Menactra (Sanofi) is a quadrivalent polysaccharide diphtheria toxoid conjugate vaccine indicated for active immunization to prevent invasive meningococcal disease (IMD) caused by Neisseria meningitidis (N. meningitidis)serogroups A, C, Y, and W-135 in individuals aged nine months through to 55 years in the US. It contains N. meningitidiscapsular polysaccharide antigens individually conjugated to diphtheria toxoid protein. The presence of bactericidal anti-capsular meningococcal antibodies has been associated with protection from IMD, and Menactra induces production of these antibodies specifically for the aforementioned serogroups.
Despite a large patient population, broad serotype coverage, and first-to-market status for meningococcal conjugate vaccines, Menactra’s dominant position in the US market has been weakened by Menveo (quadrivalent oligosaccharide diphtheria CRM-197 conjugate vaccine; GlaxoSmithKline), a vaccine that covers the same serotypes and is recommended for the same risk groups as Menactra. In addition, Menveo is the only approved quadrivalent meningococcal conjugate vaccine for high-risk children aged below nine months.
The lack of clinical differentiation between the two vaccines means that competition is driven primarily by price, and Menveo possesses a competitive advantage in this regard. Menactra’s US price increased slightly from $89.16 per dose in 2016 to $91.81 in 2019 for the pediatric population, whereas Menveo’s price decreased from $85.22 to $73.83 per dose in the same period. This competitive pricing seems to have incentivized some prescribers to preferentially procure Menveo over Menactra, as reflected by Menveo’s increasing US sales from $157.3m in 2016 to $226.2m in 2018, and Menactra’s declining sales from $563.6m in 2016 to $465.2m in 2018.
Sanofi is developing a successor vaccine, MenQuadfi (quadrivalent polysaccharide tetanus toxoid conjugate vaccine; Sanofi), which could cannibalize some of Menactra’s market share, but it is unlikely to gain significant uptake without a discounted price, due to limited available trial data suggesting only non-inferiority to Menactra. In the long term, both of Sanofi’s vaccines face a significant threat from GlaxoSmithKline’s MenABCW-135Y (pentavalent meningococcal conjugate vaccine), which is being positioned to replace standalone meningococcal ACWY (MenACWY) and meningococcal B (MenB) vaccinations in persons aged ≥10 years.
LIST OF TABLES
6 Table 1: Menactra drug profile
7 Table 2: Approval history of Menactra for meningococcal vaccination in the US and Japan
8 Table 3: Late-phase trials of Menactra for meningococcal vaccination
9 Table 4: Menactra for meningococcal disease – SWOT analysis
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