details here, but I'd like to summarize again now, in particular also with the good uptake of the new medicines.
We are very confident to get through this portfolio transition to further grow in spite of the entry of biosimilars, which has, of course, fully started now in Europe and which we expect in the years to come in the U.S. Dividend, you have seen CHF 870. Let me now quickly shift to 2019. Again, we expect a rich clinical news flow. We've just got Xofluza approved in the U.S., and we expect two new molecular entities to be launched in 2019, polatuzumab in hematology and entrectinib in a number of different tumors. Perhaps even more important from a commercial point of view, in 2019, if you look at the immediate sales impact in the short term, is actually the line extensions. We expect Hemlibra for the non-inhibitor segment in Europe. KADCYLA, again, stunning data in the adjuvant segments. That should make a difference.
Venclexta is off to a good start. The sales are booked with AbbVie. We have a profit-sharing agreement for that product. Importantly, Tecentriq. You have seen the strong clinical results for two new indications, both for very severe form of cancers, where there are really no medical options. Triple-negative breast cancer on the one hand, and small cell lung cancer on the other hand. We hope to get this approved in 2019, and that should certainly drive the growth of Tecentriq. We expect to file for another two new molecular entities, satralizumab, this is a molecule for an autoimmune disease, which affects the eye. It's a rare disease, a molecule which comes from Chugai. Then we look forward to risdiplam, where we see growing evidence that this could really make a difference for patients.
Accordingly, we got Breakthrough Therapy Designation status and I think PRIME designation as well in Europe to bring this to patients as soon as possible. I should also not forget diagnostics, even though we typically focus on the pharma portfolio. As you know, we have launched a new line of instruments, in particular the cobas e 801, which had extremely successful uptake. Now we are coming right away again with the cobas pro, which should give us, again, momentum in the so-called mid to high throughput segment in the centralized lab. Also good prospects on the portfolio side as far as diagnostics is concerned. Right. With this, I'd like to close. You have seen the outlook for sales in the low to mid-single digits. EPS, again, to grow in line with sales, and on that basis, we should be able to further increase the dividend.
Thank you very much. With this, I hand over to you, Bill. Thank you.
Thanks, Severin. It's nice to see a number of familiar faces that I've met, either in my job as the head of global product strategy at Roche a few years back or as head of Genentech. I look forward to getting to know the rest of you in the years ahead. We obviously feel really good about these results. I'm pleased to share them. Starting with the sales, as Severin mentioned, 7% overall growth. If you look at the geographic breakout, I think it would be important to emphasize the U.S. result, 14%. This is actually a record-breaking result for us. In fact, the historical sales growth record for Genentech was $2 billion, and that was in 2006, believe it or not.
Here we are in 2018 with about $2.8 billion growth, a new higher watermark driven largely by the new product launches. I'll say a little bit more about the product split on the next slide. Europe, with decreases that are mostly driven by biosimilars, partially offset by the new product portfolio. Japan, you've got a little of the same story, new products getting going and biosimilars just starting to impact. In international, a very strong showing, particularly from China, where we were able to get, for the first time, MabThera, Herceptin, and Avastin on the national drug formulary. Now literally those drugs have been made available to hundreds of millions and more in terms of population. We're seeing the benefit of that, good momentum there.
In terms of the margin picture and profits, also a nice answer in royalties and other operating income. We had good gains here based in part on third-party patents from drugs like HUMIRA, COSENTYX, that rely on our historical IP portfolio, as well as royalties from partner products. This is products like XOLAIR, Lucentis, Venclexta, XUS. On the cost of sales side, this includes some royalty payments that we make out, also about an 8% increase in COGS plus period costs. This is sort of the manufacturing part. It's an 8% increase, but that's on volume growth of 12%. We had, I think, pretty good cost containment there, even though the number's grown a little bigger than the sales number. M&D, I think this largely reflects various efforts to hold down M&D costs so that we can maximize our investment in the R&D portfolio.
I think this is a trend that will continue. We've put a lot of effort into really getting more and more productive in marketing and sales just from a standpoint of the name of the game is innovation and the place where the main innovation happens is in R&D. To the extent we can hold our marketing and sales costs down and pump that back into the pipeline, we have a gain. That's why you see M&D growing at 4% and R&D growing at 6%, and I think that's something we look to continue as we move forward. G&A is an 8% increase, but on a quite small base. This largely reflects the legal costs associated with the various acquisitions we made, as well as just ongoing work to defend our IP portfolio.
This is the product view, and I think what's most encouraging here is if you look at the top four growth drivers, these are all new products or newer products. If you look at number five, Lucentis. Lucentis will be exposed to biosimilar competition in the coming years. However, in 2018, we showed a major gain in that we demonstrated with the Lucentis device that it can be implanted in the eye and can extend the dosing interval from six months to even a year versus the monthly regimen that Lucentis has today. That will not be subject to biosimilar competition because we have the patents around how to do that and how to put it in the device.
We believe that the Lucentis franchise will be a very important franchise for some time to come for the company and obviously a big advance for patients. If you look down at the bottom of the slide, you can see the biosimilar impact primarily happening in Europe. You can see again, Japan in yellow, offset in part by the very strong growth in international. Those orange bars, and that's primarily in China. It's a bit of a balanced picture there, but obviously that's been hard on Europe. A bigger impact on MabThera, lesser on Herceptin. In 2019, that'll probably kind of reverse itself as most of the damage has already happened on MabThera and Herceptin will be more effective in 2019.
Looking at the therapy areas in oncology, we're pretty pleased that we were able to grow oncology 2% in a year where we had major losses on biosimilars on two of the biggest products. You can see the components of that. In HER2, very strong growth on Perjeta as the APHINITY regimen has proved to be quite popular. It's a curative setting, and doctors and patients are choosing to go for the maximum potential on cure. The hematology franchise, you see GAZYVA growing 40%, and I'll say a little bit more about the future of GAZYVA because we're continuing to accrue indications there. Towards the bottom, you see some increasing momentum with drugs like Tecentriq and Alecensa. This is one piece of clinical data I wanted to highlight. We presented this in San Antonio at the San Antonio Breast Cancer Symposium.
This is KADCYLA used in patients who had undergone neoadjuvant therapy with either Herceptin or Herceptin plus Perjeta and failed neoadjuvant. These basically by failing neoadjuvant, they become high risk for recurrence of metastatic disease. These patients were randomized to receive either Herceptin or KADCYLA. What we showed was about a 50% improvement in disease-free survival and a 50% reduction in the risk of metastatic disease. This has now been awarded by the FDA just in the last days, Breakthrough Therapy Designation and will be on the market. We filed already, should be on the market in the U.S. very soon in Q1 and shortly thereafter in Europe. I think this is a big advance for patients and will be a nice growth driver for KADCYLA. The other thing I would highlight on this slide is the fixed-dose combination, which is proceeding with Herceptin plus Perjeta.
This is a subcutaneous fixed-dose combination, and again, we think it'll offer a nice convenience advantage for practices and for patients, and also a nice opportunity to put Herceptin and Perjeta together. This is another, I think, really nice piece of data in breast cancer, the first major advance in triple-negative breast cancer in many years. This is the combination of Tecentriq plus nab-paclitaxel, the IMpassion130 study. What you can see, this is the PFS result in the PD-L1 positive population, but also a very strong result on OS. We filed this data and also anticipate approval from FDA in the first half of the year and shortly thereafter by EMA. Again, a really positive study for Tecentriq and one that we think is going to put continued momentum into Tecentriq. Just a slide sort of summarizing where we stand in hematology.
I wouldn't attempt to try to go into all of these, but I would note we've now got eight Breakthrough Therapy Designations in hematology. Quite a broad array of medicines and a broad number of diseases. Looking at hematological diseases, the green line that you see is sort of the area that we have covered historically with either MabThera or GAZYVA, and more recently VENCLEXTA. What you see in the middle there, we have a couple new things coming. polatuzumab vedotin, which Severin mentioned we filed, will be launching around the middle of the year and targeting refractory DLBCL or patients that have relapsed DLBCL. Really nice data here.
We've actually got two angles on this because we've got Pola, and then we also have the next two molecules that are listed are two different T-cell bispecifics that are targeting anti-CD20, and they recruit T-cells, CD3 positive T-cells, to attack the tumor. We've seen some really quite remarkable results there. We'll be expanding our depth in those therapy areas. Then if you look on the chart on the right side, you can see how we're going into things like myelodysplastic syndrome with VENCLEXTA, relapsed multiple myeloma, also VENCLEXTA. Then we have a couple molecules aiming at AML, and we've already got an approval for VENCLEXTA in AML. This actually goes a little deeper on that. This is VENCLEXTA plus either HMA or LDAC, and we really see this as a new standard of care in its first-line unfit AML.
About 50% of patients that are not seen as fit for intense chemotherapy, we believe that it'll be used probably somewhat also in patients that are fit because of the compelling clinical data. You can see the data over there in the table on the right. Things like complete responses, in 44%-55% of patients versus the historical figures of 20%. Minimal residual disease negative rates of up to 50% with Venclexta and quite nice overall survival data. This has been approved, again, I think it's one reason why we have very high confidence that Venclexta is going to become a major drug in hematology in the years ahead. I mentioned the T-cell bispecifics, this slide includes some data from two of them.
We have one of them in gRED and one in pRED, it's an interesting example of how having two early R&D centers can really complement, because we're in a position now of having a lot of data and really understanding both the mechanism and the disease, it'll put us in a good position to decide whether we are taking two drugs forward or whether we pick one. You can see, again, some very nice results in patients who typically do not respond well to therapies. Look at the CR rates, again, in various populations, but you can see ranging from 20% up to 38%. These are results that we might expect to see from something like CAR T, only these are therapies we can put in a vial and ship on a truck.
It's a much simpler way, I think, to treat than cell-based therapy in this case. Stay tuned for more on these. The immunology franchise, which continues to grow nicely. Products like ESBRIET, ACTEMRA, and XOLAIR. Again, you can see now we've achieved CHF 8 billion in sales worldwide. Again, we see additional sales potential for these. I won't say more on these right now in the interest of time, but we can talk more about them in the Q&A. The neuroscience franchise, which continues to deliver, OCREVUS in particular, in terms of sales, it's been a very strong uptake. This has been the fastest uptake of any drug in the history of Roche, one of the most powerful drug launches, I think, in the world. You can see the breakout between U.S. and international.
I think what we're seeing, the pattern is when we first launched, we got a lot of primary progressive patients, now we're seeing more and more it's relapsing MS and patients in earlier lines of therapy switching. Originally, it was mostly switching from later lines of therapy. Now we're seeing switching from early lines and new patients. In fact, we're getting now our most recent data is we have about 39% share of switches and new starts in relapsing MS, the other 13 therapies are sharing the other 61%. We feel really good about this. This is clearly the number one therapy in MS now in terms of patients choosing. By the way, our leading indicators have been very strong in terms of new patient requests for access assistance from our access assistance group in the U.S.
Basically, we think we're going to continue to have strong penetration in 2019 and beyond. Let me say a few things about risdiplam. Risdiplam is our small molecule gene splicing modifier for SMA, and this has been really quite a rapid journey because we've only had this in the clinic for a few years, and now we're starting to have more and more clinical data accrue. You can see in the chart the study that we ran, the so-called FIREFISH study part one. What this shows is the increasing levels of functionality as patients stay on therapy. The blue line on the bottom is the five to seven-month-old patients.
These were patients who had been exposed to the disease without treatment for five to seven months and were quite ill at this point and gone on risdiplam. You can see very large gains, but even larger gains and a better outcome when the patients started younger. We've actually initiated a new study called RAINBOWFISH, which is accruing patients that are zero to six weeks old, basically newborns. We hope to see yet better data with that. We're very pleased with what we're seeing in terms of how it compares to competitive therapies. The regulators are very impressed as well.
They've urged us to basically collect the data that we've got from the Type 1 study as well as the Type 2, 3 studies, which are called SUNFISH. To submit them, we plan to begin those submissions in the middle of this year. We'll have sort of rolling submissions. We look forward to approval of this molecule hopefully in 2020. The last product I want to talk about is Hemlibra. There's a lot happening with Hemlibra. We just got approval in the non-inhibitor patients in Q3 of last year, at the end of Q3 in the U.S. We've had very strong uptake. You can see essentially, we've been virtually doubling sales every quarter. I'd say the early read is that there's not one kind of patient that is getting Hemlibra. In some cases it's babies, in other cases, it's adults.
It's a broad mix of patients that are looking for better alternatives to frequent factor VIII dosing. We've also launched now in the inhibitor market in Germany, France, U.K. We had very positive reception. I think most exciting for us is that, we expect to hear, it's really imminent decision from CHMP on a non-inhibitor approval in Europe. We anticipate that will be in severe patients. Severe patients are patients with 1% or less level of factor VIII of normal factor VIII levels. That is the major market because these are the patients that tend to be on prophylaxis. These are the patients that tend to use the most factor VIII. It's about 50%-60% of total patients with hemophilia, but it's a much larger share than that of the hemophilia marketplace. That's the anticipated target for Europe.
In every case, we think we're going to have a strong penetration in the U.S. and Europe in inhibitors and then increasingly strong penetration in the non-inhibitor population in the years to come. All right. This is a chart I think we've been watching and waiting for it to develop for virtually a decade, which is this wave of the pipeline and pipeline progress and what is it going to translate to in terms of sales. This is the sales by quarter. Q4 of 2018, I think the full-year figure was 22% of sales, but in Q4, we were up to 24% of total sales were from these new products. I think again, as you can see, that rate is growing. You see the list of products and the timeline on the right.
If you look at the yellow box on the far right, these are the next products up. As Severin mentioned, we intend to see Pola and entrectinib both launching around the middle of the year. satralizumab, which is a drug coming from Chugai for neuromyelitis optica, which is a severe neurological condition. It somewhat resembles MS, but it's different. It's targeting the optic nerve and spinal cord. Patients have blindness, but also inability to walk, and motor function, lower motor function especially. We're looking forward to bringing that out. risdiplam that I mentioned in SMA are probably the next ones up. The late-stage news flow, I won't go through the list. I think you all have been tracking it. I think what's encouraging is we've had both from a phase III readouts as well as regulatory progress.
It really was a banner year. If we listed all the phase III readouts, I think we were at about 75% positive rate. That was with a high standard where we excluded studies that were positive in terms of meeting primary endpoints if we didn't believe the clinical meaningfulness was high. We're above our target rate and we want to keep it up, but good progress there. This is the 2019 key news flow, and I think maybe what stands out on this is obviously those two approvals you see with Tecentriq plus chemo, a few lines down in triple negative breast cancer and in small cell lung cancer. Both areas where Tecentriq has really great data. It's sort of all alone for now in cancer immunotherapy in those, in terms of the data.
With U.S. and E.U. approval ahead, we think we'll have nice momentum for Tecentriq. I think that's all I'll cover for now, and I'd like to invite Michael up.
Okay. Thanks, Bill. Good morning. Good afternoon, everybody. It's the first time to be with you in this setup. I'm happy to have the opportunity to show the diagnostics results to you. You can imagine being the first time with you and in a position to show some positive results makes it much easier. With this, I would like to share with you various diagnostics ending 2018. In this context, we had a great sales year, by all means. With 7% growth and about CHF 13 billion sales in diagnostics, it was probably one of the best years ever we had. I would like to also mention that the biggest contributors for this success were basically all businesses we have with centralized and point-of-care solutions leading the way, which are our most important part of the portfolio.
Severin already mentioned immunodiagnostics as part of it with the 20th consecutive year of double-digit growth. Meanwhile, already about 40% of our divisional sales. In this context, also, molecular diagnostics did well and diabetes care. In the past, we had not always the best news to share with you. With diabetes care, we reached a certain level of stabilization. I mentioned that already before, and I'm quite positive and happy that we reached that level last year. Tissue diagnostics continues double-digit growth for the 10th year in a row. Positive is also that all countries, all regions, contributed to this great success. Great is also the development in the Americas. North America, 7% growth, 25% of our sales. Latin America, 9% growth. Asia Pacific. Asia Pacific with 13% growth. China, thereof, 16% growth. The emerging markets in total already achieving about 40% of our divisional sales.
Japan, 6%. EMEA, 3%, also great development and above market growth. The diagnostics division has also been supported by the different business areas. As I mentioned, immunodiagnostics, 11% growth. This in a year where, as you know, our key competitors had launched their new platforms, their new serum worker diagnostic systems. I must say, we had a great year. We expect this to continue. Molecular diagnostics point of care, one important area, point of care, did very well, especially with the new lab-in-a-tube device, the point of care PCR system that we launched first in the U.S., and which addresses the needs, for example, in flu testing in the doctor's office. The flu season last year, as you know, was very heavy in the U.S. and in the world in general.
The sales of this point-of-care device went very well with 162% growth. Also, screening and others. I don't want to go too much in all the details. What does it mean in terms of profit? The division performed well also in profit, with 9% core operating profit growth achievement was a great result. Two percentage points higher than sales. To summarize this now. Sales grew above market. We won market share and the profit above sales. This is the way we want to go. This was also based on certain specific factors. Last year, for the first year, we did not get PCR license royalties anymore. This was a negative impact. We could compensate for that. We also invested still highly in the R&D side.
We are investing very much into new systems, disruptive technologies, digital technologies, as well as parameters to complement our complete portfolio. The complete portfolio is very much driven by the integrated core lab strategy that we have, expanding, entering into new disciplines, expanding our current disciplines, adding new test parameters to make it very convenient for customers to decide to bet, basically, their core labs requirements on one integrated solution, which is the one from Roche. We add analyzers, assays, the broadest portfolio of assays on this integrated solutions, automation software, as well as the area of digital solutions in the area of lab decision support systems, as well as clinical decision support systems. cobas e 801 was a great success story already.
We achieved now close to 2,000 placements end of last year, about 1,000 in last year alone. We also launched the cobas e 801 in China, a major market for us. cobas pro was launched on time and on budget in December. This is a major product for us, which I want to allude a little bit more on this slide. We are targeting the medium to large laboratories. Here's the area where we are already market leading with the cobas 6000, 8000 devices, where we have about 15,000 cobas 6000 already in the market, 5,000 cobas 8000. Right in this area, the cobas pro will be helping us protect our install base, but at the same time, win new customers. We have run several already launch events with customers. They really love it. We have great expectations for this system going forward.
I also mentioned it is important to add tests. On all these platforms that we have in the marketplace, we run last year, 20 billion different tests. The tests are the ones that generate the profit and are important for our further growth. To continue expanding the menu, we, for example, invested into the growth hormone portfolio to complete it. We achieved it last year. This is also one of the examples that helps us further increase our penetration in this market and helping our customers to have the best choice of a broad portfolio to be used in their integrated core lab solutions. That also means we need to connect different disciplines.
We do that by adding not only Roche disciplines that we have, like now the HbA1c testing high volume system, which is unique in the marketplace because HbA1c in diabetes is one important test that requires more and more high volume devices. Also adding our molecular diagnostics devices, which are unique. Nobody else can integrate that into core lab right now. Also competitor systems, if we don't have it in our portfolio, like for example, some infectious diseases test that we offer them with other connected systems. The global access program is something that is, you see Severin on that slide, is one of those areas that are very close to our heart, not only from a business perspective, but also from a social responsibility perspective.
We have last year expanded the access to HIV viral load testing in low resources countries, especially in Africa, to 14.2 million viral load tests in Africa. 14.2 million tests means 14.2 million infected people that are monitored with our test on a regular basis, and this helps them to maintain the viral load levels low and be able to live a normal life. Otherwise, in the past, they would have just died. Here we have expanded our portfolio, our install base in the countries. Basically, in all major African countries, we have our infrastructure placed, so this test can be done.
With the launch of the cobas Plasma Separation Card, we allow also testing of newborns, babies, as well as people in absolutely low infrastructure situations to just, with a drop of blood on this separation card, send it to the labs and get the results back in a reasonable time. One part, I said, is laboratory efficiency tests, and the other part is digitalization. In digitalization, we have invested, especially with a great collaboration with the University of Leeds and the NHS system in the U.K. The uPath enterprise software that allows the laboratories, pathology labs, using our digital pathology solutions to just exchange their slide views, their interpretations, also with their peers, and provide better results, better interpretation of results to the oncologist, for example. Coming to an end. We have the key launches in 2018. We made 11 out of 13.
In purpose of saving time, I will not allude too much to this in total, but you can ask me afterwards. It was a great year also from this side, and I want to focus on 2019. In 2019, we have a broad portfolio of solutions to be launched to the marketplace that covers instruments, devices. It covers tests, assays, coagulation, and disruptive technologies like in microbiology with the vivoDx MRSA test. Important healthcare situation in the marketplace, and also a lot of software solutions, NAVIFY, Tumor Board, sequencing, mutation profiler. Even in diabetes care, we are working on a lot of new software solutions because as we speak, our division is in full focus on transforming our division of processes into the new area of digitalization across the whole value chain. That makes us believe that we're on the right track going forward. Thank you very much.
Now, I hand over to Alan.
Great. Thanks, Michael. Great performance. Good. Great to see you. Thanks for coming. I think it was really an outstanding year, I would say. Let me emphasize right at the beginning, I think we always told you that we can grow in a period of biosimilar impact, and I think we had a great start. I think there is quite some momentum in 2018, and that will certainly help us out. Let me go through the highlights. Basically, I can do my presentation on that slide already. With the sales growth of 7%, I think my colleagues did a great deal in explaining that, I do not want to go back to that. The biosimilars impact at the same time was a CHF -1.3 billion. Do not get irritated. Severin had a CHF 1.2 on his slide. It is just a currency impact.
It is just perfectly the same number with the CHF 1.3 billion. The core operating profit is up +9%. I will come back to that and go through the P&L. Core EPS growth up 19%, excluding the tax reform, 8%. Evidently, margins went up. Dividends further increase to CHF 8.7 proposed. Cash flow, I will tell a story about that. I will touch upon net debt for all of you who are concerned that we get net cash positive rather soon, and you will see that we managed that pretty well. The net financial result. Good news and perhaps a little bit of a challenge ahead of us. I will talk about that. You see the IFRS net income up 24%. I will go through the non-core items later on.
When you look at the performance, the 7%, I think core operating profit. Let me say first, look at the currency. Currency impact was rather low in 2019. At 2018, it helps us. 2019, I come back to that, but we assume, as we always do, that might be also relatively small. I think you see the core operating profit going up. I go through there. Core net income goes to the 20%. You see really core EPS up 19%. Quick remark here. You might ask yourself, why is the momentum coming down a little bit? That is the non-controlling interest. That is basically Chugai. Chugai had a fantastic year. Evidently, they had even a higher dynamic than we had, and that brings the dynamic a little bit down. For us net income, we will talk about that. I will also touch upon the operating free cash flow.
On free cash flow, I will not talk about. When you say, okay, operating free cash flow is growing by CHF 1 billion, roughly, why is free cash flow growing by CHF 1.4 tax? That is really another residual, if you like, of the U.S. tax impact. Let us go through the P&L. Let me start with the royalties and the other operating income. I think that Bill and Michael told the story already. I think the CHF 200 million, it is really just basically a little bit of higher royalty income on the pharma side, evidently. The other piece is really out-licensing income that we have had. That is basically it. For me, it is important to say it is not really pushed by any product disposal gains that we have had. Not at all. Cost of sales up 8%.
Let me say here that in total for the group, volume went up 11%, with 12% on the pharma side, 9% on the diagnostics side. You see really a huge volume momentum moving forward. I think that's really quite good. When you look at the gross margin, the gross margin, really when you compare half year to half year, 2017 to 2018, is pretty comparable. We look at the gross margin overall for the full year, it's exactly the same than in 2017. I think really that number makes total sense. I know that you've seen the first half, and there were relatively high hopes for the full year. Nevertheless, I have to say the volume growth was really outstanding. You might have also noticed the sales increase in the last quarter, which speaks for the volume increase in total. M&D, CHF 400 million up.
I think here, as a very reasonable spend with all the launches that we have had, which we certainly support and we invested well. R&D up CHF 640 million in total, CHF 550 million on the pharma side. I hope you agree that made sense with all the things that we have moved forward. CHF 100 million on top on the Dia side. Then G&A, it's CHF 100 million on top. That's really basically half of that is the legal costs from our defense on the biosimilar side, and the other half is coming from the acquisition, so FMI, Flatiron, and so on. Good. Core operating profit up by, as you can see on that slide, CHF 1.7 billion, 9% up, and even the margin went up for the group as a whole. When I talk about margins, I think you see them here.
Margin went up for the group in total. It went up respectively on the pharma side, and it also went up on the Dia side. I might even say it even went up in diabetes care, which I think is important to mention after a couple of years where we have not seen a lot of growth in that business. I seem very happy with that. The core net financial results. You see the fantastic development that we have had in 2018. You also see, at first sight, that there's a little bit of a challenge ahead, and that's the interest expense. You see first time for a long time, the interest expense went up. As you know, we have CHF 18.8 billion of gross debt on the balance sheet. Everybody who gets dragged away by the net debt, that's one element.
Gross debt is the other element, CHF 18.8 billion. We pay roughly CHF 605 million for that CHF 18.8 billion. I think we optimized that rather well over the years. We've really came to a floor now and okay. We will see how that goes on. I will talk about that on the next slide. Let me mention here the equity securities. Quite a positive impact, and that's really our, if you like, minority investments in the Roche Venture Fund. One is pretty known, that's AveXis. We had a stake in AveXis. Company was sold to Novartis. We had a gain from that. We have another point where we have another investment in the venture fund, in a company which is listed, and certainly there is some fluctuation for that. The other company gave us roughly CHF 200 million on top. I think quite a nice development here.
Currency is interesting. Currency is hedging costs. When you look really at what I've said before on currency, you would argue, well, there was not a lot of impact. During the year, the volatility, especially also in other currencies, was quite stronger compared to last year. We had a little bit of higher hedging costs here. As said, 20% improvement, roughly, compared to 2017. When you look really at the longer period, I think that was quite a ride. From CHF 1.4 billion in 2015 to the roughly CHF 600 million in 2018. I have to say now for 2019, it's not really looking so great. On one hand, certainly when you look at the investment of the Roche Venture Fund, that's something we don't really have control in because these are minorities. That's not really in our hands.
We'll see how share prices will develop. We have now to report now the unrealized gains here. We'll see how that moves. I can imagine that there might be an additional burden around CHF 200 million here when it comes to the net financial result in 2019. Another success story is the tax rate. 26.6%, and the U.S. helped us quite a bit. Now finally, the U.S. comes down to the average of the OECD with their tax rate. Gave us a 6.9 percentage point improvement now to 19.7%. We expect the group tax rate to be around 20% in 2019. It looks like a sustainable effect, and certainly we appreciate that. The other non-core items. First of all, let me start with the core operating profit went up CHF 1.5 billion. You see the global restructuring plans.
The number came a little bit down from CHF 1.2 billion in 2017 to roughly CHF 900 million in 2018. These programs are part of our transformation the company's gone through, and they are really spread out in the whole of the company. We have programs in diagnostics, we have programs on the pharma side, and we have programs in Group. These are very targeted programs, but they all contribute to the financial flexibility moving forward. When you look at the amortization of intangible assets, that's basically ESBRIET. Because ESBRIET, with the significant amortization that we have every year, intangible assets go down and therefore amortization goes down. You see the impairments of intangible assets here, quite comparable to what we have had last year. Certainly what's significant is that we wrote down the goodwill for InterMune. You have seen what we have done last year.
Interesting is that ESBRIET does pretty well. It has grown with 19% in 2018, in the last quarter, even with 26%. That even led to the point that the intangible asset for ESBRIET, we wrote up a little bit. Really the perspective is better compared to 2017. Nevertheless, are we really matching with ESBRIET our original expectations that we have had at the time when we bought InterMune? Okay, there is a certain deviation, and that led to that point. For everybody who's interested, what enabled us to do that goodwill impairment was really the fact that we changed the structure of our cash generating units. In the past, all these pharma goodwills were under the pharma division, if you like, which is highly cash generative, as you can imagine.
Now we have stripped that down really to, we call it strategy, we call it products, and we call it technology. In these three buckets, that enables us to be a little bit more flexible when it comes really to the goodwill impairments itself. Alliance as a business combination. You see a positive impact last year. This year, a slightly negative impact. I think last year, we benefited from release considerations last year. Contingent considerations, I should say, which we didn't have in 2018. Legal and environmental, we reduced a provision for one product quite significantly by CHF 200 million. We didn't have that in 2018. In total, gave us an improvement of roughly CHF 273. IFRS operating profit increased by CHF 1.8 billion.
The total financial result in taxes and taxes once again play a role here, and certainly the U.S. tax reform with a positive over CHF 274, which increased the IFRS net income by about CHF 2 billion to roughly CHF 11 billion, an increase in constant rates of 24%. Good. Let me talk about cash. Sometimes overlooked in our industry. We have a special focus as you know. You see the increase roughly CHF 1 billion in the operating free cash flow. Margin, relatively stable here. Pharma really moving in the right direction. There was an increase of 6%. You see, Dia also at a pretty good level, and I can also say Diabetes Care contributed here as well. When you look at the bridge, where is the improvement coming from? The major driver, as it should be, is coming from operations. Which is quite nice.
We contributed by good net working capital management, very much driven by the inventories. I think we had a reasonable development on the receivable side. We had a slight increase on the accounts payable. A major point was really that we brought the inventories in the right direction, which makes sense when you look at the significant sales growth that we have had in 2018. Other net working capital is more about provisions that we had for royalty payments and whatever. Nothing really here of major impact, if you like. The inventories or the investments in PP&E, Chugai, Genentech, I can mention here a little bit all over the place, and then investments in intangible assets. I think that's what we're doing for the pipeline, and which just makes sense. Good.
When you look at the continuous improvement of the operating free cash flow, I think that really moved in the right direction over the years. We had slower years, but I think now, I think we're really at a very significant level. Let's see what we have in store for the next years. I said for all those who are really interested in net debt, and when we get net cash positive. You see really we managed that pretty well in the year 2018. We started with a net debt level of CHF 7 billion, and we ended with a net debt level of CHF 5.7 billion. Why that? Well, we had quite a significant operating free cash flow generation, as I explained. We had, well, CHF 3.9 billion outflow for taxes and treasury. That was last year, roughly CHF 4.4. The tax reform shows, if you like.
I think, well, we have the dividend and we have the transactions that we have done, the M&A transactions. The CHF 5.7 billion outflow, we were able to overcompensate with our cash flow generation. On the other hand, I would say we kept net debt pretty much stable. Good. Quick remark on the balance sheet. Well, cash and marketable securities, always good when you have cash on hand, and we increased that a little bit. The other current assets, well, inventories went down, as I explained before. The non-current assets, well, on one hand, goodwill, well, evidently went down. Intangible assets went up, and that was basically a match. Really the increase itself came from PP&E. Current liabilities, I think here, accounts payable went a little bit up, provisions went a little bit up.
When you look at the long-term liabilities, it was really about the pension liabilities. This is just an interest rate topic which came up. Interest rates went slightly up. Liabilities went down. You see the equity, which is now at a rate of 39%. Net debt to total assets now at 7%. Year-end 2017, it has been at 9%. Good. Outlook. Well, I talked about currency already and about the impact. What you see is that the US dollar gave us really a slightly negative impact on a full year basis. When you look really at the euro, gave us a slightly positive impact on a full year basis. And in total, it was pretty much balanced. When you look at the right-hand side and the impacts that we have seen, Q1, half year, Q3, and also full year, rather low.
You know what we're doing with the currency rates. We keep everything stable end of 2018 and then project everything until year-end 2019. Based on that, which is very hypothetical and certainly not the truth, we expect a very small impact on sales, core operating profit, and core EPS for the full year 2019. This will change for sure. That's the current view based on the assumption that I've explained. Good. I think we have to give you the right base for the 2019 guidance when it comes to core EPS, and I'm happy to do so because, as you know, we have in our core EPS incorporated a currency impact, which basically comes from the net financial expenses. You see really what we have reported as core EPS is CHF 18.14. You need to increase that by CHF 0.16. Where is that coming from?
The currency loss is CHF 160 million, so it's a loss. CHF 160 million. We will find that on page 54 in the finance report. That is outlined. You then take this impact, you apply a certain tax rate. Why not 19.7%? Evidently, these are hedging costs, if you like. Well, it happens in Switzerland. Perhaps 19.7% is a little bit on the higher side here. When you then divide that through 860 million shares, you get to the CHF 0.16. That gives you a starting base for 2019 of CHF 18.3. Good. I think Severin said everything about the outlook already. Once again, thanks for coming, and we're happy to take your questions after we have rearranged the setup. Thank you.
Two minutes or whatever. Two minutes, yeah.
Thanks.
[Break]
Smile. That's nice. Yeah, but it's not good. Our digital transformation. Okay. I think we're all set again. Sachin, you take us off. Can we have a mic here in the second row, please? Thank you.
Thank you very much. Sachin Jain from Bank of America. Three questions, please. Firstly, on U.S. biosimilars, I wonder if you can give us some color on what sort of erosion you expect in the U.S. in the second half. Clearly, that could be a key delta. Any color on how many competitors for each product? Do you expect them to have full labels? Your timelines based on settlement dates or assumption of non-settled companies? Any color you can give there. I know there's some sensitive information. Secondly, on midterm margins, Severin, roughly a year ago, you cautioned against dramatic expansion. Consensus has reset to limited expansion, roughly 100 basis points over the next couple of years. With portfolio rejuvenation, I wonder whether you are now more positive on the midterm.
Also noting that the 2019 guidance obviously implies margin expansion to offset the net financial pressure that Allan alluded to. Finally, just a quick product question on Huntington's. Again, you referenced it on the wires this morning. Any color on discussions with the regulators as to what data could be behind a best case filing timeline? Thank you.
Thank you very much. Perhaps I take the margin question to get us started, then Bill, if you can comment on the U.S. biosimilars and Huntington. It's true. That was, I think, a year ago or so. At that time, I was interviewed, actually, I remember at the time. We all remember. We all remember. The context or at least the context I perceived it during this interview was kind of margin will expand and go into the sky. What I said is, "Well, I'm confident about our growth through the biosimilars. The new medicines have comparable margins, but they won't go through the sky." Here we are, a year later. It's true, we could expand the margins a bit and we'll see for the coming years.
It is very good to see that we have this good momentum from the new medicines because eventually, that makes the difference. If you have new differentiated medicines, that's actually what counts in the long term. If you don't rejuvenate your pipeline, eventually your margins really go down and if you launch new innovative medicines, you can keep margins or potentially even expand margins. On a more granular level, I would say the following. We have comparable cost profit margins. There is a bit of a negative effect due to the royalty load we have associated with OCREVUS. You have seen OCREVUS, of course, is taking a bigger share as we have this tremendous success in the market. But on the other hand, we expect that to be compensated with Venclexta. As you know, we don't book sales for Venclexta.
Unless we go forward and share the profits for that medicine, that, of course, should also compensate. Broadly, I'd say, I'd expect a stable development as we go forward, and you see this also reflected in the guidance. If I look at the 2019 guidance, actually, the much bigger challenge from an operational point of view is to digest the decline in the royalties, because we lose the Cabilly patents. That's where the pressure is. That's where we have to work hard to continue with our productivity initiatives. There is a lot ongoing throughout the value chain, but we are confident that we can digest it, and that is reflected in the guidance. I hope this gives you a bit more color. With this, you had the crystal ball-
Oh, yes.
for biosimilars in the U.S.
Yes. I'm afraid I may disappoint you with my answer on U.S. biosimilars, not with the numbers, but with the lack of specificity, because frankly, there's two obstacles. One is that nobody knows exactly what's going to happen and how it's going to play out. There's ongoing litigation and ongoing disputes over IP, and it is rather difficult to see how that's going to play out. What choices various biosimilar companies might take with respect to whether they launch with partial labels versus full based on settlements, et cetera. I think there's that level of uncertainty, the other level of uncertainty is what will the uptake be when they arrive. Frankly, there's not lots of precedents to look at on that. I think we've baked in some impact in the second half.
It's not a huge impact because it happens in the second half, and there's only so much that can happen. I'm not sure I can really say much more than that. I don't want to tell you more than I know. How about that?
You have a number in guidance.
We have a plan, but I think the guidance reflects the middle of what we think could be. With respect to the question on Huntington's disease, I think there's a lot of excitement in the community and with the regulators around the potential to lower the Huntington's protein that we've demonstrated already. There is a will to move and expedite the approval of the product. It's not set, so we don't have a hard and fast timeline internally, but I think it's something that we would hope could happen in terms of filing potentially in the next 12 months.
Please, if we go this direction. Yes. Can we have the mic here in the middle? I'll come back to you.
Hi. Thanks. Richard Vosser from JP Morgan. Perhaps we could start with Ocrevus. Just perhaps you could talk about the U.S. market and the retention of patients, proportions that are returning. It seemed a little bit softer this quarter in the U.S. for Ocrevus. Maybe talk about, you alluded to more sales in relapsing remitting. Is PPMS now declining or not declining but growing at a lesser rate? Second question, just on Hemlibra. Perhaps you could give us a framework on how to think about the uptake in inhibitors in 2019 and maybe the early reaction, in 2018, in the fourth quarter to the launch.
You mean inhibitors or non-inhibitors?
Sorry, I meant non-inhibitors. Thank you. Final question, just on Lucentis. How sustainable is the return to growth from the new device? We are seeing good uptake from that. How sustainable is that? Thanks.
Sure. With respect to OCREVUS and retention, I think you said, you speculated the numbers were soft. Did you mean retention, or you meant the sales results?
Sale. I would say the sales result may be a little bit soft relative to expectations.
Potentially maybe in the U.S.
Yeah.
that leads to, I think, speculation over many years of retention for the product. Perhaps you could discuss that.
Yeah. I would say, first off, I think we were beating estimates for a number of quarters. With respect to our forecasts and our projections and our plans internally, we were very much on target. There was nothing amiss for us in Q4, in terms of patient retention, patients returning. The information, the data we have on that has held up very well. As I said, the leading indicators are quite strong. Leading indicators in terms of switchers, share. Also, we assist probably around 80% of patients with reimbursement in terms of helping them navigate the process. We get those requests directly from doctors for helping patients. That's probably our best leading indicator, and it's very strong. So far in January has been, yeah, held up very well. We're quite confident in continued strong growth in OCREVUS.
PPMS?
In PPMS, it's certainly not declining. It's still increasing. It's just my comment was that when we first launched, there was a bit of a bolus of primary progressive patients who didn't have any options, who now had an option. We got an immediate kick from that. We've continued to penetrate PPMS, and there's no sign of any sort of backing off of that.
Lucentis.
Lucentis, yeah. Lucentis, I think there's two things going on. I think one of the competitors had a bit of a challenge last year and led to some switching, both switching of some patients, but also switching of some loyalty. In addition, we launched a prefilled syringe, which has been very popular. That combination, I think, fueled the growth in 2018. In 2019, there's a potential launch of another competitor. I think there were some one-time gains that we had last year from the event that I mentioned of the competitor. I think Lucentis will be quite a strong showing this year. In terms of continued incremental gains, I'm not sure we're projecting a lot more.
Hemlibra.
Hemlibra, yes.
on inhibitors.
Yes. It's a very interesting one because Hemlibra is such a game changer. When you're going from patients that are severe hemophilia that are on prophylaxis, they're doing factor VIII infusions two, three, four times a week. Now they have an option for a once a month sub-Q that's going to give them equal or better protection to what they've had. You'd say, "Well, that's great. Everyone ought to switch right away." On the other hand, a lot of these patients have been giving themselves factor VIII infusions for five years, 10 years, 20 years, 30 years. There's a fair amount of trying to guess at what rate will they actually switch if they're sort of used to the current system. Yeah, I'd say internally, we've been
I don't think our guessing has been particularly accurate. The uptake has certainly been faster than we expected. I think we would exceed our, I guess, our faith in our own crystal ball if I was going to give you a guess as to how that's going to continue. What we know is we get a lot of anecdotes of both. There's some physicians who are now saying to all their patients like, "Hey, why aren't you switching to this product? Why are you taking factor VIII?" We have some patients that are kind of going around telling all their friends because the community's quite tight. "Hey dummies, why are you still taking factor VIII?" I think there's a lot of anecdotes, but anecdotes don't translate into forecasts. I think we're quite optimistic based on the trends we're seeing.
I think it's going to take probably another couple of quarters before we think we've figured out what the real trend line is.
Thank you. Let's take the next question here. Yes.
Thank you. It's Andrew Baum from Citi. Three questions. The first one is, I'm struck on page 12 when you go through your pivotal NMEs, just how few hail from Genentech versus the other research centers or externally. I also know that one of your former colleagues recently had a reorg inside his own organization and is effectively integrating his U.S.-based research hub, thinking obviously of MedImmune. I wouldn't want to equate the productivity historically of Genentech with that of MedImmune, I'm going to ask the question anyway. Under what circumstances would you think about integrating Genentech inside the larger organization? Second, assuming that the answer is going to be no, which I think it probably is, how do you look at the recent output relative to the other parts of the business? Is it just a function of time and cadence?
Is it related to departure of staff because of Boston and competing companies and the share prices and options and so on? Are there other factors? Just more broadly, that general concept of Genentech productivity. Second, could you talk to the potential for accelerating the filing of one of your bispecifics against CD20 for DLBCL and FL through expanding a dose? Once you've expanded the dose in the phase I, could you actually file that rather than waiting until you go to a registration file, given it's a treatment-refractory or heavily refractory patient? Finally, just some comments on your confidence in being able to work your way around the reimbursement and very P&L savvy ophthalmologists to secure that they will use the port for Lucentis as a commercial barrier rather than a biosimilar.
Very good. Let me start with the question related to the structure and Genentech. Yes, you read me well. I continue to believe that one of the strengths of the culture of Roche is this more decentralized approach, that we really truly empower people, that we bring down the decision-making to the lowest level possible in the organization. Part of that is also to keep more autonomous units. I'm deeply convinced that if you talk about research and if you talk about early development, it's really about the quality, it's about the cutting-edge science. It is not about scale. If you move into late-stage development, if you move into other functions, we want to leverage the scale, and we want the global approach.
When it comes to research, when it comes to early development, we think about it in terms of three engines, if you like: Chugai, P-RED, and G-RED, who feed, if you like, the global late-stage portfolio. It's true that it goes in waves. If I look back 10 years ago, I got exactly the other questions. It was like: Why don't you close P-RED? Why don't you integrate P-RED into G-RED? What we have seen over the last 10 years is that actually P-RED has delivered, and a lot of transitions which we saw more recently actually come from P-RED. Still, G-RED continues to be a very vibrant place. There is still very important molecules coming through. We had some of them on the slides today, which are also coming from G-RED.
It's true that there was a bit less coming through into late stage over the last two years. If I look at the projection for this year and for the coming years, there is more to come, actually.
For example, of the 16 in pivotal today, there's four of them that are from gRED, you can say, well, why isn't it eight? I remember a few years ago, we had the opposite conversation. People were saying, "Well, why wouldn't we integrate pRED into gRED because they're not delivering enough?" These things don't come. They come in bursts. When I look at the early pipeline, it's very strong.
Time delays, et cetera, the time when you make the decision, you make the decision on something which was kind of 10 years ago. This is the other element of it. I stick to this approach that the independence, this kind of diversity of thinking, eventually enhances innovation. Look at Chugai, for example. Some of the molecules they bring through, we would never have pursued. Hemlibra
Never
we would never have done. If you talk with Mike and if you talk with William, they say we would never have done this. The Japanese were kind of, I don't know how many thousand molecules they tried out, and eventually one worked. Never ever could this ever happen in our other sites around the world. They just have a different approach to that. I remember many discussions, and I won't go into the details in terms of names and molecules, but I can tell you how often did the head of gRED say, "No, this will never work out," and it was in pRED. How often did the pRED guys say, "Well, this will never work out," was at gRED. Those are now, a couple of years later, actually the most promising molecules.
It is so important that you keep this diversity of thinking, I'd rather have a little bit of duplication in the organization. You have mentioned one with the two bispecifics, where you have the problem that you have two of them, I'd rather have two of them where I can choose based on data, than having nothing, because we have a big bureaucracy where people just can't put their ideas into action. No, we won't integrate. Now, in terms of retention of people, overall voluntary fluctuation levels are pretty stable, but we do lose people from time to time. It's also true that in particular in South San Francisco and in Boston, there's a vibrant biotech community, it goes in cycles. Last year, a lot of money was going into San Francisco.
In particular, they were all looking for people to lead these new startup companies. They knock on Genentech doors. There is no doubt. By the way, the same is true with tech companies. They also start looking for scientific, clinical talent, they would also come to a company like Genentech. I regard this actually as a good thing. I'd rather have people coming to us because we are known to be a great place where great science is being done, compared to a situation where I don't have the people and people wouldn't come to us and be interested in our people. It's our obligation now to create an environment which they find exciting, where they are committed, where they continue to stay with us. I think this decentralized approach is part of it.
If we would integrate it and manage everything out of Basel, I don't think this would help on that respect either. Yes, there's a lot of competition, we always have to be sure that we are competitive, it's not at a level where I would be worried. Right. I think there was a question on the bispecifics, right?
Yeah. By the way, if you're still skeptical about the talent drain question, I think the day you stop hearing about a talent drain from Genentech, you should worry. Right? Because we've had a talent drain problem for 20 years. Again, if you stop hearing that, then the talent must have run out. I think, you don't hear as much about the talent we're bringing in, we've brought in some real stars in the last few years. We still have the ability to hire people that are running major research institutions and things, we're hiring them in as department heads in gRED. I think that as long as we can continue to do that and really hire the best, I feel pretty good about it.
It's such an important question. I have another thought, sorry. You'll get to the bispecific. It is really important. It's really, really important because, for a company like ours, it's all about innovation, it's all about science. We have to really, really take care of that. That is what is at the core of this company, and that will define our success for the future. It's really, really important. We have many discussions, as you can imagine, on what does it take to be the best environment for these type of people. Just to build on that, this other element, if you look into the Bay Area and beyond, it's full of companies, which were founded or where Genentech people contributed to the success of those companies. What it also means, actually, is we are very well connected to the network. It's not unimportant.
If there are small companies, it's less about the money. For small biotech companies, it's much more about the right partner who helps you to bring a molecule to the next level. Now, if it's a later stage asset, it's a different story. It's only about money. It's a pure financial question. To have this network out there of ex-Genentech people who are part of many startup ventures serves us well also in the longer term. People talk with each other. If we leave on good terms, and if we maintain these networks, actually it's a positive cycle where we also can attract again, new people. People who potentially also think one day they'll do something else, and if they are successful, then we have a natural partner to speak with them as well. It's not all bad.
The important thing is that you do not only lose good people, but that you also keep a pipeline of the best talent joining your company. Anyway, we'll keep an eye on it. Bispecifics.
Yeah. Bispecifics. Question about innovative approaches to sort of filing based on the early data. How to say? That never is far from our minds. We're in phase I-B with both molecules, and we will be examining all options with regulators on both sides of the Atlantic and elsewhere. Let's see. I think it all will depend on how compelling the data is and what other molecules are showing in the comparable patient categories. Let's see. On the Senasport reimbursement, I think there's trade-offs. You're sort of asking, well, gosh, if a doctor is giving 12 shots a year and they're getting paid for that, are they really going to want to do something where they're giving two shots a year? I think the reality is that patients aren't getting 12 shots a year.
Patients are getting four or five shots a year in year two and after, and they're losing their vision. In addition to that, the port delivery device actually requires a retinal surgeon. It actually requires a surgeon to operate. We hear from a lot of the surgeons, they're like, "Hey, this is what I trained to do. I trained to do surgery, not to basically do 100 injections a day." I think there might be some of those economically minded ophthalmologists who would prefer to just keep giving lots of injections. I think we'll have a really strong case, both from a patient standpoint and from a doctor practice standpoint of why this is a good way to move forward. Dom.
Yeah, there is one question via the web here from Graham Doyle. He asked about the future of the fixed dose combination of Herceptin and Perjeta, how you see the future in the United States and outside of the United States. How much you potentially could convert into that?
We're talking about the fixed dose of Herceptin plus Perjeta, and I think this is an attractive option, particularly for patients who aren't receiving chemo. Which, for example, in the adjuvant setting, they're not getting chemo. It's a choice between coming in and getting an infusion of Herceptin and an infusion of Perjeta, or coming in with a really simple injection with the Halozyme. We think over time it's going to make sense because it's better. It's more convenient, and I think it may be the kind of thing that takes a while to convert if physicians are comfortable with the practice of doing the multiple infusions. There's a lot of patients getting a lot of infusions there.
Herceptin plus Perjeta is the standard of care in metastatic breast cancer, standard of care in early breast cancer, and it starts to get pretty compelling even more so than the switch from, say, Herceptin IV to Herceptin sub-Q, because there you're just replacing one infusion. Now you've got an opportunity to replace two.
Okay, thank you. Let's move on on that side, if we can take here in the third row. Yes, thank you.
Thanks very much. It's Mark Purcell from Morgan Stanley. I was just going to follow up on the same subject there. I guess the life cycle management behind the CD20 franchise is very clear. The HER2 franchise slightly less. There's a biospecific earlier in development, but just in terms of the timing, it doesn't look like you're going to launch sub-Q Herceptin in the U.S. You're going to go straight to the combination. And given you have visibility on three of the five players, and the first one, biosimilar, is going to launch with very limited capacity for the first few years. I just wondered, obviously, you guide on risk rather than likely outcome, but if the decision to go with a 2020 launch on the combination is related to what could be a greater window than currently people are modeling.
Just going back to the dynamics here, could you help us understand whether this is also partly related to the Part B pilot programs, and the payer situation in the U.S. in terms of the choice to go with a combo as opposed to the single sub-Q Herceptin? The second one on risdiplam. Could you help us understand the sort of positives and negatives and pivot points here, versus gene therapy, in SMA one, two and three? I guess at the moment you have parents who will do anything they can to get the best outcome for their children, including combination therapy. But clearly, there's two muscles you're trying to protect, the cardiac muscle and the skeletal muscle. The skeletal muscle has huge amounts of turnover over the 20 years of these patients' lives at the moment.
Just some thoughts there would be very useful, if you can help us out. I was going to ask on gantenerumab. I've got a few questions from clients in terms of when we see the futility analysis, which was just filed with crenezumab, and when we should see the final data. The last question, going back to Andrew on the bispecifics. You have one, the FAP-IL2v, where I guess we should see some data in the first half of this year, maybe at ASCO. The CEA-CD3 program seems to be re-energized now, given you've worked out how to dose patients, pre-dose them, and then move the dosing up on that asset. I think colorectal cancer was an original target for that bispecific. If you can help us understand the position on those two assets, that'd be fantastic.
Sorry, you're talking about the CD-
CEA-CD3.
Yeah.
The FAP IL-2 as well.
Okay. CAC, yeah.
I think clinicaltrials.gov has assigned a Q1 read-out on that, so possibly data at ASCO or ESMO.
Okay. That's quite a list.
Sorry.
The first answer is there's a relatively straightforward answer. We are launching Herceptin sub-Q in the U.S. Yeah, it was a long journey because it wasn't clear the regulator was going to support it, then we had a priority on resources in EU because it was an ongoing launch. Basically, we were delayed on timelines, but we are planning to bring it to market. I don't have an update on the timing. There have been no decisions about prioritizing the fixed-dose combination over sub-Q Herceptin. We're going to bring sub-Q Herceptin as fast as we can clear the regulatory process, then we'll bring the fixed dose also as fast as we can bring it. On risdiplam versus gene therapy, this is a case where there's very little data on gene therapy and there's very little data on risdiplam.
I'm not sure I can offer much beyond what any knowledgeable person in the field could say. Gene therapy, you have some patients who have been exposed to the vector and will therefore be ineligible for the gene therapy. There'll be questions about duration of effect that, again, we won't be able to answer for some time. With risdiplam, we have a systemic agent, and so we think that we're likely to provide a benefit to all parts of the body affected, which has advantages over something that's administered, say, intrathecally. It's really going to be about the efficacy data, and I think we're particularly interested in that efficacy data we're going to get on the newborns, because that'll really say what happens if you get in there from the very beginning.
Again, based on what we've seen in Type 1 and Types 2 and 3, we're pretty encouraged. In fact, I think one of the things we're looking at is we want to make sure that we've got a well-tolerated drug, because, again, we don't know the effects of administering a splicing modifier over time in a developing child. I think for us, we're going to continue to be gathering a lot of safety data over the course of the year. The results so far have been rather remarkable, and we look to have more of that.
I think what is well-known with gene therapies in general, I think that would also apply here as a generic statement without having the data naturally, because the medicines are so early in their development or in the clinics, is that typically patients develop antibodies against viruses as you grow up. We know that for gene therapies for an adult, typically 30% would have an immunity against the common vectors which are used with gene therapy. What we know for sure is if you treat a patient with a gene therapy who has a certain age, typically 30% of the patients would not be eligible for a gene therapy. I say that because as you know, our studies go not only for Type 1, but also for Type 2 and Type 3.
What I would say is this is a big part of the market potential. I think it's likely that this is at least a complementary use next to gene therapies. The question is more how does it compare with the other molecule, which is already on the market with SPINRAZA from Biogen. Here, the big difference is that SPINRAZA is provided into the central nervous system, so the effect is in the central nervous system, whereas our molecule is given in a systemic way because it's a small molecule. Again, the data have to read out, but what we would hope is that this systemic effect would have advantages from a clinical efficacy point of view, especially over time. Again, that's a hypothesis at this stage. Clearly, you can see how the market might segment along these lines.
Of course, the other, as Bill said, the big question, which nobody can answer, is how long does a gene therapy really work? Whilst you have the advantage with babies who get a gene therapy because they are not yet immune against the vector compared to an adult, the problem with a baby is the turnover of the organs is very fast. As you know, the gene therapies, they only work in the cells where they are given in. When the cell divides, it's not in the cell which is divided. If the organ completely turns over, then of course, you lose the effect of the gene therapy. Nobody has an experience now how many years does it take until you lose this effect simply because your organ is turned over.
If you look at the liver, for example, there is literature out there which says that adults turn their liver, which is typically an organ which absorbs viral vectors, turn over their liver, everybody of us, three, four times in your life. How does this exactly play out in the case of SMA? What does this really mean in duration is a question which nobody can seriously answer because we simply do not have the data. What we do believe is there's almost certainty that there is a place for molecules next to gene therapy. What you could see is that either it's a separate segment because gene therapies simply don't work or because you could have a combination therapy over time. If the effect of the gene therapy goes down, then you would add another medicine to complement the effect.
We will see how it evolves, but it is really exciting. If you look at it from the families who are concerned, the parents, a couple of years there was no option. The babies just died within half a year or a year. Soon there will be three options out there for those families. What a success if you look at it from an industry and from a medical point of view. It is really fantastic to see how the field has moved on. Right. Now, we still have two other questions, right?
Yeah. I have got them here.
Yeah.
You asked about gantenerumab, when would we have the data. I think we would hope to have our first meaningful data in 2021. Yeah, I think that is internal plan is when we think we will know something in 2021. FAP-IL2v, we showed data at ESMO. We have got, I think, three other phase I-B's that are ongoing, and we are going to see how that evolves as to when the next update would be. The CEA-CD3-
Yeah. It is basically in the making.
Yeah.
It's open for recruitment.
Yeah.
The patients are treated.
Yeah.
I have to ask the team, and they will give us an update.
Now we have a regimen.
Yeah
we feel that it works in terms of addressing the issues we had the first time around. I think it depends on how fast we recruit the study in. We remain optimistic that that's potentially a powerful mechanism in colorectal cancer. It's one that it's not moving as fast as we thought because of some of the nature of the molecule and the anti-drug antibodies and how to overcome that. I don't have a lot more clarity on that right now.
That's great. Thank you. Just going back to the, I apologize that I made a mistake in the sub-Q Herceptin file. It wasn't in the timelines. Just going back to the part of the question around sort of the Part B pilots and the biosimilar legislation that's coming in as well. There's some confusion about how physicians will be incentivized or paid, whether it be Lucentis, to Andrew's point, whether it be something like a sub-Q versus an infused Herceptin or an infused Herceptin biosimilar.
Right.
It's not clear going forward there'll be a disincentive to using sub-Q from a position of payers and the payment system.
Yeah. Which Part B pilots are you thinking of?
I guess we're still unsure how in the Part B pilot programs, how physicians will be paid.
It's not going to be potentially linked to an ASP-type system.
Yeah
It may be linked to the complexity of the procedure, things like that.
Yeah. Well, we've been very involved with that, and I think basically there's a wide range of possibilities on the pricing front. I think it's a lot easier to say that physicians shouldn't be paid an ASP plus. It's a lot easier to say that than to do it. The reason I say that is because think of it, in fact, I've had this conversation relatively recently with the CMS administrator, and I think it was something where we were able to find agreement on that because, for example, if you have a doctor who's administering a CHF 100,000 therapy today, and tomorrow they're administering a CHF 1,000 therapy, you have to pay them differently. If something goes wrong with the CHF 100,000 therapy, they've got a big problem. If the patient doesn't pay their copay, or if they break a vial or something, they have responsibility for that in the system.
There has to be at least a part of the payment that is proportional to the value. I think what reasonable people can agree on is we don't have a problem with ASP +4, which is on average what doctors get from Medicare. We have a problem with ASP +100 or ASP +200, which is what a lot of hospitals are billing insurance companies. There's been a lot of popular talk about getting rid of the ASP system. There's a reason it exists. The mechanics of another system are very complicated, and my best guess is that ASP will remain, and that the efforts are going to be how do you rein in the market power of the hospitals to put in these sort of outrageous markups.
Should we maybe take one question from the telephone? Maybe finish here. Please. The row, the second row, and then we go to the telephone, right?
Thank you very much. Jack Scannell from UBS. Three questions. One, I think probably for Bill, then two broader ones, perhaps for Severin, and actually one for Karl. Bill, a sort of rather technical question. You implied that triple negative breast cancer will be filed, and you were positive about the OS data. Now, at ESMO, there was some discussion about the sort of technical glitch in the trial design, such that the PD-positive group was a secondary endpoint, only to be tested if it worked in the ITT, and it wasn't clear if it would work in the ITT, despite the fact that any reasonable person could see it worked in the PD-L1 positive. Has that issue been resolved, or is that still something we need to find out? That's the first question.
The second question, again, Bill, I was struck by your slides. You said revenues for pharma have grown at 7%. You said volumes have grown at 12%. What that says is the price mix globally has been at -5%. The U.S. is half of that. Right? Price mix in the U.S. is probably pretty positive because Part B drugs get a little bit more expensive every year, and you've launched OCREVUS and Hemlibra and Tecentriq, which are not inexpensive drugs. Which suggests that actually the price mix inflation ex-U.S. has been very substantially negative. U.S. politicians are concerned that drugs cost very different amount in the U.S. than ex-U.S., and your results seem to be an example that this is widening. I just wonder how you guys think about that.
Yeah.
The third question for Karl. The drug industry is discovering about twice as many drugs as it was five years ago, and arguably there's about half as many sell-side analysts as there were five years ago. Do you think we're in an unusual position in systematic underestimation of drug industry pipelines by short-staffed sell-side analysts?
You take that, Karl.
No.
I can try, yeah.
Okay. While Karl thinks about the answer, let me hand over to Bill for triple negative breast cancer first.
Okay, sure. Sure. On the triple negative breast cancer, that's right. The study of Tecentriq plus nab-paclitaxel in triple negative breast cancer was an all-comers study, where we also looked at the PD-L1 positive subset. The primary endpoint was in all comers, and it was a hierarchical analysis where the question about OS in the PD-L1 positive population was downstream of at least one endpoint, where we didn't hit a P value less than 0.01. Nevertheless, the breast cancer experts and the regulators do see this as a meaningful result. They were positive about us filing, and we anticipate both that we will get approval based on that data, but also that they'll want to see the next study because we have another study with Tecentriq and chemo in triple negative breast cancer that will read out, I think it's at the end of this year.
We think they'll be looking to see that that's also positive, but we should be able to proceed. The answer to your question about the global. It's actually really simple. It's all about China. In China, we had an average price reduction of 23%, and we had an average sales increase of 28%. You have to get out your calculator to figure out exactly what happened on volume. The volume did something. It went up by 70% or something. Somebody's done it. Anyway, China had a disproportionate effect on that global equation.
Also, if I understand your question right, there's of course also the biosimilar effect. That is of course also in the volume picture. There's part of it where we lose share, but there's also a pricing part of it. That, of course, is also only ex-U.S. At some stage, of course, that will also occur in the U.S. There's those two effects which explain the volume difference. Right. Then Karl. Come up here on stage that we can.
Actually, I had hoped that I can skip that one, I really have to say. I feel a lot of sympathy with you. I can really say that because we have lots of budget restrictions, but I know that you have much more budget restrictions at the moment. What we could see is that the number of sales has, and you know it yourself, actually, is not increasing, to say the least. This I really mean, I think you do a great job. I really have to say that. While you have still the same reduced number of people, it is true that the pipelines in the industry in general actually went up. The relative work you have to do on all that increased. On top of it's not only about oncology anymore.
You have to go into immunology, you have to go into CNS. The whole diversity of that, what you have to cover actually also increased. It's not just the sheer number of assets, but also the sheer number of therapeutic areas you have to cover. This is lots of work. I think you really all do a great job. That's all I can say. Thank you.
Karl, why don't we go to the telephone question? How does this work?
Yeah, please. Yeah. Let's try it. Yeah.
It will come in.
It will come in. Okay.
The first question on the phone is from Steve Scala from Cowen. Please go ahead.
Well, thank you very much. I have three, two for Bill and one for Alan. First, Bill, it appears as though the Hemlibra EU non-inhibitor label will be more restrictive than the U.S. label based on what you said. Can you elaborate and compare the size of the eligible populations in both markets for Hemlibra? Secondly, I apologize for splitting hairs. On Lucentis, in the prepared remarks, you said it will remain a very important franchise for years to come. In response to a question, you said you were not expecting continued incremental gains. Are you implying flat to modestly down Lucentis sales over time? For Alan, at least one other major pharma will no longer include gains or losses from equity securities in the core results. I'm wondering what Roche's practice will be going forward. Thank you.
Okay. Sure. On Hemlibra, I think this is mostly a difference between label language and actual use patterns. For example, in the U.S., we don't have a restriction around severe, moderate, or mild. However, the use is typically in severe patients because severe patients are the ones that have the lowest levels of factor VIII. They're the most subject to destructive bleeds. They're the most likely to be on prophylaxis. That's where the highest uptake will be in inhibitor patients, next highest will be in severe, and the relatively small part of the population that are either mild or moderate, there would be relatively little uptake of Hemlibra. In Europe, the regulators will just go ahead and say it's for severe. We know about 70% of factor VIII use is in the severe population, and the remaining 30% primarily in on-demand use.
By the way, Hemlibra is still a product that's very young in its life cycle. Imagine we were only putting it in pivotal trials, what, two years ago, or I guess maybe three years ago, and now it's been on the market for over a year. We will be exploring all kinds of questions about what is the use of Hemlibra in moderate and mild patients? Is it on demand? There'll be many of these questions to be worked out, but I think the EU label is very much consistent with what we've been thinking about in terms of how the market shapes up. On Lucentis, maybe I confused things, but my comment was that Lucentis will be exposed to biosimilar competition in the coming years. It's hard to say exactly when.
We will be bringing forward this port delivery system in, I don't know, what are we saying, 2021?
2021, yep.
Yeah. It kind of depends about, I think with the port delivery system, there's a massive potential for benefiting patients and quite an attractive financial opportunity as well. The question will be, well, do biosimilars hit in, let's say, one year, and then the next year we're launching the port delivery system. It could be that sales fluctuate or sales could drop, depending on the timing of the loss of exclusivity and biosimilar launch relative to the launch of the port delivery system. In any case, when I said I think this is going to be a very important franchise to come because this port delivery system is a true innovation, and it'll carry us well through a biosimilar launch. Does that make sense?
Yes, it does. Thank you.
Hi, Steve. I hope it's not too cold in Boston.
Actually, I think it is today.
Yeah, I think so. Yeah, I looked at that because I go to New York with - 14 degrees Celsius. First of all, let me say, I think we're pretty proud on our consistency that we show with the core results. I think that's really perhaps a difference maker in the industry, because we have been pretty consistent, perhaps even a bit stubborn, what we've put into non-core and what we don't put into non-core. I think when you get our results, I think you can always compare apples to apples, and I think that's something we put a lot of value in. The other piece I should say is we gave it a little bit of thought, and I agree
I think when you now look at the fact that we have to account for unrealized gains in equity securities for listed companies, that brings a little bit more volatility into the core results, which is to a certain extent, a little bit unpleasant. When I look really at what the Roche Venture Fund does, I think it's very well-connected to our core business. They work together with partnering, they work together with the research entities. Whenever we think, okay, there's something smaller, where we don't want to do the major step, we say, "Well, we take a small part and let's see, and we're part of that, and we're part of the whole story." We could discuss AveXis, but that's perhaps one element here that I would like to bring into the game. We're engaged, we're part of that.
I think it's really part of our core business, and therefore, I think it belongs to the core results, despite the fact that it could contribute a little bit more volatility into the results overall. We gave it a little bit of thought, and we feel still well with it. Let's see what the future brings. For the time being, I think it's the right setup.
Okay.
Thank you.
Let's take other questions. Yeah, I'm going a bit to the back. We have many questions still. Let's start at the very back, in this corner, right.
Thank you very much. [Mariette Amina, Primavenue] Just a follow-up question on Hemlibra, please. I'm just a little bit surprised that your spin now seems to be that we should really expect the biggest uptake in the patients who are actually already on prophylaxis and potentially switching from factor VIII. You had in the past shown us data suggesting that there's a lot of patients who are not on prophylaxis, and the proportion is obviously higher the more you go down in terms of severity, but also in the sort of moderate to severe patients, a large number are not prophylaxed.
I thought some of the thinking was that actually that segment is very much underserved because there's not really a good product out there for the people who don't desperately need to be on prophylaxis, and that could potentially be very big and also relatively low-hanging fruit. Have you actually had any real feedback from the market to the effect now that patients who are not prophylaxed are just basically completely recalcitrant to the whole idea of prophylaxis? Are you just being cautious here and that non-prophylaxed segment could potentially be a blockbuster opportunity for you? Thank you.
Yeah. I think where it gets a little complicated is because there's prophy and on-demand patients that are severe, and there's prophy and on-demand patients that are moderate. There's not a lot of prophy patients that are mild, but, you have this sort of mixing. I think we see the biggest opportunities are in the prophy and on-demand patients in severe, because they have the highest unmet need. The ones that are on prophy, they have the misery of prophy, and the ones that are on-demand, they're on-demand generally because they didn't want to be on prophy. That's the clear opportunity with the highest unmet need, with the most uncontrolled bleeds, joint damage, everything else. That's why it's 70% of the factor market. I think we've basically just said we did very much a faster market pivotal program.
It's been very successful because we came incredibly rapidly from some small-scale Japanese first-in-human studies, very rapidly to the West with bigger studies, and we've achieved that. Now we've got a life cycle program where we're going to be figuring out what is the best way to serve the patients that aren't in those categories. I think there's an opportunity in that moderate space, but we need to do our homework and figure out, which group is that. You can imagine, by the way, in moderate, there's a range of one to five. There's a big difference between a patient who has 5% of factor VIII and one. Before it didn't matter because there was no treatment options, but now we have to look at, okay, which patients are we really targeting there?
Can we take the question here in the middle? First this one, and then I'll come back to you. Please.
I'll try and be brief. It's Emmanuel Papadakis from Barclays. You alluded to it a bit earlier, followed up by similar 340B, as long as it's around, it's a big book of business for you in the U.S. Could you talk a bit about your base case by similar penetration assumptions within that channel relative to others and some of the commercial incentives that may affect that? Maybe a quick one for Michael. We've had many years of sustained margin compression in diagnostics. Does this represent a sustained inflection point? Are we any closer to seeing that elusive end-to-end NGS solution? If not, when? Maybe a quick one on balovaptan. Could you just talk about your levels of internal enthusiasm for the forthcoming phase II proof of concept data? Thank you.
Okay. Michael, you want to go first?
Okay, yeah. Emmanuel, thanks for the question. We discussed that already a couple of months ago in Rotkreuz when we had our Investors Day. Well, you saw good numbers, of course, we are working hard on keeping those good numbers. Can we call it already inflection point? We do our best to keep this good trajectory going forward. We are investing highly still, as I said at that time, in R&D, in innovation, more than everybody else. We are also doing our homework, I believe, in managing all the costs that allow us to get the flexibility to keep investing. Important is to maintain the sales trajectory, this is important. With the launch of all these new systems, cobas pro coming now, the cobas e 801 that we launched 16, 18 months ago, and the good pickup of those products.
Of course, you know, at the end, this 20 billion tests that we are performing and that being run on those analyzed in the world, this will allow us for continuous growth in sales. With the necessary measures that we are taking on all fronts internally, we should have a good trajectory going forward. I hope we can, going forward, also show a more sustainable inflection point, as you mentioned.
340B.
Yeah. Is everyone familiar with what 340B is?
No.
Okay. All right. 340B is the program in the U.S., which was initially designed to basically use pharmaceutical companies to subsidize hospitals that service the disproportionate share of low-income patients. The idea was, these are hospitals, because they got a lot of non-payment, that they have financial struggles. In its genius, the American health system figured out a way to do that would be to allow these hospitals to buy drugs at a discounted price and then charge payers, including the government, the full price, and then use the margin to subsidize their general fund. What happened under the Affordable Care Act, AKA Obamacare, was there was a significant expansion in the rate of discount, the level of discount they received, and a loosening of the rules about what it took to qualify as one of these 340B institutions.
Out of that, a whole cottage industry developed around helping healthcare institutions figure out how to become 340B, and then also how to expand their footprint. Probably the most bizarre example that I think of is there's a hospital that's a 340B hospital in the L.A. area that went around buying up rheumatology practices, because the rheumatology practices were infusing drugs. If the 340B hospital purchased the practice, they get to capture that business with the discounts. One of my favorites is Beverly Hills Rheumatology. That's actually a 340B center. Yeah. I'll let your imagination fill in the blanks. The question comes, okay, with biosimilars, if these 340B centers are making lots of money on the branded drugs, are they going to want to sell biosimilars? I'd say that's a valid question.
I would also say a lot of policymakers are also asking that question. It wouldn't surprise me if that sort of loophole got fixed somehow. I think you have to put this in the American healthcare blender a little bit because you'd say, "How can this be? What a strange thing." There's a lot of things that are strange. No, I say that the American healthcare system is a great healthcare system in terms of innovation.
You lost it.
It also. Yeah. I don't know. Maybe the answer to your question is, I think that's an open question, and it's going to get sorted out.
It's okay. Let's move to autism.
Yeah.
Right? That's my simple.
Yeah. balovaptan. Have you seen the phase II data?
Yeah.
Yeah. That's right. You saw that?
Yeah.
Yeah. Well, okay, we think there's a large need in the pediatric space for a treatment that would help with development and potentially just help kids on the spectrum to have a better functioning. We think there's a large need with adults as well. We have basically phase II data, proof of concept data in adults, and we are very hopeful about it. At the same time, I think we're quite judicious about it because it's phase II data, it's a single study, and it's a behavioral therapy. We know that the annals of drug development are replete with things like that that seem very promising based on a study, and then when you go to repeat it, you don't repeat it. We're going ahead full speed.
We had a pediatric study, phase III program in adults as well. We're gaining further pediatric studies on the phase II study. We're pressing on with the adult phase III study, I think it's a big maybe. Again, we hope, but we're being very realistic, I think.
Yeah. I would also put it into the high-risk category. The pediatric study will be important, because if a second phase II study shows the same signals, of course, the confidence level will go up. Right. No, we were here. Right.
Five more minutes.
Right?
Yeah.
Yes. Very good.
Same chap.
Thanks.
Thanks very much. Sam Fazeli from Bloomberg Intelligence. Thanks for taking my questions. They're all easy. Splits with regards to product sales going forward. Thinking about Perjeta, how should we think about 2019 with regards to the adjuvant setting versus the prior to the APHINITY data. The same for Tecentriq. Obviously, you've got new indications coming at some point. Have you had much use already off-label in Obviously, you don't promote off-label, but have you seen some? How should we think about the existing indications that may be under pressure from competitors? Net price in the U.S. Obviously, you don't have biosimilars there yet. One of your peers spoke about oncology drugs seeing some net price declines in the U.S., which was a little bit of a surprise. Have you seen anything like that?
Have you got any experience, any feelings with regards to that going forward? Biosimilars, have you become a little bit more or are you going to be less pessimistic when it comes to us modeling biosimilar models? I think Karl might know what I'm talking about in terms of the expectations in erosion rates going forward. Very last thing is gantenerumab versus crenezumab. We had felt that there's potentially some reasons why one or the one that didn't work and you stopped should have worked. Can you just remind us how the trials are different that might help us have more faith in the ongoing trials? Thanks.
We have five minutes.
Okay. I'm going to be really quick.
Yeah.
Okay. Perjeta. You said adjuvant versus what was previous. Perjeta has been approved for metastatic and neoadjuvant, then APHINITY was the adjuvant. I don't know if we have the precise breakout, but most of the growth is happening obviously in adjuvant because we were highly penetrated in metastatic and neoadjuvant. I don't know. Do we have it?
No.
Okay.
Perfect answer.
Okay. Tecentriq, off-label, you asked whether we're seeing off-label uptake. The thing is, the data was just presented at ESMO and San Antonio, I think as we said, Q4 sales results were strong, it's really too early to say what's driving that. We did get an NCCN guideline in small cell lung cancer, which there could be some use happening there because there's a guideline, we don't know what. We have some anecdotes. I don't think we're seeing off-label use in breast cancer. There's not an NCCN listing. The data was just disclosed. Could it happen before approval? It could, approval's going to be pretty soon, so I'm not sure there's really a long window for off-label. Let's see. Oncology net price declines. No, we're not seeing that. Biosimilar, are we less pessimistic? No.
Europe. You can perhaps talk about Europe if you like.
Oh, yeah. Sorry, about what we've seen?
Yeah, we have not How should I say it?
You mean, like what we experienced in Europe?
Yeah. What that means for 2019.
Yeah. That's fair. We saw in Europe, obviously it was Rituxan where we lost, I think it was approximately half of the business in one year. MabThera, sorry. We expect to lose less in 2019 because when you've lost half, you can't lose more. With Herceptin, we lost, was it 20-something% by Q4? I think we'll lose more, because they're launching. With the U.S.-
Basically-
Yeah. Sorry.
in Europe, we expect the impact to be rather similar to what you've seen in 2018.
In absolute terms.
In absolute terms.
Yeah. Then in modeling the U.S., it is hard to model because the environment is so dynamic, and there's so much talk about penetration and such. Then the last one was gantenerumab and crenezumab.
Yeah.
Yeah. The studies are similar, I think the two molecules, the MOAs are slightly different, in terms of which species of A-beta they're targeting, but also, crenezumab was an IgG4 molecule, it was designed to have less of an immune system participation in clearing the plaques. The reason for that was that the early anti-A-beta molecules caused brain edema, which was dose-limiting and treatment limiting. Cren was designed to avoid edema. The question we always had was, will it work? Is that edema also a sign that you have activity? That was always the key question. We decided because of the size of the unmet need and some data that looked somewhat promising, that we would take it into phase III. I know that Sandra Horning, our Chief Medical Officer, and I had many conversations about, is this going to work?
It doesn't work. Or at least it didn't in the population we studied, which I think was a well-designed study. Gantenerumab, very different. We know it clears plaque. There we're more testing the question of whether that clearing plaque will resolve Alzheimer's or at least make a dent in it. I think it is a pretty independent question. I think Cren and Gant are pretty independent. I know the market reacted, in terms of one of our competitors probably put more of an association between those two than we believe. We'll see.
Right. We have one more question, I go back into this corner. I've gone this way, now I still need to cover a bit over there. One more question.
We have Alan introduce. One short question, one short answer.
One short question. Let's go ahead.
You spent a large part of your annual report talking about artificial intelligence, big data. Just help us think realistically, how are you actually using it across the two businesses today? Are you really seeing it improve productivity? If not, when do you actually think the investments you made in Flatiron, Foundation Medicine actually start paying up, either from perspective diagnostics or improved probability of successes, lower trial cost in pharma?
Right. We believe that the digitalization, which is happening in healthcare as we speak, offers a great opportunity for research and development as well as for better targeted healthcare. I would say advanced analytics, artificial intelligence, et cetera, that's probably the smaller issue. The bigger issue is that you can collect the data, that there is electronic means to collect them. In big parts of Europe, data are not even available in an electronic form. Then you need high quality data. You get access to that, you have to aggregate it. I think that the challenge today is more on the data side than the advanced analytics. That's where we focus on. We also need the advanced analytics, but what we focus on is the data, and that is what Flatiron was about. This is what FMI was about.
We try to bring these data sets together to have clinically genomic data sets rather than just clinical or just genomic data sets. Eventually, we try to enlarge this kind of data set with longitudinal clinical outcome data, as well as clinical trial data, where we have lots of them in-house. That should provide us with new insights, that should help us to make clinical development more efficient, faster, and eventually also improve healthcare. We use artificial intelligence actually across the value chain. I can perhaps just give you one little example. We are developing sensors in diagnostics, and with sensors, you have high wastage. If you look at blood sensors, for example, in industry, you lose 50% of your sensors in the industry. You don't know why you lose the sensors, right?
There are small changes in this manufacturing process, which is a very complicated one, you just lose the sensor. You know it's not working, but you don't know why. Guess what? We took pictures of these sensors coming out of the production process, we applied machine learning on the pictures which came out of the sensors. The machines could predict better which sensors are falling out than these experts could predict who have worked decades on improving the manufacturing process for these sensors. We could increase the yield for those sensors. This is more an efficiency application, but I mention it because it shows that these kind of things get relevant across the space. What you have seen with uPath in pathology, for example.
You have these pictures, we are working here in the U.K. that pathologists can exchange their images to get the expertise and everything. What we can also do is we can run algorithms on these digital slides, if you like. What we do see is the quality of the interpretation of the result goes up. You don't even want to know how often the results are wrong. How much, in this case, also clinical decision-making can be improved by these kind of tools. There is huge potential here. I think, I'm looking at Karl, we really have to close here. Right. We have an opportunity outside-
We have.
We have an opportunity outside to get a drink and something to eat so for people who want to stay.
Okay. I know many of you have to leave. For those who can stay, we have an Aperol out there. I thank you very much for your interest and have a good week. Thank you very much.
Thank you.