Earnings Labs

Novo Nordisk A/S (NVO)

Q1 2012 Earnings Call· Fri, Apr 27, 2012

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Transcript

Jesper Brandgaard

Management

All right welcome to EASD, Berlin. Welcome to the Novo Nordisk Investor Conference here in Berlin. We have the entire brain trust of the management here, able to answer any questions you have I think. What I will be, we will be going through will of course making predications about the future and therefore we have included this outlining the limitations of making forward-looking statements and also highlighting the products that we have here, and we are going to talk about insulin Degludec is a product which have not yet been approved for use in diabetes in U.S. and Europe and we have also highlighted that Victoza so far is only approved for treatment of type 2 diabetes. So that has been highlighted and hopefully is clear to everybody. My name is Jesper Brandgaard, I’m the CFO for Novo Nordisk, been so for the last 12 years. My role here will be basically to give you a short introduction, and then leave the discussion and Q&A session, which we expect to get through in approximately 50 minutes. The agenda you see here and next on the podium will be Mads, who will basically reviewing the Novo Nordisk diabetes strategy, then Peter Kristensen, our Head of Global Development will review some of the key trials for both Tresiba and Ryzodeg at EASD, and Peter Kurtzhals, our Head of Diabetes Research will basically review with you the results for our next generation GLP-1 semaglutide. And then finally, our Global Chief Medical Officer, Alan Moses, will give you some clinical insight from using Liraglutide or Victoza in a clinical setting, and that should then lead us to the Q&A in approximately 50 minutes. First and of course a key focus area is, how is the regulatory process proceeding for both Tresiba and Ryzodeg…

Mads Krogsgaard Thomsen

Management

Thank you, Jesper. It’s a pleasure to see here and to be in Berlin for the event of the EASD. What I will do is actually highlight just you can see at a very high level, the way our company seeing diabetes and the future management of this chronic disorder. A beautiful molecule over here, I think Peter Kurtzhals had send Peter Kristensen, have already told you about that and will hear more in a little while. Now it all starts with the unmet need and the fact of the matter is that people among the 366 million diabetes suffers all over the world on average not in control. Familiar reasons for that from a pharmaceutical perspective one of the major reasons is obviously that we are really lacking highly efficacious anti-diabetic medications that are devoid or at least have only a minimal hypoglycemic risk. Also aggravating the problem is that many of the therapists who are actually treating patients with even worsening the problem of overweight would be instant resistance further aggravating the vicious circle of declining pancreatic β-cell function overtime. The fact that medication is the target complementary disease pathways is important, I think it’s obvious from some of the data that we have released headline results from very recently namely when you combined agent such as a internal tropic one like GLP-1 and a insulin that has the action of the insulin, you will get complementary effects on basal glucose control and boost pinto glucose control. And overall even on the side effect profiles you have some complementarity. So there is no doubt that whatever Novo Nordisk can do to deploy its protein design technology platform on whatever target would lend it so to future therapy, that’s our game. Now if you look at the attitudes among…

Peter Kristensen

Management

Thank you. Thank you, Mads. We have picked two of the FX percentage, so we have 23 presentations of insulin degludec and degludec plus here and of course we can through them here. But we picked two of the important ones, one on Tresiba and one on Ryzodeg. And the first study is the two year extension, it’s the extension of the, call a basal treatment in type 2 diabetes that some of you may have seen [Burnis Innman] present yesterday and what you’re looking at here is of course a very central study with more than 1,000 participants, three to one randomization in order for us to get a sufficient exposure of this, of a lot of patients who were not previously treated with insulin. This was to see to get a sufficient safety database and as some of you might have been at the [Jason Boras] presentation this afternoon, where we look at antibodies over one year which was of course also to a large part derived from this trial. And as it is a trial with an extension, we are looking at two groups of exposure. First one where we have approximately close to 80% of patients finalizing, the first part of the trial and then patients ask would you like to go into the extension trial of 8% to 10% to go in and of that also then continue 6% to 8% go out, so we include around 60% of the patients. And if we look at the efficacy of treatment, we could see here on the list, the change in HbA1c over time that this is a treat to target trial. We are treating the patients to a self monitored glucose target for the two insulins. So we should achieve the same HbA1c of note…

Peter Kurtzhals

Management

So I will continue explaining you about our approach in the area of once we if you wants and this is another product that does need to be shaping the road, not even prepared on the table top. This is a ready for use mutual solution ready to go in a nice pen. Semaglutide and semaglutide is shortfall for a week so that’s where that name comes from if you refer to do product. As some of you will now, we had kind of an internal competition of who could do best, the formulation, people all the chemist, the formulation people we are trying to do with once we can product of liraglutide and the chemist were trying to do a launch weekly product by molecular engineering and the end of that was communicated on to you mid this year and semaglutide you say that the chemical approach was in the end the most successful approach in our and the basis for coming to that conclusion is also cost to a large extent the data from Phase I and Phase II that I’ll share with you here today and many of you also would have seen in post us all at we conduct presentation yesterday for the Phase 2data. So semaglutide is molecular engineered on the basis of human GLP-1 so its very similar to the GLP-1 molecule itself like liraglutide modified in a few positions as a major modification in position 26 where we have (inaudible) like liraglutide but we saw the difference and there was some difference on launching of to make this molecule half life as you can see in this slide approximately one week doses from10 to 20 micrograms per kilogram. And then half life of your portfolio, you can see a nice dose dependence on…

Alan Moses

Management

Thanks Peter. Part of that in 2012, we’d not be talking about that we will mere in the stable, but you still acting like a fully in terms of energy in some of the new data. So what I’d like to do over the next couple of minutes is, talk to you about three studies that were presented here. Remember, there were total of 7 abstracts on liraglutide at EASD. That really – I think we get you here is the picture of how the liraglutide is being used and what its success pattern is, if you will in clinical medicine alone up not the first study that I’ll begin with. The first study is actually an early phase study in pediatrics. Now there are two reasons for pursuing this, of course. One is, there is a regulatory requirement to look in a pediatric age population, both from EMA and the FDA. But more importantly, I think we have to recognize the type 2 diabetes in the pediatric age range. We’re not talking about age is 10% to 17%. Is increasing in frequency dramatically in the U.S., but also in some part of Europe, and there only two approved drugs for the treatment of diabetes in the [pioglitazone] and metformin and insulin. Metformin relatively easy to use as low medication, insulin not as easy to use certainly with preparations up until today. But I think particularly in this age range in terms of compliance of (inaudible) and their effects. And also of course the issues of weight came with insulin and a population that is rather over weight to begin with, which is one of the causes of their or precipitance of their development of diabetes. So in any case there is a strong rational for looking at new drugs…

Jesper Brandgaard

Management

I think I’ll do it from down here. We’ll now do a Q&A for approximately 30 minutes. I remind you that this is being webcast and we have microphone from two investment officers. So do wait for the mike when you ask questions. After the 30 minutes, there will be refreshments outside. I would suggest that we initially limit the questions to two per individual in order to give the dialogue going, but I think there will be multiple chances of asking questions and let’s start with Michael up here and please state your name. Michael Novod – Nordea Markets: Yes, Michael Novod at Nordea Markets. Let’s turn the question to semaglutide looking at the (inaudible) sequence, it do resemble what we saw with taspoglutide. At least one of these institutions should make. So could you give us some flavor into that specific and why should not expect or not should be afraid of having a taspoglutide situation et cetera. And then the second question relating to the Japanese approval, could you give us some flavor into the Japanese label and also perhaps give some flavor. Approval process has been ongoing in terms of how much of the Japanese authorities maybe able to review of the data, not only based on the label but to actually give the entire approval (inaudible)?

Unidentified Company Representative

Management

Thanks, Michael. Good questions. We have a Nova Taspo in our hand, so how does the immediate sequence different for CMEC compared to taspoglutide. And Mads if you would (inaudible) comment on the Japanese approval process?

Mads Krogsgaard Thomsen

Management

Yeah, so to the first question, we don’t believe we have another Taspo in our hands, but you want today to see something that we will know about when it come to Phase III. That being said you’re right that the precision 8 in (inaudible). We’ve also seen taspoglutide, its pure degradation with and that was linked to the physician that was seen with Taspo and we got to say that we believe that’s a very, very minor modification to (inaudible). And we are confident that (inaudible).

Unidentified Company Representative

Management

Remember that, taspoglutide was also a physical foundation so there was physical protection in this opportunity. This is a liquid and also distribute like any of our other in technical prolonged product. So there is a big difference between creating a physical (inaudible).

Mads Krogsgaard Thomsen

Management

And to further highlight that, there were actually two ARB, two immune – is one in the interim based on (inaudible) but also in the terminals. And the one in the [compoxy] terminals has been shown to affect the (inaudible) sheet structure, i.e., the secondary restructure of taspoglutide that is not present in semaglutide and we have no change to the secondary structure whatsoever. After that that you would have like adjuvant-like effect of what Peter Kristensen describing this adulation of the vehicle that these are under the skin for longtime triggering the immune system. So no the short answer is we definitely would not anticipate to have a Sema, sorry a taspo...

Unidentified Company Representative

Management

We do have…

Unidentified Company Representative

Management

We do have Sema.

Unidentified Analyst

Management

Thanks. Unless the Japanese process for...

Unidentified Company Representative

Management

Yes, well Japanese NDA submitted as Jesper described December last year has been through a rigorous, but very systemic process according to some new Japanese guidelines where they actually expediting the way they at least will handle, you can argue parts that they concede outside. Some importance actually take us nine and a half months to get through the entire PMDA process ending up with the committee last month and then the official handover, the certificate last Friday, so it’s been a very good process, it’s not as if they haven’t asked hundreds of questions they have, ending up still with a, will be the fastest approval for a non-domestic company submitting a [numerous] entity to the PMDA. Beside all the data that was in the NDA was that, it is clinical, preclinical, CMC and so on so forth. The reason why Ryzodeg is still being assist by the PMDA is obviously that that also was submitted in March as opposed to December, but as the process also looks to be relatively explicit.

Unidentified Analyst

Management

Was the difference for the gaining that the Japanese that that make the difference in that terms of brand?

Unidentified Company Representative

Management

Okay the label in terms of, okay thank you for that. Two things, first of all Ryzodeg you need a different package also in terms of some CMC and stuff like that that call for a certain delay of that few months compared to the Tresiba. The label per se it is important what the PMDA actually does is they look at the totality for global data, but they will relatively clear piece of global data, but rather local Japanese data. So the hypoglycemia claims that we actually have in the packaging to, they are driven by the outcomes of Japanese – the Japanese once daily basal initiation trial that is a replica in the smallest scale of the one Peter just mentioned during his presentation that 3579 study. But the data were pretty much showing to seeing degrees the hyperglycemic benefit. Now the reason why we did not get the ultimate flexibility claim in there, which we’d like is that the two flexibility studies have not that all being done in Japanese subjects, they can done implications. And hence I think the two instances why the Japanese are preferring from giving on that one being the population in question, the other being probably the notion that Japanese mentality is not to allow to erratic among the people or including in Tresiba people diabetes.

Unidentified Analyst

Management

Okay thanks.

Unidentified Company Representative

Management

Next one from Carsten. Carsten Lønborg Madsen – Carnegie: Thank you very much Carsten Madsen from Carnegie. Just one more question to the Japanese processing when you (inaudible) safety. Could you elaborate a little bit on differences between FDA requirements and what is being required in Japan FDA has got this 1.8 milligrams, 95% of likelihood of success is that the same or similar in Japan? And then on the semaglutide, should we also consider semaglutide containing obesity or is that not an option?

Unidentified Company Representative

Management

Thanks, Carsten. First on the Japanese approval and the requirements for the cardiovascular safety in Japan and where those differences between Japan and U.S, so see well there is something that could read across to the AdCom. That was question, I was diving. And I don’t know what Peter Kristensen answers on how or maybe both Peter Kristensen of course can comment on what are the plans for semaglutide in terms of indications?

Peter Kristensen

Management

Well in Japan as such as you probably aware, Carsten there is not a specific CV requirement per se that obviously since as part of the and by the way in the U.S., there is actually obesity also not, because the CV guidelines for 2009 they do not the same at least as per the inclusion criteria in that guideline to injectable insulin products. Now that also can of course change over time, as you start seeing you and had very long-acting agents and got no slot, and then you took it to of course be a part of the dialogue with the agencies. But per se, you are not held up against the CV guidelines that non-insulin products are. When that is said, you still adjudicate all your wins and then that being able to report the, and so on and that is also being the case for Japan. And if you had like statistical anomalies or significances then you can imagine having a very interesting meetings with the agency in that regard. And as I said, we got this approved in nine and a half months, so well that’s not a major hiccups in that regard.

Unidentified Analyst

Management

Okay, (inaudible)?

Unidentified Company Representative

Management

Yeah I think on the obesity, therefore with semaglutide I think that what were we maintaining in that project is actually how we were with Liraglutide 3.0 milligrams for obesity and this would probably launch major development activities on that but it’s an obvious opportunity because as Peter mentioned that as semaglutide dosed with the long half life actually it gives an even flatter profile than Liraglutide. So and therefore you can easily go high on GLP-1 occupancy without getting aggressive entity. It’s easier than the fewer peaks you have. So semaglutide from that point of view was a good, a good opportunity for obesity but I don’t think you would see as we move on that from a development point of view until we passed let’s say an AdCom on Liraglutide, 3.0 milligram for obesity which is yet to come.

Unidentified Analyst

Management

Thanks, Peter.

Peter Kristensen

Management

Sachin, next questioner. Sachin Jain – Bank of America Merrill Lynch: Sachin Jain, Merrill Lynch. Semaglutide and titration on phase 3, any more color and more steps to the intervals and just what position, distance you think you have to complicated algorithms, and then second question, which monthly rose deal for CHMP, do you have any color whether are on the October meeting (inaudible). Thanks.

Peter Kristensen

Management

I guess the second one, the second one I think I’ll actually deal with and I think missed the – the short answer will be that the regulatory process for our competitors, you will have to direct your questions to our competitors. Sachin Jain – Bank of America Merrill Lynch: Degludec.

Jesper Brandgaard

Management

Was Degludec? I’m sorry, then I will take it and the reply will be as I said in my introduction that the Tresiba approval or processing in EMEA will be on CHMP within the next couple of months. When it will specific, we’ll have to wait and see. And then the first question which was related to the being three trial for semaglutide. And I guess Peter that would be – in trip to the titration algorithm that we would be intending to use.

Peter Kristensen

Management

What I can say Sachin is that, we are looking at prolonging the steps for products. But the of course there is always a challenge in how long should do that. So we will go through a four week interval at the low dose that will be used to the high dose, and from that we expect to have two different doses in Phase 3.

Jesper Brandgaard

Management

And I think just to highlight what Peter is saying, it is you can say also a very aggressive situation. I think we underestimated potencies of semaglutide because 0.8 milligram dose actually did better than we Victoza. So at a high dose, that corresponds to do that without titration as we didn’t want our corresponds to giving the patients in excess of 2 milligrams of Victoza hit on, which of course you will never do, and if you look at (inaudible), that’s titrated with a 5 microgram dose for one month, and then you go to 10 micrograms, not one week. I think Peter is in control of the titration scheme, then will not rule out, yeah, try to fix because this is an extremely efficacious deal to one agent, but that will also not give physician resistance or patient resistance for that matter, giving on boarding to the trial, I’m pretty convinced.

Jesper Brandgaard

Management

All right, we will take next question from Brian.

Brian Bourdot - Barclays Capital

Management

Thank you. It’s Brian Bourdot from Barclays. Two questions please, one on Ryzodeg and one on semaglutide please. For Ryzodeg Peter, quite interesting results from the Japanese population, so just want to ask you what your message is going to be, and Japan should a mix into an be used is that makes who ever should have basal into when we use, is that based in last your very periods. And second question on semaglutide actually is the oral version that you’ve advanced into Phase II development, just wondering what hopes you had for that so that drug, do you think you can show equivalent efficacy and safety, given that it looks like you got kind of similar doses that I would expect you to be using maybe to the injectable in Phase III and how much protein do you need to use to get to the improvement at least, thank you.

Unidentified Company Representative

Management

All right, I guess Peter, additional comments on the positioning of Ryzodeg in Japan versus the first way of Tresiba approval and knowing that Japan has a significant combination mix market how will Novo Nordisk approach that, and then maybe on to Pete, I guess the old version of semaglutide [NN9535], how do we expect the efficacy will be compared to the subcutaneous injection version and approximately how much drug will be needed so we need to expand with the huge number of facilities et cetera?

Peter Kristensen

Management

On the Ryzodeg what I presented to today was the once daily Ryzodeg study in Japanese subjects we also have a twice daily study in Japanese subjects and of course that it all depends on how you want to distribute your balance between basal and fast acting for the mill and that’s study you will start I remember presented at idea the twice daily, but having said that I think it’s important for the whole family of products building on (inaudible) that we first get an understanding in the market of the features of that insulin before we start complicating the message with Ryzodeg. So I think you will see that this is what we’ll also do in Japan.

Jesper Brandgaard

Management

But Brian, you’re absolutely right in saying that Japan is so much been a twice daily premix initiation market. The company that changed that briefly was lends us to that now basal insulin initiation has actually become the number one option, and you’re absolutely right in saying that we can either than go big time found that route and then regained the loss share to speak in the basal segment but historically there has been a boost because of carbohydrate rich food, but also because at least of the notion the boost panto glucose are extremely incremental spike, this is lost relatively early on in the Asian subjects, that there is a need for plenty of position that could be either be twice daily or could even as Peter show be once daily so that’s a lot to think about.

Unidentified Company Representative

Management

And I can go on with the old version of semaglutide, as some of you will know we are continuing those doses in Phase 1 clinical trials and the continuation of those doses to indicate that of course we were case with obese so fast. We do believe that if we get sufficient semaglutide into the blood stream, we will also have similar efficacy, because the majority of GLP-1 effect will be a systemic effect. However, you cannot exclude that an old version of GLP-1, analog relativity even more effective than a [GLP-1] because some biological data that points to some local effects of GLP-1 also is a cause as you will know indulge GLP-1 is actually secreted from the L-cells in the gut and some cells point to also (inaudible) with nervous system. So we could hope for even greater things of the GLP-1 with given all. The challenge at the moment of course clearly is to have control over the two key parameters as you also alluded to one is, bioavailability and the other one is variability. Variability we believe we can very much control on the molecule like semaglutide type dosing orally once daily, not once weekly, that will ovearll gives a fairly best action profile despite basically variability. With respect to bioavailability, it’s too early to really give any conclusion remarks from that is clearly we are talking about much lower bioavailability than when we give semaglutide, as an injected drug. So we’re talking about probably building may be a new factory and so.

Unidentified Company Representative

Management

But I think we can afford that at the current DPP-4 market, and how would say, DPP-4 inhibitor it should get an old version DPP-1 and all.

Unidentified Company Representative

Management

Well, I think Brian, it’s likely that you will be looking at bioavailabilities below 10% and hence you will easily need 10 times as much of the actual molecule per patient and hence you won’t require a significant expansion of production capacity, if that would be the case.

Unidentified Company Representative

Management

And obviously because the semaglutide such a good molecule that you are on a once weekly basis would never need more than 1 milligram or so. That even with what Jesper and Peter is saying, still means that we are in the low teens or tens of milligrams on a daily basis, and we are not talking like Aspirin doses of 500 mg.

Unidentified Company Representative

Management

All right, next question, next.

Sam Fazeli - Bloomberg Industries

Management

Hi, thanks for taking my question, it’s Sam from Bloomberg. Is there a limit on how many questions we can ask?.

Unidentified Company Representative

Management

Two please.

Sam Fazeli - Bloomberg Industries

Management

On semaglutide point on the slide that to club later on short. There was an origin in 34, 35 substitution too, although it was not actually substituted in the slide. Events are largely (inaudible). So can you explain what happened there, I’m not sure whether the slide was wrong or when there is actually a substitution that which is quite close to the same place that has substitution, that’s point one. Point two is, if you look at the FPG date of the degludec you have pretty similarly A1c drop versus glargine, you have a bigger FPG drop. I think it was [asking] in the conference too, but I’m too slow to pick up the answer. Does that automatically tell me that there is a disadvantage to degludec on a PPG basis or wider than or FPG has nothing to do with A1c which gives (inaudible).

Unidentified Company Representative

Management

Okay thanks. The first one in terms of we’ll start again on semaglutide is in these resembles to taspoglutide and specific structure of the molecule and how the [Arg] substitution was done in the molecule. And I guess if we do want to take that Mads.

Mads Krogsgaard Thomsen

Management

Yeah we can share it. Peter you want (inaudible).

Peter Kristensen

Management

No I can just say Arg 34, is exactly the same substitution as we have in liraglutide, so the (inaudible) 34. But since then it’s also a vital increase precision 26 you can say that full. And it’s much easier for the chemist to do the escalation precision 26 we substitute modeling to precision 34. And that secular thing substitution as we prove and say for reconcile.

Unidentified Analyst

Management

And unlike taspo the AIP change they have been (inaudible) does change the overall structure, so that’s the difference. This is just Victoza replica on the systems. The one that maybe, if I can try to respond to your degludec question, because this is frequently asked, we ought to comparisons has statistically significant differences in FPG and all five medical (inaudible) can that be when you get the same HbA1c that these areas around that. I like Peter Kristensen is very mainly four times literally ability that means that your fluctuation seems particular below that mean fasting glucoses are probably less such that you can actually end up from the same A1c with the low fasting glucose, if you have literally what you understand so to speak. It extremely (inaudible) that would be that you have more hypoglycemia on glargine you spent more time on a per day basis in the hypoglycemic resume, that is actually going to help you A1c, but it’s not good to the patient. Okay, so you are going to have a fasting glucose that in the morning is improve for degludec, but because you have lift hypoglycemic episodes that that live without (inaudible), but that is the highly beneficial thing. That can probably be many other explanations, but one of them would not be post-prandial glucose, because as such the basal insulin shouldn't affect post-prandial glucose, if it does, it's actually because you have a big effect and we have hear from our colleagues that they don't have a big effect on the insulin.

Unidentified Analyst

Management

This is Mark (inaudible). Two questions from me, then back to Brian’s question on Ryzodeg, because if I look at the figures, it look like that will be the same change, same level of hypos in Ryzodeg versus Tresiba, but then with in the data effect on HbA1c. Back to the question and pricing with the Ryzodeg been in Japan with product market Tresiba or like it was normally because it gives us very big difference between the parts on that. And then the same question we’ve got into (inaudible) if I look at the chart and look at 0.8 titrated very high level of an (inaudible) 0.8 was an upside titrate, it actually the same below the 1% titrated (inaudible).

Unidentified Company Representative

Management

Okay, if I handle on the pricing level for Japan, I think we will basically await the approval process and the assessment of the label for Ryzodeg Japan before we make up our mind on this specific pricing and then product. Whereas, I think in Japan with (inaudible) on the market in Japan, we have relevant benchmark and then we have clearly more education start, we provide patient with significant lower hypoglycemia and we anticipate that will then call for a premium based on the current therapies and we don't anticipate at present that we will – I'd don't say we anticipate a present level we’ll take some element of that pricing on the basal segment into the pricing of the Ryzodeg, but it will also look in on the label and we’ll have to wait the label to conclude. But it is in reality, we have two components and you could basic and take the pricing between individual components and from that you can derive theoretical price for us.

Unidentified Company Representative

Management

But within that (inaudible)

Unidentified Company Representative

Management

That would be the higher price the norm makes again it will depend on what the specific legal would be for the product one semaglutide approved (inaudible).

Unidentified Company Representative

Management

I think maybe we can allocate all basic, it will be very speculative, I think the main thing to the way up a little bit is that the numbers relatively small, so we have the 40 patients in each and if you have 5% difference between the two of the currency of the (Inaudible) that we thought more hypo in one arm than the other. So…

Unidentified Company Representative

Management

Hypo.

Unidentified Company Representative

Management

No, hypo. Any way it’s small, and then I think we can all have always speak with patient if you hit them hard in the beginning, well do then they relatively feel more relieved the following week because they just feel better or whatever, I think the major issue here is that the numbers are relatively small to compare between groups.

Unidentified Company Representative

Management

And I think if we don't have that figure here, but if you still mind (inaudible) those who see that the majority at each of the levels of the insulin miles – so it's really down to 2 or 3 per patients we've got a live nausea in that, we cannot and so it is – it's too small numbers and we actually as much as 94% that are even (inaudible) reported by the circumstances.

Unidentified Company Representative

Management

Alright next question, (inaudible) and you allow to the ones who restrain themselves to two questions and there is now an opportunity to…

Brian Bourdot - Barclays Capital

Management

Thanks Brian Bourdot again. Another question on semaglutide actually see that on semaglutide please, that will quite interesting. The analysis that you showed it’s hard to nausea at a time, is that a completed analysis? Is that a raw analysis? And if it’s not a complete analysis, how much is the increase for the higher doses overtime driven by drop down, because I think you have like normal trivial portion of (inaudible) is dropping out hence the – I think the second equation might be that will broadly, your Chief Executive has on the call stated that Novo Nordisk daily people, not weekly people? Is that can you (inaudible).

Unidentified Company Representative

Management

Just quick comment, yes, I’m a once a daily man, he did nothing we are once daily people, yeah I think he’s spoken his personal power.

Unidentified Company Representative

Management

And I think he can say Brian on that one, let’s just clear that one first, and I think the view in management is that the proof is in the data and we'll have to see the Phase III trial to really be for conclusion. It is clear that the convenient matters and where the convenience and is going to come in terms of the very, very long half life in terms of semaglutide then being converted into a convenient once daily tablet, but using the long protracting life or whether it’s going to be the self good conversion. I think (inaudible) is a little bit out on that one, but if we look at the uptick so far in the market from the once-weekly version of semaglutide. It is apparent to us that convenience has to be there both in terms of the delivery mechanism and in terms of the molecule if you want to go in that direction. So I think you have to think with the mindset of convenience, but I don't think that anything that moves out that once-weekly version or twice per month in theory could be possible or could be a feasible way for insulin or GLP-1 overtime, I think that is conceivable, but lets prove that we have very efficacious doctors, so you want to follow up on that.

Unidentified Company Representative

Management

No, I actually have another question on the... [Overlapping]

Brian Bourdot - Barclays Capital

Management

You are referring to this the current way the nausea all time?

Unidentified Company Representative

Management

That's what called the safety analysis that is just below, that’s all exposed basis, so the percentage you see is all the time the percent of all the patients who enter into that treatment on. So we don't – it's not like half of them have gone out and then it's percent of that that's not…

Unidentified Company Representative

Management

And by the way you wasn’t (inaudible)... [Overlapping]

Unidentified Company Representative

Management

I think Brian I wouldn't extrapolate too much from the GI sort of profile in a phase 2 that was the designed this way. For sheer reasons of having under estimated the proof of this molecule, we got most bank for the buck than we would have expected those level and that of course (inaudible) how we think about titration.

Unidentified Company Representative

Management

I think we had a follow-up question and then Martin you had final one on.

Brian Bourdot - Barclays Capital

Management

Thank you. Sorry, this is my last question. Injection side reaction, I think (inaudible) injection side reaction. I know (inaudible) recently hard portion, but could you quantify and describe what would (inaudible). Thank you.

Unidentified Company Representative

Management

Injection side, I think we are very low and you’d expect that because pH neutral solution and (inaudible) so it's a straightforward we should expect, would expect to meet....

Unidentified Company Representative

Management

And Brian just to answer that you actually seeing the peak already out around 24 hours, so the site of protraction here, the section to circulation due to the strong (inaudible) this is not some strange people progression that this data around in this game.

Unidentified Company Representative

Management

Actually you can say, I mean even though evaluating rare things like insecticide disorders, which are rare was escalated products, but we did have compared to it and there was no difference to liraglutide and we know that liraglutide is not ever is not effect over...

Unidentified Company Representative

Management

Okay, then Martin?

Unidentified Analyst

Management

Yes, Mark Mahan from (inaudible). Just with respect to the marketing business I guess there is a chance (inaudible) we know what mentions in the old days, it was just the once daily when you met the doctor, what would you say with the five seconds you have with the doctor on the seat?

Unidentified Company Representative

Management

This is the insulin with the ultra long action profile that quickly use safety to target.

Unidentified Analyst

Management

And you will not bring a hypo-simulator?

Unidentified Company Representative

Management

I heard today that people actually don’t feel that the hypo-simulator adequacy reflects what's going on so maybe not.

Unidentified Company Representative

Management

And that's of course the simple (Inaudible) that raises towards the TP but maybe I think we can also have the advantage of having (Inaudible) on the panel that maybe what would be a little bit more advanced message into all theses kind of diabetologist, while the outer lying insulin that provides safe efficacy but most specifically with very little variability dose-to-dose day-to-day and a very low rate of hypoglycemia best exemplified as eternal hypoglycemia which is the time period according with respect to see the effect from a basal insulin.

Jesper Brandgaard

Management

Okay, with that, thank you for your interest in Novo Nordisk. There is refreshment outside. Thank you very much.