Novartis’ strategy in 2026: rebuilding the pipeline after Entresto By Jules Adam 10 minutesmins July 3, 2026 10 minutesmins Share WhatsApp Twitter Linkedin Email Photo credits: Paul Skorupsas Newsletter Signup - Under Article / In Page"*" indicates required fieldsCommentsThis field is for validation purposes and should be left unchanged.Subscribe to our newsletter to get the latest biotech news!By clicking this I agree to receive Labiotech's newsletter and understand that my personal data will be processed according to the Privacy Policy.*Company name*Job title*Business email* Novartis’ current strategy can be traced back to October 2023, when the Swiss pharma completed the spin-off of Sandoz, its generics and biosimilars business. The company described the move as the completion of a strategic transformation into a focused innovative medicines company, while chief executive officer (CEO) Vas Narasimhan said it allowed Novartis to “fully focus on high-value innovative medicines.” Novartis says it is concentrating on four core therapeutic areas: cardiovascular, renal and metabolic diseases, oncology, immunology, and neuroscience, supported by technology platforms including xRNA, radioligand therapy, and gene and cell therapy. At the same time, in the first quarter of 2026, generic competition hit several older products: Entresto sales fell 42%, Promacta 66%, and Tasigna 59%, partly offset by growth from newer medicines including Kisqali and Pluvicto. Reuters described this as Novartis navigating its most severe period of patent expiries, led by Entresto, which accounted for 14% of sales the previous year. Despite this tough time, Novartis has been spending heavily to strengthen the next generation of its pipeline. Recent deals include the acquisition of Avidity Biosciences to expand its xRNA and late-stage neuroscience pipeline, the acquisition of Tourmaline Bio to add the anti-IL-6 antibody pacibekitug in atherosclerotic cardiovascular disease, and continued investment in radioligand therapy, which Novartis described in its 2025 annual report as one of its market-leading advanced technology platforms. Table of contentsNovartis: a story about focus Novartis was created in 1996 through the merger of Ciba-Geigy and Sandoz, bringing together businesses with roots in chemicals, pharmaceuticals and broader healthcare. Novartis did not begin as the focused innovative medicines company it is today; it was built from a much broader industrial and healthcare base. In 2015, Novartis combined its consumer healthcare business with GSK’s in a joint venture, and three years later, it sold its 36.5% stake to GSK for $13 billion, ending its participation in consumer health. Novartis described that sale as part of its portfolio transformation and a move to focus on strategic priorities. The same logic applied to eye care, when in 2019, Novartis spun off Alcon as a separate company. At the time, Novartis said the transaction would allow it to focus capital allocation and management attention on medicines, while giving the group a financial profile closer to pharmaceutical peers, including higher margins. Finally, in October 2023, Novartis completed the spin-off of Sandoz, its generics and biosimilars business. Novartis framed the move as the completion of its strategic transformation into a focused innovative medicines company. Consumer health, eye care and generics each had different economics, growth profiles and management demands. Removing them left Novartis with a cleaner pipeline strategy: allocate capital and focus on research and development (R&D). The challenge: patent lapse and generics The company entered 2026 with a clear strategic profile, but also with a visible revenue problem. In its Q1 2026 results, Novartis said net sales declined 5%, with the main pressure coming from three older products: Entresto, whose U.S. generics entered the market in Q3 2025, and Tasigna and Promacta, which faced U.S. generics from Q2 2025. The most important is Entresto, Novartis’ heart failure medicine and one of the company’s biggest products. In 2025, Entresto generated $7.75 billion in sales, making it Novartis’ largest-selling medicine ahead of Cosentyx and Kisqali. But by the first quarter of 2026, Entresto sales fell 42% year on year to $1.3 billion. Promacta, used in blood disorders, fell 66% to $184 million, while Tasigna, an older cancer therapy, fell 59% to $155 million. Novartis said generic competition negatively affected all three products, partly offset by strong growth from newer medicines including Kisqali, Pluvicto, Kesimpta, Scemblix and Leqvio. Suggested Articles Roche, a company built on oncology and diagnostics reinventing its pipeline How Daiichi Sankyo aims to become a top five oncology player by 2035 Blockbuster sales, lawsuits, and approvals: is there a recovery in sight for Bayer in 2026? Novartis’ current growth engines, including Cosentyx, Kisqali and Kesimpta, are still expanding, but they too will eventually mature and face their own lifecycle questions. Reuters reported that Cosentyx, Kesimpta and Kisqali are expected to lose patent protection in the early 2030s, which means Novartis is already trying to build the growth layer after the current one. However, Novartis is not presenting 2026 as a crisis year and reaffirmed its full-year guidance in Q1 2026, even as sales and core operating income declined, pointing to strong growth from priority brands. That is the context in which Novartis’ dealmaking should be interpreted. Building Novartis’ pipeline around four pillars Novartis’ recent dealmaking looks broad, but it is not random. Most of the deals map onto the four therapeutic areas the company says define its business: cardiovascular-renal-metabolic, oncology, neuroscience and immunology. Novartis has also said these areas are supported by technology platforms including radioligand therapy and xRNA, which helps explain why many of the deals are not just product acquisitions but capability acquisitions. Novartis cardiovascular pipeline: from Entresto to prevention, inflammation and RNA Cardiovascular disease remains central to Novartis, even as Entresto loses exclusivity. Novartis’s newer cardiovascular strategy looks broader than simply replacing one heart failure drug with another: lipid lowering, thrombosis prevention, inflammation and RNA-based approaches. Leqvio is an element of that cardiovascular pipeline. The siRNA medicine, used to lower LDL cholesterol, gives Novartis a cardiovascular asset built around long-acting RNA interference. In 2025, Leqvio sales reached $1.24 billion, up 73%, and in Q1 2026 sales grew 69%, with Novartis pointing to strong growth in China. The Anthos acquisition adds another layer to the strategy. Novartis agreed to buy Anthos for $925 million upfront, gaining abelacimab, a phase 3 Factor XI inhibitor being developed for prevention of stroke and systemic embolism in patients with atrial fibrillation. That moves Novartis into a next-generation anticoagulation space, where companies are trying to reduce clotting risk without reproducing the bleeding burden of older anticoagulants. Tourmaline Bio pushes the strategy toward inflammation in cardiovascular disease. The $1.4 billion acquisition gives Novartis pacibekitug, an anti-IL-6 antibody being developed for atherosclerotic cardiovascular disease (ASCVD). Novartis said the deal complemented its cardiovascular pipeline, with a phase 3-ready candidate targeting systemic inflammation in ASCVD. Novartis aso signed a licensing and options agreement worth up to $5.2 billion with Argo for cardiovascular siRNA candidates, including a mid-stage program for elevated blood lipids and options on additional candidates addressing cholesterol-related disease drivers. The Novartis cardiovascular story doesn’t end with Entresto’s patent expiry, and the pipeline now looks more stratified. Novartis oncology strategy: concentration around growth brands and differentiated modalities Novartis is also still heavily committed to oncology. In 2025, Kisqali, the company’s commercial anchor, generated $4.78 billion in sales, up 57%, and in Q1 2026 it grew 55% to $1.52 billion, helped by momentum in early breast cancer and metastatic breast cancer. Then there is Pluvicto; beyond a prostate cancer drug, it is the clearest commercial test of Novartis’ radioligand therapy (RLT) strategy. In Q1 2026, Pluvicto sales grew 70% to $642 million, driven by demand in pre-taxane metastatic castration-resistant prostate cancer in the U.S. and access expansion outside the U.S. The Mariana Oncology acquisition back in 2024 shows how Novartis is trying to deepen that position. Mariana brought a portfolio of preclinical radioligand therapy programs across solid tumors, including areas such as breast, prostate, and lung cancer. Novartis framed the deal as a way to strengthen its RLT pipeline and develop next-generation cancer treatments. Novartis is placing heavier emphasis on areas where it has either a strong growth brand, such as Kisqali, or a technology platform that could generate multiple products — radioligand therapy. Novartis neuroscience pipeline: rebuilding through delivery and RNA capabilities Novartis’ recent moves suggest a broader effort beyond Alzheimer’s to rebuild the neuroscience pipeline through technologies that can reach difficult tissues or difficult biology. The largest example is Avidity Biosciences. Novartis completed the acquisition earlier this year in February, adding Avidity’s antibody-oligonucleotide conjugate platform and three late-stage neuromuscular programs. There is also the Arrowhead licensing deal bringing an RNA angle into the Novartis neuroscience pipeline. The company licensed ARO-SNCA, a preclinical siRNA therapy designed to reduce alpha-synuclein, with Novartis gaining global rights in a deal worth up to $2 billion. The target places the program in synucleinopathies, including Parkinson’s disease, but strategically the deal also gives Novartis another route into RNA-based neuroscience. Novartis also looked into delivery with BioArctic. The collaboration combines BioArctic’s BrainTransporter technology with a Novartis proprietary antibody, with the aim of generating a drug candidate for severe neurological conditions. BioArctic said Novartis would take over global development and commercialization if it exercises its option. Novartis immunology strategy: defending Cosentyx while moving into new mechanisms Immunology is another area where the strategy combines lifecycle management with new mechanisms. Cosentyx remains the established franchise with $6.67 billion in sales in 2025, making it Novartis’ second-largest medicine after Entresto. But Novartis is also trying to broaden immunology beyond the IL-17 franchise. The FDA approved Rhapsido in September 2025 for chronic spontaneous urticaria in patients who remain symptomatic after antihistamines. The drug is an oral targeted BTK inhibitor, with a safety profile that requires no lab monitoring according to Novartis. The European Commission approval followed in April 2026. The Monte Rosa deal is an earlier-stage, more platform-driven immunology strategy. Novartis and Monte Rosa expanded their collaboration in 2025 to develop molecular glue degraders for immune-mediated diseases, following an earlier agreement around VAV1 degraders including MRT-6160. Monte Rosa said the collaboration is intended to accelerate degrader development against difficult-to-drug immune targets. From products to platforms Novartis is doing more than replacing one blockbuster with another. It is investing in technologies that could generate multiple products across its therapeutic areas. Radioligand therapy extends beyond Pluvicto through the Mariana acquisition, while recent deals in RNA therapeutics, protein degradation and drug delivery provide capabilities that could support future programs. Novartis itself describes xRNA, radioligand therapy, and gene and cell therapy as advanced technology platforms intended to provide sustained scalability across its pipeline. By concentrating resources on four therapeutic areas, Novartis can deepen scientific expertise, simplify capital allocation and strengthen positions in technologies where manufacturing know-how and specialized infrastructure are competitive advantages. This is particularly the case in radioligand therapy, where success depends also on securing isotope supply, manufacturing capacity and treatment networks. In its 2025 annual report, Novartis highlighted continued investment in expanding its radioligand manufacturing footprint and delivery network to support future growth. A more focused company, however, also becomes more dependent on the success of its chosen technologies. Many of Novartis’ recent acquisitions remain in clinical development, while newer modalities such as RNA therapeutics and targeted protein degradation have yet to produce large numbers of commercial medicines. The company has reduced the complexity of its portfolio, but in doing so it has concentrated execution risk around a smaller number of bets. The next challenge is proving that a more focused Novartis can also be a more resilient one. This article is reserved for subscribers Subscribe for free to continue reading.Enter your details to log in or subscribe. Email Company name Job title Continue Readingor Continue with Microsoft Continue with LinkedIn By continuing, I agree to receive Labiotech's newsletter and understand that my personal data will be processed according to the Privacy Policy. Neurological diseases R&D trends and breakthrough innovations Find out which indications have the fullest pipelines, where white space exists, and which early-stage innovations are drawing the most pharma attention. Download now Explore other topics: CancerCardiovascular diseaseimmunologyNeurodegenerative diseaseNovartis ADVERTISEMENT