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BCX7353

Phase 3FDA approved 2020

Hereditary Angioedema | Small molecule | Immunology |BioCryst Pharmaceuticals, Inc.|Trials Updated: Feb 25, 2026

BCX7353 development status

FDA approval Dec 3, 2020 as Orladeyo
Approval holderBiocryst
ApplicationNDA214094
Highest phase Phase 3
Registered trials 9 across 1 sponsor since May 2015

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

BCX7353 target and mechanism

ModalitySmall molecule

Also known as BCX7353 capsules, Berotralstat, Orladeyo®

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindCONTROLLEDDMC
Total Trials11
Total Enrollment1,048

FDA Designations

No designations recorded

BCX7353 clinical trials

BCX7353 · 11 trials · 6 indications

Phase 3 4Phase 2 3Phase 1 4
NCT05453968Berotralstat Treatment in Children With Hereditary AngioedemaHereditary Angioedema
ACTIVE NOT_RECRUITING29 Analytics
NCT04933721Open-label Berotralstat Access to HAE Patients Previously Enrolled in Berotralstat StudiesHereditary Angioedema
ENROLLING BY_INVITATION139 Analytics
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
PHASE3ACTIVE NOT_RECRUITING
Berotralstat Treatment in Children With Hereditary Angioedema
Hereditary AngioedemaUnlock trial analytics
PHASE3ENROLLING BY_INVITATION
Open-label Berotralstat Access to HAE Patients Previously Enrolled in Berotralstat Studies
Hereditary AngioedemaUnlock trial 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

Area Under the Plasma Concentration-Time Curve From Time 0 to the Last Measurable Concentration (AUC0-last) of Berotralstat
Week 2

AUC0-last is the area under the plasma concentration-time curve from time 0 to the time of the last measurable concentration.

Area Under the Plasma Concentration-Time Curve From Time 0 to 6 Hours Post-dose (AUC0-6) of Berotralstat
Predose and up to 6 hours post dose at Week 2

AUC0-6 is the area under the plasma concentration-time curve from time 0 to 6 hours.

Concentration at the End of the Dosing Interval (Ctrough) of Berotralstat
Predose at Week 2

Ctrough is the concentration at the end of a dosing interval of berotralstat.

Maximum Observed Plasma Concentration (Cmax) of Berotralstat
Predose and up to 6 hours post dose at Week 2

Cmax is the maximum observed plasma concentration of berotralstat.

Time of Last Measurable Plasma Concentration (Tlast) of Berotralstat
Predose and up to 6 hours post dose at Week 2

Tlast is the time of the last measurable concentration (Clast) of berotralstat collected over the sampling interval.

Time to Maximum Plasma Concentration (Tmax) of Berotralstat
Predose and up to 6 hours post dose at Week 2

Tmax is the time taken to reach the maximum observed plasma concentration of berotralstat.

Number and proportion of subjects with a treatment-related TEAE
240 weeks
Number and proportion of subjects who experience a serious adverse event (SAE)
240 weeks
Number and proportion of subjects who experience a treatment-related Grade 3 or 4 TEAE
240 weeks
Number and proportion of subjects who experience a treatment-related Grade 3 or 4 treatment-emergent chemistry abnormality
240 weeks
Number and proportion of subjects who discontinue due to a TEAE
240 weeks
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

Number of Participants With Treatment Emergent Adverse Events (TEAEs)
From first dose of study treatment up to approximately 73 weeks
Number of Adjusted Hereditary Angioedema (HAE) Attacks
Week 1 through Week 12 and Week 1 through Week 48
Rate of Adjusted HAE Attacks
Week 1 through Week 12 and Week 1 through Week 48
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Study Design & Arms

AllocationNON_RANDOMIZED
MaskingNONE
ModelSINGLE_GROUP
PurposePREVENTION

Treatment Arms

ArmTypeDescription
Cohort 1: ≥ 40 kg body weight (Berotralstat 150 mg)EXPERIMENTALParticipants 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)EXPERIMENTALParticipants 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)EXPERIMENTALParticipants 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)EXPERIMENTALParticipants 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 dailyEXPERIMENTALBerotralstat (BCX7353) capsules or granules orally administered once daily.
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
BerotralstatDRUGAdministered orally once daily
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 Range2 Years to 11 Years
SexALL
Healthy VolunteersNo
Study Sites15

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...

Countries:AustriaCanadaFranceGermanyIsraelItalyPolandRomaniaSpainUnited KingdomCzechiaNorth MacedoniaSlovakiaSouth AfricaSouth KoreaJapanUnited StatesHungaryAustraliaDenmarkHong KongNew ZealandSerbiaSwitzerland
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Frequently asked questions about BCX7353

What is BCX7353 used for?

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.

Who makes BCX7353?

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.

What phase is BCX7353 in?

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.

What clinical trials is BCX7353 in?

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.

Is BCX7353 the same as BCX7353 capsules?

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.