The Q1 earnings season for US stocks kicks off! Major Wall Street banks take the lead
強生2026Q1業績直播
Key Takeaways (AI-Generated)
Financial Performance
- Q1 2026 worldwide sales of $24.1 billion with operational growth of 6.4%
- Net earnings of $5.2 billion, diluted EPS of $2.14 vs $4.54 prior year
- Adjusted net earnings of $6.6 billion, adjusted diluted EPS of $2.70 (down 2.5% vs prior year)
- Free cash flow of approximately $1.5 billion in Q1, maintaining full year outlook of ~$21 billion
Business Highlights
- DARZALEX remains #1 product with $4 billion sales and 18% operational growth
- ICOTIDE launched as first and only IL-23 targeted oral peptide for plaque psoriasis
- TREMFYA delivered 64% growth and is fastest growing IL-23 therapy in US
- 28 platforms generating at least $1 billion in annual revenue with target to add more
Financial Guidance
- Raised operational sales guidance to 5.9%-6.9% range with midpoint of $100.2 billion (6.4% growth)
- Increased adjusted operational EPS guidance by $0.02 to $11.30-$11.50 range (5.7% growth at midpoint)
- Maintaining guidance for adjusted pre-tax operating margin improvement of at least 50 basis points
- On track to meet 2026 target of $100 billion annual revenue for first time
Opportunities
- Line of sight to double digit growth by end of decade with underestimated potential
- ICOTIDE potential to become one of largest products ever with peak sales potential
- Operating leverage from strong sales growth amplified when US DARZALEX royalties roll off in 2029
- Continuing opportunistic acquisition approach with recent success from ABIOMED, SHOCKWAVE, and Intracellular
Risks
- Increasing competition in IVL market for SHOCKWAVE and competitive pressures in US surgical vision
- Impact of tariffs on MedTech cost of goods sold
- Second-half impact anticipated from volume based procurement in China for electrophysiology products
Full Transcript (AI-Generated)
Operator
Good morning and welcome to Johnson and Johnson's First Quarter 2026 Earnings Conference Call. All participants will be in listen only mode until the question and answer session of the conference. This call is being recorded. If anyone has any objections, you may disconnect at this time. If you experience technical difficulties during the conference, you may press *0 to reach the operator. I will now turn the call over to Johnson and Johnson. You may begin.
Darren Snowgrove
Hello, everyone. This is Darren Snowgrove, Vice President of Investor Relations for Johnson and Johnson. Welcome to our company's review of business results for the first 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 and Johnson website at investor.j&j.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 and 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 10K, which is available at investor.j&j.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 first 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. Jennifer Taubert, 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
Good morning, everyone, and thank you for joining us. We said 2026 would be a year of accelerated growth and impact for Johnson and Johnson. And with our strong Q1 performance, including our beat on consensus and raised guidance, you can see we are delivering on that promise. In the first three months of the year, we delivered operational sales growth of 6.4%.
Our focus on areas of high innovation, high unmet need and high growth is delivering results today and for the future across each of our six key businesses: oncology, immunology, neuroscience, cardiovascular, surgery and vision. We have multiple differentiated assets to drive sustained growth and a strong competitive advantage. Our success is fueled by the strongest and youngest portfolio and pipeline in the history of Johnson and Johnson.
We currently have 28 platforms or products that generate at least $1 billion in annual revenue and we are aiming to add even more. Our unique combination of innovative medicine and MedTech together with strong execution and industry leading investment in innovation is delivering resilient growth. We are on track to meet our 2026 target of $100 billion in annual revenue for the first time and we are confident our progress will continue to improve into 2027 with line of sight to double digit growth by the end of the decade.
Let's start with innovative medicine where we delivered operational sales growth of 7.4% in the quarter with 10 brands growing double digits. In oncology, we are aiming to cure and treat more cancers with the world's leading portfolio and pipeline. DARZALEX remains the gold standard in multiple myeloma and our number one product with sales of $4 billion and operational sales growth of 18%. CARVYKTI, TECVAYLI and TALVEY also continue to deliver high double digit growth reflecting the importance of our multiple myeloma portfolio across the full treatment journey.
Progress in our pipeline accelerated in Q1 with the FDA approval of TECVAYLI plus DARZALEX FASPRO for relapsed or refractory multiple myeloma that positions the regimen as a potential new standard of care as early as second line. In solid tumors, RYBREVANT FASPRO received FDA approval for subcutaneous monthly dosing for patients with EGFR mutated non small cell lung cancer. RYBREVANT also received FDA breakthrough therapy designation in advanced head and neck cancer with new data showing 56% overall response rate in first line recurrent or metastatic head and neck cancer when combined with immunotherapy.
The treatment is being further evaluated in the ongoing phase three ORIGAMI-5 study and in high risk non muscle invasive bladder cancer. AKEEGA is outperforming all recent launches based on unique patients treated in the first six months post approval. In immunology, we continue to raise the bar in a category we have built for more than three decades, from single innovations like REMICADE and STELARA to now a dual powerhouse of ICOTIDE and TREMFYA.
TREMFYA had another strong quarter with sales up 64%. It continues to be the fastest growing IL-23 therapy in the US and is now the share leader for new patient starts in inflammatory bowel disease. And with last month's FDA approval of ICOTIDE for the first line treatment of plaque psoriasis, we are once again transforming the standard of care for immunology patients. ICOTIDE is the first and only IL-23 targeted oral peptide and has the potential to fundamentally change how psoriatic disease is treated by offering a convenient once daily pill.
The full launch of ICOTIDE took place the same day as approval with the first patient receiving treatment that very day. While it is just the beginning, we are already seeing strong demand through our patient hub. Together, ICOTIDE and TREMFYA create a complementary category shaping portfolio. ICOTIDE is the first choice systemic treatment and TREMFYA is the first choice biologic treatment for patients with moderate to severe plaque psoriasis. ICOTIDE has the potential to be one of our largest products ever. TREMFYA is projected to deliver more than $10 billion in peak year sales.
In neuroscience, we are focused on meaningfully improving outcomes in mental health. The US launch of CAPLYTA in adjunctive major depressive disorder is building momentum. Now let's turn to MedTech, where we reported Q1 operational sales growth of 4.6% with growth across all of our key focus areas. In cardiovascular we are investing in the growing need for complex interventions. Johnson and Johnson is the market leader in heart recovery, circulatory restoration and electrophysiology and we continue to deliver sustained growth.
In heart recovery, ABIOMED had another strong quarter as this shockwave. In circulatory restoration and in electrophysiology, VARIPULSE, our pulsed field ablation platform for atrial fibrillation keeps building momentum. Our confidence of continued leadership in electrophysiology was further strengthened by our recent launch of VARIPULSE PRO in Europe with five times faster ablation, which helps streamline procedures and improve efficiency as well as our recent VARIPULSE 12 months data presented just a few days ago.
We show a strong safety profile with zero reported strokes. We also continue to receive strong feedback in Europe for our dual energy THERMOCOOL SMARTTOUCH SF catheter, which we expect to launch in the US later this year, having recently submitted the complete platform to FDA. And finally, we recently announced 12 month data for OMNIPULSE, our large focal tip PFA catheter showing positive outcomes, no safety events and 100% procedural success rate.
In surgery, our strong performance reflects the deep levels of trust and our expanding presence in the operating room. In Q1, we made progress on our OTTAVA robotic surgical system and we are building on our recent de novo filing for approval with a second investigational device exemption trial now underway for inguinal hernia repair. In vision, we are restoring sight to its healthiest state with expanding access globally for our ACUVUE OASYS MAX disposable lenses for presbyopia and astigmatism and our TECNIS intraocular lenses.
Most significantly, we received FDA approval of TECNIS PUREC, the first and only extended depth of focus intraocular lens in the US to maintain contrast sensitivity comparable to a monofocal lens. 97% of patients reported no very bothersome visual disturbances like halos or glare. As you can see, we are off to a fast start in 2026, building momentum that will accelerate our impact and growth throughout the year and for the balance of the decade.
The depth of our portfolio and pipeline has never been stronger, and I'm confident we'll continue to deliver on our commitments for 2026 and beyond. And with that, I will turn the call back over to Darren.
Darren Snowgrove
Thank you, Joaquin. Moving to our financial results, unless otherwise stated, the percentages quoted represent operational results and therefore exclude the impact of currency translation. Starting with Q1 2026 sales results, worldwide sales were $24.1 billion. For the quarter, sales increased 6.4% despite an approximate 540 basis point headwind from STELARA. Excluding STELARA, Johnson and Johnson grew double digits.
For the quarter, growth in the US was 8.3% and 3.9% outside of the US. Acquisitions and divestitures had a net positive impact on worldwide growth of 110 basis points, primarily driven by the Intracellular acquisition. Now turning to earnings for the quarter, net earnings were $5.2 billion and diluted earnings per share was $2.14 versus $4.54 a year ago.
Adjusted net earnings for the quarter was $6.6 billion and adjusted diluted earnings per share was $2.70 representing a decrease of 1.4% and 2.5% respectively compared to the first quarter of 2025. I will now comment on business sales performance in the quarter, focusing on the six key areas where meaningful innovation is driving our performance and fueling long term growth.
Beginning with innovative medicine, our financial results reflect the depth of our expertise and innovation in areas of high unmet need across oncology, immunology and neuroscience. Worldwide sales of $15.4 billion increased 7.4% despite an approximate 920 basis point headwind from STELARA, which underscores the continued strength of our key brands and new launches. Growth in the US was 9.6% and 4.3% outside of the US.
Acquisitions and divestitures had a net positive impact of 180 basis points on worldwide growth, primarily due to the Intracellular acquisition. In oncology, starting with multiple myeloma, DARZALEX growth was 17.8%, primarily driven by strong share gains of 5.9 points across all lines of therapy with nearly 12 points in the frontline setting as well as market growth. CARVYKTI achieved sales of approximately $600 million with growth of 57.4% driven by share gains and continued site expansion.
TECVAYLI growth was 30.1%, with sequential growth of 14.2% driven by launch uptake and share gains from expansion in the community setting, as well as the US approval of TECVAYLI plus DARZALEX FASPRO. TALVEY growth was 72.8% driven by share gains through expansion in the community setting. In lung cancer, RYBREVANT plus LAZERTINIB delivered sales of $257 million and growth of 80.5%, driven by continued launch uptake in all regions, share gains and rapid uptake in RYBREVANT FASPRO.
Share gains in both the first and second lines continue to drive strong sequential growth of 18.8%. In prostate cancer, ERLEADA delivered strong growth of 16.2% due to continued share gains and market growth. Within immunology, TREMFYA delivered impressive growth of 63.8%. Our IBD launch is driving significant momentum and we continue to see share gains across all indications as well as market growth.
STELARA declined 61.7% driven by share loss due to biosimilar competition, increasing adoption of novel classes and unfavorable patient mix. In neuroscience, SPRAVATO grew 44.5%, driven by continued strong demand from physicians and patients. CAPLYTA, which was acquired in Q2 of 2025 as part of the Intracellular acquisition, delivered sales of $270 million for the quarter with continued strong momentum in our AMDD launch.
Since AMDD approval in the US, CAPLYTA has had its highest ever new patient start volumes across all indications. Now moving to MedTech where we delivered growth across each of our key focus areas, cardiovascular, surgery and vision. Worldwide sales of $8.6 billion increased 4.6% with growth of 5.9% in the US and 3.2% outside of the US. Divestitures had a net negative impact of 10 basis points on worldwide growth.
In cardiovascular, electrophysiology delivered growth of 9.5% driven by our newly launched products including VARIPULSE and commercial execution. ABIOMED delivered growth of 14.4% with continued strong adoption of the IMPELLA technology. SHOCKWAVE delivered strong double digit growth of 18.1% driven by continued adoption of coronary and peripheral products. Surgery grew 1.2% despite the negative impact of approximately 30 basis points from divestitures.
Growth was driven by strength of the portfolio and commercial execution in biosurgery and wound closure, partially offset by planned surgery transformation impacts and competitive pressures in energy and endo cutters as well as VBP in China. Across the portfolio, Vision contact lenses and other products grew 2.7%, driven by strong performance in the ACUVUE OASYS ONE-DAY family of products as well as strategic price actions, further solidifying our leadership position.
Surgical Vision grew 6%, driven by new product innovations, robust demand for premium IOLs and strong commercial execution, partially offset by competitive pressures in the US. Orthopedics growth this quarter was 3.2%, primarily driven by new product launches and strong commercial execution. Now turning to our consolidated statement of earnings for the first 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 10 basis points, driven by the impact of tariffs and other operational drivers in the MedTech business, an unfavorable mix in the Innovative Medicine business. This was partially offset by favorable translational currency in the Innovative Medicine business.
Selling, marketing and administrative expense deleveraged by 180 basis points, driven by heavier investment in new launches early in the year and increased investment related to the acquisition of Intracellular in the Innovative Medicine business. Research and development remained flat at 14.7% of sales. Interest income and expense was a net expense of $43 million as compared to $128 million of income in the first quarter of 2025.
The decrease in income was driven by a lower average cash balance and a higher average debt balance. Other income and expense was a net expense of $294 million as compared to $7.3 billion of income in the first quarter of 2025, with the change primarily driven by the approximate $7 billion talc reserve reversal in the first quarter of 2025.
Tax rate on a GAAP basis in the first quarter of 2026 was 12.6% compared to 19.3% in the first quarter of 2025. This was primarily driven by the reversal of the talc settlement accrual in the first quarter of 2025, which did not reoccur and discrete tax benefits associated with employee equity programs in the first quarter of 2026.
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 adjusted income before tax by segment. For the quarter, Innovative Medicine margin declined from 42.5% to 39.7%, primarily driven by heavier investment in new launches early in the year, unfavorable product mix and certain favorable one time items recorded in 2025, partially offset by favorable translational currency.
MedTech margin declined from 25.9% to 22.3%, primarily driven by the impact of tariffs in cost of products sold and certain favorable one time items recorded in 2025. As a result, adjusted income before tax for the enterprise as a percentage of sales decreased from 36.6% to 32.5%. This concludes the sales and earnings portion of the call and I will now turn the call over to Joe.
Joe Wolk
Thanks Darren. Hello everyone. We appreciate you joining us today. As Joaquin noted, we are seeing good momentum across our business powered by our industry leading portfolio, sustained investment in innovation and disciplined execution. We continue to advance our pipeline by bringing innovative new treatments to patients, which will meaningfully improve patient outcomes and fortify future performance, giving us a clear line of sight to double digit growth by the end of the decade.
Turning to cash and capital allocation, we ended the first quarter with approximately $22 billion of cash and marketable securities and $55 billion of debt for a net debt of approximately $33 billion. Free cash flow in the first quarter was approximately $1.5 billion. Clearly, this suggests a run rate below our full year projection as Q1 reflects payment timing changes on certain US rebate programs and increased US capital expenditures.
However, these were expected and we remain confident in our full year free cash flow outlook of approximately $21 billion. Our strong financial position and cash flow generation provides a competitive advantage enabling us to maintain a consistent approach to capital allocation and investment in future innovation. Since announcing our plans to invest $55 billion in US based manufacturing, technology and research and development through early 2029, we are well on our way to reaching that target.
Through the end of 2025, we invested roughly $12 billion or 22% of the $55 billion with significant investment already underway in 2026. Our manufacturing investments include facilities in North Carolina and Pennsylvania and we will have more announcements to come in upcoming quarters. Lastly, we recognize our shareholders value a growing dividend.
Today we were pleased to announce the Board of Directors authorization for a 3.1% increase to an annual rate of $5.36 per share, our 64th consecutive year of dividend growth. Turning now to full year 2026 guidance, we are increasing our operational sales guidance to be in the range of 5.9% to 6.9% with a midpoint of $100.2 billion or 6.4%.
As noted last quarter, our financial calendar in 2026 includes a 53rd week, which provides a benefit of approximately 100 basis points. We do not speculate on future currency movements and last quarter we utilized the euro spot rate relative to the US dollar of 1.17. As of last week, the euro spot rate to the US dollar has stayed relatively flat.
With modest benefit from other major currencies as a result, we estimate reported sales growth between 6.5% to 7.5% with a midpoint of $100.8 billion or 7%. Turning to other notable items on the P&L, we are maintaining our guidance for adjusted pre tax operating margin to improve by at least 50 basis points in 2026. This will be driven by continued operating efficiencies with a portion reinvested to support new product launches and further strengthen the pipeline.
As today's Q1 results reflect heavier investment is planned to occur in the first half of the year. As a reminder, our pre tax operating margin guidance takes into account the cost from the 53rd week of operations and the announced voluntary agreement with the US government to improve access to medicines and lower cost to US patients. We are maintaining our guidance for net interest expense, net other income and the effective tax rate for the full year.
Turning to adjusted operational earnings per share, we are increasing our guidance by two cents to a range of $11.30 to $11.50, representing 5.7% growth at the midpoint. As such, we now expect reported adjusted earnings per share of $11.55 at the midpoint or a growth of 7.1%. I'll now shift to some qualitative considerations on phasing for your models.
As noted last quarter, we anticipate fairly consistent operational sales growth throughout the year with a higher fourth quarter due to the benefit from the 53rd week referenced earlier. In innovative medicine, the depth and strength of our portfolio will continue to drive accelerating growth this year. We expect contributions from our newly launched products across oncology, immunology and neuroscience to increase throughout the year.
As Joaquin mentioned, we are excited by the launch of ICOTIDE as well as that of AKEEGA, our innovative new therapy for certain types of bladder cancer, which had sales slightly above $30 million in the quarter. On April 1st, we received a permanent J code for AKEEGA reimbursement, which will enable broader patient access and serve as an important catalyst for growth.
In neuroscience, CAPLYTA continued to build momentum following its FDA approval in adjunctive major depressive disorder with new patient starts and total continuing patient growth outpacing the market. We believe this performance supports CAPLYTA's peak annual sales potential of greater than $5 billion and we look forward to sharing additional data in bipolar mania later this year.
In MedTech, our focus this year is on accelerating the adoption of our recently launched products. ETHICON 4000, our next generation surgical stapler launched in the US in 2025 and is expected to launch in Europe shortly. In Vision, we continue to expand the TECNIS platform globally and look forward to the US launch of TECNIS PUREC intraocular lens, which enables surgeons to address cataract related vision loss and presbyopia in a single procedure.
In electrophysiology, VARIPULSE PRO is an innovative step forward introducing a new faster pulse sequence that reduces ablation time by 85%. We do anticipate some second-half impact from volume based procurement in China for electrophysiology products, which has been factored into our full year guidance. The orthopedics business under the leadership of Namal Nawana delivered a strong first quarter with encouraging momentum across key platforms.
We are continuing to make targeted investments in the business and working towards a mid 2027 separation. We look forward to sharing further updates later this year. And as stated last October, we are evaluating all separation vehicles that create shareholder value and set up the DePuy Synthes business for long term success.
Turning to our pipeline, we have many important catalysts that we are looking forward to in 2026. In innovative medicine, we expect regulatory approval for TREMFYA for the inhibition of structural joint damage for patients with psoriatic arthritis. As this chart indicates, we also have many important upcoming data presentations across oncology, immunology and neuroscience, including ERLEADA in localized and locally advanced high risk prostate cancer, AKEEGA in high risk non muscle invasive bladder cancer, J&J-4804 in ulcerative colitis and Crohn's disease, and CAPLYTA in bipolar mania.
In MedTech, we anticipate the following approvals and regulatory submissions: OTTAVA robotic surgical system, VARIPULSE PRO in the US, AFIRMA in biosurgery and the dual energy THERMOCOOL SMARTTOUCH SF catheter in the US. Before we move to Q&A, we'd like to thank our colleagues around the world for delivering another solid quarter.
Their execution continues to optimize our portfolio, advance our pipeline and deliver on our mission of improving and saving lives. Our diversified portfolio, robust pipeline and strong financial foundation position us to drive accelerating and sustainable growth while creating near and long term value for shareholders. Speaking of long term, we look forward to providing an in depth look at our long term strategy and the driving forces behind our path to double digit growth.
Please mark your calendars for December 8th, the date of our enterprise business review. With that, we are happy to take your questions. Kevin, can you please open the call for Q&A?
Operator
Certainly. Ladies and gentlemen, if you'd like to ask a question at this time, please press * the number one on your telephone keypad. If you'd like to withdraw your question, please press *, then the number 2. Please limit your questions to one question only. Our first question today is coming from Terence Flynn from Morgan Stanley. Your line is now live.
Terence Flynn
Great. Thanks for taking the question and congrats on all the progress. I had a two-part one on ICOTIDE. I was just wondering if you can remind us of how you're positioning that drug in the market now that we have full details on the label and pricing and also how should we think about the ramp of reimbursement coverage there and any sampling plans? Thank you.
Jennifer Taubert
Thanks. Well, good morning, Terence. Hello everyone. And just wanted to start with a big thanks to the entire innovative Medicine team throughout the world. Really strong results in the first quarter with over $15 billion in net sales, 7.4% operational growth, really importantly 11 key brands delivering double digit growth. And if you take a look at that, what is now 96% of our business that is not including STELARA, we actually grew at 15.6%. So really nice accelerating growth across the portfolio.
So I'm thrilled to talk about ICOTIDE, really one of our outstanding products. And I've got to tell you it's off to a very fast start. The product was approved back in March and we're really, really happy with what we believe is a very differentiated label for the product is the first and only targeted oral peptide that precisely blocks the IL-23 receptor. ICOTIDE, maybe it's a reminder delivers complete skin clearance, favorable safety and the simplicity of a once daily pill.
And we think it's got the potential to become one of our biggest products. So we were day one launch ready for the product and in fact first patient was actually on medication within 24 hours of approval. We're seeing very strong early enthusiasm from both physicians and patients that reinforce our confidence in the potential for this product. A number of us were out at the AAD meeting as well and the KOL receptivity to the strength and the simplicity of the label has been really encouraging.
Things like no lab monitoring, the TV language that reflects the physician clinical judgment, no black box or drug interactions really is giving us good confidence that this is going to be really the preferred choice and first choice for systemic therapy. In terms of early uptake, we're seeing so far about 1500 patients already that prescriptions have been written for that are going into access and patient support service center. So already 1500 and already over 1000 unique customers that are writing.
In terms of payers, our goal is to have both early and broad access and we're in the middle of very, very positive conversations with them to try to drive that early and very broad access. So more to come on that in terms of the positioning. I can't think of a better portfolio than being able to have both ICOTIDE and TREMFYA for our folks and really for patients.
So with ICOTIDE being the first and only targeted oral peptide, it is really going to become the preferred first line systemic therapy. We know there are so many patients that keep cycling and cycling and cycling on topical therapies. Now the International Psoriasis Foundation guidelines have changed so that patients after 2 topicals and trials of four weeks each really become eligible for systemic and advanced therapies. And so we think ICOTIDE fits right in this sweet spot as that first choice systemic.
Likewise, TREMFYA holds a really unique and distinct position as well, and that really is the first choice biologic. And so TREMFYA is both structurally and functionally different from the other IL-23s. We've been able to demonstrate really durable complete skin clearance and in our case here it's the first and only IL-23 that's got significant inhibition of structural damage. So we think it's really the first choice biologic especially in patients that have active or suspected PSA or psoriatic arthritis.
So we think that with that 1-2 punch, we have got the portfolio for psoriatic disease in patients and are really excited about both agents going forward.
John Reed
Maybe you would just add one other thing, John Reed here. Our study of ICOTIDE in psoriatic arthritis should read out later this year. That's important given that about 1/3 of patients with psoriasis also develop psoriatic arthritis and the studies in inflammatory bowel diseases, Crohn's and colitis are ongoing rolling that Phase 3 program.
Operator
Thank you. Our next question today is coming from Larry Biegelsen from Wells Fargo. Your line is now live.
Larry Biegelsen
Good morning. Thanks for taking the question and congrats on a nice start to the year here. Tim, you know, sentiment in the medical device space is relatively low right now because of the number of headwinds and concerns. But you posted, you know, respectable growth rate this quarter, but it was slightly below the Q4 growth rate and you know, the comp in Q1 was relatively easy. So you know, my question is what are you seeing in your end markets and you know, how are you thinking about the remainder of the year?
Tim Schmid
Thanks for taking the question. Well, good morning Larry and thank you for the question. Let me jump right in and say that you know as you know we've been very clear Larry in articulating our strategy which is focused on higher growth and higher innovation markets and that includes our deliberate choice to prioritize our three focus areas of cardiovascular vision and surgery as we separate ortho. And I can confidently say that that strategy is working.
And in short, while we're navigating a dynamic world and market like everybody else, for us Q1 unfolded as we expected the years to start, seasonally quieter, but operationally solid. And this was also not a one business or one region quarter. As you've seen by the results, we saw growth across the board and overall we're pleased with the 4.6% operational growth, especially given that Q1 is typically our most seasonally subdued quarter.
And I think it's also worth noting Larry that while there were some easier year over year comparisons that by no means drove the quarter. Specifically the 210 basis points of one time impact we referenced in Q1 of last year, which you will recall was a bit of a noisy quarter were almost entirely related to the items that occurred in 2024. And so those prior year events temporarily depressed the year over year growth rate creating a lighter competitor, but they did not affect on the underlying dollar sales.
And so one time items from 2024 fully lapped last year and our Q1 performance reflects underlying operational execution and normal seasonality rather than any benefit from prior one timers. So I'd say in summary, Larry, overall Q1 played out largely as we anticipated balancing normal seasonality with solid execution. And most importantly, nothing in the quarter changes our confidence in further acceleration as we look towards Q2 and the remainder of 2026 and we've got a lot of growth catalysts to be proud of.
What I will say in terms of the underlying market is that it's solid and underlying demand is what we expected. Now we did see some procedural softness early in the quarter, but nothing that we would define really as material. While certain regions particularly here in the US, you will recall we experienced some periods of severe weather in late January and early February that was largely consistent with normal seasonal patterns.
And while there was some localized impact on procedure volumes due to poor weather in parts of the business, we would not categorize them as material or meaningful at an overall level. And so what I'm proud of is our teams are highly experienced in managing these types of short term disruptions and our supply chain, our clinical support and commercial teams work closely with healthcare providers to maintain continuity of service and support patient care.
And so in short, Larry, a strong quarter for us consistent with our expectations and we believe strongly in the robustness of our end markets.
Operator
Thank you. Next question today is coming from Asad Haider from Goldman Sachs. Your line is now live.
Asad Haider
Great, thanks and congrats on yet another solid quarter for Joaquin. Just going back to the goal of double digit top line growth towards the end of the decade, that's still not something that's getting reflected in consensus models. And in light of your comment earlier that ICOTIDE could be one of your largest products ever, that would suggest an opportunity of at least $10 billion. So any updated views on what you see as the key product variances versus the street looking towards the end of the decade and related, how important is the BD lever in that growth algorithm?
Joaquin Duato
Thank you very much. And look again as you can see we are off to a fast start with momentum that will accelerate throughout the year in 2027. And as you mentioned with line of sight to double digit growth by the end of the decade. And I think it's a fair question, how is that possible for a company that this year in 2026 is going to deliver more than $100 billion. This is grounded in reality. As a matter of fact, it's already happening today.
If you look at the first quarter of 2026, we're already delivering double digit growth as total Johnson and Johnson when you exclude the STELARA. So it's already happening today and it's based on our portfolio and pipeline, the strongest in our history. And also as the decade progresses, we are going to see increasing impact in our revenue of our new product launches that are largely de-risked.
In particular as you mentioned, there's still an underestimation of the potential of ICOTIDE in psoriasis, psoriatic arthritis and IBD. The potential of RYBREVANT in non small cell lung cancer, head and neck where we got breakthrough designation and colorectal cancer and finally the potential of AKEEGA in high risk non muscle invasive bladder cancer. By the way AKEEGA got the J code earlier in April.
So I believe those are three particular products that remain underestimated that are already marketed. The same is true in MedTech where launches especially in cardiovascular including our next generation PFA catheters and IMPELLA ICP along with OTTAVA in robotic surgery are not yet fully reflected as well as the fact that the separation of orthopedics will further lift our growth rates.
So I think when you take into consideration of those factors, you are going to get into a similar conclusion of double digit growth by the end of the decade. Further, I would say that the strong sales growth will also drive operating leverage that will be further amplified when the US DARZALEX royalties roll off in 2029. So taking together this creates what some of you have called the cleanest growth story in healthcare and we are going to be providing additional details in our enterprise review that will take place in December as we have announced today.
Regarding BD, let me be clear, all these numbers do not include business development. This is based in the strong portfolio pipeline that we have today that is largely de-risked which increases the confidence in our ability to get there. When it comes to business development, I mean that remains an important part of our capital allocation. As a matter of fact, I would say we have been ahead of the curve in our investments in M&A with the acquisitions during the last 2 1/2 years of ABIOMED, SHOCKWAVE and Intracellular.
As I have commented in multiple times, our sweet spot remains early stage deals like the one we did earlier this year with Halda Therapeutics, which brings a new platform in our oncology business. And at the same time, I have to say that given the situation that I just described, our priority from a capital allocation perspective, our priority is to invest behind our portfolio of new product launches and our promising pipeline program. So that's our priority.
We will remain opportunistic from a business development standpoint, but we do not depend on M&A to be able to deliver on that promise. So in summary, we see both revenue growth and operating margins improving and we reaffirm that we have line of sight to double digit growth by the end of the decade.
Operator
Thank you. Our next question today is coming from Chris Schott from JP Morgan. Your line is now live.
Chris Schott
Great. Thanks so much for the question and congrats on the progress. I just had a 2 parter coming back to ICOTIDE, maybe the first one you mentioned 1500 prescriptions so far. Is there any color on where those customers are coming from as we think about new patients versus those switching off orals versus those switching off injectables? And then just on the bigger picture view of ICOTIDE, as you mentioned the potential for the drug to become one of the company's largest ever, the pathway to get there. Should we think about this as a similar dynamic to TREMFYA that skews more towards IBD versus psoriasis or is this one that could have more balanced sales by indication given as you mentioned, the frontline potential of the drug in the psoriasis setting?
Jennifer Taubert
Hi, Chris, thanks so much for the question. So in terms of the early information on ICOTIDE, obviously it is really early. So we're still getting information and I can tell you that there's a broad range of prescribers for ICOTIDE. As we look across the medical community, we don't yet have data that is specific to exactly where that's coming from, what is exactly new, what they're switching off of etcetera. So hopefully we'll have greater visibility on that on our next call next quarter. So obviously it's pretty new and hot off the press.
I think as we take a look at ICOTIDE, ICOTIDE is going to fit in in psoriasis really firmly in that systemic first line therapy area. And that is also a great opportunity there for market expansion. If you think there are so many patients that are cycling on topicals, they are resistant to moving into biologics for number of reasons, whether it's needle phobia, perceptions around safety profile and things. We think not only given the size of the current systemic market and having significant impact there, but really being able to expand that broader is going to be key for ICOTIDE success.
I also think when you think about IBD and having an oral agent, we've got to see the studies pan out. But based on our goals there, we think that that's going to be similar very, very large opportunity. I think here we're going to see maybe more of a balanced scenario given the strength that we really anticipate having in psoriasis. But I think both segments, both psoriatic disease and inflammatory bowel diseases are going to be very big offer a lot of potential and promise for ICOTIDE.
John Reed
Yeah. Chris, maybe just one other comment on that is that across most autoimmune diseases, about 70 to 80% of patients who were eligible for a biologic are not taking one. And so that's why we really think about this market expansion opportunity to offer patients the convenience of a highly effective, very safe once a day pill.
Operator
Thank you. Our next question today is coming from Shuden Singh from RBC Capital Markets. Your line is now live.
Shuden Singh
Thank you so much. I wanted to touch on some of your growth drivers within the medical device business. You know ABIOMED post ACC, you know some of our checks were suggesting that within the high risk population we could see up to a 30% reduction. What was that compared with your expectation? It looks like the IDEAL space is looking to get increasingly more competitive so. You know, how do you manage your marketing leadership position in that space? And then overall, as I think about all the drivers that you mentioned within medical devices, should we think about MedTech as a high single digit growth contributor towards the double digit growth that you've called out for total company by the end of the decade?
Tim Schmid
Thank you for the question and there's a lot in there. Let me try and unpack it. Firstly, we are really excited to be now significantly embedded in the cardiovascular space beyond the leadership position we hold in electrophysiology. And with the acquisitions of both ABIOMED and SHOCKWAVE, we've added to high growth, high margin businesses with tremendous trajectory for the future.
ABIOMED as you know grew 14, almost 15% in the first quarter. And this is really driven by rapid adoption of IMPELLA 5.5 and CP. And what excites me most going forward is ABIOMED's robust pipeline of not only technologies, but ongoing clinical studies showing the benefits of this technology. And you will know that in August of last year, we saw new data from the DANGER SHOCK randomized control trial published in the New England Journal of Medicine.
And this really confirmed the long term survival benefit of IMPELLA. These results found that up to 10 years when compared to the standard of care routine use of IMPELLA in patients who had a STEMI heart attack with cardiogenic shock lead to an absolute mortality reduction of 16.3%. And to put this in context, when compared with the control arm at 10 years, IMPELLA CP patients gained an average of 600 additional days alive. I mean that is compelling.
And so while you're always going to see new data and new studies come about, we believe that our evidence base for the products we have and the indications we have today are absolutely solid and will continue to drive performance in a category where we don't have line of sight to any significant competitor for the foreseeable future.
I'll turn to SHOCKWAVE, 18.1% in the first quarter and we're very pleased with that performance. The IVL market is one we completely have created ourselves through the acquisition of SHOCKWAVE and we continue to advance our leadership position. Now clearly competition is coming. Competition is going to come to any space that is attractive and certainly one as attractive as IVL.
But there's three reasons that we have confidence in our portfolio and our future. And the first thing really is our portfolio. The second is evidence and it's our presence. And over the past seven years we've had, we've earned the reputation of an innovative disruptor launching 9, yes 9 new coronary and peripheral catheters that have introduced a new standard of care when it comes to safely and effectively treating calcified lesions.
And now as a result, SHOCKWAVE IVL has become the preferred treatment strategy in most calcium cases worldwide, where has been used in now more than a million cases around the world. And global expansion has also increased since the as we have transitioned 10 markets to direct sales forces. We've expanded our presence to now cover 70 markets globally with J&J representatives where we can leverage our scale and the broader J&J organization to drive government relations and address any legal and market access opportunities.
And while we will never take any competitor for granted, new competitive entrants into the IVL market validate really SHOCKWAVE's robust portfolio in lesion specific solutions. And while competitors are introducing similar versions to our first generation products from 2017, we're introducing our fifth generation coronary peripheral devices in 2026.
And a single catheter offering will be difficult to compete against SHOCKWAVE's portfolio strategy and the improvements we've made over the years to reset the standard of IVL. And while new competitors are completing their first regulatory required clinical studies, we're continuing to invest millions in robust real world clinical evidence with nearly 25,000 patient outcomes published across 600 journals to date demonstrating our unique safety profile exclusively associated with SHOCKWAVE's ultrasonic acoustic platform.
And decisions also appreciate our compact, easy to use and rechargeable generators, which require minimal capital expenditure. And back to the point of presence, these generators provide widespread access to SHOCKWAVE's IVL technology and they're available in almost every cath lab across the United States and we actually have more than two generators in over 1700 U.S. hospitals and so very difficult competitors to unseat us.
Most importantly I'd say is we remain hyper focused on continuing to earn our innovative disruptor reputation with plans to launch at least one new IVL catheter per year that we expect will redefine the future of IVL in new indications and new disease states. And this year we will launch our C2 AERO new coronary catheter, which from the early feedback we've got from physicians is going to be another standout product.
I think your final point around long term prospects, we're excited about our growth profile and the catalysts we have to continue to accelerate MedTech from a mid single digit player into a higher single digit player as we move towards the end of the decade. I will point to some big catalysts especially in our surgery business. Surgery is one of our larger portfolios. We are a dominant leader both in the open and laparoscopic space and we have an expectation to play a big role in the robotic space.
As you know, we've submitted OTTAVA for approval and assuming everything plays out, we expect that by the end of this year we will be launching not one, but two new surgical robotic programs both with OTTAVA and MONARCH Urology. Now while we don't expect those programs to be significantly accretive to growth in the short term, they certainly will be accretive as we move to the back half of the decade. So another good example of an important catalyst that will take us from a mid single digit player into a higher single digit player as we look to the back half of the decade.
Operator
Thank you. Our next question is coming from Alexandra Hausman from Wolfe Research. Your line is now live.
Alexandra Hausman
Good morning and thanks for taking the question. A few more on ICOTIDE. Can you walk us through the investments you guys are making on prescriber and patient education? And how important do you think advertising will be to kind of engage those new patients who might be nervous to start on a systemic therapy? And then just as a follow up as well with ICONIC ASCEND trials such a readout imminently, how important could this result be to those ongoing commercial discussions?
John Reed
The study you mentioned in the head to head against the TYK2 inhibitor is I think just illustrates the best in disease profile for ICOTIDE in terms of having both that high level efficacy combined with safety in the once a day pill. How much the direct to consumer is going to matter. I'm going to let Jennifer answer that question.
Jennifer Taubert
Hi Alex. Safe to say that we are investing big and ICOTIDE to make sure that this brand can do all that it can do for patients. I think that the ease and the simplicity when you combine the clinical profile, the safety, the efficacy and then the ease of the product. We really believe that we've got a winner. And so we're investing to really get off to a very strong launch that's with all of the appropriate field teams.
Additionally, we've invested and built out what we believe are really best in class patient access and support services to help patients get on the medicine, both get on and be able to stay on. And then we're continuing to evaluate the best way to make sure that both the clinicians, all the appropriate healthcare providers and patients are aware of this important offering. So probably more to come on that, but please know that we're investing what we believe we're investing to win in this area.
Operator
Thank you. Our next question is coming from Joanne Wuensch from Citibank. Your line is now live.
Joanne Wuensch
Good morning. Thanks for taking the question and a very nice start to the year. I'm going to pause for a moment on the ophthalmology franchise, in particular your views on the US surgical and US contact lens markets. I'm curious in particular about the almost 3% decline in US surgical in the quarter and how to think about that recovery throughout the remainder of the year.
Tim Schmid
Thank you, Joanne. Thank you for the question. Vision overall delivered a solid first quarter with sales growth of 3.6%, which is really consistent with our expectations. You'll recall that business tends to be slower in the first couple quarters and then accelerate throughout the year. We've seen that over the last couple and certainly 2025 was no exception. Now keep in mind that Q1 is typically our lowest quarter and we're confident that we will see acceleration through the remainder of the year.
If you break it down into the two component businesses, contact lens grew 2.7% driven by the ACUVUE OASYS ONE-DAY Family and especially as you heard earlier from Joaquin, the MAX multifocal products And these latest launches really complete our family of daily disposables and are solidifying our leadership in the category with exceptional comfort, clarity and stability.
And when I look to surgical vision, we grew 6% driven by normal seasonality. We continue to see strong global momentum in premium IOLs led by TECNIS ODYSSEY and PUREC, where we're outpacing the market globally and this premium segment remains a key driver of value and differentiation. I think to your pointed question on US performance, if we look at Surgical vision growth in the quarter, it was offset in the US due to competitive pressures as new entrants came into the market, which is not unexpected given the attractive nature of this portfolio.
We also continue to expect some seasonality in our business as growth won't always be linear. That said, we remain confident in our clinical position with TECNIS ODYSSEY and as we prepare for the launch of TECNIS PUREC in the US later this year. And we have seen extremely strong uptake of TECNIS PUREC globally. Nearly half, it's actually almost half a million eyes worldwide have already experienced the clearer uninterrupted vision with this premium IOL.
And TECNIS PUREC, which received FDA approval this quarter is the first and only USFDA approved extended depth of focus IOL with no warning on loss of contrast sensitivity, which is a huge game changer for position and the comfort they have in recommending an IOL. In fact, 97% of patients reported no bothersome visual disturbances like halos or glares, which can often occur with other IOL.
And we're really excited about the launch of PUREC here in the US, which will give surgeons an important new lens option for their patients. And as we continue to focus on the premiumization of our portfolio, we firmly believe that the combination of TECNIS ODYSSEY, which is in the market and now TECNIS PUREC will be a key driver of value and differentiation.
On the back of this, we can confidently say that we expect accelerated growth on the back of the year for our surgical vision business and vision overall, including here in the US. So thank you again for the question.
Operator
Thank you. Next question today is coming from David Risinger from Leerink Partners. Your line is now live.
David Risinger
Yes, thanks so much. So my question is on J&J-4804, the co-antibody. Could you talk about your vision for its role in IBD treatment paradigms and the readouts that we should be focused on? And then since others have asked multiple questions, Joe, could you just share the M&A sales like you did in the first quarter for AKEEGA?
John Reed
Thanks for the question about 4804. So just to remind the audience, this is our co-antibody therapeutic that combines ustekinumab, our IL-23 inhibitor also known as TREMFYA together with our TNF inhibitor golimumab. And we are in a position to potentially be the first with a co-antibody therapeutic in the IBD space. Now even with the best of therapies, more than half of patients with IBD do not achieve a complete remission.
And so we see for patients where monotherapy is not getting the job done, then offer this dual therapy. The combined therapy is a fixed dose combination. So the phase two data on that in both Crohn's and colitis over 2 separate studies will be presented in the coming year at a medical conference. So you'll have an opportunity to see the details of the data there and that'll provide more insights into the specifics around the most ideal patient populations for this kind of co-antibody therapeutic.
But we're really excited to move this forward now with the phase three programs are underway and really excited to then try to break through these efficacy ceilings that have limited how many of these patients who battle with inflammatory bowel disease are able to achieve a complete remission and really get that mucosal healing from their therapy.
Joe Wolk
David, thanks for the extra question there. We actually don't disclose the M&A sales at this point in time. So more to come on that.
Operator
We actually have time for one last question. Certainly our final question today is coming from Matt Miksic from Barclays. Your line is now live.
Matt Miksic
Oh, great. Thank you. Thanks so much for squeezing me in and congrats again on a really impressive quarter and start to the year. So you mentioned AKEEGA a couple of times and I know you've talked at length about it in the past. Just wondering if you could give us a sense of what the commercialization plan and roll out looks like for that given it's a slightly different delivery mechanism than many of your other therapeutics and kind of where you are with that, any metrics you can provide would be great and thanks again.
Jennifer Taubert
Sure, thanks. Good morning. So maybe as a reminder, despite recent advances in bladder cancers, unmet need in that area really remains significant. And this is for bladder sparing options. There's almost 600,000 new patients diagnosed each year and another 400,000 that are recurrent. So really, really big market opportunity. We've launched AKEEGA into the BCG unresponsive population and are really excited to be able to move forward in the coming years and to be able to broaden that population.
As a reminder, we really designed the product to fit seamlessly into urology practice so that relatively speaking, easy to insert and to retrieve and fits very, very nicely into practice. So how's the product doing so AKEEGA's outperforming all the recent launches in the non muscle invasive bladder cancer and that's based on kind of the unique patients that were treated in our first six months post approval. One in five eligible patients are starting on an AKEEGA regimen during the first quarter.
And then what I think you really want to know is following our J code approval, which came at the beginning of April, what we saw in the first week was actually a 50% increase in new patient insertions. And the second week that we have under our belt, we actually saw that jump up to almost 90% increase in new patient insertions. So consistent what we've articulated on our expectations for this product once there's certainty on reimbursement following the J code, we're seeing play out in practice so far in the first couple of weeks.
So very, very excited in that in the BCG unresponsive space and look to broaden that into broader populations.
John Reed
Yeah, just to remind within AKEEGA achieved the highest complete response rates ever seen for a therapy for non muscle invasive bladder cancer, achieved breakthrough designation from the FDA as well as the rapid review from FDA. And in Japan the PMDA accepted our submission based on the single arm data. They have never previously accepted a submission based on single arm data, just showing how exciting these data are and how much unmet need there is.
I would also draw your attention to AKEEGA is just the beginning. Right behind that we have the ERDA intravesical drug releasing system. This has erdafitinib that is a small molecule targeted therapy that addresses the intermediate risk non muscle invasive bladder cancer population. There we achieved in the biomarker defining population complete response rates north of 90%. That device also custom designed to deliver that payload delivers medicine for three months compared to AKEEGA which is 3 weeks.
So we just keep getting better and better as we do the next iteration, the next iteration around this intravesical drug releasing system. And then in terms of our go to market model, this really represents the best of Johnson and Johnson and something that only a company like Johnson and Johnson with both an innovative medicine and a MedTech business can do and bring to market.
So in addition to the product that we've developed and the reimbursement and access support and that sort of excellence that's coming out of the innovative medicine business, we've really been able to tap into MedTech and their training, their world class training institutes, their modular training that can literally go to the site of care. And so we're deploying that throughout the United States to make sure that the urologists and their practices are up to speed on AKEEGA and fully trained to begin insertion for their patients as they deem fit.
So really bringing the best of Johnson and Johnson to bear for this product.
Darren Snowgrove
Great. OK, Thanks, Matt, and thanks to everyone for your questions and your continued interest in our company. I'll now turn the call over to Joaquin for some brief closing remarks.
Joaquin Duato
Thank you everybody for joining us today. As you have heard Johnson and Johnson has the strongest portfolio and pipeline in our history and we are relentlessly focused on innovation that is delivering real impact for patients. With our Q1 performance, we are off to a strong start, reinforcing our confidence in the year ahead and our ability to raise the standard of care in our six key focus areas.
Thank you for your interest in Johnson and Johnson. We'll see you at our EBR late December to give you more details on these new products that you were asking and enjoy the rest of your day. Thank you.
Operator
This concludes today, Johnson and Johnson's first quarter 2026 earnings conference call. You may now disconnect.
Details at Johnson & Johnson IR
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