Biogen Inc.

Determination of adversity and the no observed adverse effect level (NOAEL) in nonclinical toxicity studies are important components in the overall assessment of the potential for human risk during pharmaceutical development. Resources exist to guide adversity decisions in general, for findings in ganglia of the peripheral nervous system (PNS), and for gliosis in the central nervous system (CNS). The objective of this opinion article is to describe considerations that may apply when determining the adversity (or lack thereof) of nerve fiber degeneration (NFD) in either the CNS or PNS following intrathecal (IT) administration of oligonucleotide (ON) therapeutics (such as antisense oligonucleotides and short interfering RNAs). It is important to differentiate IT delivery procedure-related NFD effects from ON-related effects or ON-related exacerbation of procedure-related findings. This article presents evidence-based approaches for deciding whether NFD associated with IT ON administration is an adverse microscopic finding in the brain, spinal cord, spinal nerve roots, ganglia, and/or nerves. In the authors' collective experience, nonextensive (i.e., regionally restricted), minimal or mild NFD unaccompanied by functional or behavioral deficits, neuronal necrosis, or a substantial inflammatory response in neural tissue can be interpreted as nonadverse.

People with multiple sclerosis (pwMS) have an increased risk of infections. There are limited data characterizing who initially diagnoses infections in pwMS and how these are communicated among healthcare providers. Retrospective US claims data from January 1, 2017 to August 31, 2024 were used to identify newly diagnosed pwMS aged 18–64 years who were taking any disease-modifying therapy (DMT) for ≥ 90 days. Index date was the earliest date of the first DMT claim. Infections were based on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Severe infections included events requiring hospitalization and/or intravenous antibiotics. Overall, 69,148 pwMS who were treatment-naïve met eligibility criteria. Mean age was 44.1 years; 72

Diroximel fumarate (DRF) and dimethyl fumarate (DMF) are established disease-modifying therapies for relapsing multiple sclerosis (RMS). While DRF has demonstrated improved gastrointestinal tolerability compared to DMF, there is limited research evaluating whether this difference in tolerability translates into a difference in clinical effectiveness. This study evaluated the real-world effectiveness of DRF versus DMF on relapse outcomes in persons with MS (pwMS) in a large US population. This retrospective cohort study utilized the Forian administrative claims database (January 1, 2018–June 30, 2025). Adult pwMS initiating DRF or DMF were identified and propensity score-matched (1:3 ratio) based on baseline demographic and clinical characteristics. Endpoints were assessed over 1- and 2-year follow-up periods. The primary endpoint was annualized relapse rate (ARR). The 1-year analysis included 1780 DRF-treated and 5340 DMF-treated pwMS; the 2-year analysis included 739 DRF-treated and 2217 DMF-treated pwMS. At 1 year of treatment, DRF was associated with a significantly lower ARR compared to DMF (0.12 vs. 0.16; p = 0.03), representing a 21

Btk (Bruton's tyrosine kinase), a Tec-family kinase initially recognized for its role in B-cell signaling, has emerged as a critical player in thrombosis and cardiovascular disease. Beyond the established therapeutic effects of Btk inhibitors in B-cell malignancies, its expression in platelets, macrophages, and neutrophils implicates Btk in platelet activation, atherothrombosis, and innate immunity. This state-of-the-art review synthesizes the current understanding of Btk's mechanistic contributions to thrombosis and cardiovascular disease, evaluates the evolution of Btk inhibitors (BTKi), and explores their therapeutic potential. Patients with X-linked agammaglobulinemia who lack Btk do not have a bleeding diathesis, indicating that platelet-selective Btk inhibition would be a safe antithrombotic strategy. In platelets, Btk mediates immunoreceptor tyrosine-based activation motif-dependent and -independent signaling, driving atherothrombosis, venous thrombosis, and immunothrombosis without affecting hemostatic platelet functions. In myeloid cells, Btk amplifies inflammation via NLRP3 inflammasome activation and neutrophil extracellular trap formation, linking it to thromboinflammation and atherosclerosis. First-generation BTKi such as ibrutinib demonstrate antithrombotic efficacy but are limited by off-target effects, including bleeding and atrial fibrillation. Second- and third-generation inhibitors (eg, acalabrutinib, zanubrutinib, and pirtobrutinib) show enhanced selectivity, reducing cardiovascular toxicity in patients with B-cell malignancies. Highly selective BTKi (fenebrutinib and remibrutinib) do not show bleeding in clinical trials of various autoimmune disorders, and covalent selective BTKi applied at low dosage are expected to selectively inhibit Btk in platelets without bleeding side effects. Preclinical data and early observations from compassionate use in patients with atypical autoimmune thrombosis highlight the potential of BTKi as selective antithrombotic agents beyond traditional therapies. This review conceptualizes and underscores Btk's pivotal role at immune-thrombosis interfaces in atherothrombosis, advocating for precision medicine approaches and innovative platforms to unlock its full therapeutic potential in cardiovascular disease management.

Accurately measuring compound binding affinities is key to driving the pharmaceutical development process. Rigorous physics-based in silico approaches, particularly alchemical free energy methods, have become a gold-standard tool for estimating compound affinity changes. Here we present the results of a large-scale precompetitive collaborative assessment of relative binding free energy (RBFE) calculations generated by 15 pharmaceutical companies. We evaluate an open-source and MIT-licensed RBFE protocol from the Open Free Energy (OpenFE) ecosystem across both public and blinded private datasets, encompassing over 1,700 ligands in total. For the public dataset, the weighted RMSE across the 58 systems was 1.73(1.53)(1.96) kcal/mol, with 10 of the systems reaching sub-kcal/mol accuracy. For the private dataset, the weighted RMSE across the 37 systems was 2.44(1.94)(3.06) kcal/mol, with only 2 of the systems reaching sub-kcal/mol accuracy, reflecting the increased complexity of real-world drug discovery. The protocol's performance was system-dependent, with no single dominant error source, indicating that accuracy is primarily influenced by input quality and transformation type. Overall, these benchmark results are encouraging and indicate that OpenFE is ready for large-scale industrial applications, with an "out-of-the-box" accuracy that approaches that of commercial solutions. While comparison against published FEP+ results, which were obtained after manual parameter optimization, shows comparable ranking statistics, a gap remains in error statistics, for which we outline possible paths toward improvement. The protocol meets key criteria required for production use in an industrial setting: it shows robust performance, generates reproducible results, and achieves both sufficient throughput and rapid convergence.