Category: 3. Business

A large shipment of KitKat candy bars was stolen while in transit to distributors, a major candy crime right before the Easter holiday that could cause shortages for customers.

The truck carrying 413,793 units of a “new chocolate range”, about 12 tons of chocolate bars, was pilfered while driving through Europe on 26 March, Agence France-Presse reported.

A spokesperson for Nestlé, KitKat’s parent company, confirmed the theft to the Guardian, adding that the company is investigating the theft with local authorities and supply chain partners.

The stolen truck left a factory in central Italy and was en-route to Poland when the robbery occurred, according to a statement from Nestlé. The vehicle and the carried-off chocolate have not been located. No one was hurt during the heist, a Nestlé spokesperson told the Athletic.

“We’ve always encouraged people to have a break with KitKat,” said Nestlé in a statement, riffing off the KitKat slogan. “But it seems thieves have taken the message too literally and made a break with more than 12 tons of our chocolate.”

The statement continued: “Whilst we appreciate the criminals’ exceptional taste, the fact remains that cargo theft is an escalating issue for businesses of all sizes. With more sophisticated schemes being deployed on a regular basis, we have chosen to go public with our own experience in the hope that it raises awareness of an increasingly common criminal trend.”

The stolen bars were from KiKat’s new Formula One line, a result of KitKat’s becoming the official F1 chocolate bar last year, the Athletic reported. The candy bars were molded after race cars, still featuring KitKat’s iconic chocolate-covered wafers.

Due to the theft, the stolen KitKat bars could make their way into unofficial markets, Nestlé warned.

Company officials said that if that does occur, law enforcement can trace stolen products through batch codes assigned to individual bars.

Rezpegaldesleukin demonstrates statistically significant improvement in mean percent EASI improvement across both moderate and severe atopic dermatitis patients

Rezpegaldesleukin proof-of-concept data in alopecia areata patients presented as a late-breaking research oral presentation

SAN FRANCISCO, March 28, 2026 /PRNewswire/ — Nektar Therapeutics (Nasdaq: NKTR) today showcased data in two presentations at the 2026 American Academy of Dermatology (AAD) Annual Meeting taking place in Denver, CO.

At AAD 2026, data from the global Phase 2b REZOLVE-AD study in 393 patients with moderate-to-severe atopic dermatitis were presented by Dr. Raj Chovatiya, Associate Professor at Rosalind Franklin University of Medicine and Science Chicago Medical School and Founder and Director of the Center for Medical Dermatology and Immunology Research, in an oral poster session entitled “Novel Regulatory T-cell enhancing Biologic Rezpegaldesleukin: Phase 2b Efficacy, Safety, and Baseline Severity–Dependent Treatment Response in Moderate-to-Severe Atopic Dermatitis” [link to presentation].

Patient randomization was stratified based on baseline disease severity measured by vIGA-AD^® (validated Investigator’s Global Assessment for Atopic Dermatitis) and geographic region. As presented at AAD, patients in the Phase 2b REZOLVE-AD study demonstrated consistent reduction in mean Eczema Area and Severity Index (EASI) scores over the 16-week induction period as compared to placebo regardless of baseline disease severity as measured by baseline vIGA-AD^® scores of 3 or 4. During the 16-week induction period, patients also achieved comparable EASI-75 (at least a 75% improvement in EASI score from baseline) and EASI-90 response (at least a 90% improvement in EASI score from baseline). These disease improvement metrics were also comparable by geographic region.

“The consistency of EASI responses with rezpegaldesleukin across baseline disease severity further differentiates it from the standard of care biologic treatment, which can have lower response rates in more severe patients as compared to moderate patients,” said Raj Chovatiya, MD, PhD, MSCI, FAAD. “We believe its novel agonist mechanism to expand regulatory T cells, which act as master regulators upstream of the cytokine-specific blockade mechanisms of other biologics to address multiple pathways, allows a potentially more consistent improvement across a broader patient population.”

Based upon results from the Phase 2b REZOLVE-AD study of rezpegaldesleukin, Nektar is planning to initiate the Phase 3 ZENITH-AD program of rezpegaldesleukin in moderate-to-severe atopic dermatitis patients in the second quarter of 2026.

At AAD 2026, Dr. David Rosmarin presented a late-breaking research oral presentation highlighting previously-released data¹ titled: “Novel Regulatory T-cell Enhancing Biologic Rezpegaldesleukin: Phase 2b Efficacy and Safety Results Following 36-Weeks of Therapy in Severe-to-Very-Severe Alopecia Areata” [link to presentation].

On the primary endpoint of mean Severity of Alopecia Tool (SALT) reduction at 36 weeks of treatment, high dose rezpegaldesleukin, 24 µg/kg every two weeks (q2w), demonstrated a mean reduction in the SALT score of 28.2% in the 24 µg/kg arm versus 11.2% in the placebo arm. Mean percent reduction in SALT scores at 36 weeks was 30% for both treatment arms versus 6% in the placebo arm, achieving statistical significance (p<0.05) when excluding four patients that did not meet major study eligibility criteria at baseline. Rezpegaldesleukin was well tolerated and its safety profile was consistent with previously reported results. 

“The clear activity of rezpegaldesleukin in alopecia areata builds on prior results in atopic dermatitis and reinforces the broader potential of this approach across T cell-driven inflammatory diseases,” said David Rosmarin M.D., Chair, Department of Dermatology and Associate Professor of Dermatology, Indiana University School of Medicine. “I look forward to the upcoming results from the 16-week treatment extension to evaluate the potential for a deepening of SALT response over time.”

About REZOLVE-AD Phase 2b Study

The global REZOLVE-AD (NCT06136741) Phase 2b study enrolled 393 patients with moderate to severe atopic dermatitis who have not previously been treated with a JAK inhibitor or other biologic. Patients were randomized (3:3:3:2) to receive subcutaneous treatment with three doses of rezpegaldesleukin: a high dose of 24 µg/kg every two weeks (Q2W), a middle dose of 18 µg/kg every two weeks (Q2W), and a low dose of 24 µg/kg every four weeks (Q4W), or placebo Q2W. The primary endpoint and secondary endpoints were assessed at the end of the 16-week induction period. Following the induction period, rezpegaldesleukin-treated patients who achieved EASI percent reductions of at least 50 were re-randomized (1:1) to continue at the same dose level on a Q4W or a Q12W regimen through Week 52 in a blinded maintenance period. Placebo patients with EASI percent score reductions of at least 50 continue to receive placebo Q4W.

About REZOLVE-AA Phase 2b Study

The global REZOLVE-AA (NCT06340360) Phase 2b study enrolled 92 patients with severe-to-very-severe alopecia areata who have not previously been treated with a JAK inhibitor or other biologic. Patients were randomized (3:3:2) to receive one of two rezpegaldesleukin doses or placebo, administered as a subcutaneous injection twice-monthly. The primary endpoint was the mean percentage reduction from baseline in the SALT score at 36 weeks. Following 36 weeks of treatment, patients who demonstrated hair growth but had not yet reached SALT>20 had the option to continue for an additional 16 weeks of treatment through 52 weeks in a blinded extension period. Primary and secondary endpoints were assessed at the end of the 36-week induction treatment period.

About Rezpegaldesleukin

Autoimmune and inflammatory diseases cause the immune system to mistakenly attack and damage healthy cells in a person’s body. A failure of the body’s self-tolerance mechanisms enables the formation of the pathogenic T lymphocytes that conduct this attack. Rezpegaldesleukin is a potential first-in-class resolution therapeutic that may address this underlying immune system imbalance in people with many autoimmune and inflammatory conditions. It targets the interleukin-2 receptor complex in the body to stimulate proliferation of immune-modulating cells known as regulatory T cells. By activating these cells, rezpegaldesleukin may act to bring the immune system back into balance.

In February 2025, the U.S. Food and Drug Administration (FDA) granted Fast Track designation for rezpegaldesleukin for the treatment of adult and pediatric patients 12 years of age and older with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. In July 2025, the FDA granted Fast Track designation for rezpegaldesleukin for the treatment of severe alopecia areata (AA) in adults and pediatric patients 12 years of age and older who weigh at least 40 kg.

Rezpegaldesleukin is being developed as a self-administered injection for a number of autoimmune and inflammatory diseases. It is wholly owned by Nektar Therapeutics.

About Nektar Therapeutics

Nektar Therapeutics is a clinical-stage biotechnology company focused on developing treatments that address the underlying immunological dysfunction in autoimmune and chronic inflammatory diseases. Nektar’s lead product candidate, rezpegaldesleukin (REZPEG, or NKTR-358), is a novel, first-in-class regulatory T cell stimulator being evaluated in one Phase 2b clinical trial in atopic dermatitis, one Phase 2b clinical trial in alopecia areata, and one Phase 2 clinical trial in Type 1 diabetes mellitus. Nektar’s pipeline also includes a preclinical bivalent tumor necrosis factor receptor type II (TNFR2) antibody and bispecific programs, NKTR-0165 and NKTR-0166, and a modified hematopoietic colony stimulating factor (CSF) protein, NKTR-422.

Nektar is headquartered in San Francisco, California. For further information, visit www.nektar.com and follow us on LinkedIn.

Cautionary Note Regarding Forward-Looking Statements

This press release contains forward-looking statements which can be identified by words such as: “pan,” “develop,” “potential,” “expand,” “address,” “may” and similar references to future periods. Examples of forward-looking statements include, among others, statements regarding the therapeutic potential of, and future development plans for, rezpegaldesleukin, NKTR-0165, NKTR-0166, and NKTR-422. Forward-looking statements are neither historical facts nor assurances of future performance. Instead, they are based only on our current beliefs, expectations and assumptions regarding the future of our business, future plans and strategies, anticipated events and trends, the economy and other future conditions. Because forward-looking statements relate to the future, they are subject to inherent uncertainties, risks and changes in circumstances that are difficult to predict and many of which are outside of our control. Our actual results may differ materially from those indicated in the forward-looking statements. Therefore, you should not rely on any of these forward-looking statements. Important factors that could cause our actual results to differ materially from those indicated in the forward-looking statements include, among others: (i) our statements regarding the therapeutic potential of rezpegaldesleukin, NKTR-0165, NKTR-0166 and NKTR-422 are based on preclinical and clinical findings and observations and are subject to change as research and development continue; (ii) rezpegaldesleukin, NKTR-0165, NKTR-0166 and NKTR-422 are investigational agents and continued research and development for these drug candidates is subject to substantial risks, including negative safety and efficacy findings in future clinical studies (notwithstanding positive findings in earlier preclinical and clinical studies); (iii) rezpegaldesleukin, NKTR-0165, NKTR-0166 and NKTR-422 are in clinical development and the risk of failure is high and can unexpectedly occur at any stage prior to regulatory approval; (iv) data reported from ongoing clinical trials are necessarily interim data only and the final results will change based on continuing observations; (v) the timing of the commencement or end of clinical trials and the availability of clinical data may be delayed or unsuccessful due to regulatory delays, slower than anticipated patient enrollment, manufacturing challenges, changing standards of care, evolving regulatory requirements, clinical trial design, clinical outcomes, competitive factors, or delay or failure in ultimately obtaining regulatory approval in one or more important markets; (vi) a Fast Track designation does not increase the likelihood that rezpegaldesleukin will receive marketing approval in the United States; (vii) patents may not issue from our patent applications for our drug candidates, patents that have issued may not be enforceable, or additional intellectual property licenses from third parties may be required; and (viii) certain other important risks and uncertainties set forth in our Annual Report on Form 10-K filed with the Securities and Exchange Commission on March 13, 2026. Any forward-looking statement made by us in this press release is based only on information currently available to us and speaks only as of the date on which it is made. We undertake no obligation to update any forward-looking statement, whether written or oral, that may be made from time to time, whether as a result of new information, future developments or otherwise.

For Investors:

Vivian Wu
628-895-0661
[email protected]

Corey Davis, Ph.D.
LifeSci Advisors
212-915-2577
[email protected] 

For Media:

Susan Roberts
LifeSci Communications
202-779-0929
[email protected]

1. Nektar Therapeutics, “REZOLVE-AA Phase 2b Study of Rezpegaldesleukin Establishes Proof-of-Concept in Patients with Severe-to-Very-Severe Alopecia Areata”, press release, 12/16/2025, https://ir.nektar.com/news-releases/news-release-details/rezolve-aa-phase-2b-study-rezpegaldesleukin-establishes-proof

SOURCE Nektar Therapeutics

The US treasury department demanded on Friday that the Financial Times (FT) retract a report on treasury secretary Scott Bessent’s views on the Federal Reserve, accusing the newspaper of publishing “false claims” in a formal complaint that was escalated to the news outlet’s parent company, Nikkei Inc.

The email from treasury officials, addressed to senior editors at the FT and Nikkei, disputed multiple claims in the story and criticized the headline as misrepresenting the underlying reporting.

The FT reported on 26 March that Bessent had discussed increasing oversight of the Federal Reserve in a way that resembled the Bank of England, including through regular communication between its governor and Britain’s chancellor over inflation targets.

Treasury officials denied that Bessent had endorsed such views or discussed adopting similar practices in Washington. They also took issue with the headline, which said Bessent had “praised” the Bank of England model for tighter oversight even though that did not appear in the text of the story.

“The Secretary has never made any of the above statements in public or private,” the acting assistant secretary for public affairs, Elliott Hulse, wrote in the email, which was forwarded to the Guardian by a person directly familiar with the matter on the condition of anonymity.

“At no time has the secretary ‘discussed tightening the US Treasury’s oversight of the Federal Reserve by adopting elements of the Bank of England’s model in a step that would shake up the central bank’s relationship with government,’” the email said.

“At no time has the secretary indicated, implied, or asserted that he ‘could support the UK system in which the BoE governor corresponds regularly with the chancellor about the central bank’s inflation target,’” it added.

The complaint marked the latest effort by the US treasury to discredit the FT report. On Thursday, Bessent posted his own denials on social media, writing in part: “In short, FT has literally manufactured an entirely fake policy position for me and the Administration.”

Treasury officials stopped short of issuing a legal threat, but cited provisions in the editors code of practice established by the UK’s Independent Press Standards Organization, or Ipso, which requires publications to avoid misleading or distorted information.

The FT is not a member of Ipso and it was not immediately clear whether treasury officials would pursue additional efforts against the newspaper. A spokesperson for the FT did not return comment on the disputed elements of the story or on the complaint from the treasury.

The FT report comes amid heightened sensitivity in financial markets and among treasury officials about the Federal Reserve’s political independence following Donald Trump’s repeated threats to fire its chair, Jerome Powell, for ignoring his demands to reduce borrowing costs.

Trump has also accused the Fed chair of mismanaging renovations at the central bank’s headquarters and then lying to Congress about those plans – which sparked a criminal investigation and subsequent jitters from investors who saw the move as a threat designed to pressure Powell.

Investors place a premium on the Fed maintaining its independence in making policy decisions, rather than on the political preferences of the president. Investors worry that cutting rates too aggressively could lead to rapid inflation, which would later require sharp rate increases to correct.

Global crude oil prices have been volatile this month, swinging as much as $35 in a single day. They’re also high — around $110 per barrel right now. But they didn’t rise as much or as quickly as some analysts might have expected.

The Strait of Hormuz, the single most important waterway for global oil trade, has been largely blocked to tanker traffic for weeks now. That kind of disruption might be expected to send prices up, sharply and consistently. So why have prices been prices on this strange roller coaster instead?

In a word: uncertainty.

“The oil market right now is in the midst of this almost like ‘Schrödinger’s cat’ of the largest oil supply shock in the history of the oil market,” Rory Johnston, an oil markets researcher, said last week.

Schrödinger’s cat is the famous thought experiment designed to illustrate a core principle in quantum mechanics. Picture a cat inside a box, next to a vial of poison elaborately connected to a sample of radioactive material. If a single atom of that sample decays, the vial breaks, and the cat dies.

The cat is either alive or dead, but from outside the box you don’t know which. In fact, in the strange world of quantum mechanics, the cat is actually both at once … until someone opens the box.

In the oil version, the world is either in its worst oil crisis ever, or things are basically fine. For weeks, both cases have seemed equally plausible to the market.

The “cat’s dead” scenario is a prolonged war that disrupts the trade of oil from the Middle East for months. “If this persists, it will be bigger than the oil shocks of the 1970s,” Johnston said.

For decades, oil market watchers have worried about the closure of the strait as a worst-case scenario. It’s basically impossible for the world to fully make up the resulting shortfall in oil supplies through tapping stockpiles or sending crude through alternate routes. A prolonged closure would send prices soaring much, much higher than we see today.

But if the war ends, say, tomorrow, it’ll turn out that we’re in the “cat’s alive” situation. “Theoretically, if Trump were to pull back right now, the oil market could begin to heal itself,” Johnston said.

The world had a lot of extra crude oil floating around before this conflict began. That buffer means that a short disruption would not be catastrophic. So if the strait is poised to reopen soon, and oil fields and facilities in the Gulf region haven’t been damaged too severely and can restart production within a few weeks … well, then, prices shouldn’t go crazy at all.

And markets have a reason to anticipate a short war. In recent years, a whole series of geopolitical crises have been resolved quickly, from attacks on Saudi refineries to the U.S.-Israeli attacks on Iran last year to the U.S. military operation in Venezuela. Even Russia’s full-scale invasion of Ukraine did not disrupt oil supplies as profoundly as the market first feared — although the conflict itself remains ongoing. Time and again, buying when oil prices were high after an attack has been a good way to lose a lot of money, and traders remember that.

So which is it: a long war or a short one? The two possible realities suggest very different logical paths for oil prices.

Or as Dan Pickering, chief investment officer of Pickering Energy Partners, put it: “You could put on two different hats about crude today: ‘Why is it so high? Because this war is going to be over soon,’” he said. “The other would be, ‘Why is it so low, when 20% of global oil supply is bottlenecked behind the Strait of Hormuz?’”

Mixed signals and disconnection

Throughout this conflict, the market has been getting mixed signals. The White House has issued contradictory messages on the goals and timeline for the war. And some of those statements contradict evidence.

“There keeps being this idea that, oh, we’re going to have, you know, naval escorts, or we’ve taken out all of their ballistic missiles,” said Ellen Wald, a nonresident senior fellow with the Atlantic Council Global Energy Center and the author of Saudi, Inc. “And yet the situation on the ground is that drones are still flying; missiles are still flying across the strait.”

Oil is a physical, tangible good. But it’s also a “paper market,” a commodity traded in the abstract, prices moving on a screen.

And there’s been a disconnect between that physical world — where spot prices for fuel are soaring in the Middle East, jet fuel prices have doubled, and countries like Pakistan and Bangladesh are closing schools and rationing fuel — and the commodity markets, where every time prices have started to spike, a social media post from the president about productive talks, or a headline pointing toward a shorter conflict, sends them tumbling back down.

At least, that was the pattern. Markets may be shifting closer to a reckoning with a longer, sustained disruption. In the second half of this week, prices rose by $10 a barrel, and so far have stayed there — despite a post by the president stating talks were going well.

Al Salazar is the head of macro oil and gas research at Enverus, an energy data company. “The fact that we’re up another $10 with a seeming extension of the closure of the strait,” he said Friday, “is probably taking the hope away that this could be resolved quickly.”

A feedback loop

Crucially, unlike in the original Schrödinger’s cat scenario, what’s happening inside the box isn’t determined by chance. President Trump is one of the key decision makers.

As a result, his comments move the market. But the market also influences Trump. He watches oil and stock prices very closely, and he’s reversed policies before when markets signaled they’d crash the global economy. (Wall Street has even coined a nickname for the pattern: TACO, for “Trump Always Chickens Out.”)

“There is a feedback loop here where high prices create more anxiety for the administration, which could either create an end to the conflict or an increase in intensity,” said Pickering.

But Trump doesn’t seem to be feeling acute pressure at the moment; he’s commented that high oil prices are actually good for the U.S., and recently said, “I thought the oil prices would go up more, and I thought the stock market would go down more.”

There’s a strange possibility lurking here: Oil prices have been kept in check in large part because traders think a short war is likely. By removing market pressure on Trump, does that accidentally encourage a longer war?

Bob McNally, the founder of Rapidan Energy Group and the author of Crude Volatility, frames the question like this: Is the market “delaying the price signals that would otherwise jar the president and his advisers into either seeking to end the conflict or accelerating it one way or the other?”

His take: “Yes. Yes, it is.”

Putting off a price signal

A delayed reaction has other implications, too. High prices are how markets solve a supply shortage. When oil becomes expensive, that pushes consumers to use less gasoline and other petroleum products. Meanwhile, high prices motivate oil companies to produce more, prompting them to add production that wouldn’t be profitable at lower prices. Supply goes up and demand goes down. The two together bring the system back in balance.

But if price hikes are delayed, said Rory Johnston, they might be more painful later. If the war doesn’t end tomorrow, and we’re indeed in the worst case scenario, keeping oil prices down now means we’re “mortgaging the present for an even worse outcome in the future,” he said.

You, reader, are one factor in this complicated feedback system. Your demand for gasoline affects its price, and its price affects you.

On average, U.S. gasoline has gone up by about a dollar a gallon — but that’s nowhere close to where it could be if the war is prolonged. “The average person on the street right now does not fully appreciate the scale of the calamity that we are currently facing,” said Johnston.

Ed Crooks, vice chair of the Americas at the consultancy Wood Mackenzie, agrees: “The full effects of the Strait of Hormuz being almost entirely closed have not yet hit American consumers,” Crooks said.

So they’ve kept driving, and demand has stayed steady. For now.

The oil shortfall caused by this crisis is around 10 million barrels a day, roughly equivalent to how much demand dropped during the worst of the COVID-19 pandemic. Back then, travel bans and lockdowns led to sharp, worldwide decreases in driving and flying. So consider: How much would gasoline have to cost before the world chooses to cut travel as much as it was forced to then?

If Schrödinger’s box opens to reveal a long-term war, we might all find out the answer.

Johnson & Johnson presents new data showing high rates of complete skin clearance achieved at Week 24 and Week 52 in ICONIC-ADVANCE 1 and 2 studies

Nearly 60% of adolescents treated with ICOTYDE achieved completely clear skin at Week 52 in the ICONIC-LEAD study

SPRING HOUSE, Pa., March 28, 2026 /PRNewswire/ — Johnson & Johnson (NYSE: JNJ) today announced new long-term 52-week data from the Phase 3 ICONIC-ADVANCE 1 and 2 and ICONIC-LEAD studies, which assessed the efficacy and safety of ICOTYDE™ (icotrokinra) in the treatment of patients with moderate-to-severe plaque psoriasis (PsO). ICOTYDE is the first and only targeted oral peptide that precisely blocks the IL-23 receptor.¹ These data are being presented at the 2026 American Academy of Dermatology (AAD) Annual Meeting.

ICOTYDE achieved high levels of complete skin clearance up to Week 52 with no new safety signals^2,a

• In the ICOTYDE treatment arms, rates of completely clear skin (PASI 100) increased from 41% to 49% and 33% to 48% from Week 24 to Week 52 in ADVANCE 1 and 2, respectively.^a,b
• Patients who switched from placebo to ICOTYDE at Week 16 achieved similar rates of complete skin clearance by Week 52 (50% and 43% in ADVANCE 1 and 2, respectively) as those who were treated with ICOTYDE for the full 52 weeks.
• The ICOTYDE adverse event profile through Week 52 was consistent with that observed through Weeks 16 and 24, and no new safety signal was identified through Week 52. ICOTYDE overall adverse event and infection rates were lower than deucravacitinib through Week 24.

“Introducing a once‑daily targeted oral peptide for treating moderate‑to‑severe plaque psoriasis offers patients an option with a unique combination of benefits and a favorable safety profile,” said Linda Stein Gold, M.D., Director of Dermatology Clinical Research at Henry Ford Health and ICONIC‑ADVANCE study investigator.^c “The results from one‑year studies show encouraging outcomes for patients as they navigate this chronic condition.”

ICOTYDE demonstrated sustained skin clearance and a favorable safety profile in adolescents through Week 52 with no new safety signals identified in the ICONIC-LEAD study^3,d

• Nearly 60% of adolescents treated with ICOTYDE achieved completely clear skin (57% PASI 100, 61% IGA 0) at Week 52.
• In adolescents enrolled in ICONIC-LEAD, 86% achieved PASI 90 response at one year, with 92% maintaining that response from Week 24 to Week 52.
• No increase in AE incidence was observed over one year of treatment.
• Additional Week 52 data from ICONIC-LEAD was previously presented at the 2025 European Academy of Dermatology and Venereology (EADV) Congress.

“For the first time, patients 12 and older have access to a novel therapy capable of delivering sustained skin clearance and a favorable safety profile in a once-daily pill,” said Jennifer Soung, M.D., Director of Clinical Research at Southern California Dermatology and ICONIC‑LEAD study investigator.^c “ICOTYDE is a transformative advance in plaque psoriasis treatment and expands what’s possible for this age group.”

“The ICOTYDE one year data showcase what’s possible when targeted science meets real-world patient needs,” said Liza O’Dowd, M.D., Vice President, Immunodermatology and Respiratory Disease Areas Lead, Johnson & Johnson. “Across age groups, high‑impact disease sites, and in head‑to‑head trials, the results point to a new first-line systemic therapy that can move the needle on treatment gaps in plaque psoriasis.”

Editor’s notes:

a.  ICONIC-ADVANCE 1 & 2 are Phase 3 randomized controlled trials (RCTs) evaluating the efficacy and safety of ICOTYDE compared with placebo and deucravacitinib in participants with moderate-to-severe plaque PsO with PASI 90 and IGA score of 0/1 with at least a 2-grade improvement as co-primary endpoints.
b.  The PASI score grades the amount of surface area on each body region that is covered by psoriasis plaques and the severity of plaques for their redness, thickness and scaliness. PASI 100 corresponds to an improvement of >=100% in PASI score from baseline.⁴
c.  Drs. Soung and Stein Gold are paid consultants for Johnson & Johnson. They have not been compensated for any media work.
d.  ICONIC-LEAD is a Phase 3 RCT evaluating the efficacy and safety of ICOTYDE compared with placebo in 684 participants (ICOTYDE=456; placebo=228) 12 years of age or older with moderate-to-severe plaque PsO, with the higher efficacy bar of PASI 90 and IGA score of 0/1 with at least a 2-grade improvement as co-primary endpoints. ICONIC-LEAD enrolled 66 adolescent patients.

About the ICONIC Clinical Development Program 
The pivotal Phase 3 ICONIC clinical development program includes five Phase 3 studies of ICOTYDE in patients 12 and older with moderate-to-severe plaque PsO.

• ICONIC-LEAD (NCT06095115) is a RCT to evaluate the efficacy and safety of ICOTYDE compared with placebo in participants with moderate-to-severe plaque PsO, with PASI 90 and IGA score of 0 or 1 with at least a 2-grade improvement as co-primary.⁵
• ICONIC-TOTAL (NCT06095102) is a RCT to evaluate the efficacy and safety of ICOTYDE compared with placebo for the treatment of PsO in participants with at least moderate severity affecting special areas (e.g., scalp, genital, and/or hands and feet) with overall IGA score of 0 or 1 with at least a 2-grade improvement as the primary endpoint.⁶
• ICONIC-ADVANCE 1 (NCT06143878) and ICONIC-ADVANCE 2 (NCT06220604) are RCTs to evaluate the efficacy and safety of ICOTYDE compared with both placebo and deucravacitinib in adults with moderate-to-severe plaque PsO.^7,8
• ICONIC-ASCEND (NCT06934226) is a RCT to evaluate the efficacy and safety of ICOTYDE compared with placebo and ustekinumab in participants with moderate-to-severe plaque.⁹

Additional studies underway in other disease areas include: ICONIC-PsA 1 (NCT06878404) and ICONIC-PsA 2 (NCT06807424) in active psoriatic arthritis; ICONIC-UC (NCT071196748) in moderately to severely active ulcerative colitis; and ICONIC-CD (NCT7196722) in moderately to severely active Crohn’s disease.^10,11,12,13

About Plaque Psoriasis 
Plaque psoriasis (PsO) is a chronic immune-mediated disease resulting in overproduction of skin cells, which causes inflamed, scaly plaques that may be itchy or painful.¹⁴ It is estimated that 8 million Americans and more than 125 million people worldwide live with the disease.¹⁵ Nearly one-quarter of all people with plaque PsO have cases that are considered moderate-to-severe.¹⁴ Plaques typically appear as raised patches with a silvery white buildup of dead skin cells or scales. Plaques may appear red in lighter skin or more of a purple, gray or dark brown color in patients with darker skin tones. Plaques can appear anywhere on the body, although they most often appear on the scalp, knees, elbows, and torso.¹⁶  Living with plaque PsO can be a challenge and impact life beyond a person’s physical health, including emotional health, relationships, and handling the stressors of life.¹⁷ Psoriasis on highly visible areas of the body or sensitive skin, such as the scalp, hands, feet, and genitals, can have an increased negative impact on quality of life.^14,18

About ICOTYDE™ (icotrokinra) 
ICOTYDE™ (icotrokinra) is the first and only targeted oral peptide designed to precisely block the IL-23 receptor, which underpins the inflammatory response in moderate-to-severe plaque PsO.^1,19,20 ICOTYDE binds to the IL-23 receptor with single-digit picomolar affinity and demonstrated potent, precise inhibition of IL-23 signaling in human T cells.²¹ Clinical significance of these findings is unknown.

ICOTYDE is currently approved in the U.S. for the treatment of adults, and pediatric patients 12 years of age and older who weigh at least 40 kg, with moderate-to-severe plaque PsO who are candidates for systemic therapy or phototherapy. Patients on ICOTYDE take one pill, once a day with water upon waking, 30 minutes prior to eating food.²²

ICOTYDE was jointly discovered and is being developed pursuant to the license and collaboration agreement between Protagonist and Johnson & Johnson. Johnson & Johnson retains exclusive worldwide rights to develop ICOTYDE in Phase 2 clinical trials and beyond, and to commercialize compounds derived from the research conducted pursuant to the agreement against a broad range of indications.^23,24,25

ICOTYDE is also being studied in active psoriatic arthritis, moderately to severely active ulcerative colitis and moderately to severely active Crohn’s disease^.10,11,12,13 

ICOTYDE™ INDICATION AND IMPORTANT SAFETY INFORMATION

WHAT IS ICOTYDE™ (icotrokinra)?
ICOTYDE^TM 200 mg is a prescription medicine used to treat moderate to severe plaque psoriasis in adults and children 12 years of age and older who weigh at least 88 pounds (40 kg), who may benefit from taking injections or medicines by mouth (systemic therapy) or treatment using ultraviolet or UV light (phototherapy).

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ICOTYDE?

Before taking ICOTYDE, tell your healthcare provider about all of your medical conditions, including if you:

• have an infection that does not go away or that keeps coming back.
• have tuberculosis (TB) or have been in close contact with someone with TB.
• have recently received or are scheduled to receive an immunization (vaccine). Avoid receiving live vaccines during treatment with ICOTYDE.
• have kidney problems. 
• are pregnant or plan to become pregnant. It is not known if ICOTYDE can harm your unborn baby.
  Pregnancy Safety Study. There is a pregnancy safety study for women who take ICOTYDE during pregnancy. The purpose of this study is to collect information about the health of you and your baby. If you are pregnant or become pregnant during treatment with ICOTYDE, you can report your pregnancy by calling 1-800-526-7736 or visiting www.ICOTYDE.com.
• are breastfeeding or plan to breastfeed. It is not known if ICOTYDE passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with ICOTYDE.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What are the possible side effects of ICOTYDE?

ICOTYDE may cause serious side effects. See “What is the most important information I should know about ICOTYDE?”

The most common side effects of ICOTYDE include:

These are not all the possible side effects of ICOTYDE. Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

How should I take ICOTYDE?

• Take ICOTYDE exactly as your healthcare provider tells you to take it.
• Take ICOTYDE 1 time a day when you wake up on an empty stomach with water. Wait at least 30 minutes after taking ICOTYDE before eating food.
• If you have difficulty swallowing tablets, ICOTYDE can be dispersed in water. For more information, please read the Medication Guide.
• If you miss a dose of ICOTYDE, take the dose as soon as you remember and go back to your regular schedule the next day.

Please read the full Prescribing Information, including Medication Guide, for ICOTYDE and discuss any questions that you have with your doctor.

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About Johnson & Johnson 
At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow and profoundly impact health for humanity. 

Learn more at https://www.jnj.com/ or at www.innovativemedicine.jnj.com. Follow us at @JNJInnovMed. 

Janssen Biotech, Inc. is a Johnson & Johnson company.

Cautions Concerning Forward-Looking Statements 
This press release contains “forward-looking statements” as defined in the Private Securities Litigation Reform Act of 1995 regarding ICOTYDE™ (icotrokinra). The reader is cautioned not to rely on these forward-looking statements. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or known or unknown risks or uncertainties materialize, actual results could vary materially from the expectations and projections of Johnson & Johnson. Risks and uncertainties include, but are not limited to: challenges and uncertainties inherent in product research and development, including the uncertainty of clinical success and of obtaining regulatory approvals; uncertainty of commercial success; manufacturing difficulties and delays; competition, including technological advances, new products and patents attained by competitors; challenges to patents; product efficacy or safety concerns resulting in product recalls or regulatory action; changes in behavior and spending patterns of purchasers of health care products and services; changes to applicable laws and regulations, including global health care reforms; and trends toward health care cost containment. A further list and descriptions of these risks, uncertainties and other factors can be found in Johnson & Johnson’s most recent Annual Report on Form 10-K, including in the sections captioned “Cautionary Note Regarding Forward-Looking Statements” and “Item 1A. Risk Factors,” and in Johnson & Johnson’s subsequent Quarterly Reports on Form 10-Q and other filings with the Securities and Exchange Commission. Copies of these filings are available online at www.sec.gov, www.jnj.com or on request from Johnson & Johnson. Johnson & Johnson does not undertake to update any forward-looking statement as a result of new information or future events or developments. 

¹ Bissonnette R, et al. Data presentation. A phase 2, randomized, placebo-controlled, dose-ranging study of oral JNJ-77242113 for the treatment of moderate-to-severe plaque psoriasis: FRONTIER 1. Presented at WCD 2023, July 3-8.
² Stein Gold L. et al. Durability of response with icotrokinra, a targeted oral peptide, in adults with moderate-to-severe plaque psoriasis: One-year results from the Phase 3, placebo- and active comparator-controlled ICONIC-ADVANCE 1 & ICONIC ADVANCE 2 trials. 73228
³ Soung J. et al. Durability of icotrokinra (targeted oral peptide) effects in adolescents with moderate-to-severe plaque psoriasis: One-year results from the ICONIC-LEAD study. 73600
⁴ Thompson Jr, D. How the Psoriasis Area and Severity Index works. Everyday Health. Available at: https://www.everydayhealth.com/psoriasis/living-with/how-the-pasi-index-works. Accessed March 2025.
⁵ Clinicaltrials.gov. A study of JNJ-2113 in adolescent and adult participants with moderate-to-severe plaque psoriasis (ICONIC-LEAD). Identifier NCT06095115. https://classic.clinicaltrials.gov/ct2/show/NCT06095115. Accessed May 2025.
⁶ Clinicaltrials.gov. A study of JNJ-2113 for the treatment of participants with plaque psoriasis involving special areas (scalp, genital, and/or palms of the hands and the soles of the feet) (ICONIC-TOTAL). Identifier NCT06095102. https://classic.clinicaltrials.gov/ct2/show/NCT06095102. Accessed May 2025.
⁷ Clinicaltrials.gov. A Study of JNJ-77242113 for the Treatment of Participants With Moderate-to-severe Plaque Psoriasis. Identifier NCT06143878. https://clinicaltrials.gov/study/NCT06143878?term=jnj-77242113&rank=10. Accessed May 2025.
⁸ Clinicaltrials.gov. A Study of JNJ-77242113 for the Treatment of Participants With Moderate-to-severe Plaque Psoriasis (ICONIC-ADVANCE 2). Identifier NCT06220604. https://clinicaltrials.gov/study/NCT06220604. Accessed May 2025.
⁹ Clinicaltrials.gov. A Study to Assess Efficacy and Safety of JNJ-77242113 Compared to Placebo and Ustekinumab in Participants With Moderate-to-severe Plaque Psoriasis (ICONIC-ASCEND). Identifier NCT06934226. https://clinicaltrials.gov/study/NCT06934226. Accessed January 2026.
¹⁰ Clinicaltrials.gov. A Study to Evaluate the Efficacy and Safety of JNJ-77242113 (Icotrokinra) in Biologic-naïve Participants With Active Psoriatic Arthritis (ICONIC-PsA 1). Identifier NCT06878404. https://clinicaltrials.gov/study/NCT06878404. Accessed January 2026.
¹¹ A Study to Evaluate the Efficacy and Safety of Icotrokinra (JNJ-77242113) in Biologic-experienced Participants With Active Psoriatic Arthritis (ICONIC-PsA 2). Identifier NCT06807424. https://clinicaltrials.gov/study/NCT06807424. Accessed January 2026.
¹² Clinicaltrials.gov. A Protocol of Icotrokinra Therapy in Adult and Adolescent Participants With Moderately to Severely Active Ulcerative Colitis (ICONIC-UC). Identifier NCT07196748. https://clinicaltrials.gov/study/NCT07196748. Accessed January 2026.
¹³ Clinicaltrials.gov. A Study of Icotrokinra in Participants With Moderately to Severely Active Crohn’s Disease (ICONIC-CD). Identifier NCT07196722. https://clinicaltrials.gov/study/NCT07196722. Accessed January 2026.
¹⁴ National Psoriasis Foundation. About Psoriasis. Available at: https://www.psoriasis.org/about-psoriasis. Accessed May 2025.
¹⁵ National Psoriasis Foundation. Psoriasis Statistics. Available at: https://www.psoriasis.org/content/statistics. Accessed May 2025.
¹⁶ National Psoriasis Foundation. Plaque Psoriasis. Available at: https://www.psoriasis.org/plaque/.Accessed April 2025.
¹⁷ National Psoriasis Foundation. Life with Psoriasis. Available at: https://www.psoriasis.org/life-with-psoriasis/. Accessed June 2025.
¹⁸ National Psoriasis Foundation. High Impact Sites. Available at: https://www.psoriasis.org/high-impact-sites/. Accessed Sep June 2025.
¹⁹ Razawy W, et al. The role of IL‐23 receptor signaling in inflammation‐mediated erosive autoimmune arthritis and bone remodeling. Eur J Immunol. 2018 Feb; 48(2): 220–229.
²⁰ Tang C, et al. Interleukin-23: as a drug target for autoimmune inflammatory diseases. Immunology. 2012 Feb; 135(2): 112–124.
²¹ Pinter A, et al. Data Presentation. JNJ-77242113 Treatment Induces a Strong Systemic Pharmacodynamic Response Versus Placebo in Serum Samples of Patients with Plaque Psoriasis: Results from the Phase 2, FRONTIER 1 Study. Presented at EADV 2023, October 11-14.
²² ICOTYDE™ prescribing information.
²³ Protagonist Therapeutics. Press release. Protagonist Therapeutics announces amendment of agreement with Janssen Biotech for the continued development and commercialization of IL-23 antagonists. Available at: https://www.prnewswire.com/news-releases/protagonist-therapeutics-announces-amendment-of-agreement-with-janssen-biotech-for-the-continued-development-and-commercialization-of-il-23-antagonists-301343621.html. Accessed May 2025.
²⁴ Protagonist Therapeutics. Press release. Protagonist Reports positive results from Phase 1 and pre-clinical studies of oral Interleukin-23 receptor antagonist JNJ-2113. Available at: https://www.prnewswire.com/news-releases/protagonist-reports-positive-results-from-phase-1-and-pre-clinical-studies-of-oral-interleukin-23-receptor-antagonist-jnj-2113-301823039.html. Accessed May 2025.
²⁵ Protagonist Therapeutics. Press release. Protagonist Therapeutics announces positive topline results for Phase 2b FRONTIER 1 clinical trial of oral IL-23 receptor antagonist JNJ-2113 (PN-235) in psoriasis. Available at: https://www.prnewswire.com/news-releases/protagonist-therapeutics-announces-positive-topline-results-for-phase-2b-frontier-1-clinical-trial-of-oral-il-23-receptor-antagonist-jnj-2113-pn-235-in-psoriasis-301764181.html. Accessed May 2025.

SOURCE Johnson & Johnson

On a spring morning in 1987, a 30-year-old man named Robert Kilgour pulled up beside a row of foamy cherry trees in the town of Kirkcaldy, on Scotland’s east coast, to visit an old hotel. The building was four storeys of blackened Victorian sandstone. Kilgour was a big man, a voluble Scot with a knack for storytelling. He already owned a hotel in Edinburgh but wanted to branch into property development and was planning to turn this old place, Station Court, into apartments. A few months after he completed the purchase, however, the Scottish government scrapped a grant for developers that he had been counting on. He had just sunk most of his personal savings into a useless building in a sodden, post-industrial town. He urgently needed a new idea.

Care homes weren’t so different from hotels, Kilgour thought. And the beauty was, their elderly residents were unlikely to get drunk, steal the soap dispensers or invite sex workers back to their rooms. Turning Station Court into a care home seemed like the best way out of a bad situation. Kilgour arranged a bank loan and in June 1989 he launched Four Seasons Health Care, taking the name from a restaurant in Midtown Manhattan where he had once dined.

By sheer luck, Kilgour had found himself at the start of something big. The following year, the government in Westminster started to transfer responsibility for social care on to local councils. This gave businessmen such as Kilgour a huge opportunity. Councils began paying them to provide beds that had previously been supplied by the NHS. Demand boomed.

Kilgour opened three other homes in Kirkcaldy, another overlooking the Firth of Forth, and a further one near Dundee. Alongside running his new business, he juggled the pastimes of an increasingly wealthy man. He raised money for a cancer charity, played tennis, networked ceaselessly and began to dabble in politics, campaigning (and failing) to become one of Scotland’s few Conservative MPs. By 1997, he owned seven care homes across Fife.

That year, he chaired a fundraising appeal to open a new hospice in the grounds of Kirkcaldy’s main hospital. The guest of honour was an irascible TV celebrity called John Harvey-Jones, star of a reality show called Troubleshooter in which he dispensed tough-love advice to underperforming British businessmen. Over tumblers of whisky, Harvey-Jones counselled Kilgour: “He said I was stuck in a regional comfort zone. He said I needed to break out of it and go wider.” Deep down, Kilgour agreed.

He had few contacts in London, where the serious money was. It occurred to him that his best lead might be an accountant he knew called Hamilton Anstead, who had recently left a job at a care company in the south of England. Kilgour invited him up to a hotel in Glasgow and the two men hatched a plan for Anstead to join Four Seasons as a joint chief executive.

Kilgour told me all about this over coffee at his private members’ club in Mayfair, a high-ceilinged, low-lit place with clusters of velvet chairs arranged for quiet conversation. He had now entered the “legacy” phase of his life, he said: more concerned with what he was leaving behind than what lay ahead. He often mentioned the politicians with whom he was on first-name terms, as if showing me the photographs in a well-handled album. Mostly, he seemed happy, but there were aspects of his past that bothered him.

Over the course of two years, Kilgour and Anstead built Four Seasons into, if not quite an empire, then a small dominion of 43 homes dotted across Britain. As the business grew, however, their relationship soured. Anstead often felt that Kilgour was more interested in his political career than the minutiae of spreadsheets or suppliers. (“I’m a strategy and vision person, not a detail person,” Kilgour said. “Hamilton is a brilliant micromanager and I’m an entrepreneur.”)

In 1999, the two men decided to sell the company, with the idea that they would stay on as executives. Anstead identified a buyer, a private equity firm called Alchemy Partners. Shortly after they signed the deal, in August that year, he called Kilgour and said they urgently needed to meet. Anstead put it bluntly: neither he nor the company’s new owners wanted Kilgour to stay on as an executive at Four Seasons. Kilgour felt his temper rising. He was being asked to leave the business he had created from scratch. “He started effing and blinding and calling me all sorts of obscenities,” Anstead recalled. (Kilgour later told me that by this point he was exhausted, and wanted out.)

Alchemy sold Four Seasons in 2004, and the company became notorious as a failed experiment, a byword for the folly of entrusting elder care to private equity. “You could ask me, well, do I feel guilty about what happened?” Kilgour said. “And yes, I do, actually.”

Private equity relies on a basic technique known as the leveraged buyout, which works like this: you, a dealmaker, buy a company using just a small portion of your own money. You borrow the rest, and transfer all this debt on to the company you just bought. In effect, the company goes into debt in order to pay for itself. If it all goes well, you sell the company for a profit and you reap the rewards. If not, it is the company, not you, that is on the hook for this debt.

Leveraged buyouts first came to prominence in the 1980s, when dealmakers on Wall Street began targeting underperforming companies and bloated conglomerates in the US. Then, these American businessmen and their British imitators started to scour the world for other places to put this technique to work. With a dwindling supply of undervalued companies to choose from, some of the sharpest minds in finance found a new and unexpected target: care homes.

As people were now living well into their 80s and 90s, financiers began to think of elderly people as recession-proof investments, and assumed that the care home market in Britain and the US would keep growing. In the UK, many of these homes were bankrolled by local authorities, which guaranteed a steady income from the government. Elderly people who paid for their care out of their own pockets typically covered the cost by selling their houses, and the ceaseless increase in property prices endowed them with so much housing equity that they became the human equivalent of ATMs. Care homes were the slot for withdrawing their cash.

It takes a certain kind of mind to look into the world of colostomy bags, incontinence pads and emollient cream and see dollar signs. Nevertheless, from the turn of the 21st century, private equity investment in care homes ballooned in both Britain and the US. Fund managers thought “there are all these affluent baby boomers heading towards retirement. They’ve made a fortune from their houses, or inherited money from their parents, and they all have gold-plated pension schemes,” Nick Hood, a chartered accountant who has studied Britain’s care sector, told me. “They rubbed their hands together and said, ‘Sooner or later, as the demand increases, the prices must go up.’”

In the UK, a stream of deals took place. New companies emerged and new care homes went up, some built out of faded hotels whose clientele had migrated to southern Spain after the advent of cheap air travel. Other businessmen bought crematoriums as well as care homes, in anticipation of their clients’ final billable requirements. “Private equity’s presence in British care homes was negligible 30 years ago,” said Peter Morris, a researcher and associate scholar at the University of Oxford. “Since then, it’s grown inexorably.”

Anstead and Kilgour belonged to a small group of newly minted care home millionaires. At the heart of many of these new fortunes was a technique financiers called “sale and leaseback”. You would take a care home and split it into an operating company, or “opco”, which dealt with everything concerning the business of care, from staff to beds, medicine cabinets and cutlery. On the other side you had the property company, or “propco”, which now owned the physical home. After splitting these in two, you could sell off the propco to someone else, allowing you to quickly raise cash (this was how Anstead and Kilgour initially managed to grow Four Seasons to 43 homes in just two years).

In theory, sale and leaseback was an efficient way of raising money, with estate agents acting as middlemen between fund managers who were buying and selling the homes. “In practice, a lot of the deals were bananas,” Paul Saper, a former healthcare consultant, told me. A care home that no longer owned its own property was like a family that sold its house to a rapacious landlord. If the landlord decided to raise the rent, obviously the family would have less to spend on other essentials.

“There’s a phrase my friends use when analysing companies,” Hood told me. “Hang gliders.” Just as a hang glider coasts through the sky supported only by the spread of its wings, a company can coast along for a while supported only by the stability of its cashflow. But if it is crippled with debt, or locked into escalating rental payments, its cashflow dries up and “it crashes to earth. Because it’s got nothing to keep it up there.”

After Anstead and Kilgour sold Four Seasons, it was passed between a string of different owners. Alchemy sold the company in 2004 to a German insurance firm called Allianz Capital Partners, which then sold it to a Qatari private equity fund in 2006. When the financial crisis arrived in 2008, the care company’s debts had soared to an estimated £1.56bn. As its Qatari owners couldn’t find anyone willing to refinance the company, Four Seasons fell into the hands of its creditors, led by the Royal Bank of Scotland. “It was wonderful for the financiers, who put in these supposedly clever structures that took equity away and replaced it with debt,” said Ros Altmann, a Conservative peer who has studied the sector. “They were playing financial pass-the-parcel with elderly people’s lives. They could pile on as much debt as they liked, and there was nothing to stop them.”

By February 2012, RBS was still looking for a buyer, and word had spread about a bidding war. Among the rivals for control of Four Seasons were a Canadian pension fund, the Abu Dhabi investment authority, a Hong Kong billionaire and four private equity firms including Terra Firma, founded by Guy Hands.

After starting on the trading floor at Goldman Sachs, Hands had made his name at the Japanese bank Nomura, buying up trains and pubs, among other things. He was ambitious and had an uncompromising streak. When his team reached the final, frenetic stages of a deal, Hands would hardly sleep. He was known for having a temper. “I’m not a particularly conciliatory human being,” he told me. In an FT report in 2024, several former colleagues accused Hands of screaming and raging at staff and humiliating junior employees. (Hands and Terra Firma forcefully denied these accusations.)

In 2002, he broke away from Nomura to found Terra Firma, a phrase used by 17th-century Venetian merchants to describe the areas of Italy ruled by Venice. Like a doge surveying his kingdom from across the water, Hands relocated offshore, to the tax haven of Guernsey.

Despite his grand ambitions, however, his deals were not always a great success. In 2007, Terra Firma bought EMI, the iconic British music label that had recorded the Beatles at its Abbey Road studios. The match was ill-fated from the start. Hands had little understanding of the music business or the power that artists exerted over the label, and his clinical approach to profit creation left some musicians cold. Paul McCartney described how EMI became “boring” once it was under Terra Firma’s control, while Radiohead were so incensed by the new management that they released an album on their website, sidestepping the label altogether. Two years into its new ownership, EMI was reporting losses of £1.75bn, and in 2011 Hands surrendered control to its creditors, Citibank. (Later, Hands insisted to me that the thesis of the deal was still “100% right” and would have made Terra Firma’s investors over £14bn “had Citigroup not seized the company”.)

With his reputation now tarnished, Hands was desperate to convince the world that he could still do his job, and soon alighted on the care home sector.

In the early months of 2012, Terra Firma held 10 board meetings at which its partners frantically analysed pages and pages of presentations. Their proposition hinged upon a simple premise: they would make Four Seasons into the “IBM of care”, providing reliable, unglamorous services to local councils, much as IBM had sold reliable, unglamorous computer systems to the public sector. In the scramble for acquisition, Terra Firma’s offer won out.

Not everyone was happy. Mark Drakeford, the then first minister for Wales, was concerned that Terra Firma planned to add Four Seasons to a grab bag of unrelated assets: a garden-centre company, a group of wind farms, the Odeon cinema chain and an assortment of motorway service stations in Germany. “Older people are fellow citizens, not commodities,” Drakeford later wrote, likening the transaction to buying a sack of compost or a tub of geraniums. “It just isn’t good enough.”

Hands told me he wanted to improve the quality of care at Four Seasons to attract more residents, which in turn would make the business more profitable. “The cost of doing it would have been about £1,100 a week [per bed],” he said. “And we were getting paid about £550 by the local authorities.” Terra Firma had bought the company for £825m, putting down £325m of its investors’ money and borrowing the rest. While the firm paid off some of Four Seasons’ existing liabilities, the company was still hobbled with debt, and interest payments of £50m each year. In May 2015, the chancellor George Osborne outlined plans to cut a further £55bn from the state’s budget. This trickled down to local authorities, which cut funding for care homes. That autumn, the ratings agency Standard & Poor’s warned that Four Seasons was on track to run out of money.

In Hands’s view, the government’s unwillingness to spend more money on the sector was what caused his plans to unravel. “We believed the government was going to support care, and we got it completely wrong,” he told me. “We saw a Conservative government, with old voters, family values, and we thought, these guys are going to put money into this sector. And they did the reverse. They drained it.”

While the austerity drive undoubtedly did upset Hands’s calculations, it was almost impossible to know what was really going on inside Four Seasons. By now, its corporate structure had become a labyrinth, with 185 separate companies organised across 15 different layers. We know this thanks to research by forensic accountants at the University of Manchester, who studied the company for a 2016 report. “The rules of capitalism have been changed through the construction of opaque, complex groups of companies,” they wrote. “Four Seasons is a black box and only Guy Hands and a few close associates understand what is going on.”

Hands insisted that, in this case, the structure was inherited from Terra Firma’s predecessors, though his firm didn’t exactly simplify things. “It’s a little bit like the government issuing laws,” he told me. “They issue laws the whole time. They never abolish any … it’s much more exciting putting rules in than taking rules out.”

Private equity people tend to be better than just about anyone else at two things: managing huge amounts of debt, and concealing the inner workings of their companies. Fund managers can charge mysterious “monitoring” and “transaction” fees to a company they own. Or they can borrow against that company to pay themselves or their investors a dividend. Whenever I have spoken to policy researchers or trade unionists about this dynamic, the picture they have painted isn’t so different from the argument often made about foreign aid: that it’s pointless pouring money into countries with corrupt governments, as a group of middlemen will siphon off the donations before they can reach the people who need them. Likewise, if it isn’t possible to see how much money a care home is actually making, its owners can more easily pressure the government for more funding.

“In the old days of unionism, you had the factory up the road and you could see how well they were doing,” Natalie Grayson, a trade union organiser who worked with care home staff, told me. “But you can’t do that when your employer gets bought by an investment fund. A company can say, ‘We haven’t got any money, we can only afford to pay people the minimum wage’ and because we don’t know how much debt a company is paying, and there are so many separate companies and holding companies … it makes it impossible for us to trace that money and disprove their arguments.”

On the other hand, when presented with an impossible case, sometimes the most unlikely people find themselves playing sleuth.

It was a stifling August day when I travelled to meet Eileen Chubb, a slight, serene woman with perfectly coiffed hair and silky mannerisms, in a suburb of south London. We were sitting in her living room which, despite its crowd of ornaments and bright-orange paintwork, was a place of remarkable calm. Chubb had poured me a coffee and set out a plate of biscuits. Her rescue dog, Strider, sat at her feet.

Chubb used to work at a care home, until she became concerned by its falling standards and blew the whistle. From her living room, she then founded a charity, Compassion in Care, to help whistleblowers in similar situations. “I always tell people: go home, sit in a chair for eight hours, without food, without water, without human contact. That is what poor care is like,” she said.

In 2013, Chubb started running undercover inspections of care homes. She would pretend she was visiting to find a space for her elderly mother, and use false names – colours (Mrs Black, Mrs Green) or country and western names (Mrs Parton, Mrs Cash). Sometimes she took a walking stick to feign immobility, which let her slow down to better survey the landscape. Chubb had uncovered details of disturbing cases all over the country, both in small, family-owned homes and those run by large companies. Some of the worst cases she learned of were at homes owned by Southern Cross in the late 2000s, in the years before it collapsed. There was Betty Delaney, who developed excruciating bed sores at a home in Rochdale, two of them so bad that they wore down to muscle and bone. Or Alan Simper, a former electrical engineer who was staying at a Southern Cross home in Leighton Buzzard and was covered in dry excrement by the time he arrived at a hospital in 2009. A coroner later found he died “for want of care”.

I thought these might just be tragic exceptions, but Chubb told me that at any one time, her charity was helping between 200 and 300 employees at homes where they were worried about the quality of care, many of which were owned by private equity. “Every single day, I hear about people who haven’t been fed or given fluids, or are left in their own faeces. We see it all the time,” she said. Chubb was a one-woman detective agency, effectively doing the regulator’s job for it. She had little faith in the Care Quality Commission (CQC), the watchdog for social care in England, which had neither the resources nor the inclination to investigate many of the complaints it received, as it lost more than 10% of its budget and almost 10% of its staff between 2016 and 2020. In the six years leading up to 2024, in-person care home inspections fell by two-thirds.

Poor care, Chubb told me, mostly happened behind closed doors, to people who were too sick or senile to protest. Many of the whistleblowers who called her hotline were sharing vital information about wrongdoing that would otherwise never be exposed. But those who took matters into their own hands often found themselves alone. One woman whose mother had suffered falls and a black eye while staying at a Four Seasons home in south-west London in 2013 tried to find out whether this was an isolated incident. She wrote to the council, which refused to give her any information about other complaints patients had made because it said sharing this would affect the company’s “commercial interests”. She then submitted freedom of information requests to the CQC, which said it had received more than 1,000 notifications of serious injury from Four Seasons homes over the previous 12 months, but that it was unable to say how many residents had died as a result of specific types of injuries, because it did not keep a central record of this information.

Were these problems worse in private equity-owned homes? Anecdotally, Chubb noticed a pattern of “ingrained” cost-cutting when homes were taken over by these investors. “The staff are run ragged, absolutely exhausted. You can see it in their faces,” she said. Some of these observations were borne out in qualitative data: in one study from 2022, more than a dozen anonymous staff members in homes taken over by investment funds said their employers were “cutting corners” to curb costs. One said there were sometimes so few staff on duty, cleaners were roped in to care for elderly residents.

One of the most unsettling studies I found was from 2021. Atul Gupta, a health economist at the University of Pennsylvania, had set out with a team of researchers to analyse the changes that took place in nursing homes in the US after private equity takeovers. The team sifted through more than 100 deals between 2004 and 2015, and a dark picture emerged. After a takeover, deaths among residents increased by an average of 11%.

This result was so stark that Gupta initially thought it was an error. But when his team checked their results, they were robust. At homes that had been acquired by private equity funds, researchers found there were fewer staff. Residents were more likely to have pressure ulcers and reported higher levels of pain. “And we found an increase in the use of antipsychotic drugs, which are sometimes used [on residents] as substitutes for restraints,” Gupta said. “So we found a worsening of outcomes on multiple dimensions, including death.”

By the spring of 2016, Four Seasons’ position was tenuous. An American hedge fund was now buying up its debt, betting on financial meltdown. An interest payment of £26m fell due in December the following year. Terra Firma failed to meet it.

The hedge fund operated out of Connecticut under the management of a former Lehman banker called Spencer Haber. Little was known about Haber save for the fact that he had large sideburns and was passionate about animal welfare, making numerous donations to a charity for homeless cats in New York. That, and the fact that he had never owned a care home.

As Haber bought up more of the company’s debt, he acquired more power to determine what happened once the firm was reorganised or liquidated. Terra Firma fought to sell some of the more profitable homes, and Hands agreed to remain an owner in name alone, while Haber’s fund dictated a restructure. In 2019, Four Seasons announced it was going into administration. It could no longer pay its debts, so the restructuring would begin.

And then the pandemic struck. Suddenly, UK care homes were all over the news. The basic problem was that patients with Covid-19 were being discharged from hospitals into homes staffed by low-paid workers with little experience of dealing with a deadly and contagious virus. Compounding this, they often didn’t have enough masks or gloves to avoid catching it themselves. Eileen Chubb told me calls to her hotline increased by about 60% during the first wave of Covid-19. She found herself trying to console distraught care workers until 10pm each evening. “Many were in tears, terrified of what was going on. Being told to get used PPE out of a dustbin, spray it with Dettol and put it back on. Having to use sanitary towels for face masks,” she recalled. At first, the CQC kept data on care home deaths from Covid secret, partly – by its own admission – to protect the commercial interests of providers. It was as if the regulator didn’t want the public to find out what was happening inside these homes. Or perhaps it didn’t know: during Covid, it paused routine inspections entirely.

Once again, the task of analysing what was going on fell to self-appointed investigators and academics rather than the state. According to one paper, at the peak of Covid’s first wave, the homes with the greatest debts, where leverage was above 75%, had a death rate nearly twice as high as homes with no leverage at all. “In bad times, leveraged operators have to cut costs more than unleveraged operators,” the researchers explained.

The pandemic forced the public to focus on the industry, and the UK government sprang belatedly into action. It pumped an extra £2.1bn into the sector – about £5,900 for each bed. Homes received free PPE, money to cover staff sick pay and subsidies for empty rooms as residents died. As Amy Horton, an economic geographer and professor at UCL discovered, however, staff working in the largest for-profit homes, the majority of which were owned by private equity funds, reported working longer hours and receiving less than satisfactory sick pay. “These differences,” Horton suggested, “could be because some companies are paying out significant portions of their revenue to investors, landlords and creditors, rather than reinvesting in the service.”

Hands seemed to regret his decision to buy Four Seasons. When I asked him whether his industry should ever be responsible for the care of elderly people, he told me he felt there was a “fundamental mismatch” between private equity and social care. “I mean, private equity’s role is to make profits for its investors. And you can’t, in the care home business, just make profits. You’ve got to take into account something that is more important, which is people’s lives.” I didn’t disagree, though it seemed an easier thing to say once you had retired offshore, having made a sizable fortune.

In 2022, the remaining homes from the Four Seasons estate appeared on the website of a real-estate broker. The photos showed an early Victorian mansion, an Edwardian pile and a 1990s neo-Georgian housing block. In real-estate vernacular, the portfolio was described as “attractive”, with “strong average fee uplifts” and “favourable demographics”, a euphemism for locations where house prices had boomed, once again conjuring the idea that elderly people were asset-rich cash machines.

Ever since he was ousted from Four Seasons, Robert Kilgour had resolved to create what he told me was a different type of care business. I met him on a rainy day in Edinburgh to visit three of the homes he now owns. We drove between them in his SUV, which had a personalised number plate spelling out his surname. The first was a crenellated, three-storey Victorian manor. Inside, Kilgour pointed with pride to the artworks he had donated, and paused to appreciate the texture of a brass light switch. For lunch that day, the residents could choose between mushroom stroganoff and shepherd’s pie. There were small vases of carnations on each of the dining tables. I checked: the flowers were real. Kilgour chatted with an attendant who ran the in-house hair salon, then we went to look around the bedrooms. “This,” Kilgour told me, stroking a bedstead in an empty room with a theatrical flourish, “is life stuff.”

It would be nice to think that homes such as this provided a solution to the care crisis, but the residents of the home we visited that day paid upwards of £1,700 a week, a hefty bill that effectively ruled out almost everyone without an expensive property to remortgage or sell. Kilgour planned to expand his business to 30 homes by the end of the decade, and said he’d received various approaches from private equity funds. “You know, ‘We’d like to invest £100m in the care home sector, and we’d like to do a deal with you’ – that sort of thing.” Kilgour didn’t tell me who these were, but he was adamant that he wouldn’t work with any of them after watching what their industry had done to Four Seasons.