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阿尔兹海默病治疗即将进入新时代,Aβ靶点研发现状与产业链投资机会梳理Silver

Lining

Emerges

inAlzheimer

’s

Disease

Therapy,TheCurrent

R&DStatus

ofAβ-targeting

Therapy

andtheInvestment

Opportunities

oftheIndustrial

Chain2023年6月25日概述•

阿尔兹海默病(AD)患者近8000万,在研药物靶点丰富。AD以认知障碍为临床特征并呈谱系分布,Aβ阳性为AD患者诊断的核心标志。全球近5000万痴呆患者、近1亿MCI患者,患者人数随社会老龄化持续增加。根据Aβ阳性率计算,我们认为目前全球~8000万AD患者。AD病生理机制复杂、在研药物靶点涉及多种通路,主要包括Aβ、tau及炎症,其中抗Aβ单抗研发进度最快。•

抗Aβ单抗Aducanumab已获FDA加速批准,但疗效争取巨大,CMS报销范围限制商业化空间。由于临床试验显示药物的Aβ斑块清除作用(替代终点),Aducanumab于2021年6月获FDA加速批准,为首款上市的抗Aβ单抗。Aducanumab的疗效争议巨大,采纳利益相关方意见及经同行评议的文件后,医疗保险和医疗补助服务中心(CMS)规定

“针对抗Aβ单抗,在FDA加速批准的情况下,CMS仅报销参与FDA或NIH批准的临床试验的Medicare覆盖患者,限制了Aducanumab的商业化;而对FDA完全批准的抗Aβ单抗,CMS将报销范围拓展至纳入CMS批准的临床研究的Medicare覆盖患者,以进一步评估药物在真实世界中的疗效”。•

2款抗Aβ单抗的确证性III期成功,Lecanemab有望获FDA首次完全批准。Lecanemab和Donanemab分别为Eisai/Biogen及Eli

Lilly研发的两款抗Aβ单抗。近来,两款药物的确证性III期临床先后达到主要临床终点。Lecanemab已于2023年1月获FDA加速批准,并于2023年6月FDA咨询会议上得到完全获批的全票支持;其PDUFA日为2023年7月6日,有望成为首个FDA完全批准的抗Aβ单抗。•

抗Aβ单抗市场规模存在较大变数,取决于审评和医保政策变化。我们认为,1)在悲观情形下,抗Aβ单抗获FDA加速批准,CMS仅报销NIH或FDA批准的临床试验中Medicare覆盖患者,假设抗Aβ单抗渗透率0.2%,美国市场规模为3亿美元;2)中性情形下,抗Aβ单抗获FDA完全批准,CMS仅报销CMS批准的临床试验中Medicare覆盖患者,假设抗Aβ单抗渗透率5.0%,美国市场规模为87亿美元;3)乐观情形下:抗Aβ单抗获FDA完全批准,CMS报销Medicare覆盖患者,假设抗Aβ单抗渗透率9.0%

,157亿美元。抗Aβ单抗在欧洲市场的审评及商业化前景尚不明朗,因此我们未予预测。•

我们认为在监管完全批准情况下,美国抗Aβ单抗将新增产能需求近10万升。考虑美国660万AD源性MCI及轻度AD患者基数,假设Lecanemab的治疗渗透率为2%,Donanemab的治疗渗透率为1.5%,根据我们的假设与测算,所需的生物药产能需求达9.3万升。For

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2全球现有~8000万人患阿尔兹海默病,Aβ是确诊核心依据•

阿尔兹海默病(AD)主要表现为认知损害的连续谱,Aβ阳性是AD确诊的核心依据。AD是一种神经退行性疾病,患者存在突出的认知损害。AD的认知损害程度呈谱系分布,包括临床前AD(认知功能正常)、AD源性轻度认知损害(MCI)、AD源性痴呆多个阶段;AD源性痴呆可进一步划分为轻、中、重度。根据ATN诊断框架,对于PET或脑脊液检测提示脑内Aβ阳性的患者,无论患者认知功能正常、轻度认知损害还是痴呆,都可以确诊为AD。•

全球痴呆+MCI患者目前~1.5亿,至2050年~3.5亿。全球老龄化加速,根据WHO《2023年世界社会报告》,全球65岁以上老年人~7.6亿,预计至2050年增长至~15亿。在人口老龄化背景下,痴呆及轻度认知损害患者数将增加;2018年全球约5000万人患有痴呆,预计至2050年,痴呆患者数将翻至3倍。此外,65岁以上人口中约10-15%存在MCI,计算得65岁以上MCI患者目前~1亿,至2025年~2亿。•

痴呆+MCI患者的Aβ阳性率45%~62%,存在种族差异。美国大样本队列研究的数据分析显示,经PET扫描,痴呆及MCI患者的Aβ阳性率存在种族差异,亚裔45.4%、黑人54.1%、西班牙裔54.5%、白人57.8~61.8%。图.AD存在认知损害的连续谱及Aβ生物标志物表.痴呆+MCI患者的Aβ阳性率45%~62%亚裔黑人54.1%42.4%65.5%西班牙裔白人痴呆及MCIMCI45.4%36.3%55.9%54.5%46.1%61.6%57.8%~61.8%49.3%~53.4%63.4%~68.9%痴呆HighRiskPreclinical

ADMCIMildADModerateSevereFor

full

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methodologies

andtarget

priceformationon

allHTIratedstocks,

pleasereferto

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资料:2023年世界社会报告(WHO),

Lancet

2021;

397:

1577–90,

CNSSpectrums

(2019),

24,

78–87

,Alzheimers

Dement.

2018

Apr;14(4):483-491,Eisai公开演示材料,JAMA

Neurol.2022;79(11):1139-1147,HTI3抗Aβ单抗可能通过快速清除Aβ斑块带来临床获益•

清除斑块的抗Aβ单抗可能延缓认知下降。从淀粉样前体蛋白(APP)到最终淀粉样斑块的形成会经历可溶性Aβ单体、Aβ寡聚体、原纤维几个主要的中间过程。与靶向Aβ单体的Solanezumab、Crenezumab相比,靶向Aβ原纤维的Lecanemab及靶向斑块特异的N3pG-Aβ的Donanemab可以清除Aβ斑块,在临床试验中亦展现出认知下降延缓的临床获益,提示Aβ斑块清除有望转化为认知症状的临床获益。•

Aβ斑块清除与临床应答之间可能存在滞后效应。2022年Eric

Karran博士和Bart

De

Strooper教授发表在Nature

Review

Drug

Discovery的一篇观点文章认为,使用抗Aβ单抗后,AD患者出现临床应答较Aβ斑块清除滞后:当抗Aβ单抗将Aβ斑块水平降低至足够低的水平(<20

CL)后,大脑开始逐步恢复“稳态”,从而在Aβ斑块清除一段时间后,滞后地表现出认知衰退延缓的临床获益。这提示Aβ清除越快,临床试验观察到的认知下降延缓可能越突出。•

恒瑞医药的SHR-1707是中国企业研发的首款抗Aβ单抗。根据公司新闻,SHR-1707可以阻止Aβ斑块的组装或激活小胶质细胞吞噬各种形式的Aβ,从而降低AD患者脑内的Aβ水平,延缓患者认知功能退化并控制疾病进展。2023年3月22日,SHR-1707的Ib期临床在中国完成了首例患者入组及给药。图.AD的临床应答可能滞后于Aβ斑块清除表.全球在研抗Aβ单抗在研(含上市申请)6款,国内企业恒瑞医药布局药物名称研发企业Eisai/BiogenEisai/BiogenEli

Lilly海外研发进度

海外公示时间

中国研发进度

中国公示时间AducanumabLecanemabDonanemabRemternetugABBV-916获批上市获批上市BLA2021/6/72023/1/6INDBLAIII期III期/2023/4/272022/12/222021/10/262022/7/142022/3/212020/11/172022/3/282020/12/12022/8/18Eli

LillyIII期2023/2/22AbbVieII期/TrontinemabPRX012RocheI/II期I期//Prothena

Corp恒瑞医药//SHR-1707I期I期2021/4/26For

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andtarget

priceformationon

allHTIratedstocks,

pleasereferto

the

latest

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6资料:insight数据库,Karran,

E.,

&DeStrooper,B.

(2022).

Nature

reviews.Drug

discovery,

21(4),

306–318.,各公司官网,HTIAducanumab为FDA首个加速获批的抗Aβ单抗,临床获益惹争议•

Aducanumab为首个FDA批准上市的抗Aβ单抗,获批争议巨大。

Aducanumab于2021年6月获FDA加速批准,主要基于ENGAGE、EMERGE

2项平行III期临床中,Aducanumab治疗后AD患者脑内Aβ斑块减少的替代终点。然而针对Aducanumab治疗后Aβ斑块减少是否能够转化为临床上认知及功能的改善,ENGAGE和EMERGE两项研究结果并不一致,引发广泛的争议:仅EMERGE研究的高剂量组结果提示临床获益,并且为经过无效性分析终止试验给药、揭盲后随访的结果。•

考虑抗Aβ单抗临床获益尚不确切,美国医保与医助服务中心(CMS)决定限制Medicare报销范围。2022年4月,CMS发文明确抗Aβ单抗的Medicare报销范围,若抗Aβ单抗仅FDA加速批准下,Medicare只报销参加FDA或NIH批准的临床试验的Medicare医保患者;若完全获批,报销范围扩大至参加CMS批准临床研究的Medicare患者,以进一步评估药物在真实世界中的疗效。2022年10月,Lecanemab的确证性III期临床CLARITY

AD达到主要临床终点2023年5月,Donanemab的确证性III期临床TRAILBLAZER-ALZ2达到主要临床终点2021年6月,Aducanumab获FDA加速批准2023年1月,Lecanemab获FDA加速批准2023年1月,Donanemab申请加速批准被FDA拒绝(随访52周不满100例)2023年6月,FDA咨询会议上,6:0一致认为Lecanemab的CLARITY

AD数据支持完全获批2023年7月6日Lecanemab的PDUFA日若FDA认为没有明确显示临床获益/加速批准,Medicare仅覆盖参加FDA或NIH批准的临床试验的Medicare医保患者2022年4月,CMS2023年4月,CMS公开表示发文明确抗Aβ单抗的报销限制抗Aβ单抗完全获批后,CMS覆盖范围会变广若获得FDA传统批准(完全获批),Medicare将扩大覆盖至参与CMS批准临床研究的Medicare医保患者。这类研究包括日常诊疗及注册的数据收集。For

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disclosureofrisks,valuation

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andtarget

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allHTIratedstocks,

pleasereferto

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7资料:AlzheimersDement.

2021

Apr;17(4):692-695.,CMS.gov

(20220407新闻),Eisai官网新闻,礼来官网,HTILecanemab、Donanemab确证性III期成功,有望获FDA完全批准•

Lecanemab完全获批获FDA咨询会全票支持,PDUFA日为2023年7月6日。Lecanemab的确证性III期CLARITY

AD达到主要临床终点,

Lecanemab组治疗78周的认知及功能较安慰剂组下降延缓27%

(CDR-SB评分)

,达到统计学显著性;治疗3月后PET扫描的Aβ斑块较对照组显著减少,提示清除Aβ斑块的抗Aβ单抗可以带来一定临床获益。Lecanemab已于2023年1月获FDA加速批准,并于2023年6月FDA咨询会议上得到完全获批的全票支持。Lecanemab的PDUFA日为2023年7月6日,有望成为首个FDA完全批准的抗Aβ单抗。•

Donanemab加速获批被拒,确证性III期成功。Donanemab寻求用II期数据支持加速获批,但由于随访52周的患者数不足100例而被FDA拒绝。2023年5月,

Donanemab的确证性III期临床TRAILBLAZER-ALZ

2达到主要临床终点。该研究结果显示,

Donanema组的认知及功能较安慰剂组下降延缓35%(iARDS评分),达到统计学显著性。我们认为,Donanemab亦有机会获得FDA完全批准。2022年10月,Lecanemab的确证性III期临床CLARITYAD达到主要临床终点2023年5月,Donanemab的确证性III期临床TRAILBLAZER-ALZ2达到主要临床终点2021年6月,Aducanumab获FDA加速批准2023年1月,Lecanemab获FDA加速批准2023年1月,Donanemab申请加速批准被FDA拒绝(随访52周不满100例)2023年6月,FDA咨询会议上,6:0一致认为Lecanemab的CLARITY

AD数据支持完全获批2023年7月6日Lecanemab的PDUFA日若FDA认为没有明确显示临床获益/加速批准,Medicare仅覆盖参加FDA或NIH批准的临床试验的Medicare医保患者2022年4月,CMS2023年4月,CMS公开表示发文明确抗Aβ单抗的报销限制抗Aβ单抗完全获批后,CMS覆盖范围会变广若获得FDA传统批准(完全获批),Medicare将扩大覆盖至参与CMS批准临床研究的Medicare医保患者。这类研究包括日常诊疗及注册的数据收集。For

full

disclosureofrisks,valuation

methodologies

andtarget

priceformationon

allHTIratedstocks,

pleasereferto

the

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fullreportonourwebsiteat

8资料:AlzheimersDement.

2021

Apr;17(4):692-695.,CMS.gov

(20220407新闻),Eisai官网新闻,礼来官网,HTILecanemab、Donanemab延缓认知下降,ARIA为主要副反应药品名AducanumabEisai/BiogenLecanemabEisai/BiogenClarity

ADPhase

IIIDonanemabEli

LillyTRAILBLAZER-ALZ

2研发机构临床研究研究阶段EMERGEPhase

IIIENGAGEPhase

IIIPhase

IIIMCI+轻度痴呆,Aβ阳性中等水平的tau患者特征MCI+轻度痴呆,Aβ阳性MCI+轻度痴呆,Aβ阳性MCI+轻度痴呆,Aβ阳性治疗方案分组18月,Q4W18月,Q4W18月,10mg/kg

Q2W18月,1400mg

Q4W高剂量低剂量54326.3安慰剂54826.42.47高剂量低剂量54726.4安慰剂治疗组859安慰剂治疗组安慰剂样本量54726.32.5155526.42.4054526.42.4087525.63.22118222.9基线,MMSE基线,CDR-SB25.52.462.433.17//18个月随访,认知及功能较安慰剂组下降延缓高剂量

CDR-SB:22%(*)低剂量

CDR-SB:15%高剂量

CDR-SB:-2%低剂量

CDR-SB:12%iADRS:35%(*)CDR-SB:36%(*)CDR-SB:27%(*)18个月随访,认知较安慰剂组下降延缓高剂量

ADAS-Cog13:

27%(*)低剂量

ADAS-Cog13:

14%高剂量

ADAS-Cog13:

11%低剂量

ADAS-Cog13:

11%ADAS-Cog14:

26%(*)ADAS-Cog13:

32%(*)ADCS-iADL:40%(*)18个月随访,日常功能较安慰剂组下降延缓高剂量

ADCS-ADL-MCI:40%(*)低剂量

ADCS-ADL-MCI:16%高剂量

ADCS-ADL-MCI:18%低剂量

ADCS-ADL-MCI:18%ADCS-ADL-MCI:36%(*)Lecanemab组Aβ斑块减少Aducanumab组Aβ斑块减少Aducanumab组Aβ斑块减少斑块清除率:6月

36%,12月

71%生物标志物,Aβ斑块减少安全性,ARIA第6月随访两个剂量组均较安慰剂组显著下

第6月随访两个剂量组均较安慰剂组显著下

第3月时组间差异达到统计学显著性,降,高剂量组18月较基线下降71%ARIA-E:35%vs

26%vs

2%ARIA-微出血:20%vs

16%vs

7%降,高剂量组18月较基线下降59%ARIA-E:36%vs

26%vs

3%ARIA-微出血:19%vs

16%vs

6%第18月两组相差-59.1CLARIA-E:24.0%,有症状:

6.1%ARIA-H:31.4%(对照组

13.6%)严重ARIA:1.6%ARIA-E:12.6%vs

1.7%,有症状:

2.8%ARIA-局限性浅表铁沉着:

13%vs

10%vs

3%

ARIA-局限性浅表铁沉着:

16%vs

9%vs

2%

ARIA-H:17.3%vs

9.0%,有症状:

0.7%有症状ARIA:20%vs

21%vs

4%严重ARIA:1.5%vs

0.9%vs

0.2%有症状ARIA:209vs

16%vs

5%严重ARIA:1.4%vs

0.4%vs

0.2%严重ARIA-E:0.8%,严重ARIA-H:0.6%归因ARIA的8.7%Eli

LillyNews20230503:

2例安全性,输注相关反应资料//26.4%vs

7.4%,SAE:

1.2%JPrev

Alz

Dis

2022NEJM2023For

full

disclosureofrisks,valuation

methodologies

andtarget

priceformationon

allHTIratedstocks,

pleasereferto

the

latest

fullreportonourwebsiteat

9资料:文献整理,礼来官网新闻,Eisai公开演示材料,HTI;注:1)表格中红色表示主要临床终点,2)*表示达到统计学显著性抗Aβ单抗的美国市场规模取决于审评和医保•

我们基于美国现有1100万AD源性MCI及AD痴呆患者,其中MCI及轻度痴呆占比60%,年治疗费用26,500美元,并根据FDA批准形式及CMS报销范围,对抗Aβ单抗美国市场规模做出三种假设,得到抗Aβ单抗市场规模分别为3亿、87亿、157亿美元:–––悲观情形下:抗Aβ单抗获FDA加速批准,CMS仅报销NIH或FDA批准的临床试验中Medicare覆盖患者,假设抗Aβ单抗渗透率0.2%;中性情形下:抗Aβ单抗获FDA完全批准,CMS仅报销CMS批准的临床试验中Medicare覆盖患者,假设抗Aβ单抗渗透率5.0%;乐观情形下:抗Aβ单抗获FDA完全批准,CMS报销Medicare覆盖患者,假设抗Aβ单抗渗透率9.0%;•

我们认为,抗Aβ单抗在欧洲的市场空间尚不明朗。在CLARITY

AD研究中,Lecanemab治疗组CDR-SB评分较安慰剂组仅少下降0.45分;考虑Lecanemab:1)治疗前做脑脊液或PET扫描确证Aβ阳性;2)治疗后~13%出现ARIA-E并且需要通过MRI进行监测;3)Lecanemab在美国年治疗费用26,500美元,我们认为Lecanemab的实际临床应用可能需要有经验的医护人员、较多MRI及PET影像学检测、以及昂贵的检测和治疗费用。在对诊疗价格-临床获益较为敏感的欧洲市场,有欧洲神经病学专家及研究者在近期接受Reuters访谈中认为,Lecanemab在欧洲有可能无法获批,或上市后难以广泛应用。表.抗Aβ单抗的美国市场规模取决于FDA审评和CMS报销范围,三种情形下分别为3/8/157亿美元悲观假设中性假设乐观假设假设情形FDA加速批准FDA完全批准FDA完全批准CMS仅报销NIH或FDA批准的临床试验中Medicare覆盖患者CMS仅报销CMS批准的临床试验中Medicare覆盖

CMS报销所有Medicare覆盖患者患者AD源性MCI及AD痴呆(万人)MCI及轻度痴呆占比(%)假设:抗Aβ单抗渗透率(%)抗Aβ单抗年治疗患者数(万人)年治疗费用(美元)110060%0.2%1.3110060%110060%5.0%33.09.0%59.426,500326,5008726,500157市场规模(亿美元)For

full

disclosureofrisks,valuation

methodologies

andtarget

priceformationon

allHTIratedstocks,

pleasereferto

the

latest

fullreportonourwebsiteat

10资料:2023

ALZHEIMER’S

DISEASEFACTSANDFIGURES,

Eisai官网,Reuters(20230613),HTI美国抗Aβ单抗产能需求:假设渗透率1.5%-2%,所需生物药产能~10万升•考虑美国660万AD源性MCI及轻度AD患者基数,假设Lecanemab的治疗渗透率为2%,Donanemab的治疗渗透率为1.5%,根据我们的假设与测算,所需的生物药产能需求达9.3万升。Biogen/卫材礼来LecanemabDonanemab1400

mg

SCq4w药名10mg/kgq2w剂量,用药方案g/

/70kg计算抗体需要量(

年),平均体重按18.266018.2660AD美国

患者(万人)1%假设

:渗透率(

)2%2%实际治疗人数(万人)13.2240240075%9.9g需要的抗体量(

)180180075%2%假设

:纯化得率(

)g需要的上游原液量(

)32032004240240043g/L假设

:表达量()L需要的总反应体积(

)80080080%60060080%4假设

:产能利用率5假设

:制剂产率95%95%6假设

:年生产批次2020(所需总产能

万升)5.34.0For

full

disclosureofrisks,valuation

methodologies

andtarget

priceformationon

allHTIratedstocks,

pleasereferto

the

latest

fullreportonourwebsiteat

11资料:HTIAPPENDIX1Summary•

Approximately

80

million

people

are

living

with

Alzheimer‘s

disease

(AD),

targets

diverse

in

AD

therapies

under.

AD

is

characterized

by

a

spectrum

of

cognitiveimpairment,

and

positivity

is

the

core

marker

of

diagnosis

in

AD

patients.

There

are

nearly

50

million

dementia

patients

and

nearly

100

million

MCI

patientsworldwide,

and

the

number

of

patients

is

expected

to

continue

to

increase

with

the

aging

of

society.

Based

on

the

positivity

rate,

we

believe

that

there

are

currently~80

million

AD

patients

globally.

The

pathophysiological

mechanism

of

AD

disease

is

complex,

and

the

drug

targets

under

development

involve

a

variety

of

pathways,mainly

including

Aβ,

tau

and

inflammation,

among

which

anti-Aβ

monoclonal

antibody

(mAb)

is

the

leading

therapeutic

approach

in

development.•

The

anti-Aβ

mAb

Aducanumab

received

accelerated

approval

from

the

FDA

with

huge

controversy

in

efficacy,

the

coverage

of

CMS

limits

its

commercializationopportunity.

Based

on

clinical

trials

showing

the

drug‘s

plaque

clearance

(a

surrogate

endpoint),

Aducanumab

received

accelerated

approval

from

the

FDA

in

June2021,

making

it

the

first

anti-Aβ

mAb

ever

approved.

The

efficacy

of

Aducanumab

is

highly

controversial,

and

following

stakeholder

comment

and

peer-revieweddocuments,

the

Centers

for

Medicare

and

Medicaid

Services

(CMS)

finalized

that

"for

anti-Aβ

mAbs

that

receive

an

accelerated

FDA

approval,

Medicare

will

cover

in

thecase

of

FDA

or

National

Institutes

of

Health

(NIH)

approved

trials”,

therefore

limiting

the

commercialization

of

Aducanumab;

but

“those

received

traditional

approvalfrom

the

FDA

under

CED,

CMS

will

provide

enhanced

access

and

coverage

for

people

with

Medicare

participating

in

CMS-approved

studies”,in

which

case,

the

data

maybe

used

to

assess

whether

outcomes

seen

in

carefully

controlled

clinical

trials

are

reproduced

in

the

real-world.•

The

confirmatory

phase

III

of

the

two

anti-Aβ

mAb

was

successful,

and

Lecanemab

is

expected

to

be

the

first

to

receive

FDA’s

full

approval.

Lecanemab

andDonanemab

are

2

anti-Aβ

mAb

developed

by

Eisai/Biogen

and

Eli

Lilly,

respectively.

Recently,

the

two

drugs

have

reached

the

primary

endpoint

in

confirmatory

PhaseIII

trial.

Lecanemab

has

received

accelerated

FDA

approval

in

January

2023

and

received

unanimous

support

on

receiving

full

approval

in

a

FDA

advisory

meeting

June2023.

The

PDUFA

date

for

Lecanemab

is

July

6,

2023,

and

it

is

expected

to

be

the

first

anti-Aβ

mAb

fully

approved

by

the

FDA.•

Themarket

size

of

the

anti-Aβ

mAb

ishighly

variable,

depending

onregulatory

reviewandCMSpolicies.

We

believe

that,

1)

in

a

bear

case,

anti-Aβ

mAb

received

onlyaccelerated

FDA

approval,

CMS

only

reimburses

Medicare

patients

participating

NIH

or

FDA-approved

clinical

trials.

Assuming

an

anti-Aβ

mAb

penetration

rate

of

0.2%,and

the

US

market

size

is

$300

million.

2)

In

a

neutral

case,

the

anti-Aβ

mAb

is

fully

approved

by

the

FDA,

and

CMS

reimburses

Medicare

patients

attending

CMS-approved

clinical

studies.

Assuming

that

the

penetration

rate

of

anti-Aβ

mAb

is

5.0%,

and

the

US

market

size

is

$8.7

billion.

3)

In

a

bull

case,

anti-Aβ

mAb

is

fullyapproved

by

the

FDA,

and

CMS

reimburses

all

Medicare

patients.

Assuming

that

the

penetration

rate

of

anti-Aβ

mAb

is

9.0%,

and

the

US

market

size

is

$15.7

billion.The

prospect

in

regulatory

review

and

commercialization

of

anti-Aβ

mAb

in

Europe

are

so

far

unclear,

therefore

are

not

included.•

We

believe

that

with

full

regulatory

approval,

US

anti-Aβ

mAb

will

increase

capacity

demand

by

nearly

100,000

liters.

Considering

the

US

patient

base

of

6.6

millionAD-derived

MCI

and

mild

AD,

assuming

a

therapeutic

penetration

rate

of

2%

for

Lecanemab

and

a

1.5%

for

Donanemab,

our

assumptions

and

calculations

indicate

thatthe

required

biologic

capacity

demand

is

93,000

liters.12APPENDIX2重要信息披露本研究报告由(HTIJKK)和动。国际分销,国际是由国际研究有限公司(HTIRL),Haitong

Securities

India

Private

Limited

(HSIPL),Haitong

International

Japan

K.K.国际证券集团(HTISG)各成员分别在其许可的司法管辖区内从事证券活国际证券有限公司(HTISCL)的证券研究团队所组成的全球品牌,IMPORTANT

DISCLOSURESThis

research

report

is

distributed

by

Haitong

International,

a

global

brand

name

for

the

equity

research

teams

of

Haitong

International

Research

Limited

(“HTIRL”),Haitong

Securities

India

Private

Limited

(“HSIPL”),

Haitong

International

Japan

K.K.

(“HTIJKK”),

Haitong

International

Securities

Company

Limited

(“HTISCL”),

and

anyother

members

within

the

Haitong

International

Securities

Group

of

Companies

(“HTISG”),

each

authorized

to

engage

in

securities

activities

in

its

respectivejurisdiction.HTIRL分析师认证Analyst

Certification:我,孟科含,在此保证(i)本研究报告中的意见准确反映了我们对本研究中提及的任何或所有目标公司或上市公司的个人观点,并且(ii)我的报酬中没有任何部分与本研究报告中表达的具体建议或观点直接或间接相关;及就此报告中所讨论目标公司的证券,我们(包括我们的家属)在其中均不持有任何财务利益。我和我的家属(我已经告知他们)将不会在本研究报告发布后的3个工作日内交易此研究报告所讨论目标公司的证券。I,

Kehan

Meng,

certifythat

(i)

the

views

expressed

in

this

research

report

accurately

reflect

my

personal

views

about

any

or

all

of

the

subject

companies

or

issuers

referred

to

in

thisresearch

and

(ii)

no

part

of

my

compensation

was,

is

or

will

be

directly

or

indirectly

related

to

the

specific

recommendations

or

views

expressed

in

this

researchreport;

and

that

I

(including

members

of

my

household)

have

no

financial

interest

in

the

security

or

securities

of

the

subject

companies

discussed.

I

and

myhousehold,

whom

I

have

already

notified

of

this,

will

not

deal

in

or

trade

any

securities

in

respect

of

the

issuer

that

I

review

within

3

business

days

after

the

researchreport

is

published.13APPENDIX2我,陈铭,在此保证(i)本研究报告中的意见准确反映了我们对本研究中提及的任何或所有目标公司或上市公司的个人观点,并且(ii)我的报酬中没有任何部分与本研究报告中表达的具体建议或观点直接或间接相关;及就此报告中所讨论目标公司的证券,我们(包括我们的家属)在其中均不持有任何财务利益。我和我的家属(我已经告知他们)将不会在本研究报告发布后的3个工作日内交易此研究报告所讨论目标公司的证券。I,

Roger

Chen,

certifythat

(i)

the

views

expressed

in

this

research

report

accurately

reflect

my

personal

views

about

any

or

all

of

the

subject

companies

or

issuers

referred

to

in

thisresearch

and

(ii)

no

part

of

my

compensation

was,

is

or

will

be

directly

or

indirectly

related

to

the

specific

recommendations

or

views

expressed

in

this

researchreport;

and

that

I

(including

members

of

my

household)

have

no

financial

interest

in

the

security

or

securities

of

the

subject

companies

discussed.

I

and

myhousehold,

whom

I

have

already

notified

of

this,

will

not

deal

in

or

trade

any

securities

in

respect

of

the

issuer

that

I

review

within

3

business

days

after

the

researchreport

is

published.我,袁艺琳,在此保证(i)本研究报告中的意见准确反映了我们对本研究中提及的任何或所有目标公司或上市公司的个人观点,并且(ii)我的报酬中没有任何部分与本研究报告中表达的具体建议或观点直接或间接相关;及就此报告中所讨论目标公司的证券,我们(包括我们的家属)在其中均不持有任何财务利益。我和我的家属(我已经告知他们)将不会在本研究报告发布后的3个工作日内交易此研究报告所讨论目标公司的证券。I,

Yilin

Yuan,

certifythat

(i)

the

views

expressed

in

this

research

report

accurately

reflect

my

personal

views

about

any

or

all

of

the

subject

companies

or

issuers

referred

to

in

thisresearch

and

(ii)

no

part

of

my

compensation

was,

is

or

will

be

directly

or

indirectly

related

to

the

specific

recommendations

or

views

expressed

in

this

researchreport;

and

that

I

(including

members

of

my

household)

have

no

financial

interest

in

the

security

or

securities

of

the

subject

companies

discussed.

I

and

myhousehold,

whom

I

have

already

notified

of

this,

will

not

deal

in

or

trade

any

securities

in

respect

of

the

issuer

that

I

review

within

3

business

days

after

the

researchreport

is

published.利益冲突披露Conflict

ofInterest

Disclosures国际及其某些关联公司可从事投资银行业务和/或对本研究中的特定股票或公司进行做市或持有自营头寸。就本研究报告而言,以下是有关该等关系的披露事项(以下披露不能保证及时无遗漏,如需了解及时全面信息,请发邮件至ERD-Disclosure@)HTI

and

some

of

its

affiliates

may

engage

in

investment

banking

and

/

or

serve

as

a

market

maker

or

hold

proprietary

trading

positions

of

certain

stocks

or

companiesin

this

research

report.

As

far

as

this

research

report

is

concerned,

the

following

are

the

disclosure

matters

related

to

such

relationship

(As

the

following

disclosuredoes

not

ensure

timeliness

and

completeness,

please

send

an

email

to

ERD-Disclosure@

if

timely

and

comprehensive

information

is

needed).14APPENDIX2评级定义(从2020年7月1日开始执行):国际(以下简称“HTI”)采用相对评级系统来为投资者推荐我们覆盖的公司:优于大市、中性或弱于大市。投资者应仔细阅读HTI的评级定义。并且HTI发布分析师观点的完整信息,投资者应仔细阅读全文而非仅看评级。在任何情况下,分析师的评级和研究都不能作为投资建议。投资者的买卖股票的决策应基于各自情况(比如投资者的现有持仓)以及其他因素。分析师股票评级优于大市,未来12-18个月内预期相对基准指数涨幅在10%以上,基准定义如下中性,未来12-18个月内预期相对基准指数变化不大,基准定义如下。根据FINRA/NYSE的评级分布规则,我们会将中性评级划入持有这一类别。弱于大市,未来12-18个月内预期相对基准指数跌幅在10%以上,基准定义如下各地股票基准指数:日本

TOPIX,

韩国

KOSPI,

台湾

TAIEX,

印度

Nifty100,

美国

SP500;

其他所有中国概念股

MSCI

China.Ratings

Definitions

(from

1Jul2020):Haitong

International

uses

a

relative

rating

system

using

Outperform,

Neutral,

or

Underperform

for

recommending

the

stocks

we

cover

to

investors.

Investors

shouldcarefully

read

the

definitions

of

all

ratings

used

in

Haitong

International

Research.

In

addition,

since

Haitong

International

Research

contains

more

complete

informationconcerning

the

analyst's

views,

investors

should

carefully

read

Haitong

International

Research,

in

its

entirety,

and

not

infer

the

contents

from

the

rating

alone.

In

any

case,ratings

(or

research)

should

not

be

used

or

relied

upon

as

investment

advice.

An

investor's

decision

to

buy

or

sell

a

stock

should

depend

on

individual

circumstances

(suchas

the

investor's

existing

holdings)

and

other

considerations.Analyst

Stock

RatingsOutperform:

The

stock’s

total

return

over

the

next

12-18

months

is

expected

to

exceed

the

return

of

its

relevant

broad

market

benchmark,

as

indicated

below.Neutral:

The

stock’s

total

return

over

the

next

12-18

months

is

expected

to

be

in

line

with

the

return

of

its

relevant

broad

market

benchmark,

as

indicated

below.

Forpurposes

only

of

FINRA/NYSE

ratings

distribution

rules,

our

Neutral

rating

falls

into

a

hold

rating

category.Underperform:

The

stock’s

total

return

over

the

next

12-18

months

is

expected

to

be

below

the

return

of

its

relevant

broad

market

benchmark,

as

indicated

below.Benchmarks

for

each

stock’s

listed

region

are

as

follows:

Japan–

TOPIX,

Korea

KOSPI,

Taiwan

TAIEX,

India

Nifty100,US

SP500;

for

all

other

China-conceptstocks

–MSCI

China.15APPENDIX2评级分布Rating

Distribution16APPENDIX2截至2023年3月31日国际股票研究评级分布优于大市中性弱于大市(持有)89.6%5.2%国际股票研究覆盖率9.2%6.4%1.2%9.5%投资银行客户**在每个评级类别里投资银行客户所占的百分比。上述分布中的买入,中性和卖出分别对应我们当前优于大市,中性和落后大市评级。只有根据FINRA/NYSE的评级分布规则,我们才将中性评级划入持有这一类别。请注意在上表中不包含非评级的股票。此前的评级系统定义(直至2020年6月30日):买入,未来12-18个月内预期相对基准指数涨幅在10%以上,基准定义如下中性,未来12-18个月内预期相对基准指数变化不大,基准定义如下。根据FINRA/NYSE的评级分布规则,我们会将中性评级划入持有这一类别。卖出,未来12-18个月内预期相对基准指数跌幅在10%以上,基准定义如下各地股票基准指数:日本

TOPIX,

韩国

KOSPI,

台湾

TAIEX,

印度

Nifty100;

其他所有中国概念股

MSCI

China.Haitong

International

Equity

Research

Ratings

Distribution,

asof

Mar

31,

2023OutperformNeutralUnderperform(hold)89.6%6.4%HTI

Equity

Research

CoverageIB

clients*9.2%9.5%1.2%5.2%*Percentage

of

investment

banking

clients

in

each

rating

category.BUY,

Neutral,

and

SELL

in

the

above

distribution

correspond

to

our

current

ratings

of

Outperform,

Neutral,

and

Underperform.For

purposes

only

of

FINRA/NYSE

ratings

distribution

rules,

our

Neutral

rating

falls

into

a

hold

rating

category.

Please

note

that

stocks

with

an

NR

designation

are

notincluded

in

the

table

above.Previous

rating

system

definitions

(until

30Jun

2020):BUY:

The

stock’s

total

return

over

the

next

12-18

months

is

expected

to

exceed

the

return

of

its

relevant

broad

market

benchmark,

as

indicated

below.NEUTRAL:

The

stock’s

total

return

over

the

next

12-18

months

is

expected

to

be

in

line

with

the

return

of

its

relevant

broad

market

benchmark,

as

indicated

below.

Forpurposes

only

of

FINRA/NYSE

ratings

distribution

rules,

our

Neutral

rating

falls

into

a

hold

rating

category.SELL:The

stock’s

total

return

over

the

next

12-18

months

is

expected

to

be

below

the

return

of

its

relevant

broad

market

benchmark,

as

indicated

below.Benchmarks

for

each

stock’s

listed

region

are

as

follows:

Japan

TOPIX,

Korea

KOSPI,

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