RENAGEL Brazil

Ernando Olimpio Cruz: marketing professional and father. After being diagnosed with kidney disease in 2003, Ernando began taking Renagel in January 2005, and he reports feeling well since he started treatment. He enjoys helping care for his two daughters.

RENAGEL® sevelamer hydrochloride

HECTOROL® doxercalciferol

RAPID GROWTH FOR RENAGEL AROUND THE WORLD
Renagel, our first-line therapy for kidney disease patients on hemodialysis, continues to excel, bolstered by compelling data from studies that demonstrate long-term health and economic benefits. In 2006, Renagel sales increased 23 percent, and this therapy is now used by more than 350,000 people in approximately 50 countries. In the United States, with a market share approaching 50 percent, Renagel is the market leader. This essential therapy for renal disease is also growing around the world, with nearly half of sales taking place in international markets.

In early 2007, Kidney International published findings from the Renagel in New Dialysis Patients (RIND) study that show a significantly lower rate of death among patients treated with Renagel from the time they began dialysis compared with those using calcium-based phosphate binders. In November 2006, data presented at the American Society of Nephrology annual meeting underscored the combined clinical and economic benefits of Renagel use. Drawn from the Dialysis Clinical Outcomes Revisited (DCOR) study, the findings demonstrated that patients using Renagel experience lower rates of hospitalization and shorter stays, leading to overall reduced health-care expenditures for this group compared with patients on calcium-based phosphate binders. These results are expected to help drive the future growth of Renagel, as are the continued access to Renagel under the Medicare Part D program in the United States and market expansion in Brazil and throughout the Americas.

NEXT-GENERATION PROGRESS
Genzyme has made excellent progress on Renvela (sevelamer carbonate), a next-generation version of Renagel designed to benefit both the current Renagel patient population and those with earlier-stage chronic kidney disease (CKD) who are not on dialysis. Having successfully completed a pivotal trial comparing Renvela to Renagel in later-stage patients, we filed for approval in late 2006 and expect to launch the new product in early 2008.

CHRONIC KIDNEY DISEASE
Following the launch of Renvela for patients on dialysis, we plan to seek approval for this product candidate to treat those with CKD who are not on dialysis. Our clinical trial of a powder formulation of Renvela is now fully enrolled. Renvela powder is designed to be used once a day, an option aimed at improving convenience for patients and therefore overall compliance. We are also working to expand Hectorol, a Vitamin D2 analog used in the growing CKD market, to countries around the world. This product, our entry into the CKD market, experienced 20 percent growth in 2006. We are further investing in Hectorol by bringing manufacturing in-house.