Unknown Executive
Analyst · Evercore..
Thank you, Mike, and good morning, everyone. I'm pleased to join you all today to provide an update on our clinical development programs and highlights of our recently presented data. As Mike mentioned, ECTRIMS was a particularly productive meeting for TG, the largest in the company's history in terms of the breadth and depth of data shared with presentations highlighting long-term outcomes of BRIUMVI, continued differentiation versus others in the class, progress across our life cycle programs and encouraging initial results from azer-cel in progressive MS. I'll begin with BRIUMVI, where investigators at ECTRIMS presented seven-year follow-up results from the ULTIMATE clinical development program. These results continue to demonstrate sustained efficacy. Among patients who completed seven years of continuous BRIUMVI treatment, the annualized relapse rate was 0.018, roughly one relapse in over 50 patient years and approximately 88% remained free of 24-week confirmed display progression. To our knowledge, this is an unprecedented level of freedom from disability progression in longer-term follow-up studies originating from Phase III relapsing MS trials. The safety findings were also reassuring with no new safety signals observed over seven years of treatment. Together, these results reinforce our confidence in BRIUMVI as a long-term treatment option for people living with relapsing MS. We also presented updated real-world findings from ENABLE, our ongoing U.S. Phase IV observational study, which now includes more than 1,000 patients. The results continue to reinforce the clinical profile we saw in our registration trials. 99% of patients remained relapse-free. Infusion times were consistent with our approved one-hour maintenance infusion and rates of infusion-related reactions were lower than those observed in the registrational trials. Turning to ENHANCE. This Phase IIb study initially focused on evaluating switches to BRIUMVI from prior anti-CD20 therapy and has evolved over time to also explore alternate dosing regimens for BRIUMVI, yielding a number of valuable data sets. The study culminated in a randomized trial to evaluate consolidating our approved two-dose initiation regimen into a single 600-milligram initiation infusion with the goal of making treatment initiation more convenient for patients and providers. The trial met its primary endpoint, demonstrating bioequivalence between the two regimens. Importantly, day one infusion-related reactions were numerically lower with the single-dose initiation regimen, 16% compared to approximately 26% for the standard regimen with no grade 3 or higher infusion-related reactions in either arm. B-cell depletion and MRI outcomes were also comparable for both regimens. Together, these findings support the potential to simplify BRIUMVI initiation without compromising drug exposure or the observed safety profile. We are advancing the regulatory process and subject to approval, anticipate a potential update to our label to incorporate this new regimen around the middle of 2027. We also presented an update on an earlier cohort from the ENHANCE study, which enrolled over 100 patients who transitioned directly from ocrelizumab to BRIUMVI. Approximately 60% of these patients reported experiencing wearing off symptoms while on ocrelizumab. However, following the transition to BRIUMVI, nearly 70% did not report this wearing off effect through week 48 of treatment. Interestingly, this switch cohort also contained a number of patients who experienced incomplete B-cell depletion or early reactants on ocrelizumab, yet we were able to obtain robust B-cell depletion with BRIUMVI. We believe these findings further support the potential for meaningful biological differences among anti-CD20 therapies, and we intend to continue investigating these observations and their potential clinical significance. On that note, it's worth noting a recent publication in the journal Multiple Sclerosis and Related Disorders, which was a five-year comparative analysis of ublituximab against both ocrelizumab and ofatumumab. This peer-reviewed publication used an unanchored match-adjusted methodology to account for differences between the clinical trial populations to provide a statistically valid comparison. The findings were particularly interesting. Ublituximab was associated with a 44% lower estimated risk of confirmed 24-week disability progression compared with ocrelizumab and a 49% lower risk compared with ofatumumab. While these findings come from an indirect comparison rather than a randomized head-to-head trial, we believe the consistency of the results against both leading anti-CD20 therapies is thought-provoking and warrants further investigation. Now turning to subcu BRIUMVI. The Phase I results presented at ECTRIM support our quarterly dosing strategy. Estimated subcutaneous bioavailability was approximately 62% and PK modeling of our 400-milligram quarterly dosing regimen predicts a geometric mean ratio of exposure relative to IV BRIUMVI of 1.20 with a lower bound of the 90% confidence interval that exceeds the non-inferiority threshold for success defined in our ongoing Phase III study. The pharmacodynamic findings were equally encouraging. All patients receiving the fully subcutaneous 400-milligram regimen achieved B-cell depletion within four days with depletion maintained throughout the dosing intervals. Importantly, the 400-milligram subcu injections were well tolerated with limited local and systemic injection-related reactions observed, all of which were grade one. The Phase III study of subcu BRIUMVI is fully enrolled with top line results expected around year-end or early 2027. Assuming successful development and regulatory review, we continue to target a potential commercial launch in 2028. Lastly, turning to azer-cel, our allogeneic CD19-directed CAR T cell therapy, we presented the first clinical results from our Phase I progressive MS study in a late-breaking oral presentation at ATRS. The initial data set included 26 patients with progressive MS, all of whom had experienced disability progression despite high efficacy treatment, including prior anti-CD20 therapy. The median baseline EDSS score was 6.0, reflecting a population with substantial accumulated disability. The early safety findings were encouraging with no dose-limiting toxicities observed across all dose levels, no Grade 3 or higher CRS, no grade 2 or higher ICANS, no GvHD and no grade 3 or higher infections observed. From a pharmacodynamic perspective, 25 of 26 patients achieved peripheral B-cell depletion, and there was early evidence of reduced B cell counts in cerebrospinal fluid, a compartment generally inaccessible to current anti-CD20 therapy. Turning to the preliminary clinical findings. At day 90 post CAR-T administration, nearly 90% of evaluable patients had stable or improved EDSS scores with the longest follow-up patients sustaining a two-point reduction for 1.5 years in counting. While early, these observations are encouraging, particularly in a population with documented disability progression despite previous high efficacy therapy. We continue to follow these patients to assess longer-term outcomes while advancing dose optimization and look forward to sharing additional updates as the data mature. Finally, we continue to advance BRIUMVI into additional therapeutic areas beyond MS. Our Phase II study in generalized myasthenia gravis is evaluating whether rapid disease control with FcRn inhibition followed by BRIUMVI maintenance can provide more durable benefit while reducing the burden of ongoing treatment. This study has generated a lot of excitement as it explores a novel way to sequence therapies in MG to maximize their benefit. We are also conducting an exploratory Phase II study in treatment-resistant schizophrenia to investigate whether B-cell depletion can provide clinical benefit in a patient population where emerging evidence suggests immune dysfunction may contribute to disease biology. Both programs are designed to generate meaningful clinical evidence with a disciplined approach to development investment and additional programs in other therapeutic areas are also under development. Looking ahead, the next several years will be an important period across our development programs, and our team remains focused on executing against these opportunities. With that, I'll turn the call over to our Chief Commercial Officer, Adam Waldman, for a commercial update.