MoEDDI: Semantic Mixtures of Experts for Long Tailed Drug Drug Interaction Prediction

Mechanism-level drug-drug interaction (DDI) prediction requires identifying which enzyme or pharmacodynamic axis is implicated, in which direction, and with which evidence -- not merely whether two drugs interact. We introduce a reproducible mechanism-level DDI labelling and evaluation protocol with a structured 7-family/147-subtype taxonomy, leakage-safe cold-split protocols, and auditable reasoning metrics for evaluating pharmacological prediction beyond flat interaction classification. We propose a pipeline that produces a 7B reasoning MARD (Mirror-Augmented Reasoning Distillation), combining three training innovations: a single-token KL divergence on direction tag that ties the model's prediction, per-loss PRM-weighted DPO with programmatic hard negatives, and a leakage-safe mechanism-aware retrieval channel. Process-reward step labels are automatically verifiable against DrugBank-structured fields, requiring no human or LLM judges. On the April-2026 DrugBank release, our MARD-7B is the only system in a 32-system comparison whose accuracy survives drug-pair novelty, beating the best baseline by +13.9 pp and GPT-4o by +6.7 pp at ~1% of frontier API cost. Further analysis reveals an anti-memorisation signature where accuracy improves on rarely seen drugs, suggesting that gain comes from structured pharmacological reasoning rather than drug-frequency memorisation. We release corpus, DDI-PRM, retrieval index, and training code.

Cold-start drug-drug interaction (DDI) prediction tests whether models can identify clinically significant interactions for drugs without training-time interaction history. Existing benchmarks mostly report aggregate edge-prediction scores, leaving a key evaluation question unanswered: when models receive molecular, textual, or knowledge-graph (KG) evidence, do they actually use the evidence that pharmacologically supports the interaction? We introduce ColdDDI, a reconstructible diagnostic benchmark built from DrugBank 5.1.13, with 1,900 approved small-molecule drugs and 565,731 positive DDI pairs. ColdDDI evaluates pairs with zero, one, or two unseen drugs. It also annotates each interaction by whether it changes drug exposure or drug effect, and by whether the biomedical knowledge graph contains shared enzymes, transporters, or targets that can plausibly mediate the interaction. These annotations separate evidence availability from predictive dependence. We evaluate eight conventional DDI methods and 13 LLMs; for open-weight LLMs, we test five prompt patterns and use masking, drug replacement, and channel-sensitivity metrics to probe knowledge utilization. ColdDDI exposes that, in the hardest split where both drugs are unseen, the main performance divide is mediator availability. A fine-tuned 1B LLM recovers 89-93% of interactions with a shared enzyme, transporter, or target, but only 40-62% without such a mediator. More importantly, KG-provided evidence is not always used; several KG-augmented baselines change little when the shared mediator is masked or disrupted, whereas fine-tuned LLMs respond strongly to this intervention. Thus, ColdDDI evaluates knowledge utilization rather than knowledge access alone, showing where cold-start DDI models rely on mechanistic evidence and where they fail despite receiving it. Code is available at https://github.com/0217ljh/ColdDDI-NeurIPS2026.

Drug-drug interaction (DDI) prediction is essential for medication safety, yet it requires reasoning over heterogeneous biomedical evidence whose relevance changes across interaction mechanisms. We propose DDIAgents, a mechanism-conditioned multi-agent framework that performs DDI prediction through dynamic knowledge orchestration. Given a drug pair, a planner agent instantiates specialized expert agents, routes mechanism-relevant knowledge sources to each agent, and aggregates their analyses through a conclusion agent. By adapting context flow to the inferred interaction mechanism, DDIAgents reduces irrelevant information, supports complementary expert reasoning, and produces interpretable agent-level rationales. Extensive experiments on realistic DDI prediction benchmarks show that DDIAgents consistently outperforms existing feature-based, graph-based, LLM-based, and agent-based baselines. Beyond prediction performance, DDIAgents demonstrates how multi-agent systems can organize heterogeneous scientific knowledge for adaptive and interpretable AI4Science reasoning.