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BCX9930 for the Treatment of Paroxysmal Nocturnal Hemoglobinuria (PNH) in Participants With Inadequate Response to C5 Inhibitor Therapy

A Randomized, Open-Label, Multicenter, Parallel-Group Study to Evaluate the Efficacy, Safety, and Tolerability of Oral BCX9930 Monotherapy for the Treatment of Paroxysmal Nocturnal Hemoglobinuria in Subjects With Inadequate Response to C5 Inhibitor Therapy

Status
Terminated
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT05116774
Acronym
REDEEM-1
Enrollment
12
Registered
2021-11-11
Start date
2021-12-06
Completion date
2023-09-14
Last updated
2025-03-07

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Keywords

BCX9930, factor D inhibitor, proximal complement inhibitor, oral therapy, paroxysmal nocturnal hemoglobinuria, inadequate response to C5 inhibitor, C5 inhibitor, eculizumab, ravulizumab

Brief summary

The purpose of this study was to determine the efficacy and safety of BCX9930 monotherapy for the treatment of PNH compared to continued C5 inhibitor therapy in adult PNH participants with residual anemia despite treatment with a C5 inhibitor.

Detailed description

This was a randomized, active comparator-controlled, open-label, parallel-group, 2-part study. Parts 1 and 2 were conducted in the same participants. Part 1 of the study was designed to evaluate the efficacy, safety, and tolerability of oral BCX9930 monotherapy for 24 weeks versus continuing C5 inhibitor therapy in participants with PNH with inadequate response to their current C5 inhibitor therapy. Participants were randomized to either discontinue C5 inhibitor therapy and start BCX9930 monotherapy or to continue C5 inhibitor therapy for the 24-week randomized treatment period. The primary efficacy and safety analyses were based on Part 1. Part 2 of the study was designed to evaluate the long-term safety, tolerability, and effectiveness of BCX9930 monotherapy when administered through Week 52. All participants in Part 2 received BCX9930. Participants who were randomized to BCX9930 monotherapy in Part 1 continued to receive BCX9930 in Part 2. Participants who were randomized to C5 inhibitor therapy in Part 1 discontinued that therapy at the Week 24 visit and received BCX9930 in Part 2.

Interventions

DRUGEculizumab

Administered by intravenous infusion per current dose regimen

DRUGRavulizumab

Administered by intravenous infusion per current dose regimen

Administered orally twice daily

Sponsors

BioCryst Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Male or female, aged ≥ 18 years old * Body weight ≥ 40 kg * Documented diagnosis of PNH * Currently being treated with a stable C5 inhibitor regimen * Documentation of current vaccinations against Neisseria meningitidis and Streptococcus pneumoniae or willing to start vaccination series * At screening: PNH clone size of ≥ 10% and hemoglobin ≤ 10.5 g/dL

Exclusion criteria

* Known history of or existing diagnosis of hereditary complement deficiency * History of hematopoietic cell transplant or solid organ transplant or anticipated candidate for transplantation * Myocardial infarction or cerebrovascular accident within 30 days prior to screening, or current and uncontrolled clinically significant cardiovascular or cerebrovascular condition * History of malignancy within 5 years prior to the screening visit * Active bacterial, viral, or fungal infection or any other serious infection within 14 days prior to screening * Treatment with anti-thymocyte globulin within 180 days prior to screening * Initiation of treatment with an erythrocyte or platelet growth factor, or danazol within 28 days prior to screening * Receiving iron supplementation with an unstable dose in the 28 days prior to screening

Design outcomes

Primary

MeasureTime frame
Part 1: Change From Baseline in Hemoglobin at Week 24Baseline, Week 24

Secondary

MeasureTime frameDescription
Part 1: Number of Participants Who Were Transfusion-freeFrom Week 4 to Week 24The number of participants who did not receive any transfusions (packed red blood cells \[pRBCs\] or whole blood) during the period of interest were reported. Participants who were transfusion free were defined for each treatment group as the number of participants who did not receive any transfusions (pRBCs or whole blood) during the period of interest from the start to the end, inclusive, divided by the total number of participants in that treatment group at the start of the period of interest. Participants who (1) discontinued treatment prior to Week 24, or (2) did not receive a transfusion during the period of interest despite recording a hemoglobin (Hb) value ≤ 9 g/dL with symptoms assessed by the investigator as warranting transfusion or a Hb value ≤ 7 g/dL regardless of symptoms were not considered transfusion free.
Part 1: Number of Units of pRBCs TransfusedFrom Week 4 to Week 24
Part 1: Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale ScoreBaseline, Week 24The FACIT-Fatigue scale questionnaire was used to determine the level of fatigue experienced by participants. This questionnaire was a 13-item measure that assessed self-reported fatigue and its impact upon daily activities and function. Item scores ranged from 0 (not at all) to 4 (very much), and the total score ranged from 0 to 52, with higher scores indicating greater quality of life.
Part 1: Percent Change From Baseline in Lactate DehydrogenaseBaseline, Week 24
Part 1: Percentage (%) Reduction in the Rate of pRBC Units TransfusedPrestudy (12 months prior to screening) and from Week 4 to Week 24The rate of pRBC units transfused from Week 4 to Week 24 was calculated and compared to the rate of pRBC units transfused prestudy during the 12 months prior to screening. The percent reduction in rate of pRBC units transfused was the percent difference in rate relative to the prestudy rate, calculated as: (current rate - prestudy rate)/prestudy rate \* 100%. Total rate among all participants was evaluated here. Rate of pRBC units transfusion was defined as the percentage of participants who received pRBC transfusions.
Part 1: Number of Participants With Hemoglobin ≥ 12 Grams Per Deciliter (g/dL)Week 24
Part 1: Number of Participants Who Achieved Hemoglobin StabilizationFrom Week 4 to Week 24Hemoglobin stabilization was defined as the participants who avoided 2 g/dL or greater decrease in hemoglobin in the absence of transfusion from Week 4 to Week 24.
Part 1: Change From Baseline in Complement Component 3 (C3)-Opsonized Red Blood Cells (RBCs)Baseline, Week 24Red blood cells opsonized by C3 were to be assessed by flow cytometry .
Part 1: Change From Baseline in Total Paroxysmal Nocturnal Hemoglobinuria (PNH) RBC Clone SizeBaseline, Week 24The total PNH RBC clone size refers to the percentage of PNH affected (ie, Type 2 and 3) RBC cells within the total RBC population.
Part 1: Change From Baseline in Ratio of Total PNH RBC Clone Size to PNH White Blood Cell (WBC) Clone SizeBaseline, Week 24The total PNH RBC clone size refers to the percentage of PNH affected (ie, Type 2 and 3) RBCs within the total RBC population. The PNH WBC clone size refers to the percentage of PNH-affected WBCs within the total WBC population. The ratio of total PNH RBC clone size to PNH WBC clone size = ratio of percent total PNH RBCs / percent PNH WBCs.
Part 1: Change From Baseline in Absolute Reticulocyte Count (ARC)Baseline, Week 24
Part 1: Number of Participants With ARC in the Normal RangeWeek 24Number of participants with ARC in the normal range (0.03 - 0.12 10\^6 cells/uL) were reported.
Part 1: Change From Baseline in HaptoglobinBaseline, Week 24
Part 1: Number of Participants With Haptoglobin ≥ Lower Limit of Normal (LLN) Reference RangeWeek 24Number of Participants With Haptoglobin ≥ LLN Reference Range (≥0.3 g/L) were reported.
Part 1: Change From Baseline in Total BilirubinBaseline, Week 24

Countries

France, Hungary, Italy, Spain, United Kingdom

Participant flow

Recruitment details

A total 12 participants were randomized and treated.

Pre-assignment details

The study was conducted in France, Hungary, Italy, Spain and United Kingdom.

Participants by arm

ArmCount
BCX9930/BCX9930
Participants were randomized to receive BCX9930 during Part 1 and continued to receive the same during Part 2. Per protocol amendment, participants who previously received 500 mg BID and remained on study treatment were dose adjusted to 400 mg BID. For all newly enrolled participants, at the initiation of BCX9930 dosing, participants were administered a dose of 200 mg BID for the first 14 days of treatment before increasing to 400 mg BID. The maximum treatment duration on BCX9930 in Part 1 was 24 weeks. The overall maximum treatment duration on BCX9930 was 377 days.
8
C5-INH/BCX9930
Participants randomized to this group continued the existing C5-INH therapy during Part 1. After the sponsor decided to halt enrolment in the study permanently and terminate the study, participants entered Part 2 where they switched to open-label BCX9930 monotherapy prior to Week 24, if earlier. The maximum treatment duration on C5-INH in Part 1 was 24 weeks. The maximum treatment duration on BCX9930 was 197 days.
4
Total12

Withdrawals & dropouts

PeriodReasonFG000FG001
Part 1 (up to 24 Weeks)Adverse Event10
Part 1 (up to 24 Weeks)Withdrawal by Subject01
Part 2 (up to 52 Weeks)Adverse Event10
Part 2 (up to 52 Weeks)Miscellaneous31

Baseline characteristics

CharacteristicBCX9930/BCX9930C5-INH/BCX9930Total
Age, Continuous58.8 years
STANDARD_DEVIATION 17.66
48.5 years
STANDARD_DEVIATION 14.25
55.3 years
STANDARD_DEVIATION 16.71
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
5 Participants2 Participants7 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
3 Participants2 Participants5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants1 Participants1 Participants
Race (NIH/OMB)
Black or African American
2 Participants0 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants1 Participants2 Participants
Race (NIH/OMB)
White
5 Participants2 Participants7 Participants
Sex: Female, Male
Female
4 Participants3 Participants7 Participants
Sex: Female, Male
Male
4 Participants1 Participants5 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
0 / 80 / 40 / 3
other
Total, other adverse events
7 / 83 / 43 / 3
serious
Total, serious adverse events
2 / 80 / 41 / 3

Outcome results

Primary

Part 1: Change From Baseline in Hemoglobin at Week 24

Time frame: Baseline, Week 24

Population: Participants in the all subjects as treated (ASaT) population in Part 1 with available data were analyzed.

ArmMeasureGroupValue (MEAN)Dispersion
BCX9930Part 1: Change From Baseline in Hemoglobin at Week 24Baseline9.12 grams per deciliter (g/dL)Standard Deviation 1.096
BCX9930Part 1: Change From Baseline in Hemoglobin at Week 24Change at Week 243.48 grams per deciliter (g/dL)Standard Deviation 0.674
C5-INHPart 1: Change From Baseline in Hemoglobin at Week 24Baseline9.13 grams per deciliter (g/dL)Standard Deviation 0.847
C5-INHPart 1: Change From Baseline in Hemoglobin at Week 24Change at Week 240.72 grams per deciliter (g/dL)Standard Deviation 0.884
Secondary

Part 1: Change From Baseline in Absolute Reticulocyte Count (ARC)

Time frame: Baseline, Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureGroupValue (MEAN)Dispersion
BCX9930Part 1: Change From Baseline in Absolute Reticulocyte Count (ARC)Baseline0.2933 10^6 cells/microliter (μL)Standard Deviation 0.10453
BCX9930Part 1: Change From Baseline in Absolute Reticulocyte Count (ARC)Change at Week 24-0.2142 10^6 cells/microliter (μL)Standard Deviation 0.05384
C5-INHPart 1: Change From Baseline in Absolute Reticulocyte Count (ARC)Baseline0.3129 10^6 cells/microliter (μL)Standard Deviation 0.16201
C5-INHPart 1: Change From Baseline in Absolute Reticulocyte Count (ARC)Change at Week 24-0.0462 10^6 cells/microliter (μL)Standard Deviation 0.01823
Secondary

Part 1: Change From Baseline in Complement Component 3 (C3)-Opsonized Red Blood Cells (RBCs)

Red blood cells opsonized by C3 were to be assessed by flow cytometry .

Time frame: Baseline, Week 24

Population: No data was collected for this endpoint.

Secondary

Part 1: Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Score

The FACIT-Fatigue scale questionnaire was used to determine the level of fatigue experienced by participants. This questionnaire was a 13-item measure that assessed self-reported fatigue and its impact upon daily activities and function. Item scores ranged from 0 (not at all) to 4 (very much), and the total score ranged from 0 to 52, with higher scores indicating greater quality of life.

Time frame: Baseline, Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureGroupValue (MEAN)Dispersion
BCX9930Part 1: Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale ScoreBaseline36.3 Scores on a scaleStandard Deviation 9.69
BCX9930Part 1: Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale ScoreChange at Week 24-0.3 Scores on a scaleStandard Deviation 12.86
C5-INHPart 1: Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale ScoreBaseline40.0 Scores on a scaleStandard Deviation 8.49
C5-INHPart 1: Change From Baseline in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale ScoreChange at Week 241.0 Scores on a scale
Secondary

Part 1: Change From Baseline in Haptoglobin

Time frame: Baseline, Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureGroupValue (MEAN)Dispersion
BCX9930Part 1: Change From Baseline in HaptoglobinBaseline0.126 grams per liter (g/L)Standard Deviation 0.0732
BCX9930Part 1: Change From Baseline in HaptoglobinChange at Week 24-0.024 grams per liter (g/L)Standard Deviation 0.0409
C5-INHPart 1: Change From Baseline in HaptoglobinBaseline0.105 grams per liter (g/L)Standard Deviation 0.0268
C5-INHPart 1: Change From Baseline in HaptoglobinChange at Week 24-0.015 grams per liter (g/L)Standard Deviation 0.0268
Secondary

Part 1: Change From Baseline in Ratio of Total PNH RBC Clone Size to PNH White Blood Cell (WBC) Clone Size

The total PNH RBC clone size refers to the percentage of PNH affected (ie, Type 2 and 3) RBCs within the total RBC population. The PNH WBC clone size refers to the percentage of PNH-affected WBCs within the total WBC population. The ratio of total PNH RBC clone size to PNH WBC clone size = ratio of percent total PNH RBCs / percent PNH WBCs.

Time frame: Baseline, Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureGroupValue (MEAN)Dispersion
BCX9930Part 1: Change From Baseline in Ratio of Total PNH RBC Clone Size to PNH White Blood Cell (WBC) Clone SizeBaseline0.8128 ratioStandard Deviation 0.16528
BCX9930Part 1: Change From Baseline in Ratio of Total PNH RBC Clone Size to PNH White Blood Cell (WBC) Clone SizeChange at Week 240.2336 ratioStandard Deviation 0.11595
C5-INHPart 1: Change From Baseline in Ratio of Total PNH RBC Clone Size to PNH White Blood Cell (WBC) Clone SizeChange at Week 24-0.0668 ratioStandard Deviation 0.09462
C5-INHPart 1: Change From Baseline in Ratio of Total PNH RBC Clone Size to PNH White Blood Cell (WBC) Clone SizeBaseline0.9059 ratioStandard Deviation 0.12113
Secondary

Part 1: Change From Baseline in Total Bilirubin

Time frame: Baseline, Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureGroupValue (MEAN)Dispersion
BCX9930Part 1: Change From Baseline in Total BilirubinBaseline3.44 milligram per deciliter (mg/dL)Standard Deviation 3.679
BCX9930Part 1: Change From Baseline in Total BilirubinChange at Week 24-2.66 milligram per deciliter (mg/dL)Standard Deviation 3.672
C5-INHPart 1: Change From Baseline in Total BilirubinBaseline1.10 milligram per deciliter (mg/dL)Standard Deviation 0.424
C5-INHPart 1: Change From Baseline in Total BilirubinChange at Week 24-0.02 milligram per deciliter (mg/dL)Standard Deviation 0.25
Secondary

Part 1: Change From Baseline in Total Paroxysmal Nocturnal Hemoglobinuria (PNH) RBC Clone Size

The total PNH RBC clone size refers to the percentage of PNH affected (ie, Type 2 and 3) RBC cells within the total RBC population.

Time frame: Baseline, Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureGroupValue (MEAN)Dispersion
BCX9930Part 1: Change From Baseline in Total Paroxysmal Nocturnal Hemoglobinuria (PNH) RBC Clone SizeBaseline80.51 % of PNH-RBC within total RBC populationStandard Deviation 16.94
BCX9930Part 1: Change From Baseline in Total Paroxysmal Nocturnal Hemoglobinuria (PNH) RBC Clone SizeChange at Week 2423.18 % of PNH-RBC within total RBC populationStandard Deviation 11.81
C5-INHPart 1: Change From Baseline in Total Paroxysmal Nocturnal Hemoglobinuria (PNH) RBC Clone SizeBaseline83.40 % of PNH-RBC within total RBC populationStandard Deviation 14.34
C5-INHPart 1: Change From Baseline in Total Paroxysmal Nocturnal Hemoglobinuria (PNH) RBC Clone SizeChange at Week 24-6.34 % of PNH-RBC within total RBC populationStandard Deviation 8.986
Secondary

Part 1: Number of Participants Who Achieved Hemoglobin Stabilization

Hemoglobin stabilization was defined as the participants who avoided 2 g/dL or greater decrease in hemoglobin in the absence of transfusion from Week 4 to Week 24.

Time frame: From Week 4 to Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
BCX9930Part 1: Number of Participants Who Achieved Hemoglobin Stabilization5 Participants
C5-INHPart 1: Number of Participants Who Achieved Hemoglobin Stabilization4 Participants
Secondary

Part 1: Number of Participants Who Were Transfusion-free

The number of participants who did not receive any transfusions (packed red blood cells \[pRBCs\] or whole blood) during the period of interest were reported. Participants who were transfusion free were defined for each treatment group as the number of participants who did not receive any transfusions (pRBCs or whole blood) during the period of interest from the start to the end, inclusive, divided by the total number of participants in that treatment group at the start of the period of interest. Participants who (1) discontinued treatment prior to Week 24, or (2) did not receive a transfusion during the period of interest despite recording a hemoglobin (Hb) value ≤ 9 g/dL with symptoms assessed by the investigator as warranting transfusion or a Hb value ≤ 7 g/dL regardless of symptoms were not considered transfusion free.

Time frame: From Week 4 to Week 24

Population: Participants in the ASaT population in Part 1 were analyzed.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
BCX9930Part 1: Number of Participants Who Were Transfusion-free7 Participants
C5-INHPart 1: Number of Participants Who Were Transfusion-free4 Participants
Secondary

Part 1: Number of Participants With ARC in the Normal Range

Number of participants with ARC in the normal range (0.03 - 0.12 10\^6 cells/uL) were reported.

Time frame: Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
BCX9930Part 1: Number of Participants With ARC in the Normal Range4 Participants
C5-INHPart 1: Number of Participants With ARC in the Normal Range1 Participants
Secondary

Part 1: Number of Participants With Haptoglobin ≥ Lower Limit of Normal (LLN) Reference Range

Number of Participants With Haptoglobin ≥ LLN Reference Range (≥0.3 g/L) were reported.

Time frame: Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
BCX9930Part 1: Number of Participants With Haptoglobin ≥ Lower Limit of Normal (LLN) Reference Range0 Participants
C5-INHPart 1: Number of Participants With Haptoglobin ≥ Lower Limit of Normal (LLN) Reference Range0 Participants
Secondary

Part 1: Number of Participants With Hemoglobin ≥ 12 Grams Per Deciliter (g/dL)

Time frame: Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
BCX9930Part 1: Number of Participants With Hemoglobin ≥ 12 Grams Per Deciliter (g/dL)6 Participants
C5-INHPart 1: Number of Participants With Hemoglobin ≥ 12 Grams Per Deciliter (g/dL)0 Participants
Secondary

Part 1: Number of Units of pRBCs Transfused

Time frame: From Week 4 to Week 24

Population: Participants in the ASaT population in Part 1 were analyzed.

ArmMeasureValue (NUMBER)
BCX9930Part 1: Number of Units of pRBCs Transfused0 units of pRBCs
C5-INHPart 1: Number of Units of pRBCs Transfused0 units of pRBCs
Secondary

Part 1: Percentage (%) Reduction in the Rate of pRBC Units Transfused

The rate of pRBC units transfused from Week 4 to Week 24 was calculated and compared to the rate of pRBC units transfused prestudy during the 12 months prior to screening. The percent reduction in rate of pRBC units transfused was the percent difference in rate relative to the prestudy rate, calculated as: (current rate - prestudy rate)/prestudy rate \* 100%. Total rate among all participants was evaluated here. Rate of pRBC units transfusion was defined as the percentage of participants who received pRBC transfusions.

Time frame: Prestudy (12 months prior to screening) and from Week 4 to Week 24

Population: Participants in the ASaT population in Part 1 were analyzed.

ArmMeasureValue (NUMBER)
BCX9930Part 1: Percentage (%) Reduction in the Rate of pRBC Units Transfused100 percent reduction
C5-INHPart 1: Percentage (%) Reduction in the Rate of pRBC Units TransfusedNA percent reduction
Secondary

Part 1: Percent Change From Baseline in Lactate Dehydrogenase

Time frame: Baseline, Week 24

Population: Participants in the ASaT population in Part 1 with available data were analyzed.

ArmMeasureValue (MEAN)Dispersion
BCX9930Part 1: Percent Change From Baseline in Lactate Dehydrogenase24.3 percent changeStandard Deviation 53.07
C5-INHPart 1: Percent Change From Baseline in Lactate Dehydrogenase-21.0 percent changeStandard Deviation 4.03

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026