Approval Probability
TA Base Rate
Adjusted LOA
ML Risk
Label indication ORLADEYO ® is indicated for prophylaxis to prevent attacks of hereditary angioedema (HAE) in adults and pediatric patients 2 years of age and older. ORLADEYO is a plasma kallikrein inhibitor indicated for prophylaxis to prevent attacks of hereditary angioedema (HAE) in adults and pediatric patients 2 years and older. ( 1 ) Limitations of Use : ORLADEYO should not be used for treatment of acute HAE attacks. FDA label
Also known as BCX7353 capsules, Berotralstat, Orladeyo®
BCX7353 · 11 trials · 6 indications
AUC0-last is the area under the plasma concentration-time curve from time 0 to the time of the last measurable concentration.
AUC0-6 is the area under the plasma concentration-time curve from time 0 to 6 hours.
Ctrough is the concentration at the end of a dosing interval of berotralstat.
Cmax is the maximum observed plasma concentration of berotralstat.
Tlast is the time of the last measurable concentration (Clast) of berotralstat collected over the sampling interval.
Tmax is the time taken to reach the maximum observed plasma concentration of berotralstat.
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.
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).
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.
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.
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.
The number and percentage of subjects with treatment-emergent adverse events.
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.
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.
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.
Assessment of the proportion of subjects who had no HAE attacks during the entire dosing period
| Arm | Type | Description |
|---|---|---|
| Cohort 1: ≥ 40 kg body weight (Berotralstat 150 mg) | EXPERIMENTAL | Participants received 150 milligram (mg) berotralstat capsule orally once daily for up to 144 weeks. Dose modifications were permitted due to weight changes, PK results, or safety. |
| Cohort 2: 32 to < 40 kg body weight (Berotralstat 108 mg) | EXPERIMENTAL | Participants received 108 mg berotralstat granules orally once daily for up to 144 weeks. Dose modifications were permitted due to weight changes, PK results, or safety. |
| Cohort 3: 24 to < 32 kg body weight (Berotralstat 96 mg) | EXPERIMENTAL | Participants received 96 mg berotralstat granules orally once daily for up to 144 weeks. Dose modifications were permitted due to weight changes, PK results, or safety. |
| Cohort 4: 12 to <24 kg body weight (Berotralstat 78 mg) | EXPERIMENTAL | Participants received 78 mg berotralstat granules orally once daily for up to 144 weeks. Dose modifications were permitted due to weight changes, PK results, or safety. |
| BCX7353 capsules or granules once daily | EXPERIMENTAL | Berotralstat (BCX7353) capsules or granules orally administered once daily. |
| BCX7353 110mg once daily | EXPERIMENTAL | BCX7353 capsules administered orally once daily |
| BCX7353 150mg once daily | EXPERIMENTAL | BCX7353 capsules administered orally once daily |
| Placebo | PLACEBO_COMPARATOR | Matching placebo oral capsules administered orally once daily |
| BCX7353 110 mg once daily | EXPERIMENTAL | BCX7353 administered as oral capsules once daily |
| BCX7353 150 mg once daily | EXPERIMENTAL | BCX7353 administered as oral capsules once daily |
| Part1: BCX7353 750 mg | EXPERIMENTAL | - |
| Part 2: BCX7353 500 mg | EXPERIMENTAL | - |
| Part 3: BCX7353 250 mg | EXPERIMENTAL | - |
| Parts 1, 2 and 3: placebo | PLACEBO_COMPARATOR | - |
| Part 1: BCX7353 350 mg once daily | EXPERIMENTAL | BCX7353 capsules, 350 mg dose administered once per day for 28 days |
| Parts 2 and 3: BCX7353 250 mg once daily | EXPERIMENTAL | BCX7353 capsules, 250 mg dose administered once per day for 28 days |
| Parts 2 and 3: BCX7353 125 mg once daily | EXPERIMENTAL | BCX7353 capsules, 125 mg dose administered once per day for 28 days |
| Part 3: BCX7353 62.5 mg once daily | EXPERIMENTAL | BCX7353 capsules, 62.5 mg dose administered once per day for 28 days |
| BCX7353 API in capsule | EXPERIMENTAL | fasted administration of BCX7353 API in capsule |
| BCX7353 blend in capsule | EXPERIMENTAL | fasted administration of BCX7353 blend in capsule |
| BCX7353 blend in capsule with food | EXPERIMENTAL | administration of BCX7353 blend in capsule following high-fat meal |
| Cohort 1 | EXPERIMENTAL | Day 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 2 | EXPERIMENTAL | Day 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 3 | EXPERIMENTAL | Day 1: BCX7353 350 mg oral dose Day 14: single oral dose of Cyclosporine 600 mg and BCX7353 350 mg |
| Metabolic Probes and BCX7353 | EXPERIMENTAL | Day 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. |
| BCX7353 | EXPERIMENTAL | BCX7353 capsules administered orally |
| Name | Type | Description |
|---|---|---|
| Berotralstat | DRUG | Administered orally once daily |
| BCX7353 capsules | DRUG | BCX7353 capsules administered orally once daily |
| Placebo oral capsule | DRUG | Matching placebo capsules administered orally once daily |
| BCX7353 | DRUG | BCX7353 mg oral capsules administered once daily |
| Placebo | DRUG | oral liquid formulation to match BCX7353 |
| Digoxin | DRUG | Day 1 of Cohort 1 |
| BCX7353 + digoxin | DRUG | Day 19 of Cohort 1 |
| Rosuvastatin | DRUG | Day 1 of Cohort 2 |
| rosuvastatin + BCX7353 | DRUG | Day 15 of Cohort 1 |
| Cyclosporine + BCX7353 | DRUG | Day 14 of Cohort 3 |
| BCX7353 and probes | DRUG | - |
| Placebo to match BCX7353 | DRUG | - |
Inclusion Criteria: * Male and non-pregnant, non-lactating females 2 to \< 12 years of age * Body weight ≥ 12 kg * Clinical diagnosis of HAE * In the opinion of the investigator, the participant would benefit from long term oral HAE prophylaxis * For subjects who are not currently receiving prophyl...
| Company | Ticker | Trials | Lead Phase | Drugs |
|---|---|---|---|---|
| Intellia Therapeutics, Inc. | NTLA | 3 | PHASE3 | NTLA-2002 |
| BioCryst Pharmaceuticals, Inc. | BCRX | 2 | PHASE3 | Berotralstat |
| Ionis Pharmaceuticals, Inc. | IONS | 1 | PHASE3 | Donidalorsen |
| Pharvaris N.V. | PHVS | 1 | PHASE2 | Deucrictibant |
| BioMarin Pharmaceutical Inc. | BMRN | 1 | PHASE1 | BMN 331 |
| Astria Therapeutics, Inc. | ATXS | 1 | PHASE2 | STAR-0215 |
BCX7353 is an oral small molecule developed for the prevention of attacks in hereditary angioedema (HAE). It has been studied both as a prophylactic treatment to reduce the frequency of HAE attacks and as a treatment for acute attacks. The clinical program includes Phase 2 and Phase 3 trials in patients with HAE.
BCX7353 is developed by BioCryst Pharmaceuticals, Inc., which trades on the Nasdaq under the ticker BCRX. BioCryst is the sponsor of the clinical trials evaluating BCX7353 in hereditary angioedema.
BCX7353 has completed Phase 3 clinical development. Eight trials have been conducted, all of which are completed, including Phase 3 studies in Japan and in multiple countries across North America and Europe. The program enrolled a total of 861 participants.
BCX7353 has been evaluated in eight completed trials, including NCT03873116, a Phase 3 study of oral BCX7353 for HAE attack prevention in Japan; NCT03485911, a Phase 3 prevention study across the United States, Canada, and Europe; NCT03472040, a long-term safety study; and NCT03240133, a Phase 2 study of BCX7353 as treatment for HAE attacks.
Yes. BCX7353 and BCX7353 capsules refer to the same investigational drug candidate. BCX7353 is an oral small molecule developed by BioCryst Pharmaceuticals for hereditary angioedema, and the capsule formulation is the oral dosage form used in its clinical trials.