Key Takeaways

• Shares of NVS declined approximately 2% during pre-market trading following a first quarter earnings disappointment
• Revenue totaled $13.11B, falling short of the $13.40B Wall Street projection, representing a 1% year-over-year decline
• Sales of Entresto plummeted 42% to $1.31B following U.S. patent loss and entry of generic alternatives
• Core earnings per share decreased to $1.99 from $2.28; core operating profit contracted 12% to $4.9B
• CEO Vas Narasimhan cautioned that the U.S. “most favored nation” pricing mechanism could restrict patient access to innovative therapies in Europe and Japan over the next 18 months

Novartis delivered a challenging opening quarter for 2026, with first quarter performance falling below expectations on both revenue and profitability metrics as generic erosion proved more severe than anticipated by analysts.

Revenue registered at $13.11 billion, missing the $13.40 billion Street estimate. Core operating profit contracted 12% to $4.9 billion, likewise trailing the approximately $5.1 billion consensus compiled by Visible Alpha.

The primary driver of underperformance was Entresto, the pharmaceutical giant’s leading cardiovascular medication. Revenue from the therapy collapsed 42% to $1.31 billion following the expiration of its U.S. patent protection and subsequent generic market entry. Wall Street had projected $1.37 billion.

Novartis AG, NVS

Entresto accounted for 14% of consolidated revenue in the prior year, representing one of the most significant patent expirations in the company’s recent history. CEO Vas Narasimhan has characterized it as the most substantial patent cliff Novartis has encountered in twenty years.

The challenges extend beyond Entresto. Generic competition is also impacting Promacta, used for blood disorders, and Tasigna, a leukemia medication, compounding headwinds to revenue expansion.

Core earnings per share declined to $1.99, compared with $2.28 in the year-ago period. Operating income contracted 9% while net income fell 13%, driven by both the revenue shortfall and increased research and development expenditures.

CFO Mukul Mehta informed reporters that the performance aligned with internal projections. He indicated the company anticipates “growth to return back to our P&L in the second half of this year.”

Novartis maintained its full-year outlook, citing a robust pipeline and continuing product launches. The organization anticipates approximately $4 billion in revenue erosion this year stemming from generic competition affecting Entresto, Promacta, and Tasigna.

CEO Raises Concerns Over MFN Pricing Framework

Beyond the quarterly results, CEO Narasimhan utilized the earnings release to voice apprehensions regarding U.S. pharmaceutical pricing policy, particularly the “most favored nation” mechanism.

The MFN framework links U.S. pharmaceutical prices to those paid in other developed nations. Narasimhan cautioned that the ramifications would extend internationally, stating “the reality of MFN is going to set in in the next 18 months.”

He indicated Novartis is encouraging Europe and Japan to reconsider their pricing and reimbursement frameworks for innovative medications. Absent reforms, he cautioned that “novel medicines might see delayed entry” and patient access could deteriorate.

Currently, the immediate impact on Novartis remains contained. MFN presently affects approximately 5% to 10% of Medicaid-associated revenue. However, Narasimhan views the policy as permanent. “I don’t see it disappearing in the U.S.,” he stated.

His remarks parallel those from competitors. Roche and AstraZeneca have similarly identified Europe’s reimbursement structure as an escalating threat to future therapeutic availability.

Analyst Community Maintains Cautious Optimism

Notwithstanding the earnings miss, the investment community has not abandoned confidence in the shares. Novartis maintains a Moderate Buy consensus rating derived from six analyst opinions.

The consensus price target stands at $169.86, suggesting approximately 17% appreciation potential from present trading levels.

Entresto will face patent expirations in Europe beginning in November, which will introduce additional revenue pressure during the latter half of the year.

• Tillis’s condition: Ethics provisions limiting White House officials from sponsoring, endorsing, or issuing digital assets must be included before he will vote yes.
• Democratic position: Senator Ruben Gallego states there is “no final bill” without bipartisan agreement on ethics language; Senator Adam Schiff says talks are narrowing.
• Trump family exposure: The Trump family’s crypto ventures exceed $1 billion in value, including World Liberty Financial and the USD1 stablecoin, which prompted the Democratic push for restrictions.
• Procedural complication: The Senate Banking Committee lacks jurisdiction over ethics provisions, meaning the language must be added outside the committee markup process before floor consideration.
• Bill structure: The legislation divides crypto oversight between the CFTC and SEC; stablecoin yield payment disputes have also delayed progress.

The crypto market fell for a second day on Tuesday with bitcoin BTC$76,316.36 and ether (ETH) both losing around 0.75% since midnight UTC.

The decline comes after bitcoin twice failed to break above the $80,000 level of resistance over the past week, with the most recent attempt occurring during Asian hours on Monday.

The jubilation from last week’s jump to $79,500 from $70,000 is beginning to subside as several key price indicators flip bearish, including the Coinbase Premium index flipping negative, a signal of waning demand from U.S. investors.

U.S. equities are also set to open down on Tuesday with Nasdaq 100 futures trading 0.5% lower since midnight UTC while the U.S. dollar index (DXY) is up by 0.25%.

Stalled peace talks between Iran and the U.S. continue to drive traditional markets, and Brent crude oil is now firmly above $105 per barrel.

Derivatives positioning

• Across the market, crypto futures open interest (OI) has fallen by over 1% to $120 billion in the past 24 hours. That’s alongside a 3% decline in trading volume and an 8% drop in liquidations, suggesting a slight cooling in market activity. Fewer open positions, lower participation and reduced forced liquidations indicate less aggressive trading overall.
• Bitcoin’s options-to-futures open interest ratio has dropped to 57.5%, the lowest since Jan. 31. It’s a sign of renewed bias for directional bets and higher short-term volatility.
• Bitcoin’s futures OI fell to 723.54 BTC, down over 9% from the recent high of 796.71 BTC. This decline comes alongside persistently negative funding rates, which are usually a sign of bearish positioning. However, this time, they stem from institutional hedging and not outright bearish bets.
• DOGE’s open interest stands out, having climbed 6% in the past 24 hours, outpacing other major cryptocurrencies. OI at 14.39 billion tokens is the highest since Oct. 10, indicating strong capital inflows. Positive funding rates and a rising 24-hour cumulative volume delta suggest traders are increasingly positioning for potential upside.
• SOL and ADA have the most negative 24-hour cumulative volume deltas (CVD), indicating that more trades are being initiated by market sellers hitting bids than by market buyers lifting offers. It shows aggressive selling pressure, even though a buyer matches every seller.
• Bitcoin and ether’s 30-day implied volatility indexes are hovering at three-month lows, indicating subdued market pricing of risk amid macro pressures such as elevated oil prices and unresolved U.S.–Iran peace talks. As Deribit says, “Negotiation game theory in the Middle East has drugged the BTC Spot market into a deep slumber.”
• On Deribit, risk reversals in options show puts trading at a premium in both BTC and ETH, with BTC puts notably more expensive than ETH puts. The pricing points to a bullish outlook for the ether-to-bitcoin ratio.
• As for flows, the $80,000 strike bitcoin has been the most actively traded in 24 hours, both in volume and open interest. Meanwhile, block flows featured risk reversals and put spreads in BTC and put spreads and straddles in ether.

Token talk

• The altcoin market underperformed bitcoin on Tuesday, as evidenced by CoinDesk’s Memecoin Select Index (CDMEME) and DeFi Select Index (DFX) tumbling by 1.6% and 1.2%, while the bitcoin-dominant CoinDesk 20 (CD20) benchmark lost just 0.8%.
• Privacy token zcash (ZEC) was the worst-performing altcoin in the CoinDesk 100 (CD100), losing 5.6% since midnight UTC, closely tracked by CHZ and HYPE, which were down by 3.9% and 3.5%, respectively.
• While the broader crypto market is down, apecoin (APE) bucked the bearish trend, rising by more than 17% as traders capitalized on a negative long/short ratio, liquidating a $1 million short position in the process.
• CoinMarketCap’s “Altcoin Season” indicator remains in a neutral zone at 39/100, suggesting investors are focused on bitcoin and whether it can break above $80,000 or continue its slide into the mid $70,000 region.

Bitcoin BTC$76,882.32 pulled back to $76,500 from above $79,000 earlier this week, stalling the rally from late-March lows below $65,000. Those expecting a swift return to form may want to take note that recent economic releases do not support a big bullish move.

The most important is the University of Michigan’s Survey of Consumers, which showed the consumer sentiment index falling to an all-time low of 49.8 this month, largely driven by inflationary pressures tied to the Iran conflict.

Inflation expectations also moved sharply higher, with the one-year gauge surging to 4.8% in April from 3.8% the previous month. Long-term expectations (five to 10 years) have risen to 3.5%, the highest reading since October 2025.

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Inflation expectations can become self-fulfilling, which is why central banks like the Federal Reserve monitor them closely and try to anchor them. The sharp rise, therefore, could limit the Fed’s ability to signal interest-rate cuts or liquidity easing in the near term, as additional monetary easing risks reinforcing inflationary pressures. That hawkish tilt could, in turn, cap upside or slow gains in BTC and other risk assets.

“For the Federal Reserve, the long-term expectations move is the more dangerous data point. It is the variable the central bank watches most closely when assessing whether inflation psychology is becoming unanchored, and a one-month shift of this size raises the bar for any near-term easing pivot, even as the real economy weakens at the margin,” analysts at Bitfinex said.

The Fed is expected to keep its benchmark interest rate steady between 3.5% and 3.75% this Wednesday.

In the meantime, traders are also pricing in a potential Bank of Japan rate increase in June.

“Rate hikes this month are looking improbable, according to current market opinion. Financial bets suggest we may see more than two rate increases in the eurozone and the U.K. before year-end. A June hike is almost fully priced in. We are now lacking clarity in the data to make good decisions, and that is the main impediment,” Timothy Misir, head of research at BRN, said in an email.

On the crypto-specific side, sustained ETF inflows remain crucial to keeping spot BTC supported on dips.

Meanwhile, coordinated industry efforts to contain fallout from the KelpDAO exploit have helped DeFi tokens hold up better than the broader market. The CoinDesk DeFi Select Index gained 0.5% over 24 hours, decoupling from the CoinDesk 20’s 1.5% decline. Stay alert!

Read more: For analysis of today’s activity in altcoins and derivatives, see Crypto Markets Today . For a comprehensive list of events this week, see CoinDesk’s “Crypto Week Ahead.”

What’s trending

Today’s signal

The chart shows bitcoin’s hourly price swings in candlestick format since late March.

BTC has dived out of an ascending trendline (white dashed line) that guided its upward trajectory since early this month. Moreover, prices are trading at a discount to their 50- and 200-hour averages.

That configuration points to uptrend exhaustion and scope for a deeper price pullback. The bullish case would reassert itself if prices reclaim both moving averages.

XRP price fell 5% from last week’s high, driven down by declining network activity and cooling retail interest. It has now formed a bearish pennant pattern that positions the token for more pain in the coming sessions.

According to data from crypto.news, XRP (XRP) price fell 5% from last Wednesday’s high to $1.39 at press time, while its market cap dropped to $85.8 billion. At its current price, the token is down nearly 40% from its year-to-date high of $2.36 reached in early January.

XRP price fell alongside a visible slowdown in XRP Ledger activity. Network revenue has remained subdued, with the protocol generating just $34,900 in fees so far this month. That follows $75,000 in the first quarter, down from $128,000 in the previous quarter, pointing to reduced usage despite the project’s large valuation.

Transaction metrics also show a clear decline. Daily payment transactions on the XRP Ledger have fallen to around 212,856, a sharp drop from the millions recorded a few months ago. Active user count has continued to slide as well, currently standing at about 168,000.

At the same time, the network’s burn rate has eased further. Only around 400 XRP tokens, valued at less than $600, are being burned each day. A slower burning rate reduces the deflationary pressure on the circulating supply and makes it harder for the price to sustain upward momentum.

XRP price analysis

On the weekly chart, XRP price has formed a bearish pennant pattern, a technical setup consisting of a flagpole with a symmetrical triangle pattern that typically signals a continuation of the previous downward trend.

XRP price action has also slipped below the 61.8% Fibonacci retracement level, a threshold traders often watch to confirm downside continuation. Furthermore, the Chaikin Money Flow index has fallen to a negative reading, suggesting that capital is flowing out of the asset as whales and institutional investors trim their positions.

Given these signals, the near-term outlook remains tilted to the downside. The next major level to monitor sits around $1. A break below that zone could open the door to deeper losses, potentially toward psychological support levels seen late last year.

Kash Patel said the FBI arrested Xu Zewei, a Chinese national accused of cyber attacks during the COVID-19 pandemic.

Xu was extradited from Italy to the United States over the weekend. He is expected to face federal charges linked to hacking activity between 2020 and 2021.

Officials said Xu and others targeted U.S.-based universities and medical researchers. The attacks focused on institutions working on COVID-19 vaccines and treatments.

Alleged role in HAFNIUM operations

The FBI linked Xu to HAFNIUM, a group accused of a wide cyber intrusion campaign.

Authorities said the group compromised nearly 13,000 U.S. organizations. The activity included access to email accounts and sensitive research data.

Patel described the case as a major step in cyber enforcement. He said the operation shows authorities will act against threats targeting U.S. systems.

Additionally, the FBI worked with Italian officials to secure Xu’s arrest and extradition.

Patel thanked Italian police leadership for their role in the case. He said cooperation between agencies helped bring Xu into custody.

The FBI also confirmed joint operations during the investigation process. Officials said coordination remained active until extradition was completed.

Lawsuit against The Atlantic

At the same time, Patel filed a $250 million defamation lawsuit against The Atlantic and reporter Sarah Fitzpatrick.

The complaint alleges the publication reported “false and obviously fabricated allegations” about his conduct as FBI Director.

The report claimed issues including drinking, absences, and erratic behavior. Patel disputes these claims and has taken the case to U.S. District Court in Washington.