<div id="readability-page-1"><div id="article-body-row"> <div> Novartis CEO Vas Narasimhan is doubling down on a growth forecast for 2026, even as the Swiss drugmaker’s fourth-quarter results start to show the impact of the “largest patent expiry” in its history. And while a $4 billion revenue hole awaits, Narasimhan insisted that a wave of newer blockbusters will pull the company back into growth by year-end. The steep patent cliff that Narasimhan was referring to follows the 2025 U.S. entry of generic rivals to heart failure treatment Entresto, blood disorder drug Promacta and cancer therapy Tasigna. Combined, these three meds contributed more than $6 billion to Novartis’ U.S. top line in 2024, before generic impact. And they are expected to create a $4 billion revenue gap in 2026 versus 2025, outgoing CFO Harry Kirsch said during a press call Wednesday. The damage is already visible in the fourth-quarter 2025 numbers, which saw Entresto sales plunge 45% at constant currencies to below $1.3 billion. Even excluding the effect of a revenue deduction adjustment in the U.S., the decline sat at a steep 34%. While the drug held onto its title as Novartis’ biggest product with $7.7 billion in full-year sales, it ranked third in Q4. The impact on the other two brands was even more severe, with Promacta sales plummeting 63% to $226 million and Tasigna falling 58% to $179 million in Q4. The generic hangover will extend into the first half of 2026, during which Novartis expects sales to decline by a low single-digit percentage. That said, Novartis expects a second-half surge to salvage the year for a low-single-digit sales increase overall. To do that, Narasimhan is counting on scaling high-growth assets like cancer drugs Kisqali and Pluvicto, which, according to ODDO BHF analysts, “proved somewhat disappointing” in the fourth quarter. The two drugs posted strong growth numbers, but apparently the gains were not as big as analysts had hoped to see. Thanks to a recent FDA approval in early-stage breast cancer, Kisqali has been on fire, with 44% sales growth at constant currencies in Q4 reaching $1.3 billion. But the number undershot Wall Street’s expectations by 8%, which Narasimhan attributed to a one-time revenue adjustment. Despite the quarterly miss, Narasimhan backed Kisqali’s $10 billion peak annual sales outlook, which he first provided last year. “What’s underpinning that confidence is the very strong volume growth we’re seeing across geographies,” Narsimhan said. In early breast cancer, Kisqali’s new-to-brand share has reached 63% in the U.S. and is “holding steady,” while its share in Germany has reached over 80%, according to the CEO. For Pluvicto, sales of the PSMA-targeted radioligand therapy jumped 70% year over year, reaching $605 million in Q4, which pushed up its full-year sales to just shy of $2 billion. The growth was driven primarily by the U.S. market, where Pluvicto has received a boon from a 2025 FDA approval in first-line metastatic castration-resistant prostate cancer. In that setting, Pluvicto’s U.S. share reached 16% in October, surpassing chemotherapy, according to Narasimhan. And the company expects sales to accelerate with upcoming launches in Japan and China, too. Novartis has also submitted Pluvicto for FDA approval in the hormone-sensitive setting, which adds about 75% of additional patients to the drug’s base. “We have the right foundation for that launch to be, we think, a rapid uptake with two-thirds of eligible hormone-sensitive patients already with existing treaters or providers,” Narasimhan said. While Kisqali and Pluvicto are blockbusters driving major growth today, analysts spent some time during Wednesday’s call on Rhapsido, the oral BTK inhibitor that just came to market last fall as a treatment for chronic spontaneous urticaria. Industry watchers were unnerved following the FDA’s recent rejection of Sanofi’s rival BTK drug tolebrutinib in multiple sclerosis due to liver toxicity concerns. For its part, Novartis expects Rhapsido to read out phase 3 data in relapsing MS in the second half of 2026. Rhapsido does not have liver side effect warnings on its label. But “out of an abundance of caution, given the findings of the other competitors,” the FDA has asked Novartis to implement “limited liver monitoring” in its MS program, Narasimhan explained. Besides tolebrutinib, Roche’s fenebrutinib trial also raised a liver safety signal. “We fully plan to advocate to FDA that we should stick to the current label in the absence of [any liver toxicity signal],&#34; Narasimhan said, noting that in relapsing MS, safety is “absolutely paramount” given the many alternative therapies currently available. The CEO declined to provide an estimate on a potential commercial opportunity, saying that it will be data-driven. He acknowledged that antibodies targeting B-cell pathways, such as Novartis’ own Kesimpta, will continue to be “the dominant class,” given that an oral drug is not expected to have the same level of efficacy. But Narasimhan noted that there’s a large market for patients who’d prefer oral drugs, flagging that 25% of patients in the U.S. and 65% outside of the U.S. are not on injectable B-cell therapy. </div> </div></div>

Novartis CEO Vas Narasimhan remains optimistic about the company's growth forecast for 2026, despite facing a significant revenue loss due to major patent expirations. The company anticipates a $4 billion revenue gap from the loss of exclusivity for key drugs like Entresto, Promacta, and Tasigna. However, Narasimhan expects newer products, particularly cancer drugs Kisqali and Pluvicto, to drive growth in the second half of 2026. Despite recent sales declines, he maintains confidence in Kisqali's potential and the upcoming FDA approvals for Pluvicto, which could enhance its market share.

Novartis CEO eyes 2026 growth despite record patent cliff