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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
full
disclosureofrisks,valuation
methodologies
andtarget
priceformationon
allHTIratedstocks,
pleasereferto
the
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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
disclosureofrisks,valuation
methodologies
andtarget
priceformationon
allHTIratedstocks,
pleasereferto
the
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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
full
disclosureofrisks,valuation
methodologies
andtarget
priceformationon
allHTIratedstocks,
pleasereferto
the
latest
fullreportonourwebsiteat
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
full
disclosureofrisks,valuation
methodologies
andtarget
priceformationon
allHTIratedstocks,
pleasereferto
the
latest
fullreportonourwebsiteat
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
latest
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(
人
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
Aβ
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
Aβ
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
Aβ
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
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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