การประชุมแถลงผลประกอบการไตรมาส 3 ปี 2026 ของ จอห์นสัน แอนด์ จอห์นสัน (JNJ): ปรับเพิ่มคาดการณ์ยอดขาย

สรุปประเด็นสำคัญ

• จอห์นสัน แอนด์ จอห์นสัน รายงานยอดขายทั่วโลกในไตรมาส 3/2026 ที่ระดับ 2.54 หมื่นล้านดอลลาร์ เพิ่มขึ้น 6.0% จากการดำเนินงาน โดยยอดขายในสหรัฐฯ เพิ่มขึ้น 9.1% ขณะที่ยอดขายในต่างประเทศเพิ่มขึ้น 1.8%
• ยอดขายกลุ่มเวชภัณฑ์นวัตกรรมเติบโต 7.9% สู่ระดับ 1.68 หมื่นล้านดอลลาร์ โดยได้รับการสนับสนุนจากการเติบโตของกลุ่มยามะเร็งประมาณ 17% และอุปสงค์ที่แข็งแกร่งสำหรับ TREMFYA, CAPLYTA, SPRAVATO และ RYBREVANT ร่วมกับ LAZCLUZE
• ยอดขายกลุ่ม MedTech เพิ่มขึ้น 2.5% สู่ระดับ 8.6 พันล้านดอลลาร์ โดย Shockwave เติบโต 17.2% แต่ Abiomed ลดลง 1.5% และกลุ่มศัลยกรรมลดลง 1.0% ท่ามกลางปัจจัยท้าทายในต่างประเทศ
• กำไรสุทธิตามมาตรฐาน GAAP อยู่ที่ 210 ล้านดอลลาร์ หรือ 0.09 ดอลลาร์ต่อหุ้นปรับลด สะท้อนถึงข้อเสนอขอยุติคดีความเรื่องแป้งทาตัวและค่าใช้จ่ายที่เกี่ยวข้องกับการทำรายการ ด้านกำไรต่อหุ้นปรับลดแบบปรับปรุง (Adjusted EPS) ลดลง 7.5% สู่ระดับ 2.59 ดอลลาร์
• ผู้บริหารได้ปรับเพิ่มและแคบลงสำหรับคาดการณ์การเติบโตของยอดขายจากการดำเนินงานในปี 2026 เป็น 6.7%-7.1% โดยมียอดขายจากการดำเนินงานอยู่ที่ 1.007 แสนล้านดอลลาร์ ณ จุดกึ่งกลาง
• บริษัทคาดว่ากลุ่มผลิตภัณฑ์ที่มีอยู่ การเปิดตัวผลิตภัณฑ์ใหม่ และการลงทุนเชิงกลยุทธ์ภายในองค์กร จะช่วยสนับสนุนการเติบโตในระดับสองหลักภายในสิ้นทศวรรษนี้ โดยผู้บริหารชี้แจงว่าเป้าหมายนี้ไม่ได้นับรวมการควบรวมและซื้อกิจการ (M&A) เพิ่มเติม

ผลประกอบการทางการเงินที่สำคัญ

กำไรก่อนภาษีปรับปรุงในรูปเปอร์เซ็นต์ของยอดขายลดลงจาก 35.2% สู่ 30.2% โดยอัตรากำไรของกลุ่มเวชภัณฑ์นวัตกรรมลดลงจาก 44.3% สู่ 35.4% สาเหตุหลักมาจากค่าใช้จ่ายวิจัยและพัฒนาโครงการที่อยู่ระหว่างดำเนินการจากการเข้าซื้อกิจการ ต้นทุนการทำรายการ และส่วนผสมผลิตภัณฑ์ ด้านอัตรากำไรของ MedTech เพิ่มขึ้นจาก 21.0% สู่ 22.9% โดยได้รับการสนับสนุนจากการเรียกคืนภาษีศุลกากร

ผลการดำเนินงานทางธุรกิจและการดำเนินงาน

เวชภัณฑ์นวัตกรรม

กลุ่มยามะเร็งเติบโตประมาณ 17% โดยยอดขาย DARZALEX เพิ่มขึ้น 15.6%, TREVICTA เพิ่มขึ้น 35.2% และ RYBREVANT ร่วมกับ LAZCLUZE เติบโต 63.5% ส่วน ERLEADA เพิ่มขึ้น 9.4%

ผู้บริหารระบุว่า INLEXZO สร้างยอดขายสะสมตั้งแต่ต้นปีจนถึงปัจจุบันประมาณ 200 ล้านดอลลาร์ รวมถึงมากกว่า 90 ล้านดอลลาร์ในไตรมาส 3 บริษัทยังเผยว่าจำนวนการใช้อุปกรณ์ในผู้ป่วยใหม่เพิ่มขึ้น 45% จากไตรมาสก่อนหน้า และมองเห็นโอกาสที่กว้างขึ้นในมะเร็งกระเพาะปัสสาวะชนิดไม่ลุกลามถึงชั้นกล้ามเนื้อ

TREMFYA เติบโต 68.2% ขับเคลื่อนจากการเปิดตัวยารักษาโรคลำไส้อักเสบเรื้อรังและการแย่งส่วนแบ่งการตลาดในโรคลำไส้อักเสบเรื้อรังชนิด ulcerative colitis และโรคโครห์น ส่วน STELARA ลดลง 54% เนื่องจากยังคงเผชิญการแข่งขันจากยาไบโอซิเมิลาร์และการเปลี่ยนไปใช้กลุ่มยารักษาใหม่ ๆ

ในกลุ่มประสาทวิทยา CAPLYTA เพิ่มขึ้น 66.1% และมียอดขายสะสมตั้งแต่ต้นปีถึงปัจจุบันแตะ 1 พันล้านดอลลาร์ SPRAVATO เติบโต 36% โดยได้รับการสนับสนุนจากการนำไปใช้ของแพทย์และอุปสงค์ของผู้ป่วยในภาวะซึมเศร้าที่ดื้อต่อการรักษา

ผู้บริหารกล่าวว่ามีผู้ป่วยมากกว่า 20,000 รายได้เริ่มการรักษาด้วย icotide ผ่านผู้สั่งจ่ายยาเกือบ 9,000 ราย โดยประมาณ 60% เป็นผู้ที่ไม่เคยได้รับการรักษาออกฤทธิ์ทั่วร่างกายมาก่อน ขณะที่ประมาณ 20% เปลี่ยนมาจากยารับประทาน และอีก 20% มาจากการรักษาอื่น ๆ ซึ่งมีแนวโน้มสูงที่จะเป็นยาชีววัตถุ

MedTech

ยอดขายกลุ่มหลอดเลือดและหัวใจเติบโต 4.1% โดย Shockwave เพิ่มขึ้น 17.2% รับแรงหนุนจากการยอมรับในการรักษาหลอดเลือดหัวใจและหลอดเลือดส่วนปลาย ผลิตภัณฑ์ใหม่ และการเบิกจ่ายค่ารักษาสำหรับห้องปฏิบัติการนอกโรงพยาบาลในสหรัฐฯ

กลุ่มสรีรวิทยาไฟฟ้าหัวใจเติบโต 4.4% แม้ว่าจะเจอแรงกดดันด้านการแข่งขันจากเทคโนโลยี pulsed-field ablation ที่ชัดเจนยิ่งขึ้นในภูมิภาคเอเชียแปซิฟิก ผู้บริหารระบุว่า Varipulse Pro กำลังขับเคลื่อนการเติบโตในระดับสองหลักในยุโรป และได้รับการอนุมัติในญี่ปุ่นแล้ว โดยคาดว่าจะได้รับการอนุมัติในสหรัฐฯ ในไตรมาส 4

Abiomed ลดลง 1.5% เนื่องจากจำนวนผู้ป่วยที่ลดลง ผู้บริหารอธิบายว่าแรงกดดันนี้เป็นเพียงเรื่องชั่วคราวไม่ใช่เชิงโครงสร้าง และได้เน้นย้ำถึงการยอมรับใช้อย่างต่อเนื่องในภาวะช็อกเหตุหัวใจจากกล้ามเนื้อหัวใจตายเฉียบพลัน และ Impella 5.5

กลุ่มศัลยกรรมลดลง 1.0% สะท้อนถึงการขยายโครงการจัดซื้อจัดจ้างตามปริมาณของจีน กิจกรรมปรับโครงสร้างกลุ่มผลิตภัณฑ์ และภาวะชะงักงันในตะวันออกกลาง ทั้งนี้ จอห์นสัน แอนด์ จอห์นสัน กำลังเริ่มทำการค้าสำหรับ Ottava หลังจากได้รับการอนุมัติแบบ De Novo จาก FDA แต่ผู้บริหารคาดว่าการสร้างรายได้จะค่อย ๆ เพิ่มขึ้นตามลำดับ

กลุ่มผลิตภัณฑ์ด้านสายตาเติบโต 5.1% ซึ่งรวมถึงการเติบโต 7.1% ในกลุ่มศัลยกรรมสายตา และเติบโต 4.3% ในกลุ่มคอนแทคเลนส์และผลิตภัณฑ์อื่น ๆ ส่วนกลุ่มออร์โธปิดิกส์เติบโต 3.4% โดยได้รับการสนับสนุนจากการเปิดตัวผลิตภัณฑ์และการดำเนินงานเชิงพาณิชย์

คาดการณ์โดยผู้บริหาร

จอห์นสัน แอนด์ จอห์นสัน ได้ปรับเพิ่มค่ากึ่งกลางและแคบลงสำหรับช่วงคาดการณ์แนวโน้มปี 2026:

แนวโน้มยอดขายตามรายงานตั้งอยู่บนสมมติฐานอัตราแลกเปลี่ยนเงินยูโรต่อดอลลาร์สหรัฐเฉลี่ยที่ 1.15 โดยผู้บริหารระบุว่า สกุลเงินอาจกลายเป็นปัจจัยลบหากอัตราแลกเปลี่ยนทันทีปัจจุบันยังคงดำเนินต่อไปจนถึงปี 2027

คาดว่า Firefly Bio และความร่วมมือกับ Sale Biomedicines จะส่งผลให้กำไรต่อหุ้นปรับปรุงปี 2026 ลดลง 0.64 ดอลลาร์ ผู้บริหารคาดว่าจะมีผลกระทบทางลบสะสมแบบปรับลดรวมเต็มปี 1.36 ดอลลาร์ต่อหุ้นในปี 2027 และวางแผนจะให้รายละเอียดเพิ่มเติมในการทบทวนธุรกิจองค์กรวันที่ 8 ธันวาคม

ความเสี่ยงและประเด็นที่ต้องจับตา

• การเติบโตของ MedTech ยังคงต่ำกว่าที่ผู้บริหารคาดการณ์ไว้ โดยเฉพาะอย่างยิ่งในตลาดหลอดเลือดและหัวใจ และตลาดศัลยกรรมในต่างประเทศ
• Abiomed ยังคงเผชิญกับความระมัดระวังในการเลือกใช้ของแพทย์ และข้อสงสัยที่เกิดจากการศึกษา PCI ในกลุ่มเสี่ยงสูงนอกสหรัฐฯ
• กลุ่มศัลยกรรมได้รับผลกระทบจากโครงการจัดซื้อจัดจ้างตามปริมาณของจีน ตลอดจนการประมูลที่ล่าช้า การเปลี่ยนแปลงคำสั่งซื้อ และการตัดสินใจใช้จ่ายของโรงพยาบาลทั่วตะวันออกกลาง
• STELARA ยังคงเผชิญกับแรงกดดันมหาศาลจากยาไบโอซิเมิลาร์
• ข้อเสนอยุติคดีความแป้งทาตัวมะเร็งรังไข่มูลค่า 5.5 พันล้านดอลลาร์ ต้องได้รับการเข้าร่วมจากอย่างน้อย 95% ของผู้ฟ้องร้องคดีมะเร็งรังไข่ที่เหลืออยู่ ซึ่งผู้บริหารกล่าวว่าการเข้าร่วมกำลังมีแนวโน้มเข้าสู่เกณฑ์ดังกล่าว
• แผนการแยกธุรกิจออร์โธปิดิกส์ยังคงมีเป้าหมายในช่วงกลางปี 2027 โดยผู้บริหารมีแนวโน้มเอียงไปทางวิธีการแยกบริษัทออกไป (spin-off) แต่ยังคงประเมินโครงสร้างการแยกธุรกิจในรูปแบบอื่น ๆ ที่ทำได้

ประเด็นสำคัญจากการถาม-ตอบกับนักวิเคราะห์

ผู้บริหารยืนยันว่าเป้าหมายการเติบโตระดับสองหลักภายในสิ้นทศวรรษนี้อิงจากธุรกิจที่มีอยู่และการลงทุนเชิงกลยุทธ์ภายในองค์กร โดยไม่ได้นับรวมการเข้าซื้อกิจการเพิ่มเติม

สำหรับ MedTech ผู้บริหารระบุว่าสิ่งที่ต้องทำเป็นอันดับแรกในขณะนี้คือการปรับปรุงการดำเนินงานในปัจจุบัน มากกว่าการใช้การควบรวมและซื้อกิจการ (M&A) เพื่อแก้ไขผลการดำเนินงานที่อ่อนแอ บริษัทคาดว่าผลิตภัณฑ์ใหม่ ซึ่งรวมถึง Varipulse Pro และ Ottava จะกลายเป็นผู้สร้างรายได้ที่สำคัญยิ่งขึ้นเมื่อเวลาผ่านไป

สำหรับ icotide ผู้บริหารเน้นย้ำถึงการเข้าถึงเชิงพาณิชย์ที่กว้างขวางและการนำไปใช้ระยะแรกที่แข็งแกร่ง ทั้งนี้ คาดว่าข้อมูลระยะที่ 3 (Phase III) สำหรับโรคข้ออักเสบสะเก็ดเงิน ข้อมูลเปรียบเทียบโดยตรงกับ STELARA และการพัฒนาเพิ่มเติมในโรคลำไส้อักเสบเรื้อรังชนิด ulcerative colitis และโรคโครห์น จะช่วยบ่งชี้โอกาสในระยะยาวของผลิตภัณฑ์นี้

ผู้บริหารยังคงมีความมั่นใจในโครงการยา Milvexian สำหรับป้องกันโรคหลอดเลือดสมองซ้ำและภาวะหัวใจห้องบนสั่นพลิ้ว โดยอ้างถึงประสิทธิภาพ ขอบเขตขนาดยา และขอบเขตความปลอดภัย โดยข้อมูลโรคหลอดเลือดสมองซ้ำอาจพร้อมเปิดเผยในปี 2026 ขณะที่ข้อมูลภาวะหัวใจห้องบนสั่นพลิ้วคาดว่าจะได้เห็นในปี 2027

ในโรคมะเร็งเม็ดเลือดขาวมัลติเพิลไมอิโลมา บริษัทกำลังเตรียมความพร้อมสำหรับการใช้ CARVYKTI ในระยะเริ่มต้นของการรักษา ขณะที่การทดลอง CARTITUDE-5 และ CARTITUDE-6 ดำเนินไปอย่างต่อเนื่อง โดยผู้บริหารให้ความสำคัญกับการให้ความรู้แก่แพทย์ การคัดเลือกผู้ป่วย และความพร้อมของศูนย์รักษา

บันทึกการแถลงผลประกอบการฉบับเต็ม

บทถอดเสียงฉบับเต็มของการประชุมทางโทรศัพท์ผลประกอบการ

คำชี้แจงจากฝ่ายบริหาร

Operator

Good morning, and welcome to Johnson & Johnson's Third Quarter 2026 Earnings Conference Call. This call is being recorded. I will now turn the conference call over to Johnson & Johnson. You may begin.

Ryan Koors

Hello, everyone. This is Ryan Koors, Vice President of Investor Relations for Johnson & Johnson. Welcome to our company's review of business results for the third quarter of 2026 and our financial outlook for the full year. First, a few logistics. As a reminder, today's presentation and associated schedules are available on the Investor Relations section of the Johnson & Johnson website at investor.jnj.com.

Please note that this presentation contains forward-looking statements regarding, among other things, the company's future operating and financial performance, market position and business strategy. You are cautioned not to rely on these forward-looking statements which are based on the current expectations of future events using the information available as of the date of this recording. They are subject to certain risks and uncertainties that may cause the company's actual results to differ materially from those projected. The description of these risks, uncertainties and other factors can be found in our SEC filings, including our 2025 Form 10-K, which is available at investor.jnj.com and on the SEC's website. Additionally, several of the products and compounds discussed today are being developed in collaboration with strategic partners or licensed from other companies. This slide acknowledges those relationships.

Moving to today's agenda. Joaquin Duato, our Chairman and CEO, will discuss our business performance and growth drivers. I will then review the third quarter sales and P&L results. Joe Wolk, our CFO, will then close by sharing an overview of our capital allocation priorities and updated guidance for 2026.

Tom Cavanaugh, Executive Vice President, Worldwide Chairman, Innovative Medicine, John Reed, Executive Vice President, Innovative Medicine Research and Development; and Tim Schmid, Executive Vice President, Worldwide Chairman, MedTech will be joining us for Q&A. To ensure we provide enough time to address your questions, we anticipate the webcast will last approximately 60 minutes.

With that, I will now turn the call over to Joaquin.

Joaquin Duato

Thank you, Ryan, and good morning, everyone. Our strong performance in the third quarter reinforces our confidence in 2026 as a year of accelerated growth and impact for Johnson & Johnson. In Q3, we reported operational sales growth of 6% ahead of analyst consensus and increased sequential growth compared to the second quarter. With 6 strategic focus areas: oncology, immunology, neuroscience, cardiovascular surgery ambition, we are leading in areas of high unmet need where innovation can make the greatest difference for patients. Our powerful combination of innovative medicine and med tech expertise strengthens our competitiveness.

Our products and platforms now generate at least $1 billion in annual sales. Our marketed portfolio continued to perform. Our launches are gaining significant traction, and we are advancing our new product pipeline that will sustain our growth into the next decade with sales in the quarter of more than $25 billion we are on track to meet our guidance and exceed $100 billion in annual revenue for the first time in our company's 140-year history. As we advance our differentiated portfolio and pipeline, we have a clear path to double-digit growth by the end of the decade.

In innovative medicine, we delivered operational sales growth of 7.9%, with 8 brands growing double digits. Let's start with oncology. We are making progress to redefine cancer care from treatment to cure. In the third quarter, our oncology business grew approximately 17%. Our multiple myeloma portfolio and pipeline are a match with 80% of patients receiving a Johnson & Johnson therapy as part of their treatment journey. And we continue to strengthen the body of evidence supporting our recently launched multiple myeloma therapies and combination regimens.

New Phase III results announced in July demonstrated that the combination of the bile plus tale reduced the risk of disease progression or death by 89% as early as the second line of treatment. In solid tumors, sales of REMBRANDT increased by 64%, reflecting its strength in lung cancer. And by the end of the year, we expect to receive U.S. FDA approval for RYBREVANT Faspro in advanced head and neck cancer, a disease with significant unmet needs.

In bladder cancer, Inlexzo has rapidly emerged as a market leader for new patient share, just 1 year after its launch. Nearly 1 in 3 eligible patients started on an elector regimen in the third quarter, demonstrating its growing role in transforming care in high-risk non-muscle invasive disease. During the quarter, we also invested to bolster our oncology pipeline. We completed our acquisition of [ Fire Flavio ] adding a promising new degraded antibody conjugate platform that targets drivers of difficult-to-treat cancers, including KRAS. Our ambition is to become the #1 oncology company by 2030, with sales projected to exceed $50 billion.

Turning to immunology. We are building on our 25-year legacy to drive industry-leading innovation for patients. TREMFYA delivered exceptional sales growth of 68% in the quarter, reflecting strong momentum across its indications. In the U.S., it is now brand share in colon disease, alterative colitis and psoriatic arthritis. And we continue to generate evidence that reinforces TREMFYA's clinical differentiation based on the landmark STAR study, TREMFYA is the first and only IL-23 inhibitor to demonstrate positive outcomes in axial disease clinical trials including significant improvement in spinal pain, steepness and inflammation in patients with psoriatic arthritis. This momentum reinforces our conviction in TREMFYA as a foundational medicine in inflammatory bowel and psoriatic diseases and our belief that it can grow into a $10 billion-plus franchise.

ICO Tide, our first-in-class targeted oral peptide for plaque psoriasis continues to outpace the recent competitors' launches. More than 20,000 patients have initiated therapy through nearly 9,000 prescribers since ICO tides launched in the U.S. We continue to make strong progress on commercial access with ICO Tide now broadly covered across all national plans. Also this quarter, IMAVIO was approved as the first advanced treatment specifically for warm autoimmune hemolytic anemia, a rare life-threatening disease that causes severe and EMEA and fatigue. This new indication builds on Mavi's momentum in generalized myasthenia gravis and reflects its broad potential across auto antibody diseases. And we continue to pursue next-generation therapies.

In July, we announced a collaboration with sale biomedicines to advance in vivo carte approaches for immune-mediated diseases. Next, in neuroscience, we aim to transform the future of brain health by addressing complex nervous system disorders. Today, we are the definitive leader in neuropsychiatry. [ CAPLYTA ] reached $1 billion in year-to-date sales, making it our $29 billion platform driven by strong uptake as an adjunctive treatment for major depressive disorder, CAPLYTA is now the fastest-growing oral branded therapy in this space. And last month, we presented pivotal Phase III data that show CAPLYTA significantly and rapidly improve symptoms of bipolar mania. SPRAVATO also delivered impressive growth of 36% this quarter, reflecting strong demand in treatment-resistant depression.

Now let's turn to Medtech, where we delivered Q3 operational sales growth of 2.5%. While we fell short of our expectations for this segment our conviction in our future direction has not changed. Starting with cardiovascular, we continue to invest in hard recovery, circulatory restoration and have written disorders to address the leading global cause of death. This was another strong quarter for Shockwave, our circulatory restoration business, which grew 17% and the ongoing global launch of Software C2 Aero continues to broaden the reach of our intravascular lists platforms.

Varipulse, our post-field ablation platform reached a major milestone this quarter with more than 100,000 AV patients treated worldwide. Varipulse Pro, which delivers 5x faster ablation speed has been very well received in Europe where it is driving double-digit growth. And just last week, we received approval for Varipulse Pro in Japan. With increasing clinical experience, we are seeing differentiated benefits from Varipulse in a recent retrospective analysis various demonstrated a 68% lower risk of adverse cardiac events compared to a competing post-field ablation platform. and in hard recovery, while physician selectivity continued to affect the biomed performance. We remain confident in the technology and focus on supporting appropriate patient selection.

In surgery, we are poised to shape the next era of care through robotics digital innovation and advanced instrumentation. In July, the U.S. FDA granted the novo authorization for Ottava, the world's first table integrated soft tissue robotic system. This is one of the most significant metric innovations we will bring to market this decade, Ottava's unique architecture, automated features and next-generation robotic instruments help address surgeon needs for operating room space and better surgical workflows, its connection to our open digital ecosystem polyphonic turns procedure data into actionable insights for clinicians.

We already signed our first commercial customer for Ottava, and we are progressing our development program. our investigational device exemption trial is already underway in ininal hernia repair with future plans for indication expansion into urology and gynecology. Finally, in vision, we are advancing life long eye health to bring better site to more than 40 million people each year. the recent U.S. launch of TECNIS PRC further strengthened our portfolio of intraocular lenses. During the quarter, TECNIS PureSee and TECNIS Odyssey surpassed 1 million implants worldwide, reflecting continued surgeon adoption and our leadership in personalized vision solutions. We also received CE marking for ACUVUE ASYS MAX 2-week reusable lenses, expanding our ACUVUE portfolio in Europe.

Overall, this quarter's strong results demonstrate the impact of the choices we have made to build a foundation for durable growth. We sharpened our portfolio to focus on innovation with the greatest potential to change lives. We proved our ability to grow through a significant loss of exclusivity. Our strategic investments in high-growth areas are delivering results, and our innovation engine continues to drive breakthroughs for patients. That is why we have the confidence to say that we will finish 2026 strong and that 2027 will be an even better year for Johnson & Johnson.

I will now turn the call back over to Ryan.

Ryan Koors

Thank you, akin. Moving to our financial results. Unless otherwise stated, the percentages quoted represent operational results. and therefore, exclude the impact of currency translation. Starting with Q3 2026 sales results. Worldwide sales were $25.4 billion for the quarter, increasing 6%. Growth in the U.S. was 9.1% and 1.8% outside the U.S. Acquisitions and divestitures had a net negative impact on worldwide growth of 10 basis points.

Now turning to earnings. For the quarter, net earnings were $210 million and diluted earnings per share were $0.09 versus $2.12 a year ago. Results in the quarter were impacted by the proposed talk litigation resolution as well as expenses associated with the Firefly Bio transaction and sale and biomedicines collaboration amounting to approximately $7 billion. Adjusted net earnings for the quarter were $6.3 billion, and adjusted diluted earnings per share were $2.59, representing a decrease of 6.8% and 7.5%, respectively, compared to the third quarter of 2025. Adjusted earnings in the quarter were also impacted by expenses associated with the Firefly Bio transaction and sale biomedicines collaboration.

I will now comment on business sales results in the quarter, focusing on the 6 key areas where meaningful innovation and strong commercial execution are driving our performance and fueling long-term growth. Beginning with innovative medicine, where our financial results reflect the depth of our expertise in innovation in areas of high unmet need across oncology, immunology and neuroscience. Worldwide sales of $16.8 billion increased 7.9%, which underscores the continued strength of our key brands and new launches. Growth in the U.S. was 11.1% and 3% outside the U.S. Divestitures had a negative impact of 10 basis points on worldwide growth. In oncology, starting with multiple myeloma.

DARZALEX growth was 15.6% and primarily driven by strong share gains of 5 points across all lines of therapy with 10 points in the frontline setting as well as continued market growth, partially offset by OUS pricing headwinds. TREVICTA achieved growth of 35.2% driven by share gains across earlier lines of therapy and continued site expansion. [ Sigvaily ] growth was 77.3% and driven by launch uptake and share gains across earlier lines of therapy following last quarter's approval in the U.S., PROTECT Vale press DARZALEX Faspro with U.S. growth greater than 100%. Tale growth was 42.1%, driven by share gains due to increased depth of prescribing in the community setting.

In lung cancer, RYBREVANT plus LAZCLUZE delivered growth of 63.5% and with strong share gains in the first and second lines driven by continued launch uptake in all regions, along with rapid uptake in RYBREVANT Fastpro. In prostate cancer, ERLEADA delivered growth of 9.4% and with continued share gains and market growth, partially offset by unfavorable patient mix. Within immunology, TREMFYA delivered impressive growth of 68.2% driven by continued momentum from the IBD launch with 4 points of share growth in both ulcerative colitis and Crohn's disease alongside continued market growth.

STELARA declined 54%, which reflects continued competitive pressures from biosimilars and the ongoing shift towards novel classes. Growth in other immunology is driven by move and ICO Tide launch uptake in the U.S. In neuroscience, SPRAVATO grew 36% driven by continued share gains, reflecting strong physician adoption and increased patient demand. CAPLYTA showed significant growth of 66.1% and driven by strong continued launch momentum in adjunctive major depressive disorder and continued demand increases across bipolar disorder and schizophrenia.

Now moving to med tech. Worldwide sales of $8.6 billion increased 2.5% with growth of 4.8% in the U.S. and 0.1% outside the U.S. overall cardiovascular grew 4.1%, including 20 basis points related to acquisitions. Electrophysiology delivered growth of 4.4%, driven by procedure expansion, commercial execution and new product performance partially offset by competitive PFA pressures, which were more pronounced in AsPac this quarter as well as the lapping of prior year OUS inventory dynamics. Abiomed saw a decline of 1.5% due to lower patient volume. There are encouraging signals in the U.S. performance with improvement in the quarter, supported by acute myocardial infarction cardiogenic shock and Impella 5.5 continuing to gain adoption.

Shockwave grew double digits at 17.2%, driven by continued adoption of coronary and peripheral products as well as new product launches and the reimbursement in the office-based lab setting within the U.S. Surgery saw a decline of 1%, including a negative impact of approximately 30 basis points from divestitures. The decline is more notably driven by ongoing expansion of VBP in China, surgery transformation program outcomes across the portfolio and Middle East disruption, which impacted tender timing and ordering patterns. The decline was partially offset by portfolio strength, driven by recent innovations such as Ethicon 4000 and DUALTO as well as commercial execution in biosurgery.

Envision growth was 5.1%, driven by premium innovation, strong execution and global reach. Contact lenses and other products grew 4.3% and driven by strong performance in the ACUVUE OASYS 1-day family of products, further solidifying our leadership position, partially offset by U.S. inventory dynamics. Surgical vision delivered growth of 7.1%, driven by new product innovations, robust demand for premium IOLs and strong commercial execution, partially offset by market-specific factors such as disruptions in the Middle East. Orthopaedics growth for the quarter was 3.4%, primarily driven by new product launches such as volt and trauma and emphasis and hips, including strong commercial execution and velis pull-through in knees.

Now turning to our consolidated statement of earnings for the third quarter of 2026. I'd like to highlight a few noteworthy items that have changed compared to the same quarter of last year. Cost of goods sold deleveraged by 150 basis points, driven by unfavorable product sales mix and increased intangible asset amortization expense in the Innovative Medicine segment for intracellular partially offset by the impact of tariff recoveries in the med tech business.

Selling, marketing and administrative expenses were flat as a percent of sales, reflecting consistent commercial investments in the innovative medicine business. We continue to invest strategically in research and development, deploying approximately $4.7 billion or 18.3% of sales, which includes $1 billion related to the acquisition of Firefly Bio. In process, research and development impairment costs of $339 million in the quarter is related to the write-off of Pre-cardia, a noncore asset acquired as part of the broader Abiomed transaction.

Other income and expense was a net expense of $5.8 billion as compared to $478 million of income in the third quarter of 2025 with the change primarily driven by the proposed talk litigation resolution in orthopedic separation-related costs. The tax rate was a small net benefit in the quarter, primarily related to the positive tax effect associated with the accrual for the proposed talc litigation resolution. More information can be found in our upcoming 10-Q for changes in taxes.

Lastly, I'll direct your attention to the box section of the slide where we have also provided our income before tax net earnings and earnings per share adjusted to exclude the impact of intangible amortization expense and special items. Now let's look at the adjusted income before tax by segment for the quarter. Innovative Medicine margin declined from 44.3% to 35.4%, primarily due to acquired in-process research and development expense of approximately $1 billion related to the acquisition of Firefly Bio transaction costs for sale of biomedicine and unfavorable product sales mix and cost of products sold.

Medtech margin increased from 21% to 22.9%, driven by the impact of tariff recoveries partially offset by increased strategic investments in commercial capabilities. As a result, adjusted income before tax for the enterprise as a percentage of sales decreased from 35.2% to 30.2%.

This concludes the sales and earnings portion of the call, and I will now turn the call over to Joe.

Joseph Wolk

Thanks, Ryan. Hello, everyone, and thank you for joining us today. As you heard from Joaquin and Ryan, our third quarter results were driven by the strength of our innovative medicine business. This performance more than offset headwinds in certain areas of med tech, enabling us to exceed expectations on both the top and bottom line. while continuing to invest in our pipeline and future growth. We are clear on where med tech performance needs to improve, specifically cardiovascular and surgery outside the U.S. and are taking action to strengthen results. while disappointing, the underlying fundamentals of the med tech business remains strong, supporting our confidence in the long term for that business.

Across Johnson & Johnson, the drivers underpinning our outlook remain firmly in place. As a result, we are raising our guidance for 2026 versus our most recent update in July. The depth of our portfolio, momentum from new product launches and upcoming pipeline catalysts further reinforce our conviction in achieving double-digit growth by the end of this decade with sustainable growth beyond.

Turning to financial metrics and our cash position. We ended the third quarter with approximately $17 billion of cash and marketable securities and approximately $45 billion of debt for a net debt position of approximately $28 billion. Generating more than $6 billion in free cash flow in the third quarter. We remain confident in our full year free cash flow guidance of approximately $21 billion.

During the quarter, we completed the $1 billion acquisition of Firefly Bio, deepening capabilities in oncology with next-generation antibody engineering to address complex tumor biology. As Joaquin referenced earlier, we also entered into a collaboration with sale Biomedicines to advance in vivo CAR T therapies for immune-mediated diseases. Our disciplined approach to capital allocation is principled on prioritizing investments that support key commercial launches, accelerating future innovation, increasing our annual dividend and strengthening our pipeline through strategic value-creating inorganic opportunities.

In July, we announced an agreement for a resolution of the ovarian talc litigation for $5.5 billion, which is reflected in our third quarter GAAP results. The agreement is conditioned upon the express participation of at least 95% of the remaining ovarian claims. We are trending to meet the 95% threshold.

Let me now turn to full year 2026 guidance. As always, our outlook reflects what we know today regarding foreign exchange rates, the broader macroeconomic environment and other external factors. Based on our year-to-date performance and expectations for the fourth quarter, we are raising the midpoint and tightening the range of our operational sales guidance. We now expect full year operational sales growth in the range of 6.7% to 7.1%, which represents operational sales of $100.7 billion at the midpoint or growth of 6.9%. We do not speculate on future currency movements.

As of last week, the euro spot rate to the U.S. dollar was 1.12. However, the average rate for the fiscal year stands at 1.15. Based on that average rate, we estimate reported sales growth of 7.2% to 7.6%, with a midpoint of $101.2 billion or 7.4%. Assuming the current spot rate holds into next year, you could expect currency to be a headwind.

Turning now to other items of the P&L. Regarding operating margin, we now expect a decline of approximately 60 basis points. This is an improvement from the 75 basis points decline reflected in our updated July guidance that included the impact of the Firefly Bio and sale Biomedicines transactions, which had an unfavorable impact of 150 basis points. Absent those deals, we continue to deliver base margin improvement. As a reminder, our pretax adjusted operating margin outlook also reflects the costs associated with the 53rd week of operations and our previously announced agreement with the U.S. government to improve access to medicines.

For net interest expense, we are lowering our guidance to $150 million to $200 million. We are also tightening the range of our effective tax rate guidance. Based on our year-to-date results, we now expect a full year effective tax rate of 17.0% to 17.5%. Given those updates, we now expect adjusted operational earnings per share in the range of $10.95 to $11.05 or 2% at the midpoint. We expect reported adjusted earnings per share of $11.05 to $11.15 with a midpoint of $11.10 or growth of 2.9%. Excluding the impact of Firefly Bio and sale biomedicines transactions of $0.64, reported EPS growth would approach 9%.

As a reminder, for your 2027 modeling, we expect Firefly Bio and sale Biomedicines to have a combined dilutive impact of $1.36 per share on a full year adjusted earnings per share next year. We will provide more details on our 2027 outlook later this year at our enterprise business review. Let me now highlight several upcoming developments that reinforce our growth outlook and performance for the remainder of the year.

In oncology, we expect several important data readouts in the fourth quarter. These include data for pasritamig, a first-in-class bispecific antibody in patients with advanced prostate cancer who have progressed after multiple lines of therapy. We also expect data for J&J-6143, an investigational first-in-class once-daily oral therapy for metastatic castration-resistant prostate cancer. We continue to see strong adoption for with year-to-date sales of approximately $200 million and expect to build on that momentum with a data readout in high-risk non-muscle invasive bladder cancer later this year. We also expect U.S. approval of RYBREVANT Faspro in advanced head and neck cancer.

In immunology, as Joaquin referenced earlier, it is off to a strong start, and we look forward to presenting data in psoriatic arthritis later this year. In medtech, we expect U.S. approval of Varapulse Pro in the fourth quarter, further complementing last week's approval in Japan. In heart recovery, we are taking corrective action to improve Abiomed's performance. We continue to invest in clinical evidence and expect results from the HRPCI PROTECT IV trial in 2027. The trial will have 1,252 patients, 4x more than the CHIP BSIS 3 study. This large-scale study will evaluate the safety and efficacy of Abiomed's Impella CP pump during high-risk percutaneous coronary intervention.

In surgery, we are focused on commercializing Ottava following its recent FDA de novo authorization. We expect adoption and revenue contribution to build over time with the goal of establishing Ottava as a significant pillar of our surgery portfolio by the end of the decade. Regarding orthopedics, we remain on track for the planned separation of the P Synthes by mid-2027. I'm really proud of the team working to evaluate all separation vehicles and all options are better positioned today than when we announced our intentions with this business. Given the way depute Synthes is performing and the momentum [ Namal Noona ] and his team are generating, we are leaning towards a spin as being the best option to create long-term value for Johnson & Johnson shareholders. That has always been our base plan, and we are confident that it can be successfully executed. We will provide additional updates as appropriate and when there is more information to share.

Finally, I am really looking forward to and hope you join us for the Enterprise business review on December 8. At that event, we will provide additional perspective on our 2027 outlook and the key drivers that reinforce our conviction in achieving double-digit growth by the end of the decade. Perhaps more importantly, we will highlight our earlier-stage pipeline and how it represents the next wave of growth into the next decade. Attendees will also have the opportunity to experience firsthand some of our latest innovations such as Ottava. 2026 is on track for another successful year, exceeding expectations set at the beginning of the year. We look forward to closing out 2026 strong and setting up 2027 for continued success.

Thank you to our colleagues whose dedication and commitment continue to advance innovation, improve patient outcomes and create long-term value for shareholders. With that, we are ready to answer your questions. Kevin, can you please open the call for Q&A?

Operator

[Operator Instructions]. Our first question today is coming from Asad Haider from Goldman Sachs.

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Asad Haider

At the progress. Just 1 point of clarification. On the double-digit growth by the end of the decade, the [ Pocari ] in the press release references the progress in the underlying business quote together with strategic investments. Just want to be clear that, that refers to internal investments and not M&A, if that's a question we're getting this morning. And then, Joe, on your comments that you aren't satisfied with med tech performance and our taking action to strengthen that growth. Is the implication there that you now feel more urgency to add to higher-growth areas via M&A and medtech or do you think that you have the product portfolio today to drive the improved performance you're looking for?

Joseph Wolk

Yes, Asad. On the first aspect, that is correct. Your interpretation of that being internal strategic investments is what will us to double-digit growth by the end of this decade in the coming years with increasing performance. So is the correct interpretation. It does not assume any inorganic additions at this moment in time. we always are on lookout for strategic drivers that could complement our business. makes sense to be in our hands versus where the asset would currently reside, but also creates value for the risk we're bearing on behalf of shareholders. With respect to the urgency, it's an urgency to fix what we currently have. We like the the construct that currently exists with the 3 focus areas of Vision Care of surgery as well as cardiovascular.

I think you're very familiar, and maybe I'll even hand it over to Tim to talk about some of the things we're doing in heart recovery specifically to address that I would say is now a stable business, but we want to catalyze back to double-digit growth. We're very excited what's on the horizon for surgery with the addition of Ottava over time. That will be significant contributor to growth by the end of the decade. And then as I mentioned earlier, vision seems to be functioning well both on the surgery side as well as the contact lens side, where we are the market leader.

But Tim, maybe you want to offer a comment or 2 around Abiomed.

Tim Schmid

Sure, Joe. So sad ultimately, Abiomed remained a temporary headwind as you saw our conviction in the long-term opportunity has not changed at all. The slowdown we're seeing continues to be the same issue we highlighted in the quarter before, which is this study outside of the U.S. focused on high-risk PCI and importantly, we do not view these challenges as structural in nature and ones that will drive a long-term impact on the business. We're not seeing any changes in the patient need not to reimbursement or any meaningful competitive pressures. We also have highlighted some questions we have around the study as to whether best practice would practices were used in the study. And so our focus today is really on education and advancing the clinical evidence base to show the incredible impact that Impella has in both saving and improving lives. And so we believe it's a short-term headwind.

It's important to recognize that in any emerging area of science, there's always going to be a debate and discussion. And our responsibility is to continue to advance the evidence base to support within the best interest of patients and in the case of Abiomed we're doing exactly that. And so a short-term headwind, but we are very confident this is going to be a strong platform for growth for Johnson & Johnson for the future.

Operator

Questions coming from Larry Biegelsen from Wells Fargo.

Larry Biegelsen

Joe, I wanted to ask about the 2027 comments you made at Deutsche Bank. On the top line, you said you expect reported sales growth to be similar to 2026 after adjusting 100 basis points for the extra week in both years, which I think would mean about 5.4% reported growth next year. And on EPS, how should we think about your ability to grow earnings, excluding IP R&D? And just remind us of how much the Firefly and sale dilution is IP R&D this year and next year?

Joseph Wolk

So for this year, the IPR&D dilution is $0.64. And for next year, the combination of those deals is $1.36. And the way I would think about that, Larry, and you've covered us long enough where you know that typically, our income growth or EPS growth will be a little bit better than our sales growth. That's how you can think about that next year adjusting for the $1.36 adjustment. So we'll continue to look at margin improvement as part orthopedic separation, looking more holistically at our business, some of the advances we're getting with technology and getting us more efficient across all parts of our business, but that's probably a good way to kind of frame in your now for 2027, but we'll be a little bit more explicit on December 8 at our Investor Day. Outline specifically kind of the components to that and then even probably provide a pro forma with respect to the orthopedic separation should that occur at some point next year as well as a longer-term outlook.

Operator

Our next question is coming from Chris Schott from JPMorgan Chase.

Christopher Schott

I just wanted to touch base on ICO Tide. So just a 2-part question here. First, can you just give us an update in terms of what you're seeing in terms of patient uptake as we think about new to biologic versus oral switches versus injectable switches? And then bigger picture for the drug. Are you talking about this as a $10 billion-plus asset. But when you think about this very strong launch we've seen so far in psoriasis, you got a number of additional indications pending I guess how do you think about -- could this be a much larger asset than $10 billion as you think about the peak sales opportunity for icotide?

Tom Cavanaugh

Great. Chris, it's Tom. Good to hear from you. First, I do want to start by recognizing Jennifer Taubert and thanking her for her tremendous leadership and partnership. Jennifer leaves Innovative Medicine incredibly well positioned, as you see from our quarterly earnings. With strong momentum, outstanding portfolio and pipeline, and most importantly, a great team. We're fortunate to build on that foundation. She established, and I'm excited about what's ahead. And really, what I'm excited about is what you're touching on right now is icotide, we do foresee icotide to be one of our biggest assets in innovative medicine, and it is off to an incredibly great start as you highlighted and as Joaquin highlighted on the call this morning, I think getting into some of the launch performance, you heard from Joaquin.

Already to date, we've seen over 20,000 patients initiated on therapy. With over 8,000 prescribers or nearly 9,000 prescribers, I would say. So absolutely tracking better than some of most all launches in psoriatic diseases. I think early prescribing trends is what you wanted to get at kind of as we think about -- and we are expanding the systemic marketplace. Approximately 60% of the patients are systemic naive, so they haven't received any systemic therapy. And roughly the 40 remaining 20% are sourced from orals and 20% are sourced from other treatments, most likely biologics as we dig into the data.

So I can say, as you're seeing with regards to the launch performance, earlier a bit expansion of the marketplace and absolutely an opportunity to continue to drive that. Highlighted as well, as Joaquin highlighted earlier, I think it's important to point out, we do have broad commercial access now and preferred access in place on all national commercial plans or are actively engaged to expand that to the Medicare population. So I would say we're fairly very excited about the launch to date as equally as excited about the future. And we do foresee this to be one of our largest assets, as I pointed out. We're excited about the upcoming data readouts both with a PSA and Phase III data as well as the head-to-head STELARA data for ASCEND that we should be releasing in the coming months. And as we look to expand beyond that and we'll get into more of this at the EDR at IBD and expansions into UC and CD, expecting similar results with regards to launch performance as we go into those other indications.

Operator

Next question is coming from Joanne Wuensch from Citi.

Joanne Wuensch

I want to focus a little bit on that tech here. When you use the phrase underlying fundamentals in med tech are solid. I want to confirm that you're thinking about all the good stuff, the patient volumes, the CapEx spending from the hospitals and then what you're seeing in terms of just general flows. And then as a sister question to that, how do you -- or what do you think needs to be done to improve the J&J franchise?

Tim Schmid

Joanne, it's Tim. Thank you very much for the question. Let me start by really putting the overall med tech Q3 results in context for you and all on the call. And to be clear, our performance is below the standard. We have said internally and below the expectations we previously communicated to investors. Simply put, we can do better, and we absolutely will. And right now, we are focused solely on the actions needed to deliver stronger results in the fourth quarter and beyond. And that said, when to your question. When we break down our results, you will see that the pressure was primarily concentrated actually in 2 very distinct areas.

Firstly, our performance outside of the U.S. And secondly, Abiomed globally, which we already touched on. And to put it in perspective, growth in the U.S., which, as you know, is the most important market wasn't fact robust in the quarter and accelerated to almost 5%. Our performance outside of the U.S. was a challenge, and that reflected a combination of mostly known headwinds and which we have discussed previously. For example, in surgery, the expected impact of the transformation program and the ongoing expansion of volume-based procurement in China. And electrophysiology, competitive intensity, especially in Asia Pacific, which is a region that you know is still relatively early in the adoption of did introduce a new headwind, which is really the incremental pressure that we're seeing on the business due to the conflict in the Middle East.

But when you actually step back and you look deeper into these results, we're seeing several encouraging indicators, which give us confidence in a stronger Q4 and outlook beyond that. For example, in electrophysiology in markets like Europe, where we've already launched Varapulse Pro, which, by the way, is a faster and easier to use catheter, we're back to double-digit growth. And we will launch Varapulse Pro in Japan shortly after receiving regulatory approval last week. You can also anticipate a U.S. launch by the end of this year.

I think at Abiomed, we've already touched on the study in IRIS-PCI, a study where we actually believe that the methodology employed did not follow well-established is an issue which we're addressing through education. We think we're going to get through that because the evidence base is so solid, especially in areas like AMI cardiogenic shock, and we're still seeing tremendous performance of we did, by the way, already see some improvement sequentially throughout the quarter, and we do believe that, that business will be back to growth in short order.

While Q3 for med tech was not a strong quarter, this should not distort the whole picture. As mentioned, the issues are primarily concentrated in the 2 areas I mentioned. It's also worth reinforcing to your question that the underlying procedure environment stable across our key markets. I know there's been a lot of debate about that. Our job now is to make sure that we convert that demand into more consistent performance. And so we remain confident in the combination of the momentum we're seeing in the U.S. and the moderation of these near-term headwinds, which will support improved performance in Q4, while positioning us for stronger performances in 2027 and beyond. And as you've already heard from Joaquin and Joe will share more detail around what that looks like for '27 and beyond, specifically with a focus on new innovations like Ottava when we come together on December 8.

Operator

Next question today is coming from Jason Gerberry from Bank of America.

Unknown Analyst

Hello. This is Richard Wagner for Jason. I had a question regarding the icotide psoriasis launch. Are there lessons that can be learned that would be useful when icotide launches in specifically in IBD, competitors are developing high-efficacy combination programs and wondering how that could affect the efficacy perception by physicians of icotide.

Tom Cavanaugh

Richard, it's Tom addressing your question. A couple of things I'd point out, and I'd obviously turn it over to Sean, if he has any further remarks with regards. So I'll say a couple of things. absolutely know the space very well, whether it be in psoriasis or IBD. And you could tell by the launch that we had with TREMFYA and IBD, it's off to an incredibly great start. As you can see, over 70% growth year-over-year and heavily penetrated in becoming the -- actually the fastest-growing biologic across all indications, in particular, in IBD, new patient starts. So we know the space very well.

With that said, I will say there's still significant unmet need in a large amount of patients that are untreated or not treated, earlier in the course of their diseases. And we do see that to be a great opportunity for not only market expansion as we're seeing in psoriatic disease or psoriasis with icotide, but the profile of the product fits beautifully and I would say. Obviously, the data will be depend on how we look at it in the positioning once it becomes on the marketplace. But I will tell you, we'll have early access as one of the other keys and we'll see rapid uptake once we get those data results.

Unknown Attendee

Yes, maybe just to build on that a little bit. I think the reason that we've had such a great start in psoriasis is because of that trifecta biologics like efficacy coupled with placebo-like safety combined with the convenience of a once-a-day pill, and we think that will play very well across all indications, including IBD, where as Tom reference still a large percentage of patients are not on an advanced therapy.

The data in our Phase II study were quite encouraging and look like coal can deliver on par with the current monotherapies. Of course, we're very aware that some patients need something more that they need a combination therapy, and that's why we're developing [ 480 ] which pairs are guselkumab, our IL-23 inhibitor with golimumab, our TNF inhibitor and that is in Phase III studies now after a really compelling Phase II data that show that in that refractory population that have failed 2 or more prior advanced therapies. This really delivers superior efficacy to the monotherapy. So we're actively pursuing that for those patients where monotherapy is not enough and could see then that opportunity to migrate patients if needed, beyond the monotherapies to the dual therapies with our coantibody therapeutic [ 4804 ].

Unknown Executive

Our next question is coming from Vamil Divan from Guggenheim Securities.

Vamil Divan

Great. Maybe one just follow-up and then one actual question. Following up on the icotide. I appreciate the comments you've made so far. Just curious if you would be willing to provide any commentary on the actual net sales in the quarter or kind of how it compares to where consensus was. We're just getting some questions from investors on that specifically? And then my other question is just around -- so I appreciate the comments there you made around the sales so far. I'm wondering if you can just quantify, I know you have the data coming up later this year as well. how you see the market opportunity for an expanding based on the current indication? And then what sort of the SunRISe-5 data, what's the size of that opportunity relative to what you have currently?

Unknown Executive

Yes. Obviously, we haven't disclosed any sales for IcoType, but I'm confident we're going to be doing that next year just based on the momentum and the progress that we're seeing with the launch of code. Turning it over to Enlexo, also another exciting product that we have or even a platform as we think about TAR210 as well. and the opportunity that exists for us. We're off to an incredibly great start. Joe disclosed that we're nearly $200 million in net trade sales for year-to-date. And quite honestly, we haven't reported quarterly sales, but I could say at Q3 was north of $90 million. So we're seeing great sequential growth. This quarter, we saw new patient inserts grow 45% versus the previous quarter. And I wanted to point out that this is any population in non-muscle invasive bladder kids or high risk with carcinoma in situ, it represents roughly 4,000 patients in totality. So relatively small in nature. And we're still seeing patients being put on Enlexo in this patient population.

You touched on SunRISe-5, which is a broader patient population, roughly 15,000 patients and what we call SunRISe-3, which is the BCG naive population, roughly 50,000. This is where we absolutely see a greater opportunity for us to live into the number of $5 billion plus for the platform, and I do believe we will do just that and above that, given the unmet medical need. The simplicity of Alexa delivers and high response high durable complete remission rates that we are delivering within Leo as we look to expand in the population.

Maybe I'll turn it to John to on a little bit of the clinical development program.

John Reed

Indeed, the -- as you know, the approval currently is for the CIS type of nonmuscle-invasive bladder cancer, which spreads laterally. But the more common is the papillary and in our so-called SunRISe-1 study, we had a cohort devoted to patients with papillary cancers where those leases, which project out word from the bladder wall are excised by the urologist. And then Enlexo is applied and one tries to prevent recurrence. And we show nearly 75% of patients had no recurrence after 1 year and that over 95% had no progression of their disease. In other words, they did not progress to more invasive types of disease. So based on that, the use of Enlexo in that papillary form of disease, which is by far, the more common and is already in the NCCN guidelines and the FDA has invited us to submit for an expansion of our label into that population.

Joaquin Duato

Both icotide and enlexo are going to be together with RYBREVANT key drivers of our growth acceleration driving to double-digit growth. So they will become one of our largest products, both of them.

Operator

Our next question is coming from Michael Yee from UBS Securities.

Michael Yee

Maybe 2 pipeline science questions. On icotide, obviously, you have great data in psoriasis a little bit lower than biologics, but great data. In IBD, the UC data was quite strong. I'm just wondering if you think that would be replicated to biologic like efficacy as an oral and that differentiation there due to the release in the gut is the reason for the potentially stronger data in IBD, which could be a bigger driver? Second part question is on Milvexian. I know you share in that partnership but SSP data is coming up, and I just wanted to check in on your confidence that, that should be similar to Milvexian, and that should be a fairly derisked indication as a Factor XI.

John Reed

John Reed here. Thanks for your questions. I'll start off and then maybe Tom will want to supplement. But on icotide and IBD, we get that question all the time asking might we see even greater efficacy with an oral because of the gut absorption. All I can say is to be determined. We were quite pleased with the Phase II data in ulcerative colitis.

I would also tell you the Phase III studies, as we saw with our psoriasis and psoriatic arthritis, studies are enrolling briskly in the prior studies. They enrolled in about 1/3 of the time that it normally takes us to enroll in those indications reflecting, I think, the real enthusiasm that both physicians and patients have for this oral option. So that theory about oral absorption and improved efficacy to be determined by the data.

Moving to Milvexian and we remain confident in the studies underway, particularly with the secondary stroke because of the [ Asondexian ] data. As we know in vitro, Milvexian is a more potent inhibitor of Factor XI. We also have been able to have a safety margin that allows us to push that dose to ranges that we're confident are quite effective. So we remain confident in the results and expect that perhaps the secondary stroke data will be available even this year. It's been driven the study. The atrial fibrillation, the larger population will be next year. It will be exciting for us if we can prevail in both those indications because about 25% of patients who are candidates for secondary stroke have atrial fibrillation. That's probably why they had the stroke in the first place. And so if we can benefit both of those populations that will be exciting. We are confident in the atrial fibrillations study as well there, we were able to push the dose 4x higher, given our safety margin in the drug NPL from monitoring of the anticoagulation status of the blood with laboratories that we're in the right range to benefit patients and prevent thrombosis. So thank you for the question.

Unknown Executive

Yes, I'll just reinforce what John has said there's an absolute need for highly effective oral anticoagulation therapy with a reduced bleeding risk. In Afib alone, approximately 40% of the patients eligible for oral anticolagants are not receiving oral anorectypically due to the concerns on potential safety and the bleeding risk associated with the current...

Operator

Our next question is coming from Jayson Bedford from Raymond James.

Jayson Bedford

Just I wanted to go back to the international med tech business. Is there any way to quantify the impact of the dynamics in the Mid-East and VBP? And then Tim, I wanted to ask about international surgery. First, just to confirm your view is that there's been no change to the underlying demand profile internationally? And then second, I think Joe mentioned taking actions internationally for surgery. What are those actions?

Joseph Wolk

Let me try to get to all of those. Let me start with the Middle East. And clearly, we've highlighted that as a new risk has broadened over time. And really, the effect is no longer limited to a handful of markets as we initially thought we've seen increased disruption to ordering patterns tender timing and hospital spending decisions across a wider group of countries, unfortunately. And we've also seen governments and health care systems become more cautious in their spending priorities with some funding and procurement decisions taking longer than what we normally would expect.

That has created a more meaningful impact on purchasing behavior than we saw earlier in the year. That said, I think it's important that we see this really as a short-term factor. I mean the underlying issues have not changed. The clinical need remains intact, and we would expect many of these opportunities to be deferred rather than permanently lost. I think that's an important factor as it relates to any form of conflict and certainly what we're seeing in the Middle East.

On surgery, as I mentioned, we're actually really excited about the performance in the U.S. Our issue really was outside of the U.S. And as you know, primarily driven by factors we discussed for such as the transformation program and volume-based procurement. And then, of course, the incremental pressure that we've just mentioned around the Middle East. I will say that despite those headwinds, we're focused on where we can have an impact we have a lot of opportunities. Wound closure growth continue to benefit. This is a category where we absolutely dominate. And that growth has been driven by innovation such as Stratificas sutures, biosurgery and other billion platform delivered solid growth, driven by key brands like SURGIFLO, SURGICEL and VISTASEAL and we continue to see good traction with our in the mechanical innovations such as Ethicon 4000 and Dualto. And so we are confident that we will see continued growth in the U.S. And to your question, we will see acceleration in EMEA and return to growth overall in the fourth quarter. I do think it's also worth mentioning our confidence in this business going forward. This was core to how we started Johnson & Johnson Medtech, and we are absolutely committed to it for the long term. I'd say the biggest reason for confidence is the fact that we will be entering the surgical robotic space. And combined with our leadership positions across wound closure, biosurgery and advance instrumentation, we believe that Ottava gives us an opportunity to participate more fully in one of the most attractive and underpenetrated areas of surgery. And so as we continue to execute our portfolio transformation, advanced innovation across the existing business and prepare for the launch of Ottava, we remain confident in the long-term trajectory of the surgery franchise.

We do get a lot of questions on Ottava and rest assured that when you come together for the meeting on December 8. We will provide perspective on the outlook for that innovation and further build your confidence in what we believe will be a material contributor to Johnson & Johnson's growth over the long term.

Unknown Executive

Thank you, Jason. We have time for 1 last question.

Operator

Certainly, our final question today is coming from Alex Hammond from Wolfe Research.

Alexandria Hammond

So I guess as the CARTITUDE-5 and 6 trials of advance and newly-diagnosed multi myeloma, how is J&J preparing to educate physicians and treatment centers for the potential shift to use it earlier into the treatment journey. And I guess how should investors think about potential to capture share from these existing frontline regimens?

Tom Cavanaugh

Alex, it's Tom. Thanks for the question. I think first and foremost, yes, we're anxiously awaiting for those trials to read out. I would say we're already doing that right now with CARTITUDE-4 across the globe. CARTITUDE is available in over 20 markets, and we're seeing substantial share growth in the earlier-line settings. And I would say roughly in the U.S. of the utilization of parity lies in lines 2 and 3. So there's becoming more familiarity with the product and access to the product and excitement about it predominantly due to the unmatched overall survival as early as Line 2 of therapy that we've seen versus standard of care. So we're already educating health care providers on the product and how they can utilize it earlier. Some of the education that is centered around is appropriate patient selection and the earlier, the better as well as proper bridging, getting the patients to the highest level MRD negativity to be effectively treated with CARVYKTI.

Unknown Executive

Just to remind on top of that, that at the recent myeloma meetings, we showed 5-year follow-up data from the card study that's in second line showing that about half of those patients enjoyed complete remission out to 5 years with no further treatment. So a one and done in 5 years of continued disease-free survival. So very exciting data.

Joseph Wolk

Great. Thank you, John, and thank you, Alex, for the question. And thanks to everyone for your questions and continued interest in our company. I will now turn the call over to Joaquin for some brief closing remarks.

Joaquin Duato

Thank you for your questions and your engagement in today's call. As you can see, we continue to build momentum growth improved sequentially in the third quarter, and we expect further acceleration in 2027 with a clear path to double-digit growth by the end of the decade. In innovative medicine growth will come from both our existing portfolio, including DARZALEX and TREMFYA and newer products such as icotide, RYBREVANT and enlexo as they begin to contribute more meaningfully. We see similar opportunities in medtech the potential from our cardiovascular launches, including next-generation and IVL catheters, additional data supporting Impella and Ottava and robotic surgery are not yet fully reflected in our growth.

Taken together, these drivers position Johnson & Johnson as one of the cleanest growth stories in health care. We will provide more details about our portfolio and late-stage pipeline at our enterprise business review later in December. Thank you very much, and enjoy the rest of your day.

Operator

Thank you. This concludes today's Johnson & Johnson's Third Quarter 2026 Earnings Conference Call. You may now disconnect.