Marc Elia
Analyst · Jefferies. Please go ahead, Michael
Great. Thanks so much. Let me start and then I’ll ask Tim to answer the second part. So regarding EUA, you asked a couple of different things, but with respect to maintenance of EUA, it is actually our preference to move with the FDA beyond that construct. Indeed, it’s generally understood that EUAs are designed to effectively convert at some pace and subject to some mechanism. We’ve not actually had that conversation with the new FDA, which as you may or may not know is effectively recently seated, but we’re looking forward to it very much. Critically, our current EUA for the prevention of COVID-19 in certain immunocompromised persons, yes, was generated on the basis of immunobridging, but of course carries with it the results of a randomized clinical study interrogating both safety and exploratory clinical efficacy. So in our minds, those data are unique in the field. This is the point we’ve raised in a few different domains, particularly our recent Citizen Petition. So unlike any other company we’re aware of that has an authorized preventative or approved preventative, we actually have contemporary efficacy data and so would seek to leverage that in one form or another subject to discussion with the FDA of moving toward BLA. That would be our preference and it would certainly be our preference going forward. So I don’t think any of that is either of nerve wracking nor surprising. It’s in fact embedded into the very nature of a granted EUA and we’re really looking forward to talking with them about that. On a go forward basis, I think what we see is a pretty clear scientific, and I mean, sort of academic and clinical understanding, that sVNA titers are a highly useful validated surrogate endpoint. And you can see that embedded into, of course, the work that we’ve done with FDA to-date, and in fact, the evolution of our product fact sheet, which alludes to some of the meta-analytics describing these relationships. So we see the endemic virus situation as an opportunity to normalize all of this away from EUA into a landscape akin to an accelerated approval with a post-market conversion study, which I think not coincidentally, perhaps, appears to be the direction of travel for COVID-19 vaccines. All of that is to us highly welcome and embedded into all of our plans for both pemivibart and our molecules going forward. You have to remember that an EUA does not carry an express obligation to generate randomized clinical data on the other side of it, but of course, accelerated approvals do. So we would look forward to that paradigm and it’s going to be a major feature of what we believe will be our upcoming discussions with the agency. So I hope that’s clear. If it’s not, please, please get back into the queue. But meanwhile, I’ll ask Tim to expand on our Q1 changes and our confidence going forward.