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Houy N, Flaig J. Value of information dynamics in Disease X vaccine clinical trials. Vaccine 2024; 42:1521-1533. [PMID: 38311534 DOI: 10.1016/j.vaccine.2024.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 12/29/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Solutions have been proposed to accelerate the development and rollout of vaccines against a hypothetical disease with epidemic or pandemic potential called Disease X. This may involve resolving uncertainties regarding the disease and the new vaccine. However the value for public health of collecting this information will depend on the time needed to perform research, but also on the time needed to produce vaccine doses. We explore this interplay, and its effect on the decision on whether or not to perform research. METHOD We simulate numerically the emergence and transmission of a disease in a population using a susceptible-infected-recovered (SIR) compartmental model with vaccination. Uncertainties regarding the disease and the vaccine are represented by parameter prior distributions. We vary the date at which vaccine doses are available, and the date at which information about parameters becomes available. We use the expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) to measure the value of information. RESULTS As expected, information has less or no value if it comes too late, or (equivalently) if it can only be used too late. However we also find non trivial dynamics for shorter durations of vaccine development. In this parameter area, it can be optimal to implement vaccination without waiting for information depending on the respective durations of dose production and of clinical research. CONCLUSION We illustrate the value of information dynamics in a Disease X outbreak scenario, and present a general approach to properly take into account uncertainties and transmission dynamics when planning clinical research in this scenario. Our method is based on numerical simulation and allows us to highlight non trivial effects that cannot otherwise be investigated.
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Affiliation(s)
- Nicolas Houy
- University of Lyon, Lyon F-69007, France; CNRS, GATE Lyon Saint-Etienne, F-69007, France.
| | - Julien Flaig
- Epidemiology and Modelling of Infectious Diseases (EPIMOD), Lyon F-69002, France.
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Grayling MJ, Wason JMS, Villar SS. Response adaptive intervention allocation in stepped-wedge cluster randomized trials. Stat Med 2022; 41:1081-1099. [PMID: 35064595 PMCID: PMC7612601 DOI: 10.1002/sim.9317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stepped-wedge cluster randomized trial (SW-CRT) designs are often used when there is a desire to provide an intervention to all enrolled clusters, because of a belief that it will be effective. However, given there should be equipoise at trial commencement, there has been discussion around whether a pre-trial decision to provide the intervention to all clusters is appropriate. In pharmaceutical drug development, a solution to a similar desire to provide more patients with an effective treatment is to use a response adaptive (RA) design. METHODS We introduce a way in which RA design could be incorporated in an SW-CRT, permitting modification of the intervention allocation during the trial. The proposed framework explicitly permits a balance to be sought between power and patient benefit considerations. A simulation study evaluates the methodology. RESULTS In one scenario, for one particular RA design, the proportion of cluster-periods spent in the intervention condition was observed to increase from 32.2% to 67.9% as the intervention effect was increased. A cost of this was a 6.2% power drop compared to a design that maximized power by fixing the proportion of time in the intervention condition at 45.0%, regardless of the intervention effect. CONCLUSIONS An RA approach may be most applicable to settings for which the intervention has substantial individual or societal benefit considerations, potentially in combination with notable safety concerns. In such a setting, the proposed methodology may routinely provide the desired adaptability of the roll-out speed, with only a small cost to the study's power.
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Affiliation(s)
- Michael J. Grayling
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - James M. S. Wason
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Sofía S. Villar
- MRC Biostatistics Unit, School of Clinical MedicineUniversity of CambridgeCambridgeUK
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van der Plas JL, van Esdonk MJ, Kamerling IMC, Cohen AF. Accelerating vaccine trial conduct in a pandemic with a hot spot-based inclusion strategy using trial and epidemic simulation. Clin Transl Sci 2021; 14:2391-2398. [PMID: 34260149 PMCID: PMC8444900 DOI: 10.1111/cts.13104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/07/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022] Open
Abstract
Clinical development of vaccines in a pandemic situation should be rigorous but expedited to tackle the pandemic threat as fast as possible. We explored the effects of a novel vaccine trial strategy that actively identifies and enrolls subjects in local areas with high infection rates. In addition, we assessed the practical requirements needed for such a strategy. Clinical trial simulations were used to assess the effects of utilizing these so‐called “hot spot strategy” compared to a traditional vaccine field trial. We used preset parameters of a pandemic outbreak and incorporated realistic aspects of conducting a trial in a pandemic setting. Our simulations demonstrated that incorporating a hot spot strategy shortened the duration of the vaccine trial considerably, even if only one hot spot was identified during the clinical trial. The active hot spot strategy described in this paper has clear advantages compared to a “wait‐and‐see” approach that is used in traditional vaccine efficacy trials. Completion of a clinical trial can be expedited by adapting to resurgences and outbreaks that will occur in a population during a pandemic. However, this approach requires a speed of response that is unusual for a traditional phase III clinical trial. Therefore, several recommendations are made to help accomplish rapid clinical trial setup in areas identified as local outbreaks. The described model and hot spot vaccination strategy can be adjusted to disease‐specific transmission characteristics and could therefore be applied to any future pandemic threat.
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Affiliation(s)
- Johan L van der Plas
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ingrid M C Kamerling
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
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Golding H, Khurana S, Zaitseva M. What Is the Predictive Value of Animal Models for Vaccine Efficacy in Humans? The Importance of Bridging Studies and Species-Independent Correlates of Protection. Cold Spring Harb Perspect Biol 2018; 10:cshperspect.a028902. [PMID: 28348035 DOI: 10.1101/cshperspect.a028902] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Animal models have played a pivotal role in all stages of vaccine development. Their predictive value for vaccine effectiveness depends on the pathogen, the robustness of the animal challenge model, and the correlates of protection (if known). This article will cover key questions regarding bridging animal studies to efficacy trials in humans. Examples include human papillomavirus (HPV) vaccine in which animal protection after vaccination with heterologous prototype virus-like particles (VLPs) predicted successful efficacy trials in humans, and a recent approval of anthrax vaccine in accordance with the "Animal Rule." The establishment of animal models predictive of vaccine effectiveness in humans has been fraught with difficulties with low success rate to date. Challenges facing the use of animal models for vaccine development against Ebola and HIV will be discussed.
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Affiliation(s)
- Hana Golding
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland 20993
| | - Surender Khurana
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland 20993
| | - Marina Zaitseva
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland 20993
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Cnops L, van Griensven J, Honko AN, Bausch DG, Sprecher A, Hill CE, Colebunders R, Johnson JC, Griffiths A, Palacios GF, Kraft CS, Kobinger G, Hewlett A, Norwood DA, Sabeti P, Jahrling PB, Formenty P, Kuhn JH, Ariën KK. Essentials of filoviral load quantification. THE LANCET. INFECTIOUS DISEASES 2016; 16:e134-e138. [PMID: 27296694 DOI: 10.1016/s1473-3099(16)30063-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/07/2016] [Accepted: 04/20/2016] [Indexed: 11/29/2022]
Abstract
Quantitative measurement of viral load is an important parameter in the management of filovirus disease outbreaks because viral load correlates with severity of disease, survival, and infectivity. During the ongoing Ebola virus disease outbreak in parts of Western Africa, most assays used in the detection of Ebola virus disease by more than 44 diagnostic laboratories yielded qualitative results. Regulatory hurdles involved in validating quantitative assays and the urgent need for a rapid Ebola virus disease diagnosis precluded development of validated quantitative assays during the outbreak. Because of sparse quantitative data obtained from these outbreaks, opportunities for study of correlations between patient outcome, changes in viral load during the course of an outbreak, disease course in asymptomatic individuals, and the potential for virus transmission between infected patients and contacts have been limited. We strongly urge the continued development of quantitative viral load assays to carefully evaluate these parameters in future outbreaks of filovirus disease.
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Affiliation(s)
- Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anna N Honko
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | | | - Armand Sprecher
- Médecins Sans Frontières-Operational Center of Brussels, Brussels, Belgium
| | - Charles E Hill
- Molecular Diagnostics Laboratory, Emory University Hospital, Atlanta, GA, USA
| | - Robert Colebunders
- International Health Unit, Global Health Institute, Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
| | - Joshua C Johnson
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Anthony Griffiths
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Gustavo F Palacios
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Colleen S Kraft
- Pathology and Laboratory Medicine, Emory University Medical School, Atlanta, GA, USA
| | - Gary Kobinger
- National Microbiology Laboratory, Public Health Agency of Canada, University of Manitoba, Winnipeg, MB, Canada
| | | | - David A Norwood
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Pardis Sabeti
- FAS Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Peter B Jahrling
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | | | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
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