Delving into the Latest Updates on Bardoxolone Methyl with Synapse

This multi-center, randomized, double-blind, placebo-controlled, Phase 2 trial will study the safety, tolerability, and efficacy of bardoxolone methyl in qualified patients with CKD due to multiple etiologies at risk of rapid disease progression. Approximately 70 patients will be enrolled and randomized 1:1 to either bardoxolone methyl or placebo. Patients with CKD secondary to varying etiologies will be enrolled from age 18-70 years with eGFR ≥ 20 to < 60 mL/min/1.73 m2, and other risk factors for rapid progression of kidney disease.
The maximum target dose will be determined by baseline proteinuria status. Patients with baseline urine albumin to creatinine ratio (UACR) ≤ 300 mg/g will be titrated to a maximum dose of 20 mg, and patients with baseline UACR > 300 mg/g will be titrated to a maximum dose of 30 mg. Qualified patients will be randomized 1:1 to receive either bardoxolone methyl or placebo once daily (preferably in the morning) throughout a 12-week dosing period.
Patients in the study will follow the same visit and assessment schedule. Patients will be assessed during treatment at Day 1, Weeks 1, 2, 4, 6, 8, and 12 and by telephone contact on Days 3, 10, 21, 31, 35, and 45. Date of last dose and the end-of-treatment assessments mark the end of the treatment period. Patients will not receive study drug during a 5-week off-treatment period between Weeks 12 and 17. The off-treatment (OT) period includes 5 visits requiring various assessments to characterize eGFR from the time of study drug discontinuation through Day 35 off-treatment.

Start Date09 Feb 2021

Sponsor / Collaborator

Biogen, Inc.

NCT04494646

/ CompletedPhase 2IIT

BARCONA: A Phase II, Randomized, Double-blind, Placebo-controlled, Multi-center Study of the Effects of Bardoxolone Methyl in Participants With SARS-Corona Virus-2 (COVID-19)

This multi-center, double-blind, placebo-controlled, randomized Phase 2 trial will study the safety, tolerability, and efficacy of bardoxolone methyl in patients hospitalized with confirmed COVID-19. The trial will include approximately 40 patients and is designed to provide an early interim analysis of safety. Patients will be randomized using permuted block randomization in a 1:1 fashion to either once-daily administration of bardoxolone methyl (20 mg) or matching placebo and treatment will be administered for the duration of hospitalization (until recovery), with a maximum treatment duration of 29 days.

Start Date08 Sep 2020

Sponsor / Collaborator

NYU Langone Health

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100 Clinical Results associated with Bardoxolone Methyl

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100 Translational Medicine associated with Bardoxolone Methyl

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100 Patents (Medical) associated with Bardoxolone Methyl

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620

Literatures (Medical) associated with Bardoxolone Methyl

01 Jan 2026·TOXICOLOGY

Deciphering the quantitative relationship between NRF2 and SRXN1 through semi-mechanistic computational modeling

Article

Author: White, Andrew ; Niemeijer, Marije ; Middleton, Alistair M ; Ter Braak, Bas ; Sharma, Raju Prasad ; van de Water, Bob ; Loonstra-Wolters, Liesanne ; Beltman, Joost B

Nuclear factor erythroid 2-related factor 2 (NRF2) plays a vital role in the regulation of various antioxidant response element (ARE) genes, which control physiological processes such as oxidative stress, autophagy, proliferation and apoptosis to maintain cellular homeostasis. It is not understood in detail how the NRF2 program acquires its flexibility with respect to regulation of its downstream targets. Various NRF2 binding partners and cofactors specific to ARE genes are involved in this regulation, and are potentially condition-specific (e.g., type of stressor) and dependent on non-canonical signaling pathways (i.e., crosstalk). Here, we explored the quantitative relationship between NRF2 and sulfiredoxin 1 (SRXN1), a bona fide key NRF2 target gene. We developed a semi-mechanistic mathematical model based on time course experimental data of NRF2 and SRXN1 protein expression in HepG2 cells following single or repeated exposure to NRF2 activating soft electrophiles (sulforaphane, andrographolide, ethacrynic acid or CDDO-me) at a wide concentration range. We showed that a nonlinear mixed effect modeling approach with partially hierarchical parameters accurately captures the observed experimental dynamics. Our analysis highlights that NRF2 requires a cofactor or post-translational modification to regulate its activity as a transcription factor. Moreover, this modulation of the transcription factor activity of NRF2 is time-, compound- and exposure scenario specific. We conclude that a complete understanding of NRF2-mediated ARE genes activation requires detailed dynamic information on NRF2 binding partners and cofactors.

01 Dec 2025·FREE RADICAL BIOLOGY AND MEDICINE

Cigarette smoke disrupts osteogenic-adipogenic balance via Nrf2/HERC2 axis-driven ferroptosis

Article

Author: Wang, Nani ; Song, Li ; Li, Wenjing ; Pan, Yuqin ; Zhang, Fanxuan ; Huang, Feihua ; Xu, Weixing

BACKGROUND:

Disruption of iron homeostasis induced by cigarette smoke (CS) exposure is a major risk factor for smoking-related osteoporosis. However, the specific mechanisms remain unclear.

METHODS:

For in vivo experiments, wild-type (WT) and Nuclear factor E2-related factor 2 (Nrf2)-knockout mice received daily intraperitoneal injections of fresh CS extract for 60 days (0.2 mL/20 g/d), after which bone tissues were harvested for analysis of bone mineral density, histomorphometry, and molecular markers. In vitro experiments were performed using bone marrow-derived mesenchymal stem cells (BMSCs) exposed to CS, with or without treatment of the Nrf2 agonist CDDO. The changes of Nrf2/HECT and RLD domain containing E3 ubiquitin protein ligase 2 (HERC2) pathway in both in vivo and in vitro models were evaluated.

RESULTS:

CS triggered ferroptosis in murine bone and BMSCs by stimulating nuclear receptor coactivator 4 (NCOA4)-mediated ferritinophagy. This process shifted BMSCs differentiation towards adipogenesis via enhancing peroxisome proliferator-activated receptor-γ, while suppressing osteogenesis by inhibiting β-catenin. Mechanistically, CS upregulated Kelch-like ECH-associated protein 1, inhibiting Nrf2 nuclear translocation. Consequently, suppressed Nrf2 reduced transcription of downstream HERC2, impairing its role in degrading NCOA4 and ultimately activating ferroautophagy. Nrf2-knockout mice exhibited exacerbated CS-induced reduction in bone mineral density loss and decreased BMSCs markers. Similarly, Nrf2 or HERC2 knockdown in BMSCs amplified CS-induced ferroptosis and adipogenic commitment. Conversely, Nrf2 activation via agonist bardoxolone restored HERC2 expression, thereby attenuating ferroautophagy and rebalancing osteogenic-adipogenic differentiation.

CONCLUSION:

CS induces bone loss by dysregulating the Nrf2/HERC2 axis, leading to ferroautophagy-driven ferroptosis and impaired osteogenesis. Pharmaceutical Nrf2 activation mitigates these effects, highlighting a novel therapeutic target for smoking-related osteoporosis.

01 Oct 2025·BIOTECHNOLOGY AND APPLIED BIOCHEMISTRY

Senkyunolide I Improves Septicemia‐Induced Brain Dysfunction via Regulating Nrf2 and Astrocyte Activity.

Article

Author: Cao, Haohao ; Liu, Tao ; Xu, Meixia

ABSTRACT:

Senkyunolide I (Sen I) has a protective effect on the blood–brain barrier (BBB) in rats with sepsis‐associated encephalopathy (SAE). This study investigated whether Sen I regulates Nrf2 to ameliorate sepsis‐induced brain dysfunction (SIBD). Sixty rats were randomly assigned into Sham group, SAE group (Model group), SAE + Sen I group (72 mg/kg, Sen I group), and SAE+ positive control group (RTA 402, Nrf2 receptor agonist, RTA 402 group), with 15 rats in each group. The cecal ligation and puncture (CLP) method was applied to induce sepsis in rats. SAE modeling was verified 6 h after operation. The drug was administered 24 h after surgery. Six rats in each group were sacrificed 24 h after administration, with brains extracted. The remaining rats would continue to be observed for their survival status until 72 h post‐surgery. Brain cell apoptosis was measured using TUNEL. We detected the expression of glial fibrillary acidic protein (GFAP) by immunofluorescence, Nrf2 gene expression by RT‐qPCR, and the protein expression of Nrf2, MMP‐9, AQP‐4, and occludin by Western blot. TNF‐α and IL‐1β levels were tested by ELISA, and malondialdehyde (MDA) and glutathione peroxidase (GSH‐Px) by biochemical tests. Survival rate at 72 h post‐surgery, Sham group was 100%. The survival rate of the Sen I group (44.4%) and the RTA 402 group (55.6%) is significantly higher than that of the Model group (11.1%). Both Sen I and RTA 402 can improve the brain tissue damage in rats caused by sepsis, specifically by reducing apoptosis and GFAP expression, reducing TNF‐α, IL‐1β, and MDA levels, increasing the activity of GSH‐Px, downregulating the protein expression of MMP‐9 and AQP‐4, and upregulating the protein expression of Nrf2 and occludin. Moreover, Sen I significantly increased the expression of Nrf2 in rat brain tissues. Sen I ameliorates SIBD in rats by regulating the expression of Nrf2 and astrocyte activation.

38

News (Medical) associated with Bardoxolone Methyl

08 Dec 2023

·synapse.patsnap.com

What are Nrf2 inhibitors and how do you quickly get the latest development progress?

Nrf2, or nuclear factor erythroid 2-related factor 2, is a transcription factor that plays a crucial role in the human body's defense against oxidative stress and inflammation. It regulates the expression of various antioxidant and detoxification genes, promoting cellular protection and maintaining redox homeostasis. Nrf2 activation is essential for combating harmful free radicals and reactive oxygen species, which can lead to various diseases, including cancer, neurodegenerative disorders, and cardiovascular conditions. Understanding and harnessing the potential of Nrf2 signaling pathways have become a significant focus in pharmaceutical research, aiming to develop novel therapeutic interventions for oxidative stress-related diseases. Due to the biological characteristics of tumors, multidrug resistance (MDR) is a major cause of chemotherapy failure. Studies have shown that high expression of Nrf2 is found in different types of cancer cells (bladder cancer, lung cancer, pancreatic cancer, liver cancer, and head and neck cancer). Nrf2 can activate the transcription of more than 500 genes in the human genome, most of which have cell protective functions, enhancing the detoxification and excretion of harmful substances and toxic metals, thereby leading to tumor resistance to chemotherapy drugs. Therefore, the development of Nrf2 inhibitors is considered an important strategy to overcome chemotherapy drug resistance. The use of Nrf2 inhibitors as sensitizers in combination with anticancer drugs will reverse tumor resistance and significantly improve the efficacy of chemotherapy drugs. The analysis of the target Nrf2 in the pharmaceutical industry reveals a competitive landscape with companies like Biogen, Inc., Reata Pharmaceuticals, Inc., and Teva Pharmaceutical Industries Ltd. leading the way in R&D progress. Multiple drugs targeting Nrf2 have been approved for indications such as Multiple Sclerosis and Friedreich Ataxia. Small molecule drugs are progressing rapidly, with biosimilars indicating intense competition. The United States is at the forefront of development, followed by the European Union, China, and other countries. The future development of target Nrf2 holds promise for the treatment of various indications and requires continued research and investment in innovative drug development. How do they work?Nrf2 inhibitors are a class of compounds or drugs that specifically target and inhibit the activity of the nuclear factor erythroid 2-related factor 2 (Nrf2). Nrf2 is a transcription factor that plays a crucial role in regulating the expression of genes involved in antioxidant response and cellular defense against oxidative stress. From a biomedical perspective, Nrf2 inhibitors are of interest because they have the potential to modulate the Nrf2 pathway and alter the cellular response to oxidative stress. By inhibiting Nrf2, these compounds can prevent the activation of antioxidant genes and disrupt the cellular defense mechanisms against oxidative damage. Nrf2 inhibitors have been studied in various biomedical contexts, including cancer research. In some cancer cells, Nrf2 is overexpressed, leading to increased antioxidant capacity and resistance to chemotherapy or radiation therapy. By inhibiting Nrf2, researchers aim to sensitize cancer cells to treatment and enhance the effectiveness of anticancer therapies. Moreover, Nrf2 inhibitors have also been investigated as potential therapeutic agents for other conditions associated with oxidative stress, such as neurodegenerative diseases, cardiovascular diseases, and inflammatory disorders. By modulating the Nrf2 pathway, these inhibitors may offer a way to restore redox balance and mitigate the detrimental effects of oxidative stress in these conditions. It is important to note that the development and use of Nrf2 inhibitors require careful consideration of their potential side effects and impact on normal cellular functions. While inhibiting Nrf2 may be beneficial in certain disease contexts, it may also disrupt the physiological antioxidant defense mechanisms and have unintended consequences. Therefore, further research and clinical trials are necessary to fully understand the therapeutic potential and safety profile of Nrf2 inhibitors. List of Nrf2 InhibitorsThe currently marketed Nrf2 inhibitors include: OmaveloxoloneMonomethyl fumarateDiroximel fumarateDimethyl fumarateBardoxolone MethylOltipraz10-Nitrooleic acidALZ-001ALZ-002APPAFor more information, please click on the image below. What are Nrf2 inhibitors used for?Nrf2 inhibitors have been studied in various biomedical contexts, including cancer research. For more information, please click on the image below to log in and search. How to obtain the latest development progress of Nrf2 inhibitors?In the Synapse database, you can keep abreast of the latest research and development advances of Nrf2 inhibitors anywhere and anytime, daily or weekly, through the "Set Alert" function. Click on the image below to embark on a brand new journey of drug discovery!

10 May 2023

·www.fiercebiotech.com

Reata, Kyowa Kirin's bardoxolone faces the music after ph. 3 flop, ending 13-year saga

Kyowa Kiryin and Reata have worked together on bardoxolone for more than 13 years. Reata and Kyowa Kirin are burying bardoxolone methyl after new phase 3 data laid bare the dwindling—if not non-existent—potential of the kidney disease treatment. The two companies said that while the treatment hit the primary and secondary endpoints in a phase 3 trial testing bardoxolone in patients with diabetic kidney disease, there was no difference in the time to end-stage renal disease between treated patients and placebo. That was the nail in the coffin, with Kyowa and Reata saying Wednesday that they’ll end development of bardoxolone as a treatment for chronic kidney disease. Investors punished Reata for the disappointing conclusion, with shares down roughly 23% an hour after the market opened, from $105.37 down to $81. Thus ends an incredibly tumultuous saga for bardoxolone that’s extended some 13 years and spanned three different partnerships. Reata first handed over commercialization rights to certain markets to both Kyowa Kirin and Abbott (now AbbVie) back in 2009 and 2010, respectively, when bardoxolone was in phase 2 development for patients with diabetes who had chronic kidney disease. AbbVie double dipped a year later, offering up another $400 million to jointly develop and commercialize other Reata projects aimed at kidney and autoimmune diseases. But the wheels slowly, but surely, began to come off, beginning in 2012 when a phase 3 trial was halted after treated patients were experiencing higher rates of heart-related side effects, including hospitalizations and death. The company swiftly pivoted to aiming the treatment at patients with pulmonary arterial hypertension. Reata couldn’t just step away from the kidney ambitions, however, launching additional studies including one testing bardoxolone in patients with chronic kidney disease caused by Alport syndrome. AbbVie had enough, backing out in 2019 and recouping $330 million out of the original $850 million it handed over across the two deals. FDA advisors told Reata to go back to the drawing board two years later when they unanimously voted against the risk-benefit profile of bardoxolone kidney disease treatment in patients with Alport syndrome. The FDA formally rejected the med last year. Kyowa Kirin has dutifully held on throughout, launching a phase 3 study five years ago testing bardoxolone in diabetic patients with chronic kidney disease. But after the latest readout, the Japanese pharma said it no longer sees a viable regulatory route. The axed development plan has forced Reata to address a $350 million investment from Blackstone in 2020 to help develop bardoxolone, the majority of which was to be paid from royalties on the treatment. Reata says Blackstone will now receive single-digit royalties on Skyclarys (omaveloxolone), which was approved in March as a treatment for Friedreich’s ataxia and is one of two assets remaining in the company's pipeline. Reata's attention is now on the commercialization effort for Skyclarys. The company says it has received approximately 500 patient start forms since approval but doesn’t expect to be in specialty pharmacies until mid-August while the FDA reviews an NDA supplement submitted by Reata asking for an increase in drug substance specification. The company says approval of the supplement is required before the drug can be sent to pharmacies. Reata is also working on RTA 901 treatment for diabetic peripheral neuropathic pain, completing a phase 1 single ascending and multiple ascending dose study. The company planned to launch a phase 2 study in the second half of 2022 but it’s unclear if that’s happened. A phase 2 clinical trial record was not found on clinicaltrials.gov.

Phase 3Phase 2Drug ApprovalNDAPhase 1

10 May 2023

·endpts.com

Reata culls bardoxolone, ending decade of R&D on troubled kidney disease drug

Reata’s long and winding road with bardoxolone appears to be over. The Plano, TX-based biotech and partner Kyowa Kirin said Wednesday morning that they are scrapping development of the asset in chronic kidney disease programs, which include CKD caused by Alport syndrome, people with diabetic CKD and a rare, hereditary form of the disease. With that, Reata expects to save more than $100 million previously set aside for the drug, a move that will push runway to the end of 2026, the company said in a presentation. Reata also disclosed a non-dilutive $275 million debt facility as part of its first-quarter update .

100 Deals associated with Bardoxolone Methyl

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KEGG	Wiki	ATC	Drug Bank
D09585	Bardoxolone Methyl	-	DB05983

R&D Status

10 top R&D records.

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Indication	Highest Phase	Country/Location	Organization	Date
Nephritis, Hereditary	NDA/BLA	European Union	Reata Pharmaceuticals, Inc.	27 Oct 2021
Kidney Failure, Chronic	Phase 3	United States	Biogen, Inc.	08 Mar 2019
Kidney Failure, Chronic	Phase 3	Japan	Biogen, Inc.	08 Mar 2019
Kidney Failure, Chronic	Phase 3	Australia	Biogen, Inc.	08 Mar 2019
Kidney Failure, Chronic	Phase 3	France	Biogen, Inc.	08 Mar 2019
Kidney Failure, Chronic	Phase 3	Puerto Rico	Biogen, Inc.	08 Mar 2019
Kidney Failure, Chronic	Phase 3	Spain	Biogen, Inc.	08 Mar 2019
Polycystic Kidney, Autosomal Dominant	Phase 3	United States	Biogen, Inc.	08 Mar 2019
Polycystic Kidney, Autosomal Dominant	Phase 3	Japan	Biogen, Inc.	08 Mar 2019
Polycystic Kidney, Autosomal Dominant	Phase 3	Australia	Biogen, Inc.	08 Mar 2019

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Clinical Result

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT03749447 (EAGLE, CTgov)	Phase 3	Polycystic Kidney, Autosomal Dominant \| Kidney Failure, Chronic \| Nephritis, Hereditary ... View more	270	Placebo+Bardoxolone Methyl (Prior Placebo to Bardoxolone Methyl)	xiyeizrhja = vrficdroae avvyofoust (pwewxmpawn, ptkwnyzocm - coykcidyfs) View more	-	19 Mar 2024
				Bardoxolone Methyl (Prior Bardoxolone Methyl to Bardoxolone Methyl)	xiyeizrhja = qanpzxcnwb avvyofoust (pwewxmpawn, mtzqdsnjru - olxiyofefj) View more
NCT03068130 (RANGER, CTgov)	Phase 3	Hypertension, Pulmonary	261	Bardoxolone Methyl	dcjtbmezyf = zfgyxkdpgg nwybmtgglk (gsemizacxa, fsatdevpmq - utiimlxynw) View more	-	12 Oct 2023
NCT03019185 (CARDINAL, CTgov)	Phase 2/3	Nephritis, Hereditary	187	Bardoxolone Methyl (Phase 2 Bardoxolone Methyl)	oidomsuufm(edyoudrkqe) = jyeqhxcfeu pxiyrecuvr (zfsxfroxzz, 1.4111) View more	-	11 Oct 2023
				Placebo Oral Capsule (Phase 3 Placebo)	irsvjbxmkh(bpntlvyuoj) = ypdajdapry edmgjvvnzn (kxfkwnykmy, 1.248) View more
NCT02657356 (CTgov)	Phase 3	Connective Tissue Diseases \| Pulmonary arterial hypertension associated with connective tissue disease	202	Placebo capsules (Placebo Capsules)	lrckfzacil(tcfoggsoxu) = ikkyszekid dswwmcoppg (cmcpvrryxj, 4.954) View more	-	19 May 2023
				Bardoxolone methyl capsules (Bardoxolone Methyl Capsules)	lrckfzacil(tcfoggsoxu) = crapnoesce dswwmcoppg (cmcpvrryxj, 4.952) View more
NCT04702997 (MERLIN, CTgov)	Phase 2	Chronic Kidney Diseases	81	Bardoxolone methyl oral capsule (Bardoxolone Methyl)	yuotioozme(cdbikyoroc) = btszmhwngm yoqcbxnasj (cslszfyedi, 0.925) View more	-	01 Dec 2022
				Placebo oral capsule (Placebo)	yuotioozme(cdbikyoroc) = rndnqpucgx yoqcbxnasj (cslszfyedi, 0.868) View more
NCT03019185 (CARDINAL, Pubmed) Manual	Phase 2/3	Nephritis, Hereditary	157	Bardoxolone Methyl	xuwozpplzo(enxwvoraid) = hwrisxzjgv byosmheafd (vigejyzqsg ) View more	Positive	21 Nov 2022
				Placebo	xuwozpplzo(enxwvoraid) = qwttttegif byosmheafd (vigejyzqsg ) View more
NCT03749447 (EAGLE, ISN WCN2022)	Phase 3	Nephritis, Hereditary	112	Bardoxolone methyl 5 mg	tdfoxgnzks(owkjklrdns) = xjaxltvogy lwvzkbxsrn (nffndhtjmg, 11.1)	Positive	01 Feb 2022
NCT03366337 (PHOENIX, CTgov)	Phase 2	Polycystic Kidney, Autosomal Dominant \| Type 1 diabetes mellitus with established diabetic nephropathy \| Glomerulosclerosis, Focal Segmental ... View more	103	Bardoxolone methyl capsules (Bardoxolone Methyl - ADPKD)	teinnyqyei(xjmahnkhlu) = jgsdyijtni isfkzwagww (xchyipaxve, 1.3743) View more	-	18 Jan 2022
				Bardoxolone methyl capsules (Bardoxolone Methyl - IgAN)	teinnyqyei(xjmahnkhlu) = cjobroubvc isfkzwagww (xchyipaxve, 1.5700) View more
NCT04494646 (CTgov)	Phase 2	COVID-19	40	Bardoxolone Methyl (Bardoxolone Methyl)	pntmnscgmt = uiroujxlto epkogrlmgv (xssvndzmyi, movdvhddvm - rdjkdhopfj) View more	-	12 Jan 2022
				Placebo (Placebo)	pntmnscgmt = nkbijwmmwa epkogrlmgv (xssvndzmyi, yfaimohdju - mskdowwxpb) View more
NCT01351675 \| NCT02316821 \| NCT03019185 (CARDINAL \| TSUBAKI \| BEACON, ASN2021)	Phase 2/3	Chronic Kidney Diseases	3,448	Bardoxolone methyl	kznonzxoiw(oewnmjdhhv) = No serious AEs of cardiac failure were reported with Bard in CKD trials conducted after BEACON ticpsxinda (wgalxfoekp ) View more	Positive	27 Oct 2021
				Placebo