February 24, 2022 AstraZeneca Pharmaceuticals LP Attention ...

1 May 17, 2022 AstraZeneca Pharmaceuticals LPAttention: Stacey Cromer Berman, PhDSenior Regulatory Affairs Director and Team Lead One MedImmune Way Gaithersburg, MD 20878 RE: Emergency Use Authorization 104 Dear Dr. Cromer Berman: This letter is in response to AstraZeneca Pharmaceuticals LP s ( AstraZeneca ) request that the Food and Drug Administration (FDA or Agency) issue an Emergency Use Authorization (EUA) for the emergency use of EVUSHELD (tixagevimab co-packaged with cilgavimab) for thepre-exposure prophylaxis of coronavirus disease 2019 (COVID-19) in certain adults and pediatric individuals (12 years of age and older weighing at least 40 kg), as described in the Scope of Authorization (Section II) of this letter, pursuant to Section 564 of the Federal Food, Drug, and Cosmetic Act (the Act) (21 360bbb-3). On February 4, 2020, pursuant to Section 564(b)(1)(C) of the Act, the Secretary of the Department of Health and Human Services (HHS) determined that there is a public health emergency that has a significant potential to affect national security or the health and security of United States citizens living abroad, and that involves the virus that causes coronavirus disease 2019 (COVID-19).

2 1On the basis of such determination, the Secretary of HHS on March 27, 2020, declared that circumstances exist justifying the authorization of emergency use of drugs and biological products during the COVID-19 pandemic, pursuant to Section 564 of the Act (21 360bbb-3), subject to terms of any authorization issued under that December 8, 2021, the Food and Drug Administration (FDA) issued an EUA for emergency use of EVUSHELD for use as pre-exposure prophylaxis of COVID-19 in certain adults and pediatric individuals (12 years of age and older weighing at least 40 kg), as described in the Scope of Authorization (Section II) of the letter. Tixagevimab and cilgavimab, the active components of EVUSHELD, are neutralizing IgG1 monoclonal antibodies that bind to distinct, non-overlapping epitopes within the receptor binding domain of the spike protein of SARS-CoV-2. EVUSHELD is an investigational drug and is not approved for any uses, including use as pre-exposure prophylaxis of COVID-19.

3 1 Department of Health and Human Services, Determination of a Public Health Emergency and Declaration that Circumstances Exist Justifying Authorizations Pursuant to Section 564(b) of the Federal Food, Drug, and Cosmetic Act, 21 360bbb-3. February 4, 2020. 2 Department of Health and Human Services, Declaration that Circumstances Exist Justifying Authorizations Pursuant to Section 564(b) of the Federal Food, Drug, and Cosmetic Act, 21 360bbb-3, 85 FR 18250 (April 1, 2020). Page 2 AstraZeneca Pharmaceuticals LP FDA subsequently reissued the letter of authorization on December 10, 20213, December 20, 2021,4and February 24, May 17, 2022, having concluded that revising this EUA is appropriate to protect the public health or safety under section 564(g)(2)(C) of the Act, FDA is reissuing the February 24, 2022 letter in its entirety, to revise the scope of authorization to refer to section (Warnings and Precautions) of the authorized Fact Sheet for Healthcare Providers, which as of this reissuance, includes new information on hypersensitivity reactions and the risk of cross-hypersensitivity with COVID-19 vaccines and related clinical recommendations.

4 Corresponding information was also incorporated into the authorized Fact Sheet for Patients, Parents and Caregivers. Based on the review of the data from the PROVENT clinical trial (NCT04625725), a Phase III randomized, double-blind, placebo-controlled clinical trial, it is reasonable to believe that EVUSHELD may be effective for use as pre-exposure prophylaxis of COVID-19 in certain adults and pediatric individuals (12 years of age and older weighing at least 40 kg), as described in the Scope of Authorization (Section II), and when used under the conditions described in this authorization, the known and potential benefits of EVUSHELD outweigh the known and potential risks of such product. Having concluded that the criteria for issuance of this authorization under Section 564(c) of the Act are met, I am authorizing the emergency use of EVUSHELD for use as pre-exposure prophylaxis of COVID-19, as described in the Scope of Authorization section of this letter (Section II) and subject to the terms of this authorization.

5 I. Criteria for Issuance of Authorization I have concluded that the emergency use of EVUSHELD for pre-exposure prophylaxis of COVID-19 when administered as described in the Scope of Authorization (Section II) meets the criteria for issuance of an authorization under Section 564(c) of the Act, because: 1. SARS-CoV-2 can cause a serious or life-threatening disease or condition, including severe respiratory illness, to humans infected by this virus; 2. Based on the totality of scientific evidence available to FDA, it is reasonable to believe that EVUSHELD may be effective for use as pre-exposure prophylaxis of COVID-19 in certain adults and pediatric individuals (12 years of age and older weighing at least 40 kg), as described in the Scope of Authorization (section II), and that, when used 3 In its December 10, 2021 revision, FDA revised the letter of authorization (LOA) to add a new limitation in the Scope of Authorization (section II) detailing the scope of healthcare providers who are authorized to prescribe EVUSHELD for use under this EUA.

6 4 In its December 20, 2021 revision, FDA revised the limitation in the Scope of Authorization (section II) in the LOA detailing the scope of healthcare providers who are authorized to prescribe EVUSHELD for use under this EUA. The Fact Sheet for Healthcare Providers was also revised to reflect this limitation. 5 In its February 24, 2022 revision, FDA revised the LOA to include a new condition of authorization on registration and listing. The authorized Fact Sheet for Healthcare Providers and authorized Fact Sheet for Patients, Parents and Caregivers were also revised to include updated dosing information for EVUSHELD. Page 3 AstraZeneca Pharmaceuticals LP under the conditions described in this authorization, the known and potential benefits of EVUSHELD outweigh the known and potential risks of such product; and 3. There is no adequate, approved, and available alternative to the emergency use of EVUSHELD as pre-exposure prophylaxis of COVID-19 as further described in the Scope of Authorization (section II).

7 Of Authorization I have concluded, pursuant to Section 564(d)(1) of the Act, that the scope of this authorization is limited as follows: Distribution of the authorized EVUSHELD will be controlled by the United States ( ) Government for use consistent with the terms and conditions of this EUA. AstraZeneca will supply EVUSHELD to authorized distributor(s)7, who will distribute to healthcare facilities or healthcare providers as directed by the Government, in collaboration with state and local government authorities as needed; EVUSHELD may only be used in adults and pediatric individuals (12 years of age and older weighing at least 40 kg): Who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARS-CoV-2 and o Who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination8oro For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).

8 9 Limitations on Authorized Use Evusheld is not authorized for the following uses in individuals: For treatment of COVID-19, or For post-exposure prophylaxis of COVID-19 in individuals who have been exposed to someone infected with SARS-CoV-2. 6 No other criteria of issuance have been prescribed by regulation under Section 564(c)(4) of the Act. 7 Authorized Distributor(s) are identified by AstraZeneca as an entity or entities allowed to distribute authorized EVUSHELD. 8 For additional information please see Healthcare providers should consider the benefit-risk for an individual patient. 9 See section , Warnings and Precautions, of the authorized Fact Sheet for Healthcare Providers for additional information. Page 4 AstraZeneca Pharmaceuticals LP EVUSHELD may only be prescribed for an individual patient by physicians, advanced practice registered nurses, and physician assistants that are licensed or authorized under State law to prescribe drugs in the therapeutic class to which EVUSHELD belongs ( , anti-infectives).

9 10 Pre-exposure prophylaxis with EVUSHELD is not a substitute for vaccination in individuals for whom COVID-19 vaccination is recommended. Individuals for whom COVID-19 vaccination is recommended, including individuals with moderate to severe immune compromise who may derive benefit from COVID-19 vaccination, should receive COVID-19 vaccination. For individuals who have received a COVID-19 vaccine, EVUSHELD should be administered at least two weeks after vaccination. The use of EVUSHELD covered by this authorization must be in accordance with the authorized Fact Sheets. Product Description EVUSHELD is supplied as a single carton (NDC 0310-7442-02) containing 1 single-dose vial of tixagevimab injection and 1 single-dose vial of cilgavimab injection. Tixagevimab injection (NDC 0310-8895-01) is a sterile, preservative- free , clear to opalescent and colorless to slightly yellow solution supplied in a single-dose vial for intramuscular use.

10 The vial stoppers are not made with natural rubber latex. Each mL contains 150 mg tixagevimab, L- histidine ( mg), L- histidine hydrochloride monohydrate ( mg), polysorbate 80 ( mg), sucrose ( mg), and Water for Injection, USP. Cilgavimab injection (NDC 0310-1061-01) is a sterile, preservative- free , clear to opalescent and colorless to slightly yellow solution supplied in a single-dose vial for intramuscular use. The vial stoppers are not made with natural rubber latex. Each mL contains 150 mg cilgavimab, L-histidine ( mg), L- histidine hydrochloride monohydrate ( mg), polysorbate 80 ( mg), sucrose ( mg), and Water for Injection, USP. The authorized storage and handling information is included in the authorized Fact Sheet for Healthcare Providers. EVUSHELD is authorized for emergency use with the following product-specific information required to be made available to healthcare providers and to patients, parents, and caregivers, respectively, through AstraZeneca s website (referred to as the authorized labeling ): 10 Under section 201(a)(1) of the Act, the term State is defined to mean any State or Territory of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.