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    Clinical Trial Results:
    An Open-Label study to Evaluate the Long-Term Safety of Daily Oral BCX7353 in subjects with Type I and II Hereditary Angioedema

    Summary
    EudraCT number
    2017-003281-27
    Trial protocol
    GB   DE   HU   DK   AT   ES   SK   PL   BE   NL   IT  
    Global end of trial date
    27 Apr 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    15 Dec 2022
    First version publication date
    15 Dec 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    BCX7353-204
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03472040
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    IND: 135,058
    Sponsors
    Sponsor organisation name
    BioCryst Pharmaceuticals Inc.
    Sponsor organisation address
    4505 Emperor Blvd., Suite 200, Durham, United States, NC 27703
    Public contact
    Study Director, BioCryst Pharmaceuticals Inc., 001 919859 1302, clinicaltrials@biocryst.com
    Scientific contact
    Study Director, BioCryst Pharmaceuticals Inc., 001 919859 1302, clinicaltrials@biocryst.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-002449-PIP02-18
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    15 Jul 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    27 Apr 2022
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Apr 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the long-term safety and tolerability of daily dosing of oral BCX7353 in subjects with HAE
    Protection of trial subjects
    This trial was conducted in compliance with International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) guidelines for conducting, recording, and reporting trials, and in accordance with the Declaration of Helsinki. The informed consent form (ICF), protocol and amendments for this trial were submitted to and approved by an appropriate Independent Ethics Committee (IEC). Routine monitoring was performed to verify that rights and well-being of subjects were protected. Emergency equipment and medications were available within the clinical unit as per current standard procedures. Any medication considered necessary for the subject’s safety and well-being was given at the discretion of the Investigator. Signed informed consent was obtained from each adult subject or parent or guardian of adolescent subjects prior to performing any study-related procedures. Similarly, subject assent by subjects aged 12 to 17 was obtained from each adolescent prior to performing any study-related procedures. The informed consent/assent process took place under conditions where the subject and/or parent/guardian had adequate time to consider the risks and benefits associated with the subject’s participation in the study. The Investigator explained the aims, methods, reasonably anticipated benefits, and potential hazards of the trial and any discomfort it may entail.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    27 Feb 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Australia: 20
    Country: Number of subjects enrolled
    United States: 165
    Country: Number of subjects enrolled
    Hong Kong: 7
    Country: Number of subjects enrolled
    Israel: 40
    Country: Number of subjects enrolled
    North Macedonia: 6
    Country: Number of subjects enrolled
    New Zealand: 7
    Country: Number of subjects enrolled
    Serbia: 6
    Country: Number of subjects enrolled
    South Africa: 22
    Country: Number of subjects enrolled
    Korea, Republic of: 12
    Country: Number of subjects enrolled
    Switzerland: 6
    Country: Number of subjects enrolled
    Netherlands: 3
    Country: Number of subjects enrolled
    Poland: 23
    Country: Number of subjects enrolled
    Slovakia: 13
    Country: Number of subjects enrolled
    Spain: 2
    Country: Number of subjects enrolled
    United Kingdom: 16
    Country: Number of subjects enrolled
    Austria: 4
    Country: Number of subjects enrolled
    Belgium: 1
    Country: Number of subjects enrolled
    Denmark: 7
    Country: Number of subjects enrolled
    France: 6
    Country: Number of subjects enrolled
    Germany: 10
    Country: Number of subjects enrolled
    Hungary: 3
    Country: Number of subjects enrolled
    Italy: 8
    Worldwide total number of subjects
    387
    EEA total number of subjects
    80
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    28
    Adults (18-64 years)
    346
    From 65 to 84 years
    13
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Subjects with a clinical diagnosis of HAE Type 1 or 2 who, in the opinion of the investigator, were expected to benefit from an oral treatment for the prevention of angioedema attacks were eligible for the study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    110 mg followed by 150 mg Berotralstat
    Arm description
    Subjects were initially treated with berotralstat 110 mg QD. Following the results from Part 1 of Study BCX7353-302, all subjects were transitioned to a berotralstat dose of 150 mg QD.
    Arm type
    Experimental

    Investigational medicinal product name
    berotralstat
    Investigational medicinal product code
    Other name
    BCX7353
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects initially received 1x 110 mg capsule of berotralstat QD. Once transitioned to the 150 mg dose, subjects received either 3x 50 mg capsules or 1x 150 mg capsules QD. Dosing continued for up to 96 weeks (US) / 240 weeks (ROW)

    Arm title
    150 mg Berotralstat
    Arm description
    Subjects were treated with berotralstat 150 mg QD.
    Arm type
    Experimental

    Investigational medicinal product name
    berotralstat
    Investigational medicinal product code
    Other name
    BCX7353
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received either 3x 50 mg capsules or 1x 150 mg capsules QD. Dosing continued for up to 96 weeks (US) / 240 weeks (ROW)

    Number of subjects in period 1
    110 mg followed by 150 mg Berotralstat 150 mg Berotralstat
    Started
    100
    287
    Completed
    0
    1
    Not completed
    100
    286
         Intercurrent illness/new medical condition
    2
    3
         Consent withdrawn by subject
    10
    23
         Physician decision
    -
    3
         Subject non-compliance
    2
    5
         Lab abnormality or AE
    7
    25
         Perceived lack of efficacy
    29
    30
         Other
    4
    19
         Berotralstat provided by alternative means
    46
    175
         Subsequent ineligibility
    -
    2
         Discontinuation due to rash
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    110 mg followed by 150 mg Berotralstat
    Reporting group description
    Subjects were initially treated with berotralstat 110 mg QD. Following the results from Part 1 of Study BCX7353-302, all subjects were transitioned to a berotralstat dose of 150 mg QD.

    Reporting group title
    150 mg Berotralstat
    Reporting group description
    Subjects were treated with berotralstat 150 mg QD.

    Reporting group values
    110 mg followed by 150 mg Berotralstat 150 mg Berotralstat Total
    Number of subjects
    100 287 387
    Age categorical
    Units: Subjects
        Adolescents (12-17 years)
    5 23 28
        Adults (18-64 years)
    93 253 346
        From 65-84 years
    2 11 13
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    37.6 ± 14.04 40.5 ± 15.26 -
    Gender categorical
    Units: Subjects
        Female
    62 180 242
        Male
    38 107 145

    End points

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    End points reporting groups
    Reporting group title
    110 mg followed by 150 mg Berotralstat
    Reporting group description
    Subjects were initially treated with berotralstat 110 mg QD. Following the results from Part 1 of Study BCX7353-302, all subjects were transitioned to a berotralstat dose of 150 mg QD.

    Reporting group title
    150 mg Berotralstat
    Reporting group description
    Subjects were treated with berotralstat 150 mg QD.

    Primary: Safety & Tolerability

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    End point title
    Safety & Tolerability [1]
    End point description
    The safety population included all subjects who received at least 1 dose of study drug. This population was used in the assessment and reporting of safety data.
    End point type
    Primary
    End point timeframe
    Up to 96 weeks (US / 240 weeks (ROW).
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Primary endpoint was safety and tolerability; no statistical analysis is considered applicable
    End point values
    110 mg followed by 150 mg Berotralstat 150 mg Berotralstat
    Number of subjects analysed
    100
    287
    Units: subjects
        TEAE
    94
    240
        Drug-related TEAE
    58
    119
        TESAE
    23
    20
        Drug-related TESAE
    3
    1
        DMID Grade 3 or 4 TEAE
    18
    35
        Drug-related DMID Grade 3 or 4 TEAE
    7
    11
        TEAE leading to study drug discontinuation
    8
    28
        TEAE leading to study drug interruption
    8
    32
        Drug-related rash
    5
    5
        Drug-related rash leading to IMP discontinuation
    1
    2
    No statistical analyses for this end point

    Secondary: Number of HAE attacks

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    End point title
    Number of HAE attacks
    End point description
    Number of 'adjusted' attacks were assessed. Adjusted attacks included at least 1 symptom of swelling, had a response of 'no' to the diary question, 'In retrospect, could there be an alternative explanation for your symptoms other than an HAE attack (i.e., allergic reaction, viral cold etc.)?', and were considered unique (attack began > 24 hours from the end of the prior attack). Any attack that began within 24 hours from the end of a prior attack was combined with the prior attack.
    End point type
    Secondary
    End point timeframe
    Up to 96 weeks (US) / 240 weeks (ROW)
    End point values
    110 mg followed by 150 mg Berotralstat 150 mg Berotralstat
    Number of subjects analysed
    100
    287
    Units: subjects
        Subjects reporting at least 1 attack
    95
    231
        Subjects reporting at least 1 treated attack
    87
    214
        Subjects reporting at least 1 untreated attack
    59
    99
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events (AEs) were reported from ICF signature until the last follow-up visit, approximately 3 weeks following the last dose of study drug, or until the AE was resolved or the subject was in a clinically stable condition with regard to the AE.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.1
    Reporting groups
    Reporting group title
    110 mg followed by 150 mg Berotralstat
    Reporting group description
    Subjects were initially treated with berotralstat 110 mg QD. Following the results from Part 1 of Study BCX7353-302, all subjects were transitioned to a berotralstat dose of 150 mg QD.

    Reporting group title
    150 mg Berotralstat
    Reporting group description
    Subjects were treated with berotralstat 150 mg QD.

    Serious adverse events
    110 mg followed by 150 mg Berotralstat 150 mg Berotralstat
    Total subjects affected by serious adverse events
         subjects affected / exposed
    23 / 100 (23.00%)
    20 / 287 (6.97%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute myelomonocytic leukaemia
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Abortion spontaneous
         subjects affected / exposed
    2 / 100 (2.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ruptured ectopic pregnancy
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Anxiety
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Suicide attempt
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Medical observation
         subjects affected / exposed
    2 / 100 (2.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatic enzyme increased
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Liver function test abnormal
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Lower limb fracture
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Radius fracture
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Road traffic accident
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Seroma
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Congenital, familial and genetic disorders
    Hereditary angioedema
         subjects affected / exposed
    11 / 100 (11.00%)
    2 / 287 (0.70%)
         occurrences causally related to treatment / all
    0 / 36
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Splenic hamartoma
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Facial paralysis
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Enteritis
         subjects affected / exposed
    2 / 100 (2.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diarrhoea
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Biliary colic
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    0 / 100 (0.00%)
    2 / 287 (0.70%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Foot deformity
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intervertebral disc protrusion
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    2 / 100 (2.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anal abscess
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastroenteritis viral
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gingivitis
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peritonsillar abscess
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    0 / 100 (0.00%)
    1 / 287 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sinusitis
         subjects affected / exposed
    1 / 100 (1.00%)
    0 / 287 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    110 mg followed by 150 mg Berotralstat 150 mg Berotralstat
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    94 / 100 (94.00%)
    240 / 287 (83.62%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    23 / 100 (23.00%)
    34 / 287 (11.85%)
         occurrences all number
    44
    49
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    14 / 100 (14.00%)
    42 / 287 (14.63%)
         occurrences all number
    17
    51
    Abdominal pain
         subjects affected / exposed
    14 / 100 (14.00%)
    29 / 287 (10.10%)
         occurrences all number
    40
    37
    Gastrooesophageal reflux disease
         subjects affected / exposed
    8 / 100 (8.00%)
    14 / 287 (4.88%)
         occurrences all number
    8
    16
    Vomiting
         subjects affected / exposed
    3 / 100 (3.00%)
    17 / 287 (5.92%)
         occurrences all number
    3
    17
    Nausea
         subjects affected / exposed
    9 / 100 (9.00%)
    28 / 287 (9.76%)
         occurrences all number
    10
    32
    Abdominal pain upper
         subjects affected / exposed
    10 / 100 (10.00%)
    18 / 287 (6.27%)
         occurrences all number
    13
    25
    Dyspepsia
         subjects affected / exposed
    5 / 100 (5.00%)
    19 / 287 (6.62%)
         occurrences all number
    5
    21
    Abdominal discomfort
         subjects affected / exposed
    6 / 100 (6.00%)
    17 / 287 (5.92%)
         occurrences all number
    7
    25
    Respiratory, thoracic and mediastinal disorders
    Oropharyngeal pain
         subjects affected / exposed
    10 / 100 (10.00%)
    12 / 287 (4.18%)
         occurrences all number
    19
    20
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    33 / 100 (33.00%)
    59 / 287 (20.56%)
         occurrences all number
    84
    140
    Upper respiratory tract infection
         subjects affected / exposed
    14 / 100 (14.00%)
    36 / 287 (12.54%)
         occurrences all number
    31
    47
    COVID-19
         subjects affected / exposed
    10 / 100 (10.00%)
    20 / 287 (6.97%)
         occurrences all number
    10
    20
    Influenza
         subjects affected / exposed
    8 / 100 (8.00%)
    20 / 287 (6.97%)
         occurrences all number
    8
    25
    Urinary tract infection
         subjects affected / exposed
    7 / 100 (7.00%)
    21 / 287 (7.32%)
         occurrences all number
    10
    33
    Sinusitis
         subjects affected / exposed
    10 / 100 (10.00%)
    15 / 287 (5.23%)
         occurrences all number
    20
    19
    Gastroenteritis
         subjects affected / exposed
    10 / 100 (10.00%)
    12 / 287 (4.18%)
         occurrences all number
    11
    17

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    05 Dec 2017
    The protocol was adapted to allow patients to participate in LTSS, who had not previously participated in efficacy studies of berotralstat. An efficacy study (BCX7353-302) with the same doses was conducted in parallel to this study. Thus, the design was amended to two arms to collect safety data of for treatment with 110 mg and 150 mg berotralstat. To obtain significant safety data, the number of patients included was increased to 200. Exclusion criterion 13 regarding creatinine clearance and transaminases was broadened following regulatory authority feedback, to allow inclusion of patients in the study that were more representative of the general HAE patient population. Additional safety assessments were added to monitor transaminase elevation.
    06 Dec 2017
    Expansion of inclusions criteria to include adolescent subjects ≥ 12 to 17 years of age to screen and enroll in participating regions. Expansion of inclusion criteria to allow enrolment of subjects who had not previously participated in a berotralstat study; i.e., subjects with a clinical diagnosis of HAE Type 1 or 2 who, in the opinion of the Investigator, were expected to benefit from treatment with an oral treatment for the prevention of angioedema attacks.
    05 Oct 2018
    Introduction of additional stopping criteria associated with liver enzyme elevations to precisely reflect FDA Guidance on Drug-Induced Liver Injury: Premarketing Clinical Evaluation. Clarification of requirements for discontinuation due to QTcF increase. Study duration extended to 96 weeks. To obtain significant safety data, the number of patients included was increased to 225.
    07 Feb 2019
    US-Specific Protocol Amendment. Protocol was updated to reflect the addition of multiple centres in the US. Amendment to remove reference to participation in a prior berotralstat study for US subjects, since completed studies of BCX7353 were conducted in Europe only. Additional safety screening assessments to characterise liver function after cessation of androgens and prior to allocation to study drug. Number of subjects increased to 275 including approximately 50 subjects in the US. To provide updated guidance on the management of subjects with treatment emergent increases in serum aminotransferases, based on the accumulation of clinical experience with dosing berotralstat.
    31 Jul 2019
    US-specific Protocol Amendment. Based on the results of BCX7353-302, Part 1, all subjects were transitioned to the 150 mg berotralstat dose level. Number of subjects increased to 475 including approximately 250 subjects in the US. Inclusion criteria updated to allow historic lab diagnosis of HAE. Amendment to allow males to participate in the study, without the need for contraception. Berotralstat has no identifiable genotoxicity risks, no evidence of effects on male fertility and no evidence of fetotoxicity in animal studies. Female participants continued to be required to take acceptable effective contraception.
    21 Aug 2019
    Amendment to allow subjects to continue receiving berotralstat for up to 240 weeks OR until an alternative method was available for participants to access berotralstat (locally marketed or market access program). Amendment to allow males to participate in the study, without the need for contraception. Berotralstat has no identifiable genotoxicity risks, no evidence of effects on male fertility and no evidence of fetotoxicity in animal studies. Female participants continued to be required to take acceptable effective contraception. Based on the results of BCX7353-302, Part 1, all subjects were transitioned to the 150 mg berotralstat dose level. Number of subjects increased to 475 including approximately 250 subjects in the US. Updated guidance regarding stopping criteria associated with liver enzyme elevations based on the accumulation of clinical experience with berotralstat dosing.
    06 Feb 2020
    US-specific Protocol Amendment. Protocol provided interim results from the study as well as updated benefit/risk to reflect information from BCX7353-302. As a result of additional safety data, the number of clinic visits were reduced and DMC meeting frequency decreased to every 6 months. Exclusion criterion relating to potential prolongation removed following negative results in a thorough QT study and no other cardiac signal having been detected. Prohibited Concomitant Medications also updated as a result of this. Exclusion criterion regarding creatinine clearance and transaminases was removed, as cumulative safety data had determined no additional safety risk in subjects with severe renal or hepatic disease dosed with berotralstat. Protocol clarified regarding evaluation of rash events, which were confirmed as a delayed type hypersensitivity benign drug rash that does not result in T-cell memory. The rash phenotype and biopsy results had been consistent throughout the development program, making it unlikely that additional data collection on other types of skin conditions or rashes not suspected to be due to study drug would be useful in further understanding the drug rash. Drug rashes continued to require enhanced data collection, and the need to discontinue study drug with severe rash remained.
    23 Mar 2020
    US-specific Protocol Amendment. To require coagulation parameters to be collected for all patients as part of routine safety labs. Reintroduction of limited PK samples in the first 12 weeks for adolescent subjects, to gain additional data to support future paediatric development.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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