Amgen Inc. v. Sandoz Inc. ( 2023 )


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  • Case: 22-1149   Document: 10     Page: 1     Filed: 04/19/2023
    United States Court of Appeals
    for the Federal Circuit
    ______________________
    AMGEN INC.,
    Plaintiff-Cross-Appellant
    v.
    SANDOZ INC., ZYDUS PHARMACEUTICALS (USA)
    INC.,
    Defendants-Appellants
    MANKIND PHARMA LTD., TORRENT
    PHARMACEUTICALS LTD., GLENMARK
    PHARMACEUTICALS LIMITED, MACLEODS
    PHARMACEUTICALS LTD., MSN LABORATORIES
    PRIVATE LTD., ACTAVIS LLC, PRINSTON
    PHARMACEUTICAL INC., EMCURE
    PHARMACEUTICALS LTD., HERITAGE
    PHARMACEUTICALS INC., AUROBINDO PHARMA
    LTD., AUROBINDO PHARMA USA, INC., ANNORA
    PHARMA PRIVATE LIMITED, HETERO USA, INC.,
    CIPLA LIMITED, ALKEM LABORATORIES LTD.,
    DR. REDDY'S LABORATORIES, INC., DR. REDDY'S
    LABORATORIES, LTD., AMNEAL
    PHARMACEUTICALS LLC, PHARMASCIENCE
    INC.,
    Defendants
    ______________________
    2022-1147, 2022-1149, 2022-1150, 2022-1151
    ______________________
    Appeals from the United States District Court for the
    District of New Jersey in Nos. 3:18-cv-11026-MAS-DEA,
    Case: 22-1149    Document: 10     Page: 2   Filed: 04/19/2023
    2                                 AMGEN INC.   v. SANDOZ INC.
    3:18-cv-11267-MAS-DEA, 3:18-cv-11269-MAS-DEA, 3:19-
    cv-18806- MAS-DEA, Judge Michael A. Shipp.
    ______________________
    Decided: April 19, 2023
    ______________________
    STEVEN J. HOROWITZ, Sidley Austin LLP, Chicago, IL,
    argued for plaintiff-cross-appellant. Also represented by
    PAUL J. ROGERSON, JULIA G. TABAT; JOSHUA JOHN
    FOUGERE, Washington, DC; SUE WANG, San Francisco, CA;
    ERIC MICHAEL AGOVINO, GREGORY DAVID BONIFIELD,
    CHRISTINA NICHOLE GIFFORD, DENNIS J. SMITH, STUART
    WATT, WENDY A. WHITEFORD, Amgen Inc., Thousand Oaks,
    CA; JEFFREY B. ELIKAN, MICHAEL N. KENNEDY, GEORGE
    FRANK PAPPAS, Covington & Burling LLP, Washington,
    DC; ALEXA HANSEN, San Francisco, CA.
    MAUREEN L. RURKA, Winston & Strawn LLP, Chicago,
    IL, argued for all defendants-appellants. Defendant-appel-
    lant Sandoz Inc. also represented by SAMANTHA MAXFIELD
    LERNER; EIMERIC REIG-PLESSIS, San Francisco, CA.
    MICHAEL GAERTNER, Locke Lord LLP, Chicago, IL, for
    defendant-appellant Zydus Pharmaceuticals (USA) Inc.
    Also represented by DAVID BRIAN ABRAMOWITZ, HUGH S.
    BALSAM, CAROLYN ANNE BLESSING, AUGUST MELCHER,
    EMILY SAVAS.
    ______________________
    Before LOURIE, CUNNINGHAM, and STARK, Circuit Judges.
    LOURIE, Circuit Judge.
    Sandoz Inc. (“Sandoz”) appeals from a decision of the
    United States District Court for the District of New Jersey
    holding that claims 3 and 6 of Amgen Inc.’s (“Amgen”) U.S.
    Patent 7,427,638 (the “’638 patent”) and claims 1 and 15 of
    Amgen’s U.S. Patent 7,893,101 (the “’101 patent”) had not
    Case: 22-1149      Document: 10    Page: 3    Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                                3
    been shown to be invalid as obvious. Amgen cross-appeals
    from the district court’s decision holding that claims 2, 19,
    and 21 of its U.S. Patent 10,092,541 (the “’541 patent”)
    were shown to be invalid as obvious. See Amgen Inc. v.
    Sandoz Inc., No. 18-11026, 
    2021 WL 5366800
     (D.N.J. Sept.
    20, 2021) (“Decision”). For the reasons provided below, we
    affirm.
    BACKGROUND
    Amgen produces apremilast, which is stereomerically
    pure                (+)-2-[1-(3-ethoxy-4-methoxyphenyl)-2-
    methylsulfonylethyl]-4-acetylaminoisoindoline-1,3-dione,
    with the following structure:
    Amgen markets apremilast, a phosphodiesterase-4
    (“PDE4”) inhibitor, which is used for treating psoriasis and
    related conditions, under the brand name Otezla®. The
    ’638, ’101, and ’541 patents, covering Otezla, were initially
    owned by Celgene Corporation (“Celgene”) and later as-
    signed to Amgen.
    Sandoz submitted an Abbreviated New Drug Applica-
    tion (“ANDA”) seeking approval from the United States
    Food and Drug Administration (“FDA”) to market a generic
    version of apremilast. Celgene, the original plaintiff, then
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    4                                    AMGEN INC.   v. SANDOZ INC.
    brought this Hatch-Waxman suit, asserting that Sandoz’s
    generic product would infringe the ’638 and ’101 patents.
    After the ’541 patent issued, Celgene asserted infringe-
    ment of that patent as well. In February 2020, Amgen was
    substituted as plaintiff.
    I. The ’638 Patent
    The ’638 patent is directed to pharmaceutical composi-
    tions comprising stereomerically pure apremilast, includ-
    ing oral formulations, as well as dosing forms.
    Asserted claims 3 and 6 are dependent claims. For ease
    of understanding, we incorporate the parent claims into the
    claims that are asserted.
    Asserted claim 3 of the ’638 patent reads as follows:
    3.    The pharmaceutical composition of
    claim 2 [A pharmaceutical composition
    comprising stereomerically pure (+)-2-[1-(3-
    ethoxy-4-methoxyphenyl)-2-
    methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione,      or    a
    pharmaceutically acceptable salt, solvate or
    hydrate, thereof; and a pharmaceutically
    acceptable carrier, excipient or diluent,
    wherein said pharmaceutical composition is
    suitable for parenteral, transdermal, mucosal,
    nasal,     buccal,   sublingual,    or    oral
    administration to a patient], wherein said
    pharmaceutical composition is suitable for
    oral administration to a patient.
    ’638 patent at col. 31 ll. 27–39.
    Asserted claim 6 of the ’638 patent reads as follows:
    6.   The pharmaceutical composition of
    claim 5 [A pharmaceutical composition
    comprising stereomerically pure (+)-2-[1-(3-
    ethoxy-4-methoxyphenyl)-2-
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    AMGEN INC.   v. SANDOZ INC.                                  5
    methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione,      or    a
    pharmaceutically acceptable salt, solvate or
    hydrate, thereof; and a pharmaceutically
    acceptable carrier, excipient or diluent,
    wherein said pharmaceutical composition is
    suitable for parenteral, transdermal, mucosal,
    nasal,     buccal,   sublingual,    or    oral
    administration to a patient, wherein the
    amount of stereomerically pure (+)-2-[1-(3-
    ethoxy-4-methoxyphenyl)-2-
    methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione is from 1 mg
    to 1000 mg, wherein the amount of
    stereomerically pure (+)-2-[1-(3-ethoxy-4-
    methoxyphenyl)-2-methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione is from 5 mg
    to 500 mg], wherein the amount of
    stereomerically pure (+)-2-[1-(3-ethoxy-4-
    methoxyphenyl)-2-methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione is from 10
    mg to 200 mg.
    ’638 patent at col. 31 ll. 27–36, col. 32 ll. 1–12.
    At the district court, Amgen asserted infringement of
    claims 3 and 6. In response, Sandoz alleged that those
    claims were invalid as obvious over U.S. Patent 6,020,358
    (the “’358 patent”) and PCT application WO 01/034606 (the
    “’606 application”). The ’358 patent is the first U.S. patent
    describing a racemic mixture containing apremilast, and it
    claims a genus of phosphodiesterase inhibitors, including a
    racemic mixture containing apremilast. The ’358 patent
    discloses seventeen example compounds that fall within
    the scope of the claimed genus. Example 12 of the ’358
    patent is a racemic mixture comprised of 50% of the
    (+) enantiomer      of 2-[1-(3-ethoxy-4-methoxyphenyl)-2-
    methylsulfonylethyl]-4-acetylaminoisoindoline-1,3-dione
    and 50% of the (-) enantiomer. The (+) enantiomer is
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    6                                   AMGEN INC.   v. SANDOZ INC.
    apremilast. The ’358 patent more generally discloses that
    racemates can be separated into individual enantiomers.
    The ’606 application is directed to a group of
    phosphodiesterase inhibitors and teaches that the
    individual enantiomers of racemic mixtures can be
    separated.    Sandoz asserted the ’606 application as
    reinforcing the teachings disclosed in the ’358 patent.
    The district court held that Sandoz had failed to show
    by clear and convincing evidence that claims 3 and 6 would
    have been obvious over the ’358 patent and the ’606 appli-
    cation. In particular, the court found that Sandoz failed to
    meet the burden of establishing that the ’358 patent and
    the ’606 application gave a skilled artisan reason or moti-
    vation to resolve the Example 12 racemic mixture into its
    enantiomers, further finding that there was not sufficient
    evidence to conclude that a skilled artisan would have had
    reason to believe that the desirable properties of Example
    12 derived in whole or in part from the apremilast enanti-
    omer (i.e., the (+) enantiomer). The court also concluded
    that Sandoz had not demonstrated that a skilled artisan
    would have had a reasonable expectation of success in re-
    solving Example 12 into its individual enantiomeric com-
    ponents.
    The district court also looked to objective indicia of non-
    obviousness, also known as secondary considerations. In
    particular, the court noted that apremilast unexpectedly
    provided substantial improvement over previously known
    phosphodiesterase inhibitors in terms of both efficacy and
    tolerability and that there was a nexus between the unex-
    pected potency and side-effect profile of apremilast and the
    compounds of asserted claims 3 and 6 of the ’638 patent.
    The court also looked to long-felt, unmet need, noting that
    before apremilast, there was a long-felt need for a psoriasis
    treatment that was suitable for oral administration to a pa-
    tient, without the risks and barriers to adherence that were
    common with other psoriasis treatments. The court also
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    AMGEN INC.   v. SANDOZ INC.                                 7
    found a nexus between the compounds of the asserted
    claims and this long-felt, unmet need.
    The district court further found that others in the field
    had attempted to develop other PDE4 inhibitors, but that
    several had been discontinued due to disappointing efficacy
    or failure to progress in the drug-development pipeline and
    that there had been a degree of skepticism about the safety
    of apremilast because of its structural similarity to thalid-
    omide, which was found to have teratogenic effects in fe-
    tuses leading to severe and debilitating birth defects.
    Finally, the court noted the commercial success of Otezla
    since it achieved FDA approval, noting approximately 1.7
    million prescriptions for the drug between its 2014 launch
    and April 2020. In view of these findings, the court found
    that the objective indicia of nonobviousness weighed
    strongly in favor of a finding that claims 3 and 6 of the ’638
    patent would not have been obvious over the relevant art.
    In view of its objective indicia analysis, as well as its
    finding that there was not sufficient motivation or reason-
    able expectation of success in isolating apremilast from the
    racemic mixture disclosed in Example 12 of the ’358 patent,
    the district court held that claims 3 and 6 of the ’638 patent
    were not invalid as obvious.
    II. The ’101 Patent
    The ’101 patent is directed to solid forms (e.g., crystal-
    line polymorphic forms) of apremilast and claims priority
    from several earlier-filed applications, including U.S. Pro-
    visional Application 60/366,515 (the “’515 provisional ap-
    plication”), which was filed on March 20, 2002.
    Asserted claim 1 of the ’101 patent reads as follows:
    1.   A Form B crystal form of the compound
    of Formula (I):
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    8                                    AMGEN INC.   v. SANDOZ INC.
    which is enantiomerically pure, and which
    has an X-ray powder diffraction pattern com-
    prising peaks at about 10.1, 13.5, 20.7, and
    26.9 degrees 2θ.
    ’101 patent at col. 59 ll. 2–24.
    Asserted claim 15 of the ’101 patent reads as follows:
    15. A solid pharmaceutical composition com-
    prising the crystal form of any one of claims 1
    and 2 to 13.
    ’101 patent at col. 60 ll. 28–29.
    At the district court, the parties disputed the priority
    date to which the ’101 patent was entitled, and therefore,
    which date should be used for purposes of an obviousness
    analysis. Amgen argued that claims 1 and 15 were entitled
    to a priority date of March 20, 2002, the filing date of the
    ’515 provisional application. Amgen asserted that Exam-
    ple 2 of the ’515 provisional application provided written
    description and enablement support for the asserted
    claims, arguing that crystalline Form B of apremilast was
    inherently disclosed in the ’515 provisional application.
    Sandoz responded, arguing that the claims of the ’101
    patent were only entitled to a priority date of March 27,
    Case: 22-1149      Document: 10    Page: 9    Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                                 9
    2008, the filing date of the application resulting in the ’101
    patent since, according to Sandoz, the crystalline Form B
    of apremilast was neither explicitly nor inherently dis-
    closed in the ’515 provisional application. Sandoz also ar-
    gued that Celgene represented to the European Patent
    Office that following Example 2 could result in crystalline
    Form C of apremilast as well as Form B.
    The district court held that claims 1 and 15 of the ’101
    patent were entitled to the March 2002 priority date, not-
    ing that the parties did not dispute that Example 2 of the
    ’515 provisional application disclosed a synthetic chemical
    procedure for preparing apremilast. Although the court
    noted that Example 2 did not explicitly describe the final
    resulting form of apremilast as a crystalline polymorphic
    structure, but rather as a solid, the court credited Amgen’s
    expert, who testified that Example 2 inherently produces
    crystalline Form B and that thirteen third-party experi-
    ments that replicated the procedures in Example 2 re-
    sulted in the crystalline Form B of apremilast. The court
    also noted that Amgen’s expert’s uncontradicted trial testi-
    mony stated that, although Celgene once claimed that it
    made crystalline Form C of apremilast by following the pro-
    cedures in Example 2 of the ’515 provisional application,
    Form C involves a toluene solvent, which becomes a part of
    the crystalline structure, and toluene is not mentioned in
    Example 2. Therefore, the court credited Amgen’s expert’s
    testimony that Celgene made a mistake in representing
    that Example 2 could produce crystalline Form C of apre-
    milast.
    The district court concluded that Amgen met its burden
    of showing that the ’101 patent is entitled to the ’515 pro-
    visional application’s March 20, 2002 filing date as its pri-
    ority date. The court further concluded that Sandoz failed
    to argue that art prior to March 2002 rendered the claims
    of the ’101 patent invalid for obviousness and that Sandoz’s
    arguments merely reduced to a question whether claims 1
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    10                                  AMGEN INC.   v. SANDOZ INC.
    and 15 were entitled to claim priority from March 20, 2002
    through the ’515 provisional application.
    III. The ’541 Patent
    The ’541 patent is directed to methods for the treat-
    ment of diseases ameliorated by inhibition of phos-
    phodiesterases using dose titration of apremilast. Asserted
    claim 2 of the ’541 patent claims a dose-titration schedule
    and reads as follows:
    2.   A method for treating a patient with
    stereomerically pure (+)-2-[1-(3-ethoxy-4-
    methoxyphenyl)-2-methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione,   wherein
    the patient is suffering from psoriasis, the
    method consisting of:
    (a) administering to the patient stereomerically
    pure (+)-2-[1-(3-ethoxy-4-methoxyphenyl)-2-
    methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione      in    an
    initial titration dosing schedule consisting of
    (i)     10 mg in the morning on the first day
    of administration;
    (ii)    10 mg in the morning and 10 mg af-
    ter noon on the second day of admin-
    istration;
    (iii)   10 mg in the morning and 20 mg af-
    ter noon on the third day of admin-
    istration;
    (iv)    20 mg in the morning and 20 mg af-
    ter noon on the fourth day of admin-
    istration;
    Case: 22-1149     Document: 10       Page: 11   Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                                11
    (v)     20 mg in the morning and 30 mg af-
    ter noon on the fifth day of admin-
    istration; and
    (b) on the sixth and every subsequent day,
    administering to the patient 30 mg in the
    morning and 30 mg after noon of
    stereomerically pure (+)-2-[1-(3-ethoxy-4-
    methoxyphenyl)-2-methylsulfonylethyl]-
    4-acetylaminoisoindoline-1,3-dione.
    ’541 patent at col. 31 ll. 3–26.
    Asserted claim 19 of the ’541 patent reads as follows:
    19. A method as in any one of claims 1–14,
    wherein the stereomerically pure (+)-2-[1-(3-
    ethoxy-4-methoxyphenyl)-2-
    methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione comprises
    greater than about 98% by weight of the (+)
    isomer of 2-[1-(3-ethoxy-4-methoxyphenyl)-2-
    methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione based on
    the total weight percent of 2-[1-(3-ethoxy-4-
    methoxyphenyl)-2-methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-dione.
    ’541 patent at col. 36 ll. 22–29.
    Asserted claim 21 of the ’541 patent reads as follows:
    21. A method as in any one of claims 1–14,
    wherein the stereomerically pure (+)-2-[1-(3-
    ethoxy-4-methoxyphenyl)-2-
    methylsulfonylethyl]-4-
    acetylaminoisoindoline-1,3-
    dione is administered in tablet form.
    ’541 patent at col. 36 ll. 38–41.
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    12                                  AMGEN INC.   v. SANDOZ INC.
    At the district court, Amgen asserted infringement of
    claims 2, 19, and 21. In response, Sandoz alleged that the
    claims would have been obvious over Papp, 1 Schett, 2 and
    Pathan. 3
    Papp reports the results of a Phase IIb clinical trial in-
    vestigating the clinical efficacy and safety of different doses
    of apremilast in the treatment of patients with moderate to
    severe plaque psoriasis. The district court found that Papp
    teaches the following five-day dose titration of apremilast
    while initiating treatment to mitigate potential dose-de-
    pendent adverse events:
    •   Day 1: 10 mg first dose; 10 mg second dose
    •   Day 2: 10 mg first dose; 10 mg second dose
    •   Day 3: 20 mg first dose; 20 mg second dose
    •   Day 4: 20 mg first dose; 20 mg second dose
    •   Day 5: 30 mg first dose; 30 mg second dose.
    Decision at *31; see also J.A. 18583; Papp at 739.
    Schett reports the results of a Phase II clinical trial on
    apremilast in which patients were given a 40 mg daily dose,
    either as a single 40 mg dose or as two 20 mg doses. Alt-
    hough Schett did not evaluate treatment of plaque psoria-
    sis, it discloses a dose-escalation protocol during the first
    seven days of treatment for psoriatic arthritis with the aim
    1   Kim Papp et al., Efficacy of apremilast in the treat-
    ment of moderate to severe psoriasis: a randomised con-
    trolled trial, 380 LANCET 738 (2012).
    2   Georg Schett et al., Oral apremilast in the treat-
    ment of active psoriatic arthritis: results of a multicenter,
    randomized, double-blind, placebo-controlled study, 64
    ARTHRITIS & RHEUMATOLOGY 3156 (2012).
    3   Ejaz Pathan et al., Efficacy and safety of apre-
    milast, an oral phosphodiesterase 4 inhibitor, in ankylosing
    spondylitis, 72 ANNALS OF RHEUMATIC DISEASES 1475
    (2012).
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    AMGEN INC.   v. SANDOZ INC.                               13
    of decreasing the likelihood of adverse events related to
    treatment initiation. Schett at 3157–58. Pathan also
    teaches initiation of apremilast using a dose-escalation
    protocol, starting patients suffering from ankylosing spon-
    dylitis with 10 mg apremilast twice daily, titrating the dose
    by 20 mg every two days until a maximum dose of 30 mg
    twice daily was achieved on day 5. Pathan at 1476, 1479.
    The district court found that it would have been within
    the ability of a skilled artisan to titrate apremilast for a
    patient presenting with psoriasis and that doing so would
    have been a routine aspect of treating psoriasis with a drug
    like apremilast that was known in the art to require dose
    titration to ameliorate side effects. Thus, the court held
    that claims 2, 19, and 21 of the ’541 patent were invalid as
    obvious.
    In summary, the district court concluded that claims 3
    and 6 of the ’638 patent and claims 1 and 15 of the ’101
    patent were not invalid as obvious and that claims 2, 19,
    and 21 of the ’541 patent were invalid as obvious. Sandoz
    appealed, and Amgen cross-appealed. We have jurisdiction
    under 
    28 U.S.C. § 1295
    (a)(1).
    DISCUSSION
    Sandoz raises two issues on appeal. First, with regard
    to the ’639 patent, Sandoz contends that the district court
    erred in failing to find a motivation to isolate apremilast
    from a known racemic mixture and also for failing to find a
    reasonable expectation of success in separating the mix-
    ture. Second, with regard to the ’101 patent, Sandoz ar-
    gues that the court erred in holding that the ’515
    provisional application inherently disclosed the crystalline
    Form B of apremilast, and thus provided the necessary
    written description support to entitle claims 1 and 15 of the
    ’101 patent to a March 2002 priority date. Amgen raises
    one issue on cross-appeal, asserting that the court erred in
    holding that the dose-titration schedule in claims 2, 19, and
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    14                                 AMGEN INC.   v. SANDOZ INC.
    21 of the ’541 patent would have been obvious. We address
    each argument in turn.
    “Obviousness is a question of law, reviewed de novo,
    based upon underlying factual questions which are re-
    viewed for clear error following a bench trial.” Aventis
    Pharma Deutschland GmbH v. Lupin, Ltd., 
    499 F.3d 1293
    ,
    1300 (Fed. Cir. 2007) (quoting Alza Corp. v. Mylan Lab’ys,
    Inc., 
    464 F.3d 1286
    , 1289 (Fed. Cir. 2006)). The presence
    or absence of a motivation to arrive at the claimed inven-
    tion, and of a reasonable expectation of success in doing so,
    are questions of fact. Alza Corp., 
    464 F.3d at 1289
    .
    I. The ’638 Patent
    We first consider Sandoz’s challenge to the district
    court’s determination that it failed to prove that claims 3
    and 6 of the ’638 patent would have been obvious over the
    ’358 patent and the ’606 application. Sandoz argues that
    the court erred in failing to find a motivation to isolate
    apremilast from a known racemic mixture. Sandoz asserts
    that, where the methods of isolation are known, as it ar-
    gues they are here, there is a motivation to separate race-
    mic mixtures.      Sandoz also asserts that its expert
    established that the ’606 application taught that com-
    pounds, including the apremilast-containing racemic mix-
    ture in Example 12, were preferably administered as
    substantially stereomerically pure and that, by the late
    1980s, there was pressure from regulatory agencies, in-
    cluding the FDA, to synthesize new drugs as single enanti-
    omers. Sandoz argues that apremilast being a thalidomide
    analogue taught toward, rather than away from, separat-
    ing the enantiomers in the racemic mixture.
    Sandoz further argues that the district court erred in
    holding that a skilled artisan would not have had a reason-
    able expectation of success in isolating apremilast from a
    known racemic mixture. Sandoz asserts that the ’358 pa-
    tent discloses a racemic mixture containing apremilast in
    Example 12 and states that apremilast can be isolated from
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    AMGEN INC.   v. SANDOZ INC.                                15
    the racemic mixture using chiral chromatography, a tech-
    nique described as well-known in the art. Sandoz also as-
    serts that the court further erred in holding that the ’358
    patent would not have enabled a skilled artisan to isolate
    apremilast without undue experimentation. Sandoz con-
    tends that a finding of obviousness does not require that
    every detail for isolation of a compound be described.
    Sandoz further argues that the court inappropriately relied
    on Amgen’s expert’s comments about difficulties he had ex-
    perienced in isolating enantiomers unrelated to apremilast
    in concluding that isolation of apremilast from the racemic
    mixture would have required undue experimentation.
    Lastly, Sandoz also argues that the district court failed to
    hold Amgen to the statement in the specification that
    methods for isolating apremilast (referred to as Compound
    A in the patent) from the racemate were known in the prior
    art. ’638 patent at col. 9 ll. 9–24.
    Sandoz also contends that the district court erred in ex-
    cluding Celgene’s alleged admission that the European
    counterpart to the ’358 patent discloses stereomerically
    pure apremilast. According to Sandoz, where a represen-
    tation to a foreign patent office is relevant and not unique
    to issues of foreign law, it must be considered. Sandoz ar-
    gues that the court misapplied Federal Rule of Evidence
    Rule 703, which allows experts to rely on otherwise inad-
    missible statements if they meet certain criteria, including
    that an expert would reasonably rely on them, in excluding
    those statements.
    Sandoz further contends that the district court erred in
    its consideration of objective indicia of nonobviousness. In
    analyzing long-felt but unmet need, failure of others, and
    skepticism, Sandoz argues that the court impermissibly
    credited evidence that lacked a nexus to the allegedly novel
    aspects of the ’638 patent claims, namely stereomerically
    pure apremilast. Sandoz concedes that the court did not
    err in considering evidence related to novel features of the
    claim in the unexpected results analysis, but that the court
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    16                                  AMGEN INC.   v. SANDOZ INC.
    did err in basing its analysis on a difference of degree (i.e.,
    that apremilast was 20-fold more potent than the racemic
    mixture), rather than a difference in kind, which would
    have, Sandoz asserts, resulted in a finding of obviousness.
    Amgen responds that the district court did not err in
    finding a lack of a motivation to resolve the racemate to
    achieve the claimed composition of apremilast. Amgen as-
    serts that the prior art taught away from thalidomide ana-
    logues due to safety concerns, and that no known desirable
    property of apremilast would have motivated a skilled ar-
    tisan to defy that teaching to select any of the multitude of
    compounds disclosed in the ’358 patent as a starting point,
    much less the known racemic mixture of Example 12.
    Amgen asserts that, without any biological data, a skilled
    artisan would not have been motivated to pursue a com-
    pound that was likely to be suitable for patient administra-
    tion, and that a skilled artisan would not have been able to
    predict properties of the individual enantiomers in the ra-
    cemic mixture.
    Amgen further contends that the district court did not
    err in finding the absence of a reasonable expectation of
    success in resolving the racemic mixture in Example 12.
    Amgen contends that resolving a racemic mixture is a time-
    consuming, trial-and-error process filled with unpredicta-
    bility, and that the ’358 patent does not provide any specific
    procedure beyond general techniques like chiral chroma-
    tography. Even assuming a reasonable expectation of suc-
    cess in isolating apremilast, Amgen contends that Sandoz
    would have needed to prove a reasonable expectation of
    success in obtaining a compound as claimed, here, apre-
    milast for use in a pharmaceutical composition that is suit-
    able for oral administration to a patient. Amgen asserts
    that there was no reason to believe which enantiomer of
    the Example 12 racemic mixture would have therapeutic
    utility or be useful in a pharmaceutical composition.
    Amgen also contends that Sandoz is incorrect to suggest
    that the court required the ’358 patent to be fully enabled,
    Case: 22-1149     Document: 10    Page: 17   Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                              17
    and instead asserts that Sandoz’s contentions amount to a
    disagreement with the court’s finding that there would
    have been no reasonable expectation of success in isolating
    apremilast.
    Amgen further asserts that the court’s exclusion under
    Federal Rule of Evidence Rule 703 of statements made dur-
    ing European prosecution was not an abuse of discretion.
    Amgen asserts that chemists would not routinely rely on
    the statements of patent lawyers, and so Rule 703 subse-
    quently would not apply. 4
    Amgen also asserts that the court did not err in finding
    strong objective indicia of nonobviousness. In particular,
    Amgen notes that apremilast was unexpectedly potent,
    showing a 20-fold increase in potency relative to the race-
    mic mixture, and that apremilast was met with widespread
    skepticism among industry participants because of its
    structural similarity to thalidomide. Amgen also asserts
    that apremilast met a long-felt need for better psoriasis
    treatments, and it succeeded where many other psoriasis
    drugs have failed.
    We agree with Amgen that the district court did not err
    in finding that claims 3 and 6 of the ’638 patent were not
    shown to have been obvious by a standard of clear and con-
    vincing evidence over the ’358 patent and the ’606 applica-
    tion. We find no clear error in the court’s holding that
    Sandoz did not meet its burden of establishing that the
    prior art gave a skilled artisan reason or motivation to re-
    solve the Example 12 racemic mixture into its enantio-
    mers, to conclude that a skilled artisan would have had
    reason to believe that the desirable properties of the
    4   Given our conclusions, particularly as to the
    strength of the objective evidence of nonobviousness, any
    error in this evidentiary determination—even assuming
    there was error—was harmless.
    Case: 22-1149    Document: 10     Page: 18    Filed: 04/19/2023
    18                                 AMGEN INC.   v. SANDOZ INC.
    Example 12 racemic mixture derived in whole or in part
    from the apremilast isomer, or that a skilled artisan would
    have had a reasonable expectation of success in resolving
    the mixture of Example 12. In making these findings, the
    court appropriately credited the statements of both
    Amgen’s and Sandoz’s experts, finding the statements of
    Amgen’s expert more persuasive. Included in that testi-
    mony was information establishing that resolving a race-
    mic mixture is a difficult process based on trial-and-error
    experimentation and that using chiral chromatography to
    resolve the Example 12 racemic mixture into its enantio-
    mers would require a skilled artisan to find an appropriate
    solvent system for the chiral column, of which there were
    many possible options at the time the invention was made.
    Decision at *14–15.
    The district court did not err in not holding Amgen to
    the statements set forth in the specification regarding iso-
    lating apremilast. See Appellant’s Br. 30–32 (citing Phar-
    maStem Therapeutics, Inc. v. ViaCell, Inc., 
    491 F.3d 1342
    ,
    1362 (Fed. Cir. 2007)). In PharmaStem, we held that it was
    not unfair to hold the inventors to the consequences of their
    admissions because their characterization of the prior art
    references was not unreasonable, and the prior art refer-
    ences themselves strongly supported the interpretation.
    
    491 F.3d at 1362
    . In contrast, here, the district court found
    that Sandoz’s own expert conceded that the formation of
    chiral salts was not a viable method for separating the Ex-
    ample 12 enantiomers contrary to the statement in the
    specification. Decision at *14 (“[B]oth Amgen’s and De-
    fendants’ experts appear to agree that the formation of chi-
    ral salts was not a viable method for separating the
    enantiomers of Example 12, notwithstanding the ’358 Pa-
    tent’s representation to the contrary.”). Considering the
    unpredictable nature of resolving racemic mixtures and the
    district court’s acceptance of Amgen’s expert testimony as
    credible, PharmaStem is distinguishable from this case.
    Case: 22-1149     Document: 10     Page: 19    Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                                19
    We also agree with Amgen that the district court did
    not err in its finding of strong objective indicia of nonobvi-
    ousness. A court’s evaluation of the objective indicia of
    nonobviousness “is not just a cumulative or confirmatory
    part of the obviousness calculus but [rather] constitutes in-
    dependent evidence of nonobviousness.” Ortho-McNeil
    Pharm., Inc. v. Mylan Lab’ys, Inc., 
    520 F.3d 1358
    , 1365
    (Fed. Cir. 2008). The obviousness inquiry is one that is “ex-
    pansive and flexible.” KSR Int’l Co. v. Teleflex Inc., 
    550 U.S. 398
    , 415 (2007). Thus, there are a variety of objective
    indicia of nonobviousness that may inform the circum-
    stances surrounding the origin of the subject matter sought
    to be patented including, but not limited to, “commercial
    success, long-felt but unresolved need, failure of others,
    copying, and unexpected results.” Ruiz v. A.B. Chance Co.,
    
    234 F.3d 654
    , 660 (Fed. Cir. 2000).
    “[A] court need not find that all factors are present to
    determine that the objective considerations support a find-
    ing of nonobviousness.” Mitsubishi Tanabe Pharma Corp.
    v. Sandoz, Inc., 
    533 F. Supp. 3d 170
    , 204 (D.N.J. 2021) (cit-
    ing Graham v. John Deere Co., 
    383 U.S. 1
    , 17–18 (1966)).
    We focus our analysis of the objective indicia of nonobvi-
    ousness on the alleged unexpected potency of apremilast
    discovered relative to the apremilast-containing racemic
    mixture during testing and experimentation. The district
    court found that the trial record established the presence
    of unexpected results, crediting testimony from Dr. Peter
    H. Schafer, a Celgene researcher listed as an inventor on
    the ’638 patent. The court credited the testimony as estab-
    lishing that apremilast was much more effective than the
    apremilast-containing racemic mixture at reducing pro-
    duction of tumor necrosis factor alpha (“TNFα”), a pro-
    moter of the inflammatory response linked to clinical
    problems associated with psoriasis, in murine models. De-
    cision at *17. Dr. Schafer noted a 20-fold difference in po-
    tency between apremilast alone and the apremilast-
    containing racemic mixture and stated that the inventors
    Case: 22-1149    Document: 10      Page: 20     Filed: 04/19/2023
    20                                  AMGEN INC.   v. SANDOZ INC.
    “didn’t expect a 20-fold difference in potency . . . . Nor-
    mally, if a racemate is a 50/50 mixture of two enantiomers,
    you might expect a two-fold difference in potency, all things
    being equal.” 
    Id.
     Dr. Schafer’s credited testimony, in ad-
    dition to a 20-fold difference in potency between apremilast
    and the racemic mixture, is sufficient to establish the pres-
    ence of unexpected results, and thus to support a finding of
    nonobviousness. The district court did not err in so finding.
    There is no specific fold-difference that defines what
    may, or may not, support a finding of nonobviousness. Nor
    do we draw a line between a difference in degree insuffi-
    cient to rebut a showing of obviousness and a difference in
    kind that may be sufficient to do so; each inquiry need be
    fact-specific. Bristol-Myers Squibb Co. v. Teva Pharms.
    USA, Inc., 
    752 F.3d 967
    , 977 (Fed. Cir. 2014) (“‘[D]iffer-
    ences in degree’ of a known and expected property are not
    as persuasive in rebutting obviousness as differences in
    ‘kind’—i.e., a new property dissimilar to the known prop-
    erty.”). Instead, we hold that the 20-fold difference, when
    an otherwise two-fold difference would have been expected
    by the skilled artisan, as shown in this case, suffices to sup-
    port a finding of an unexpected result and thus to affirm
    the district court’s finding that claims 3 and 6 of the ’638
    patent would not have been obvious.
    We further agree with Amgen, and subsequently affirm
    the district court’s finding, that there is no clear error in
    the district court’s finding of a nexus between the unex-
    pected potency of apremilast and claims 3 and 6 of the ’638
    patent. “To accord substantial weight to . . . evidence [of
    objective indicia of nonobviousness], it ‘must have a
    “nexus” to the claims, i.e., there must be “a legally and fac-
    tually sufficient connection” between the evidence and the
    patented invention.’” Quanergy Sys., Inc. v. Velodyne Lidar
    USA, Inc., 
    24 F.4th 1406
    , 1417 (Fed. Cir. 2022) (quoting
    Teva Pharms. Int’l GmbH v. Eli Lilly & Co., 
    8 F.4th 1349
    ,
    1360 (Fed. Cir. 2021)). The court credited evidence estab-
    lishing that apremilast’s potency over the Example 12
    Case: 22-1149     Document: 10     Page: 21     Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                                 21
    racemic mixture derives from the separation of apremilast
    from the other enantiomer. Further, the unexpected prop-
    erties of a compound necessarily have a nexus to that com-
    pound. Thus, we find no clear error in the court’s holding.
    Although we do not find error in the district court’s find-
    ing of unexpected potency of apremilast relative to the ra-
    cemic mixture, and we also find it to be dispositive, we also
    affirm the district court’s findings pertaining to the other
    objective indicia of nonobviousness.
    First, the district court did not err in determining that,
    before apremilast, there was a long-felt need for a psoriasis
    treatment that was suitable for oral administration to a pa-
    tient without the risks and barriers to adherence that were
    common with other psoriasis treatments. In making this
    finding, the court credited expert testimony establishing
    that topical treatments, including creams and ointments,
    had several drawbacks for patients suffering from moder-
    ate to severe psoriasis, including messiness, difficulty of
    application to large areas of affected skin, inability to treat
    associated psoriatic arthritis, and the tendency for topicals
    to lose efficacy over time. The credited expert testimony
    also established that older oral systemic treatments had
    their own compliance barriers, including treatments that
    required lab monitoring before, during, and sometimes af-
    ter treatment, and for being contraindicated in immuno-
    suppressed patients. Decision at *18.
    We also find no clear error with respect to the district
    court’s findings that others in the field had tried and failed
    to develop other PDE4 inhibitors, including expert testi-
    mony establishing that many PDE4 inhibitors failed to pro-
    gress in experimentation and trials or were not sufficiently
    effective at tolerable doses. We also find no clear error in
    the court’s finding that there was industry and regulatory
    skepticism about the safety of apremilast because of its
    structural similarity to thalidomide, evidenced by credited
    expert testimony, 
    id.
     at *20–21, or that Otezla has achieved
    Case: 22-1149    Document: 10      Page: 22    Filed: 04/19/2023
    22                                 AMGEN INC.   v. SANDOZ INC.
    commercial success since receiving FDA approval, based on
    credited expert testimony from Amgen’s economic expert,
    
    id.
     at *21–22.
    In summary, the district court did not err in finding
    that the objective indicia of nonobviousness strongly weigh
    in favor of a finding that claims 3 and 6 of the ’638 patent
    would not have been obvious over the ’358 patent or the
    ’606 application. Accordingly, we affirm the court’s holding
    that Sandoz did not meet its burden to show by clear and
    convincing evidence that claims 3 and 6 of the ’638 patent
    would have been obvious over the ’358 patent and the ’606
    application.
    II. The ’101 Patent
    We next consider Sandoz’s challenge to the district
    court’s determination that it failed to prove that claims 1
    and 15 of the ’101 patent would have been obvious. In es-
    sence, Sandoz challenges the priority date to which claims
    1 and 15 of the ’101 patent are entitled.
    Sandoz argues that the district court erred in finding
    that the ’515 provisional application inherently disclosed
    crystalline Form B of apremilast, and thus provided the
    necessary support for claims 1 and 15 of the ’101 patent to
    be entitled to a March 2002 priority date. Sandoz asserts
    that Amgen was required to show that the ’515 provisional
    application met the written description requirements of 
    35 U.S.C. § 112
     and that it failed to do so. Sandoz contends
    that the ’515 provisional application does not explicitly dis-
    close crystalline Form B of apremilast, and that Amgen is
    barred from relying on inherency because crystalline Form
    B and the claimed X-ray powder diffraction peaks of claims
    1 and 15 were material to the patentability of the claims,
    but an allegedly inherent limitation cannot be material to
    the patentability of the invention. As proof of the materi-
    ality to the patentability of the invention, Sandoz notes
    that Celgene relied on crystalline Form B of apremilast and
    Case: 22-1149     Document: 10    Page: 23    Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                               23
    the peaks recited in the asserted claims to overcome prior
    art rejections during prosecution. J.A. 11383–84.
    Sandoz further notes that, even assuming that crystal-
    line Form B of apremilast and the associated X-ray powder
    diffraction peaks were immaterial to patentability, the dis-
    trict court erred in determining that the ’515 provisional
    application inherently disclosed crystalline Form B of apre-
    milast. Sandoz contends that Amgen was required to es-
    tablish that Example 2 of the ’515 provisional application
    necessarily disclosed crystalline Form B of apremilast, but
    at most, it presented thirteen third-party experiments that
    varied parameters of Example 2, and each experiment pro-
    duced crystalline Form B. That, Sandoz contends, is not
    sufficient to establish inherency.
    Sandoz also argues that the district court erred in dis-
    regarding Celgene’s affirmative admissions made during
    prosecution that Example 2 of the ’515 provisional applica-
    tion could produce crystalline Form C of apremilast, not
    only Form B, using procedures that fall within the confines
    of Example 2 of the ’515 provisional application.
    Amgen responds that the ’515 provisional application
    provides written description support for the ’101 patent
    claims. Amgen asserts that it presented thirteen experi-
    ments replicating Example 2 of the ’515 provisional appli-
    cation under a variety of conditions and that Sandoz did
    not produce any studies or findings showing that Example
    2 of the ’515 provisional application failed to produce crys-
    talline Form B of apremilast.
    Amgen further contends that the prosecution state-
    ments were made in error because Form C requires tolu-
    ene, which is not within the scope of Example 2. Amgen
    thus asserts that the procedure in Example 2 of the ’515
    provisional application necessarily discloses the claimed
    invention and inherently discloses crystalline Form B of
    apremilast. Thus, Amgen’s argument concludes that
    Case: 22-1149    Document: 10      Page: 24     Filed: 04/19/2023
    24                                  AMGEN INC.   v. SANDOZ INC.
    claims 1 and 15 are entitled to the priority date of the ’515
    provisional application.
    We agree with Amgen that the district court did not
    clearly err in finding that claims 1 and 15 of the ’101 patent
    were entitled to the March 2002 priority date (i.e., the filing
    date of the ’515 provisional application). As a starting
    point, the parties did not dispute that the ’515 provisional
    application, filed on March 20, 2002, discloses a synthetic
    procedure for preparing apremilast in Example 2. Amgen
    provided the results of over a dozen experiments following
    the procedure in Example 2 of the ’515 provisional applica-
    tion, all of which resulted in crystalline Form B of apre-
    milast. In response, Sandoz did not produce the results of
    any experiments showing that Example 2 of the ’515 provi-
    sional application did not produce crystalline Form B of
    apremilast. Thus, although Sandoz alleges that Example
    2 may have been capable of producing a crystalline Form
    other than Form B, it provided no evidence to establish
    that contention.
    We also note that the district court based its holding on
    the finding that the ’515 provisional application inherently
    disclosed crystalline Form B of apremilast. In doing so, the
    district court relied on Yeda Research & Development Co.
    v. Abbott GmbH & Co. KG, 
    837 F.3d 1341
     (Fed. Cir. 2016),
    a case cited to us by both Sandoz and Amgen on appeal.
    Appellant’s Br. 55; Cross-Appellant’s Br. 74–75. Demon-
    strating inherent disclosure requires meeting a stringent
    standard. See, e.g., Bettcher Indus., Inc. v. Bunzl USA, Inc.,
    
    661 F.3d 629
    , 639 (Fed. Cir. 2011) (“Inherency can be es-
    tablished when ‘prior art necessarily functions in accord-
    ance with, or includes, the claimed limitations,’” but “‘may
    not be established by probabilities or possibilities.’” (first
    quoting In re Cruciferous Sprout Litig., 
    301 F.3d 1343
    ,
    1349 (Fed. Cir. 2002); and then quoting In re Oelrich, 
    666 F.2d 578
    , 581 (CCPA 1981))). But in Yeda, 
    837 F.3d at
    1345–46, we held that an earlier-filed application con-
    tained adequate written description of a claimed protein
    Case: 22-1149     Document: 10    Page: 25    Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                               25
    even though the application did not explicitly disclose the
    complete N-terminus sequence of that protein. Here we
    need not reach the issue of inherent disclosure because the
    trial evidence credited by the district court, including the
    experiment-related evidence introduced by Amgen (and the
    lack of contrary evidence from Sandoz) as well as testimony
    of Amgen’s expert, see Decision at *36, establishes that
    crystalline Form B of apremilast is actually disclosed in the
    ’515 provisional application. A finding of inherency is not
    required, and therefore, the district court did not clearly
    err in holding that claims 1 and 15 of the ’101 patent were
    entitled to the March 2002 priority date.
    The district court adequately considered Amgen’s un-
    contradicted trial testimony that crystalline Form C of
    apremilast requires the use of a toluene solvent, which be-
    comes a part of the crystal structure that comprises crys-
    talline Form C of apremilast. As the court noted, and as
    Amgen’s expert stated, toluene is not mentioned in Exam-
    ple 2 of the ’515 provisional application, and thus the court
    did not clearly err in finding that Celgene had made a mis-
    take in asserting to the European Patent Office that Exam-
    ple 2 of the ’515 provisional application could produce
    forms of apremilast other than crystalline Form B.
    We further note, as the district court found, that
    Sandoz fails to argue that any prior art from before March
    2002 renders the ’101 patent claims invalid for obvious-
    ness, and thus its arguments reduce to a question whether
    claims 1 and 15 of the ’101 patent are entitled to the March
    2002 priority date. We therefore affirm the court’s holding
    that Sandoz failed to prove that claims 1 and 15 of the ’101
    patent were not entitled to the March 2002 priority date or
    that they are otherwise not invalid as obvious.
    III. The ’541 Patent
    We finally consider Amgen’s cross-appeal challenge to
    the district court’s determination that claims 2, 19, and 21
    Case: 22-1149   Document: 10     Page: 26    Filed: 04/19/2023
    26                                AMGEN INC.   v. SANDOZ INC.
    of the ’541 patent would have been obvious over Papp,
    Schett, and Pathan.
    Amgen argues that the district court relied on general-
    ized characterizations of a dose-titration schedule and in-
    appropriately analyzed the “gist” of the invention rather
    than the invention as claimed. Amgen argues that this er-
    ror resulted in a failure to make express findings that a
    skilled artisan would have been motivated to achieve the
    claimed dosage schedule. Amgen also asserts that the
    court’s motivation-to-combine findings did not address why
    a skilled artisan would have had good reason to pursue cer-
    tain features of the claimed schedule, including a dosing
    schedule with asymmetric dosing versus symmetric dosing,
    a dosing schedule that mixes once-a-day and twice-a-day
    dosing, or using a six-day dosing schedule, all of which
    were absent in the prior art. Amgen further asserts that
    the court’s obvious-to-try statements do not remedy the al-
    leged errors in the court’s motivation-to-combine analysis.
    Amgen contends that evidence proffered in support of an
    obvious-to-try theory must show that the possible options
    skilled artisans would have encountered were finite, small,
    or easily traversed. Cross-Appellant’s Br. 86 (citing In re
    Cyclobenzaprine Hydrochloride Extended-Release Capsule
    Pat. Litig., 
    676 F.3d 1063
    , 1072 (Fed. Cir. 2012)). Amgen
    notes that its expert alleged that there were over 70,000
    possible six-day dose-titration schedules. To determine
    whether any were efficacious and tolerable, Amgen con-
    tends, a skilled artisan would have had to administer each
    schedule to patients in a controlled setting.
    Sandoz responds that the district court did not err in
    determining that claims 2, 19, and 21 of the ’541 patent
    would have been obvious over the prior art or in crediting
    expert testimony stating that dose-titration modification
    would have been routine to a skilled artisan. Sandoz as-
    serts that a skilled artisan would have been motivated to
    modify the dosing schedule in Papp, which begins with two
    days of two 10 mg doses of apremilast, followed by two days
    Case: 22-1149     Document: 10     Page: 27    Filed: 04/19/2023
    AMGEN INC.   v. SANDOZ INC.                                27
    of two 20 mg doses of apremilast, and followed by a fifth
    day of two doses of 30 mg of apremilast, Decision at *31; see
    also J.A. 18583; Papp at 739, to further reduce known side
    effects and would have had a reasonable expectation of suc-
    cess in doing so. Sandoz further contends that the court
    did not reduce the claims to a “gist” in its motivation-to-
    combine analysis, and even if it did, the process of the
    claims would have been obvious to try. Amgen further as-
    serts that there was evidence that a skilled artisan would
    have been motivated to ease the dose-escalation burden on
    patients to reduce the risk of known side effects by moving
    to a one-step-at-a-time regimen starting at 10 mg apre-
    milast per day and increasing by 10 mg per day. Sandoz
    asserts that that logic naturally leads to the claimed dose-
    titration regimen.
    Sandoz further argues that the court appropriately re-
    jected as inflated the estimate that there were over 70,000
    possible dose-titration schedules. Sandoz asserts that the
    faulty estimate was based on two incorrect assumptions:
    (1) that there were six available dose strengths of apre-
    milast instead of three and (2) that a skilled artisan would
    not have preferred an evenly titrated dose, each of which is
    incorrect. Sandoz concludes that correction of these as-
    sumptions reduces the possible estimate to eighteen possi-
    ble dose-titration schedules.
    We agree with Sandoz that the district court did not err
    in holding that claims 2, 19, and 21 of the ’541 patent would
    have been obvious over the prior art, principally Papp and
    Schett. The court credited expert testimony establishing
    that it was well within a skilled artisan’s ability to titrate
    an apremilast dose for a patient presenting with psoriasis
    and that doing so would have been a routine aspect of treat-
    ing psoriasis. Decision at *31. The court did not err in
    finding that the twice-daily fixed apremilast dosing sched-
    ule, initiating treatment at 10 mg and increasing toward a
    30 mg twice-daily target dose in 10 mg increments, was
    rendered obvious by the prior art. Further, the court
    Case: 22-1149    Document: 10     Page: 28    Filed: 04/19/2023
    28                                 AMGEN INC.   v. SANDOZ INC.
    appropriately noted that, when prescribing apremilast or
    other drugs with known dose-dependent adverse events in
    the early weeks of treatment, a skilled artisan would have
    been motivated to use the Papp schedule as a starting point
    and extend it to titrate the dosing up in smaller amounts.
    We have previously held that varying a dose in re-
    sponse to the occurrence of side effects is a well-known,
    standard medical practice that may well lead to a finding
    of obviousness. Genentech, Inc. v. Sandoz Inc., 
    55 F.4th 1368
    , 1376–77 (Fed. Cir. 2022) (“[I]t is worth noting our in-
    itial perception that, as the district court noted, varying
    doses in response to the occurrence of side effects would
    seem to be a well-established, hence obvious, practice.
    Thus, claiming it as an invention would appear to be at best
    a long shot.”). We note here, as in Genentech, that varying
    a dose in response to the occurrence of side effects is well-
    known and obvious to the skilled artisan. Accordingly, we
    find no error in the district court’s findings that claims 2,
    19, and 21 would have been obvious over Papp, Schett, and
    Pathan.
    CONCLUSION
    We have considered the parties’ remaining arguments
    but find them unpersuasive. For the foregoing reasons,
    we affirm the district court’s decision.
    AFFIRMED
    COSTS
    No costs.