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Novartis expects a second-half surge will salvage the year into a low-single-digit sales increase overall. 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]," 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.

Novartis said further generic erosion of three blockbuster medicines, including its top-selling heart failure drug Entresto, will leave a $4 billion hole in its sales this year. Generic competition started to make a mark in the fourth quarter, as Entresto sales plummeted 45% from the year-earlier period in constant currencies to $1.25 billion. Sales of thrombocytopenia treatment Promacta plunged 63% to $226 million, while blood cancer drug Tasigna declined 58% to $179 million. Even with the three generic rivals entering the market around mid-2025, Novartis was able to produce total fourth-quarter sales of $13.3 billion, relatively steady compared to the previous year. As for the coming full year, the company is predicting an increase in the low-single digits. “We expect to grow in 2026 through the largest patent expiries in Novartis history,” CEO Vas Narasimhan told the media. “This demonstrates the strength of our growth drivers and the strength of our pipeline.” Novartis’ revenue forecast suggests 2026 sales of $56.2 billion to $57.9 billion, Jefferies analysts wrote in a same-day note. At the same time, Novartis foresees core operating income declining by low-single digits, according to its latest earnings report . Full-year 2025 sales were up 8% from the year before, at $54.5 billion, supported by two products that passed the $1 billion mark for the first time. Blood cancer drug Scemblix pulled in $1.29 billion in 2025, up 85% from 2024. And sales of cholesterol medicine Leqvio grew 57% to hit $1.19 billion. Investors seemed to be reassured by these figures. The company’s share price remained flat on the Swiss exchange early Wednesday. On the pipeline side, Novartis discontinued several early- to mid-stage programs following a review. The majority of culled candidates were in Phase 1 development for cancer, namely: Novartis also dropped a candidate for tendinopathy called NGI226 that was in Phase 2 development. A company spokesperson wrote in an email that the cuts were “balanced by the addition of new projects entering our pipeline.” Novartis also slightly delayed some of its highly anticipated R&D milestones. It now expects to report Phase 3 data for pelacarsen in this year’s second half, as opposed to the first half, according to an earnings presentation . The drug is for certain patients who have elevated levels of lipoprotein(a). The company also said Phase 3 data for its rare kidney disease drug zigakibart would come in the first half of 2027, instead of this year. Novartis amended the protocol of a trial in IgA nephropathy so that kidney biomarker data would come at the same time as results on the primary endpoint of proteinuria, which is considered a more robust marker of kidney function. Elsewhere, Narasimhan said Novartis was still “very active” when it came to deals in China. Last month, it spent $50 million upfront to license a radiopharmaceutical candidate from Zonsen PepLib Biotech. Oncology will be a core focus for Novartis’ M&A deals going forward, Narasimhan told analysts on a separate earnings call. On the media call, the CEO described China’s biotech environment as “very important” and “exciting,” adding that US and European regulators could take lessons from some of the ways China has “streamlined regulatory oversight” and “modernized its clinical trial enrollment approach.” Novartis isn’t the first company to double down on its interest in China. Last month, AstraZeneca announced it would spend $15 billion on manufacturing and R&D projects in China through 2030. In December, Novartis said it had reached a deal with President Donald Trump’s administration to lower drug prices in the US. That deal included an agreement to launch future medicines with “comparable prices” across high-income countries. Narasimhan told analysts the company is “working through strategies” for anticipated launches, including its Sjögren’s disease candidate ianalumab, which is expected to launch in the G7 countries next year. Editor’s note: This article was updated to add comments from Novartis’ analyst call.