Astra’s Tackle disappoints

Astrazeneca is already seeking authorisation of its antibody combo AZD7442 for the prevention of Covid-19. Today’s topline data from the Tackle study show the project to have utility in the outpatient treatment setting, too, halving the risk of severe infection or death when given within seven days of symptom onset. In a prespecified subset who received the treatment within five days of symptom onset, AZD7442 cut this risk by 67% versus placebo. But there are a couple of reasons for caution. Most obviously, Merck & Co recently showed a similar level of efficacy in the same setting with molnupiravir, which has the vast advantage of being oral. And several other antibodies and antibody combos are already authorised for the treatment of non-hospitalised patients, with notably better headline efficacy than AZD7442. Perhaps ’7442 has a bit of an edge over these in that it is long-acting, and is delivered intramuscularly rather than needing to be infused – but molnupiravir clearly still wins on convenience. Forecast sales for ’7442 are far behind the blockbuster numbers the sellside has pencilled in for many of these treatments, and this situation seems unlikely to change on the back of the Tackle data. 

Selected Covid-19 MAbs and antivirals for outpatient treatment
Project Company Trial Cut in risk of hospitalisation/
death vs pbo
EUA for outpatient treatment?
AZD7442 Astrazeneca Tackle 50%*, "statistically significant" No
Molnupiravir Merck & Co Move-Out 50%, p=0.0012 Filed
BRII-196/BRII-198 Brii Biosciences Activ-2 78%, p<0.00001 Filed
(casirivimab + imdevimab)
Regeneron/Roche COV-20678 70%, p=0.0024 Yes
Bamlanivimab + etesevimab Lilly Blaze-1 70%, p= 0.0004 Yes
Sotrovimab (VIR-7831) Glaxosmithkline/
Comet-Ice 79%, p<0.001 Yes
*Reduction in risk of severe Covid-19 or death. Source: company releases.

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