Basel, April 28, 2026 — Novartis CEO Vas Narasimhan said the company delivered a “strong start” to 2026 across priority brands and launches, while US generic erosion weighed on first-quarter results “as expected.” He added that Novartis continued to advance its pipeline, citing Phase III results for remibrutinib in chronic inducible urticaria and Phase II data in food allergy. The company also completed the acquisition of Avidity and announced early-stage deals to support its breast cancer and allergic disease franchises, and said it remains on track to deliver full-year guidance.
Q1 2026 financial performance: sales decline amid generic pressure
Novartis reported first-quarter net sales of USD 13.1 billion, down 1% year-on-year (down 5% on a constant-currency basis). The company said volume contributed 13 percentage points to growth, more than offset by 14 percentage points of generic competition. Pricing reduced sales by 4 percentage points, including net 1 percentage point from revenue deduction adjustments in the US, while currency added 4 percentage points.
Operating income fell to USD 4.2 billion (-9%, -11% cc), driven by lower net sales and higher R&D investments, partly offset by higher divestment gains. Net income decreased to USD 3.2 billion (-13%, -13% cc), mainly reflecting lower operating income. Earnings per share (EPS) were USD 1.65 (-10%, -11% cc).
Profitability and cash flow
Core operating income declined to USD 4.9 billion (-12%, -14% cc), with core operating income margin at 37.3% of net sales, down 4.8 percentage points (4.1 percentage points on a constant-currency basis). Core net income fell to USD 3.8 billion (-15%, -17% cc), and core EPS was USD 1.99 (-13%, -15% cc).
Free cash flow was USD 3.3 billion, broadly in line with the prior-year quarter.
Priority brands: growth led by Kisqali, Kesimpta, Leqvio and Scemblix
Novartis said its Q1 growth drivers included the following priority brands, ranked by contribution to Q1 growth:
- Kisqali: USD 1,516 million (+55% cc), with momentum in early and metastatic breast cancer.
- Pluvicto: USD 642 million (+70% cc), supported by strong demand in US pre-taxane metastatic castration-resistant prostate cancer (mCRPC) and access expansion ex-US.
- Kesimpta: USD 1,164 million (+26% cc), driven by increased demand and strong access across regions.
- Leqvio: USD 452 million (+69% cc), accelerating ex-US, including uptake in China following NRDL listing.
- Scemblix: USD 433 million (+79% cc), with strong momentum from early-line use in the US, Japan and Germany.
- Fabhalta: USD 169 million (+103% cc), more than doubling in Q1 on expansion in PNH and renal indications.
- Rhapsido: USD 37 million, showing early uptake in the US supported by a free drug program and increasing coverage.
- Cosentyx: USD 1,566 million (-2% cc), broadly stable; US sales declined while ex-US continued to grow, with underlying global growth of +2% cc.
- Zolgensma Group: USD 302 million (-12% cc), reflecting a lower incidence of SMA despite continued share in the incident population and treatment phasing.
R&D update: approvals, regulatory actions and trial readouts
New approvals
- Cosentyx (secukinumab): FDA approval for moderate to severe hidradenitis suppurativa (HS) in pediatric patients aged 12 years and older.
Regulatory updates
- Rhapsido (remibrutinib): EMA CHMP adopted a positive opinion recommending marketing authorization for remibrutinib as an oral treatment for chronic spontaneous urticaria (CSU) in adults with inadequate response to H1-antihistamine therapy.
- Ianalumab (VAY736): FDA granted Breakthrough Therapy designation and priority review for Sjögren’s disease after Phase III trials showed a statistically significant reduction in disease activity; submissions were completed in the US, Europe, China and Japan.
- Cosentyx: regulatory submissions completed for polymyalgia rheumatica (PMR) in the US, Europe and Japan.
- Pluvicto: Novartis withdrew an EMA type II variation application for pre-chemotherapy PSMA+ mCRPC after CHMP feedback that it would not support the application; Novartis said the withdrawal is not related to quality, efficacy or safety and does not affect ongoing clinical trials or other submissions.
Key results from ongoing trials and other highlights
- Remibrutinib: Phase III RemIND trial topline results in chronic inducible urticaria (CIndU) showed the primary endpoint was met, with statistically significant and clinically meaningful complete response rates versus placebo at Week 12 across symptomatic dermographism, cold urticaria and cholinergic urticaria; no liver safety concerns were reported. An sNDA for symptomatic dermographism was submitted to the FDA, with full data planned for a medical congress and global health authority submissions. In Phase II food allergy, remibrutinib showed superior efficacy versus placebo with dose-dependent effects and rapid onset; data were presented at AAAAI, and a Phase III program is on track to start in H2 2026.
- Fabhalta (iptacopan): Phase III APPLAUSE-IgAN final two-year results published in The New England Journal of Medicine reported that Fabhalta slowed kidney function decline by 49.3% versus placebo and reduced the risk of composite kidney failure events in adult patients with IgA nephropathy (IgAN). The safety profile was consistent with prior findings, and the drug received FDA priority review for traditional approval.
- Vanrafia (atrasentan): Phase III ALIGN final results showed a slowing in kidney function decline in IgAN patients; Novartis cited a positive difference in eGFR change from baseline versus placebo at Week 136 (4 weeks after treatment end, p = 0.057) and Week 132 (end of treatment, nominal p = 0.039). Novartis plans to submit for traditional approval in H1 2026.
- Pluvicto: real-world analyses from the Novartis PRECISION platform reported median progression-free survival (PFS) of 13.5 months in men with PSMA+ mCRPC who were taxane-naïve and had received at least one androgen receptor pathway inhibitor (ARPI). Data were presented at ASCO-GU.
- Cosentyx: a matched adjusted indirect comparison of HS trials (SUNSHINE and SUNRISE) indicated greater flare prevention and lower risk of Candida infections versus bimekizumab through Week 48, while maintaining similar HiSCR50 responses; data were presented at AAD.
- Del-zota: one-year data from Phase I/II EXPLORE44 and EXPLORE44-OLE in Duchenne muscular dystrophy amenable to exon 44 skipping showed sustained reductions in serum creatine kinase, significant increases in dystrophin, and improvements in multiple functional measures; data were presented at MDA.
- Del-desiran: final Phase I/II MARINA results in myotonic dystrophy type 1 (DM1), published in The New England Journal of Medicine, reported effective delivery to muscle, reduction in DMPK mRNA, and improvements across multiple functional measures. Phase III HARBOR readout is anticipated in H2 2026.
Transactions: Avidity acquisition and early-stage deals
Novartis said it successfully completed the acquisition of Avidity Biosciences, strengthening its late-stage neuroscience pipeline and advancing its xRNA strategy. It also entered into agreements to acquire SNV4818 from Synnovation Therapeutics and Excellergy, including Exl-111.
- SNV4818: a pan-mutant selective PI3Kα inhibitor in Phase I/II for HR+/HER2- breast cancer and other advanced solid tumors. The transaction is expected to close in H1 2026, subject to customary closing conditions.
- Excellergy / Exl-111: a half-life extended, high-affinity anti-IgE antibody in Phase I designed to dissociate receptor-bound IgE and drive faster and deeper FcεRIα downregulation. The transaction is expected to close in H2 2026, subject to customary closing conditions.
Capital structure and net debt: share buybacks and higher leverage
In Q1 2026, Novartis repurchased 10.4 million shares for USD 1.6 billion on the SIX Swiss Exchange second trading line under an up-to USD 10 billion share buyback announced in July 2025 (with up to USD 6.1 billion still to be executed). The company also repurchased 2.0 million shares from employees (equity value of USD 0.3 billion) and delivered 12.3 million shares to employees related to equity-based compensation plans.
Novartis said it aims to offset 2026 dilution related to equity-based compensation plans over the remainder of the year, in addition to share repurchases under the buyback program. The total number of shares outstanding decreased by 0.1 million versus December 31, 2025. Treasury share transactions resulted in an equity decrease of USD 1.6 billion and a cash outflow of USD 1.9 billion.
Net debt increased to USD 38.1 billion at March 31, 2026, from USD 21.9 billion at December 31, 2025. Novartis attributed the increase mainly to free cash flow of USD 3.3 billion being more than offset by net cash outflows for M&A and intangible asset transactions of USD 12.5 billion, a USD 6.2 billion annual net dividend payment in March (gross dividend of USD 9.1 billion reduced by USD 2.9 billion Swiss withholding tax paid in April 2026), and cash outflows for treasury share transactions of USD 1.9 billion.
As of Q1 2026, Novartis reported a long-term credit rating of Aa3 with Moody’s Ratings and AA- with S&P Global Ratings.
2026 outlook: low single-digit net sales growth expected
For 2026, Novartis said it expects net sales to grow in the low single digits versus the prior year on a constant-currency basis, and core operating income to decline in the low single digits. It also said that if late-April exchange rates prevail for the remainder of 2026, foreign exchange impact would be positive 2 percentage points on net sales and positive 1 percentage point on core operating income.
