Michael Ehlers
Analyst · Evercore ISI. Please go ahead
Thank you, Michel, and good morning everyone. Last July, we communicated our vision for securing definitive leadership in neuroscience. This past quarter we have executed against our goal to meaningfully enhance our pipeline by adding or advancing five clinical stage programs, improving our research productivity, and bolstering our portfolio of pre-clinical assets. I'd like to talk about how we continued that momentum in the first quarter across our core and emerging growth areas. Starting with MS and neuroimmunology. This week we are presenting data at the 70th Annual Meeting of the American Academy of Neurology or AAN, which was also presented at ECTRIMS, regarding real world use of TYSABRI, and the potential impact of extended interval dozing on the risk of PML. A post-hoc analysis of data from the touch database supported an approximately 90% reduction in the risk of PML when taking TYSABRI using extended interval dosing as compared to the standard dosing. Based on these data, we're accelerating efforts to generate more data evaluated in the efficacy of alternate dosing. If this additional research supports a high level of efficacy with a lower risk of PML, we believe it would represent a significant advancement of the treatment of MS. This builds on our broader risk stratification efforts for TYSABRI including the use of JCV index values. Earlier this month, the FDA approved an updated label highlighting the association between index values and the risk of PML. Further, Alkermes will be presenting data at AAN from the EVOLVE-MS-1 study which is a Phase 3 open label long-term study of our partnered monomethyl fumarate prodrug BIIB98 in patients with relapsing remitting MS with 528 patients enrolled to-date. In a one-year interim analysis of exploratory efficacy endpoints, the annualized relapse rate in patients treated with BIIB98 was 0.16 and there was a significant reduction in number of gadolinium positive lesions from baseline to year one. These preliminary results for annualized relapse rate and MRI parameters support BIIB98 as a potential oral treatment option for patients with relapsing remitting MS. Alkermes is planning to file with the FDA by the end of the year. In other areas of MS, given their well characterized efficacy and safety profile, and many years of patient experience, we believe that interferon therapies will continue to play an important role for MS patients. To that end, and as Michel mentioned, we are pleased to announce plans to develop an intramuscular formulation of PLEGRIDY with the goal of reducing injection site reactions, ultimately with the aim of delivering a therapy with safety and tolerability comparable to AVONEX with the efficacy and dosing convenience of PLEGRIDY. Finally, we continue to advance the Phase 2b study of opicinumab as the potentially transformative therapy for many MS patients by promoting remyelination with the goal of improving pre-existing disability. All of these are examples of how we continue to innovate, aspire to create new options for MS patients, and aim to maintain our long-term leadership position in MS. We believe our current MS portfolio uniquely benefits patients across the full spectrum of the disease and we are committed to pursuing new advancements to address the remaining unmet needs of MS patients. I'll now turn to our progress in Alzheimer disease and dementia. We continue to advance our leading Alzheimer's portfolio with multiple assets across complementary modalities and pathways, including the industry's most advanced program targeting beta amyloid. We presented a new analysis of the Phase 1b prime study of aducanumab at AAN. In the 10-milligram per kilogram group aducanumab demonstrated up to 71% reduction in amyloid back on the centelloid scale a method used to standardize pep results. This is the largest degree of plaque reduction ever observed in the field. We believe each new analysis of the Phase 1b data reinforces aducanumab's position as the most advanced potential disease modifying therapy for Alzheimer's disease across the industry. Also targeting beta-amyloid, BAN2401, the A beta antibody currently being developed by our collaboration partner Eisai is continuing to the final 18 month readout in the third quarter of this year and the BACE inhibitor elenbecestat continues to recruit in Phase 3 studies also being inducted by our collaboration partner Eisai. Beyond A beta, we believe that Tau plays an important and complementary role in Alzheimer's disease pathology and we are advancing a suite of Tau assets. We have begun screening patients in the Phase 2 Alzheimer's disease trial of BIIB092, the anti-tau antibody we license from BMS last year and we expect data from the Phase 1 study of BIIB076 another anti-tau antibody by the end of this year. Further, our first-in-class Tau antisense Oligonucleotide BIIB080 is advancing in Phase 1 studies. Turning to neuromuscular disorders, we made significant progress in our strategic priority of spinal muscular atrophy. In March, we presented important new data for SPINRAZA at the Muscular Dystrophy Association Clinical Conference. New interim Phase 2 results from NURTURE studying pre-symptomatic infants with SMA showed that all infants treated with SPINRAZA were alive did not require permanent ventilation and showed improvement in motor function and motor milestone achievements compared to the decline normally seen over the course of the disease. All NURTURE participants achieved the age expected WHO motor milestone of sitting without support. We also presented a case series of five SPINRAZA treated patients with SMA Type 2 or 3 between the ages of 17 and 19 upon their last visit, showing stable or improved motor function and improved quality of life. These data are important and support the clinical value of SPINRAZA for older patients who represent the majority of the current prevalence of the disease. We aim to continue to build on the body of data in this patient population over time. At AAN this week, we are presenting interim results from the SHINE open-label extension study for patients who have transitioned from the ENDEAR study demonstrating long-term benefits for infantile-onset SMA in terms of both improved motor function and longer event free survival. And in collaboration with Columbia University, we are also presenting a case study of 14 later onset patients between the ages of two and 15 showing that with SPINRAZA treatment they were able to walk longer distances, while experiencing decreases in fatigue. In February, the end of study results from the SPINRAZA Phase 3 CHERISH study were published in The New England Journal of Medicine, another important acknowledgement of the unprecedented benefits that SPINRAZA provides to later onset patients. Biogen remains committed to advancing the standard of care in SMA beyond SPINRAZA. We continue to advance our genetherapy program in collaboration with University of Pennsylvania with study initiation expected in the middle of the year. But we are not stopping there. We believe that the future treatment landscape may involve combination for sequential therapy across different modalities. We have heard reports that seven of the 15 patients in AveXis Phase 1 gene therapy study have subsequently gone on to SPINRAZA, suggesting that clinical experience to-date may support the utility of ASOs in combination with gene therapy. Sequential or additive benefits of gene therapy in ASOs could include additive effects on protein levels on a per cell basis, complementary distribution and transduction across the CNS, and durability and stability of Episomal transgene expression. These are some of the reasons we are actively pursuing a strategy to evaluate SPINRAZA in combination with gene therapy, but simply, we do not believe the gene therapy will replace ASOs but rather provide a complementary modality. Moving to our progress and movement disorders. At AAN, we are presenting Phase 1 data for BIIB054, our anti-alpha-synuclein antibody for Parkinson's disease. BIIB054 demonstrated favorable pharmacokinetics as well as a safety and tolerability profile which support advancement into the ongoing Phase 2 trial. At AAN, we're also presenting Phase 1 data for anti-tau antibody BIIB092 in progressive supranuclear palsy which was well tolerated and demonstrated reductions in CSF pre-tau levels of over 90%. We laid the foundation for our entry in neuropsychiatry this quarter, with our agreement to acquire Phase 2b ready AMPA receptor potentiator now called BIIB104 from Pfizer. This transaction has now closed. BIIB104 is a first-in-class molecule initially targeting cognitive impairment associated with schizophrenia or CIAS, a devastating aspect of schizophrenia with no current treatment options. We believe BIIB104 has compelling data from a number of distinct early clinical studies demonstrating functional circuit activation as measured by FMRI, treatment effects on relevant domains of cognition, and the potential for a favorable benefit risk profile. In particular, the multiple ascending dose study in stable subjects with schizophrenia demonstrated dose dependent effects on improvement from baseline to day 14 across multiple cognitive domains including working memory, short-term memory, verbal recall and reasoning. Importantly, we saw correlation to this clinical advocacy with plasma exposure. We believe this molecule is differentiated from prior compounds in the class due to its high potency and favorable PKPD profile which we believe allows for an improved therapeutic index. We plan to initiate a Phase 2b trial in CIAS by the end of the year in parallel to exploring additional studies across other indications supporting our core growth areas. Within acute neurology, we are excited about the potential for BIIB093, our first-in-class IV glibenclamide therapeutic targeting brain edema in large hemispheric infarcts. We plan to start our Phase 3 study in the middle of this year. We also recently initiated the Phase 2 study of natalizumab in drug resistant focal epilepsy and we dosed the first patient last month. Within neuropathic pain, we are advancing BIIB074 into Phase 3 for Trigeminal Neuralgia, the start of activities outside the U.S. in parallel to FDA engagement. We expect to dose the first patient by the end of the year. We have completed enrolment in the Phase 2 study of BIIB074 for Painful Lumbosacral Radiculopathy with data expected towards the end of the year and we've began screening patients in the Phase 2 trial of BIIB074 in small fiber neuropathy as we explore multiple potential indications. Given the high unmet medical needs of neuropathic pain patients especially in light of the growing opioid epidemic, we are excited to expand our pain portfolio with the recent initiation of a Phase 1 study for BIIB095, our second Nav 1.7 inhibitor. Within ophthalmology, our partner AGTC recently completed enrolment in the Phase 1/2 trial with it's AAV based gene therapy program for X-Linked Retinoschisis or XLRS. Top-line data are anticipated by Q4 with the final analysis at the 12-month time point. Last week, AGTC also dosed the first patient in the Phase 1/2 study in X-Linked's Retinitis Pigmentosa or XLRP. Underpinning all of our efforts across our core and emerging growth areas, is investing in core capabilities, platforms, and modalities to enhance our translational mission in neuroscience. To that end, last week we announced a new exclusive 10-year collaboration agreement with Ionis Pharmaceuticals to develop novel antisense oligonucleotide drug candidates for a range of neurological diseases. This partnership brings together the industry-leader in ASO drug discovery with the industry-leader in neuroscience drug development to create what we believe will be a powerful CNS genetic medicine engine. Based on our experience with SPINRAZA and other ASOs we have in development, we believe that Intrathecal ASOs may address many genetic diseases and genetic targets of the central nervous system including some pathways that were previously undruggable with small molecules and monoclonal antibodies. Given their ability to directly intervene at the genetic origin of disease, we believe ASO approaches have a higher probability of success than traditional modalities with a more efficient development path and greater potential speed to patients. We believe this collaboration solidifies a key pillar of our R&D strategy to become the leader in neuroscience. We aim to advance several SPINRAZA like drugs to patients in the future. Importantly ASOs are now validated as a transformative therapeutic modality for CNS in particular. Now with an industry-leading CNS ASO platform partnership secured, we further aim to build emerging synergistic modalities including gene therapy to further augment Biogen's leadership in neurological diseases. We see high complementarity for ASO therapeutics in gene therapy. Intrathecal ASOs can be well tolerated, exclusively selective, can up or down regulate gene expression, may be readily manufactured, may not be subject to immune surveillance, and exert effects that may be reversed based on drug pharmacokinetics. We further believe that a powerhouse ASO platform will significantly augment our overall approach to genetic diseases and targets of the CNS. Please refer to our webcast from Friday, April 20th, which is available on our website for more details on this new collaboration. Overall, we had a remarkably productive quarter across our pipeline in both our core and emerging growth areas and we aim to maintain this momentum through the rest of this year and beyond. I will now pass the call to Jeff.