Citi sees the risk-reward balance as favourable for AstraZeneca PLC (LSE:AZN, NASDAQ:AZN) ahead of headline results from a pivotal trial of its heart drug Wainua, expected in the third quarter of 2026.
Wainua is a TTR-silencer, a drug that suppresses production of a protein called transthyretin (TTR) which can misfold and accumulate in the heart and nerves, causing a progressive condition known as ATTR-cardiomyopathy (ATTR-CM).
The CARDIO-TTRansform trial is a phase three study examining Wainua's efficacy specifically in ATTR-CM patients, a larger and more commercially significant population than the nerve disease indication for which the drug is already approved.
Citi believes there is a relatively high probability that the trial hits its primary endpoint, which would push its peak Wainua sales estimate for ATTR-CM to $6 billion, or $7 billion including the existing nerve disease approval.
This is well above the risk-adjusted consensus of around $3 billion and represents a 2% uplift to the bank's discounted cash flow valuation.
If a secondary endpoint showing benefit in patients already treated with stabiliser drugs is also met, Citi sees peak ATTR-CM sales reaching $8 billion and total Wainua sales of $9 billion, equivalent to a 4% DCF uplift.
Trial failure would represent a 3% DCF downside, but Citi notes that even in this scenario, its valuation remains more than 20% above the current share price, suggesting investors should treat any weakness as a buying opportunity.