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BCX7353

Phase 3

Hereditary Angioedema | Small molecule | Immunology |BioCryst Pharmaceuticals, Inc.|Last Updated: Jul 19, 2024

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindCONTROLLEDDMC
Total Trials6
Total Enrollment728

FDA Designations

No designations recorded

Clinical trial landscape

BCX7353 · 9 trials · 5 indications

Phase 3 2Phase 2 3Phase 1 4
NCT03873116Study to Evaluate the Efficacy and Safety of BCX7353 as an Oral Treatment for the Prevention of HAE Attacks in JapanHereditary Angioedema, HAE
COMPLETED19 Analytics
NCT03485911Efficacy and Safety Study of BCX7353 as an Oral Treatment for the Prevention of Attacks in HAEHereditary Angioedema
COMPLETED121 Analytics
PHASE3COMPLETED
Study to Evaluate the Efficacy and Safety of BCX7353 as an Oral Treatment for the Prevention of HAE Attacks in Japan
Hereditary Angioedema, HAEUnlock trial analytics
PHASE3COMPLETED
Efficacy and Safety Study of BCX7353 as an Oral Treatment for the Prevention of Attacks in HAE
Hereditary AngioedemaUnlock trial analytics

Study Endpoints

Primary Endpoints

Part 1: The Rate of Expert-confirmed HAE Attacks During Dosing in the Entire 24-week Treatment Period (Day 1 to Day 168)
24 weeks

The angioedema event rate and the treatment comparisons between each berotralstat dose and placebo in the rate of expert-confirmed angioedema events during the entire dosing period was analyzed using a negative binomial regression model. The number of expert-confirmed angioedema events was included as the dependent variable, the treatment was included as a fixed effect, the stratification variable (baseline monthly angioedema event rate) and study (for the combined study analysis) were included as covariates, and the logarithm of duration on treatment was included as an offset variable. The estimated rate of angioedema events for each treatment group, the treatment differences expressed as the angioedema event rate ratio (berotralstat) over placebo rate ratio), and their associated 95% confidence intervals (CIs) were provided from the negative binomial regression model.

Part 2: To Evaluate the Long-term Safety and Tolerability of Berotralstat 110 and 150 mg in Subjects With HAE
Part 1: 24 weeks (Week 0 to 24 to 52), Part 2: 28 weeks (Week 24 to 52)

The safety data was assessed for the safety population for subjects who entered Part 2, and includes TEAEs that occurred in Part 1 and Part 2 for these subjects with a data cut-off date of 10-April-2020. TEAEs are defined as AEs that occurred on or after first dose of study treatment, whether in Part 1 or 2, and were assigned to the relevant treatment depending on when the TEAE began (Part 1 or Part 2 treatment). TEAEs were assessed for severity (graded) using the Division of Microbiology and Infectious Disease (DMID) criteria for grading AEs. TEAEs not covered by the DMID criteria were assessed as Mild (Grade 1), Moderate (Grade 2), Severe (Grade 3) or Life-threatening (Grade 4).

Part 3: To Evaluate the Long-term Safety and Tolerability of Berotralstat Administered QD Over a 52- to up to 104-week Administration Period in Subjects With HAE.
Part 3: Week 52 to up to Week 104.

The safety data was assessed for the safety population for subjects who entered Part 3, and includes TEAEs that occurred in Part 3 for these subjects.

Part 1: The Rate of Investigator-confirmed HAE Attacks During Dosing in the Entire 24-week Treatment Period (Day 1 to Day 168)
24 weeks

Treatment comparisons between each berotralstat dose and placebo in the rate of investigator-confirmed HAE attacks during the Part 1 dosing period were analyzed using a negative binomial model. The number of investigator-confirmed attacks was included as the dependent variable, the treatment was included as a fixed effect, the stratification variable (baseline attack rate) was included as a covariate, and the logarithm of duration on treatment was included as an offset variable. The estimated attack rate for each treatment group, the treatment differences expressed as the attack rate ratio (berotralstat over placebo rate ratio), and the associated 95% confidence intervals (CIs) were provided from the negative binomial model.

Part 2 & 3: To Evaluate the Long-term Safety and Tolerability of Berotralstat 110 and 150 mg in Subjects With HAE
Part 2: 24 weeks (Days 169 to 337). Part 3: 48 weeks (Days 338 to 674).

The safety data was assessed for the safety population, for subjects who entered Part 2 and Part 3, and includes TEAEs that began in Part 2 or 3, respectively, for these subjects. Safety data for Part 2 and Part 3 is combined to clearly show TEAEs occurring in subjects as the proceeded through the 2 study parts. TEAEs are defined as AEs that occurred on or after first dose of study treatment, whether in Part 1 or 2, and were assigned to the relevant treatment depending on when the TEAE began (Part 2 or Part 3 treatment). No statistical analysis was performed on this safety data.

Safety & Tolerability
Up to 96 weeks (US) / 216 weeks (Rest of World (ROW)).

The number and percentage of subjects with treatment-emergent adverse events.

Proportion of Subjects With Improved or Stable Composite Visual Analog Scale (VAS) Score
Mean composite VAS for HAE attack symptoms severity prior to IMP treatment and 4 hours post-dose

Subjects completed a 3-component VAS on a 100 mm scale for severity of abdominal pain, skin pain and skin swelling associated with the HAE attack, where zero indicated no pain or swelling and 100 mm indicated worst possible pain or swelling. Subjects completed the VAS immediately prior to study drug administration, then at 1, 2, 3, 4, approximately 8 \& at 24 hours post-dose. The primary endpoint was the proportion of subject attacks with an improved or stable 3-symptom composite VAS score at 4 hours post dose. The 3-symptom composite was calculated as the average of the VAS scores for abdominal pain, skin pain, and skin swelling. A subject was considered improved or stable if the change from baseline (CFB; time of drug administration) in VAS was ≤ 0.

Percentage of Attacks Treated With Standard of Care Acute Attack Medication (SOC-Rx) Through 24 Hours
24 hours

The proportion of attacks for which subjects took SOC-Rx in the 24 hours following treatment with study drug. HAE Rescue Medications included C1-INH (Berinert, Cinryze, Ruconest) and Firazyr/Icatibant.

Number of Confirmed HAE Attacks
Investigators collected data from patient diaries from the first day of dosing through to Day 29 or last day of dosing +24 hrs (the effective dosing period).

Efficacy was evaluated by the number of acute angioedema attacks. To ensure that consistent, objective assessments were used in accepting subject-reported attack data, a panel of expert physicians in the treatment of HAE patients adjudicated all subject-reported attacks prior to their inclusion in primary efficacy analyses.

Proportion of Subjects Who Were HAE Attack-free During the Entire Dosing Period
Investigators collected data from patient diaries from the first day of dosing through to Day 29 or last day of dosing +24 hrs (the effective dosing period).

Assessment of the proportion of subjects who had no HAE attacks during the entire dosing period

Geometric least-squares mean ratio for Cmax for test (blend in capsule) versus reference formulation (API in capsule)
plasma pharmacokinetic parameters are based on blood sampling over a 72 hour period
Geometric least-squares mean ratio for AUClast for test (blend in capsule) versus reference formulation (API in capsule)
plasma pharmacokinetic parameters are based on blood sampling over a 72 hour period
Geometric least-squares mean ratio for AUCinf for test (blend in capsule) versus reference formulation (API in capsule)
plasma pharmacokinetic parameters are based on blood sampling over a 72 hour period
Geometric least-squares mean ratio for Cmax for test (blend in capsule fed) versus reference formulation (blend in capsule fasted)
lasma pharmacokinetic parameters are based on blood sampling over a 72 hour period
Geometric least-squares mean ratio for AUClast for test (blend in capsule fed) versus reference formulation (blend in capsule fasted)
lasma pharmacokinetic parameters are based on blood sampling over a 72 hour period
Geometric least-squares mean ratio for AUCinf for test (blend in capsule fed) versus reference formulation (blend in capsule fasted)
lasma pharmacokinetic parameters are based on blood sampling over a 72 hour period
Cmax of probe substrate
plasma pharmacokinetic parameters are based on blood sampling over a 48 - 72 hour period
AUClast of probe substrate
plasma pharmacokinetic parameters are based on blood sampling over a 48 - 72 hour period
AUCinf of probe substrate
plasma pharmacokinetic parameters are based on blood sampling over a 48 - 72 hour period
Cmax of probe substrates
plasma pharmacokinetic parameters are based on blood sampling through 24 hours on Day 1, 2, 10 and 11
Tmax of probe substrates
plasma pharmacokinetic parameters are based on blood sampling through 24 hours on Day 1, 2, 10 and 11
AUClast of probe substrates
plasma pharmacokinetic parameters are based on blood sampling through 24 hours on Day 1, 2, 10 and 11
AUCinf of probe substrates
plasma pharmacokinetic parameters are based on blood sampling through 24 hours on Day 1, 2, 10 and 11
t1/2 of probe substrates
plasma pharmacokinetic parameters are based on blood sampling through 24 hours on Day 1, 2, 10 and 11
Cl of intravenous midazolam
plasma pharmacokinetic parameters are based on blood sampling through 24 hours on Day 1, 2, 10 and 11
Adverse events
Part 1 and Part 3 single dose cohort: absolute and change from baseline through Study Day 7; Part 2 and Part 3 multiple dose cohort: absolute and change from baseline through 14 or 21 days (depending on dosing duration)
Laboratory analyses
Part 1 and Part 3 single dose cohort: absolute and change from baseline through Study Day 7; Part 2 and Part 3 multiple dose cohort: absolute and change from baseline through 14 or 21 days (depending on dosing duration)
Vital signs
Part 1 and Part 3 single dose cohort: absolute and change from baseline through Study Day 7; Part 2 and Part 3 multiple dose cohort: absolute and change from baseline through 14 or 21 days (depending on dosing duration)
Electrocardiograms
Part 1 and Part 3 single dose cohort: absolute and change from baseline through Study Day 7; Part 2 and Part 3 multiple dose cohort: absolute and change from baseline through 14 or 21 days (depending on dosing duration)
Physical examination findings
Part 1 and Part 3 single dose cohort: absolute and change from baseline through Study Day 7; Part 2 and Part 3 multiple dose cohort: absolute and change from baseline through 14 or 21 days (depending on dosing duration)

Secondary Endpoints

Part 1: Proportion of Days With Angioedema Symptoms Through 24 Weeks.
24 weeks
Part 1: Rate of Expert-confirmed Angioedema Events During Dosing in the Effective Treatment Period
Day 8 through to 24 weeks
Part 1: Change From Baseline in Angioedema Quality of Life (AE-QoL) Questionnaire at Week 24 (Total Score)
Baseline and 24 weeks
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Study Design & Arms

AllocationRANDOMIZED
MaskingTRIPLE
ModelPARALLEL
PurposePREVENTION

Treatment Arms

ArmTypeDescription
BCX7353 110mg once dailyEXPERIMENTALBCX7353 capsules administered orally once daily
BCX7353 150mg once dailyEXPERIMENTALBCX7353 capsules administered orally once daily
PlaceboPLACEBO_COMPARATORMatching placebo oral capsules administered orally once daily
BCX7353 110 mg once dailyEXPERIMENTALBCX7353 administered as oral capsules once daily
BCX7353 150 mg once dailyEXPERIMENTALBCX7353 administered as oral capsules once daily
Part1: BCX7353 750 mgEXPERIMENTAL -
Part 2: BCX7353 500 mgEXPERIMENTAL -
Part 3: BCX7353 250 mgEXPERIMENTAL -
Parts 1, 2 and 3: placeboPLACEBO_COMPARATOR -
Part 1: BCX7353 350 mg once dailyEXPERIMENTALBCX7353 capsules, 350 mg dose administered once per day for 28 days
Parts 2 and 3: BCX7353 250 mg once dailyEXPERIMENTALBCX7353 capsules, 250 mg dose administered once per day for 28 days
Parts 2 and 3: BCX7353 125 mg once dailyEXPERIMENTALBCX7353 capsules, 125 mg dose administered once per day for 28 days
Part 3: BCX7353 62.5 mg once dailyEXPERIMENTALBCX7353 capsules, 62.5 mg dose administered once per day for 28 days
BCX7353 API in capsuleEXPERIMENTALfasted administration of BCX7353 API in capsule
BCX7353 blend in capsuleEXPERIMENTALfasted administration of BCX7353 blend in capsule
BCX7353 blend in capsule with foodEXPERIMENTALadministration of BCX7353 blend in capsule following high-fat meal
Cohort 1EXPERIMENTALDay 1: Digoxin 0.25 mg oral dose Day 11-18: BCX7353 350 mg oral dose Day 19: Digoxin 0.25 mg oral dose and BCX7353 350 mg oral dose Day 20-21: BCX7353 350 mg oral dose
Cohort 2EXPERIMENTALDay 1: Rosuvastatin 10 mg oral dose Day 7-14: BCX7353 350 mg oral dose Day 15: Rosuvastatin 10 mg oral dose and BCX7353 350 mg oral dose Day 16: BCX7353 350 mg oral dose
Cohort 3EXPERIMENTALDay 1: BCX7353 350 mg oral dose Day 14: single oral dose of Cyclosporine 600 mg and BCX7353 350 mg
Metabolic Probes and BCX7353EXPERIMENTALDay 1: 1 mg midazolam will be administered as an IV bolus simultaneously to administration of 500 mg tolbutamide, 40 mg omeprazole, and 30 mg dextromethorphan orally. Day 2: a single oral dose of 2 mg midazolam. Days 3 to 9: 350 mg BCX7353 once a day. Day 10: 1 mg midazolam will be administered as an IV bolus simultaneously to administration of 500 mg tolbutamide, 40 mg omeprazole, 30 mg dextromethorphan and 350 mg BCX7353, orally. Day 11: a single oral dose of 2 mg of midazolam along with 350 mg BCX7353.
BCX7353EXPERIMENTALBCX7353 capsules administered orally

Interventions

NameTypeDescription
BCX7353 capsulesDRUGBCX7353 capsules administered orally once daily
Placebo oral capsuleDRUGMatching placebo capsules administered orally once daily
BCX7353DRUGBCX7353 mg oral capsules administered once daily
PlaceboDRUGoral liquid formulation to match BCX7353
DigoxinDRUGDay 1 of Cohort 1
BCX7353 + digoxinDRUGDay 19 of Cohort 1
RosuvastatinDRUGDay 1 of Cohort 2
rosuvastatin + BCX7353DRUGDay 15 of Cohort 1
Cyclosporine + BCX7353DRUGDay 14 of Cohort 3
BCX7353 and probesDRUG -
Placebo to match BCX7353DRUG -
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Eligibility Criteria

Age Range12 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites10

Key Inclusion Criteria: * A clinical diagnosis of hereditary angioedema (HAE) Type 1 or Type 2, defined as having a C1-INH functional level and a C4 level below the lower limit of the normal (LLN) reference range, as assessed during the Screening period. * Access to and ability to use one or more a...

Countries:JapanUnited StatesAustriaCanadaCzechiaFranceGermanyHungaryNorth MacedoniaRomaniaSpainUnited KingdomAustraliaDenmarkHong KongIsraelItalyNew ZealandPolandSerbiaSlovakiaSouth AfricaSouth KoreaSwitzerland
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Frequently asked questions about BCX7353

What is BCX7353 used for?

BCX7353 is an investigational small molecule being developed for the treatment of hereditary angioedema (HAE), a rare genetic condition characterized by recurrent episodes of severe swelling. It is currently in Phase 3 clinical development and has not been approved by regulatory authorities.

Who makes BCX7353?

BCX7353 is being developed by BioCryst Pharmaceuticals, Inc., a biopharmaceutical company traded on the NASDAQ under the ticker symbol BCRX. The company is conducting clinical trials to evaluate the drug's safety and efficacy in patients with hereditary angioedema.

What phase is BCX7353 in?

BCX7353 is currently in Phase 3 clinical development for hereditary angioedema. It is an investigational drug, meaning it has not yet received regulatory approval and is still undergoing clinical trials to assess its safety and effectiveness in treating the condition.

What clinical trials has BCX7353 been in?

BCX7353 has been studied in six completed clinical trials with a total enrollment of 728 participants. These include early-phase studies such as NCT02448264, a first-in-human trial in healthy volunteers, and NCT02819102, NCT03136237, and NCT03202784, which evaluated drug interactions and formulations. All trials were conducted in the United Kingdom.

Is BCX7353 the same as berotralstat?

BCX7353 is the investigational code name for the drug also known as berotralstat. BioCryst Pharmaceuticals is developing this oral small molecule for hereditary angioedema, and it is currently in Phase 3 clinical trials. The drug has not yet been approved for commercial use.