1
|
Wang M, Ma H, Shi Y, Ni H, Qin C, Ji C. Single-arm clinical trials: design, ethics, principles. BMJ Support Palliat Care 2024:spcare-2024-004984. [PMID: 38834238 DOI: 10.1136/spcare-2024-004984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024]
Abstract
Although randomised controlled trials are considered the gold standard in clinical research, they are not always feasible due to limitations in the study population, challenges in obtaining evidence, high costs and ethical considerations. As a result, single-arm trial designs have emerged as one of the methods to address these issues. Single-arm trials are commonly applied to study advanced-stage cancer, rare diseases, emerging infectious diseases, new treatment methods and medical devices. Single-arm trials have certain ethical advantages over randomised controlled trials, such as providing equitable treatment, respecting patient preferences, addressing rare diseases and timely management of adverse events. While single-arm trials do not adhere to the principles of randomisation and blinding in terms of scientific rigour, they still incorporate principles of control, balance and replication, making the design scientifically reasonable. Compared with randomised controlled trials, single-arm trials require fewer sample sizes and have shorter trial durations, which can help save costs. Compared with cohort studies, single-arm trials involve intervention measures and reduce external interference, resulting in higher levels of evidence. However, single-arm trials also have limitations. Without a parallel control group, there may be biases in interpreting the results. In addition, single-arm trials cannot meet the requirements of randomisation and blinding, thereby limiting their evidence capacity compared with randomised controlled trials. Therefore, researchers consider using single-arm trials as a trial design method only when randomised controlled trials are not feasible.
Collapse
Affiliation(s)
- Minyan Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huan Ma
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yun Shi
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haojie Ni
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chu Qin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Conghua Ji
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| |
Collapse
|
2
|
Kumar P, Holland DA, Secrist K, Taskar P, Dotson B, Saleh-Birdjandi S, Adewunmi Y, Doering J, Mantis NJ, Volkin DB, Joshi SB. Evaluating the Compatibility of New Recombinant Protein Antigens (Trivalent NRRV) with a Mock Pentavalent Combination Vaccine Containing Whole-Cell Pertussis: Analytical and Formulation Challenges. Vaccines (Basel) 2024; 12:609. [PMID: 38932338 PMCID: PMC11209613 DOI: 10.3390/vaccines12060609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Introducing new recombinant protein antigens to existing pediatric combination vaccines is important in improving coverage and affordability, especially in low- and middle-income countries (LMICs). This case-study highlights the analytical and formulation challenges encountered with three recombinant non-replicating rotavirus vaccine (NRRV) antigens (t-NRRV formulated with Alhydrogel® adjuvant, AH) combined with a mock multidose formulation of a pediatric pentavalent vaccine used in LMICs. This complex formulation contained (1) vaccine antigens (i.e., whole-cell pertussis (wP), diphtheria (D), tetanus (T), Haemophilus influenza (Hib), and hepatitis B (HepB), (2) a mixture of aluminum-salt adjuvants (AH and Adju-Phos®, AP), and (3) a preservative (thimerosal, TH). Selective, stability-indicating competitive immunoassays were developed to monitor binding of specific mAbs to each antigen, except wP which required the setup of a mouse immunogenicity assay. Simple mixing led to the desorption of t-NRRV antigens from AH and increased degradation during storage. These deleterious effects were caused by specific antigens, AP, and TH. An AH-only pentavalent formulation mitigated t-NRRV antigen desorption; however, the Hib antigen displayed previously reported AH-induced instability. The same rank-ordering of t-NRRV antigen stability (P[8] > P[4] > P[6]) was observed in mock pentavalent formulations and with various preservatives. The lessons learned are discussed to enable future multidose, combination vaccine formulation development with new vaccine candidates.
Collapse
Affiliation(s)
- Prashant Kumar
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, KS 66047, USA
| | - David A. Holland
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, KS 66047, USA
| | - Kathryn Secrist
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, KS 66047, USA
| | - Poorva Taskar
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, KS 66047, USA
| | - Brandy Dotson
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, KS 66047, USA
| | - Soraia Saleh-Birdjandi
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, KS 66047, USA
| | - Yetunde Adewunmi
- New York State Department of Health, Division of Infectious Diseases, Wadsworth Center, Albany, NY 12208, USA
| | - Jennifer Doering
- New York State Department of Health, Division of Infectious Diseases, Wadsworth Center, Albany, NY 12208, USA
| | - Nicholas J. Mantis
- New York State Department of Health, Division of Infectious Diseases, Wadsworth Center, Albany, NY 12208, USA
| | - David B. Volkin
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, KS 66047, USA
| | - Sangeeta B. Joshi
- Department of Pharmaceutical Chemistry, Vaccine Analytics and Formulation Center, University of Kansas, Lawrence, KS 66047, USA
| |
Collapse
|
3
|
Sun G, Wang G, Zhong H. Observational analysis of the immunogenicity and safety of various types of spinal muscular atrophy vaccines. Inflammopharmacology 2024; 32:1025-1038. [PMID: 38308795 DOI: 10.1007/s10787-023-01395-7] [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: 08/30/2023] [Accepted: 11/14/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND This study aimed to evaluate the immunogenicity and safety of different types of poliovirus vaccines. METHODS A randomized, blinded, single-center, parallel-controlled design was employed, and 360 infants aged ≥ 2 months were selected as study subjects. They were randomly assigned to bOPV group (oral Sabin vaccine) and sIPV group (Sabin strain inactivated polio vaccine), with 180 infants in each group. Adverse reaction events in the vaccinated subjects were recorded. The micro-neutralization test using cell culture was conducted to determine the geometric mean titer (GMT) of neutralizing antibodies against poliovirus types I, II, and III in different groups, and the seroconversion rates were calculated. RESULTS Both groups exhibited a 100% seropositivity rate after booster immunization. The titers of neutralizing antibodies for the three types were predominantly distributed within the range of 1:128 to 1:512. The fold increase of type I antibodies differed markedly between the two groups (P < 0.05). Moreover, the fold increase of type II and type III antibodies for poliovirus differed slightly between the two groups (P > 0.05). The fourfold increase rate in sIPV group was drastically superior to that in bOPV group (P < 0.05). When comparing the post-immunization GMT levels of type I antibodies in individuals who completed the full course of spinal muscular atrophy vaccination, bOPV group showed greatly inferior levels to sIPV group (P < 0.05). For type II and type III antibodies, individuals in bOPV group demonstrated drastically superior post-immunization GMT levels to those in sIPV group (P < 0.05). The incidence of adverse reactions between the bOPV and sIPV groups differed slightly (P > 0.05). CONCLUSION These findings indicated that both the oral vaccine and inactivated vaccine had good safety and immunogenicity in infants aged ≥ 2 months. The sIPV group generated higher levels of neutralizing antibodies in serum, particularly evident in the post-immunization GMT levels for types II and III.
Collapse
Affiliation(s)
- Guojuan Sun
- Immunization Program Department, Daqing Center for Disease Control and Prevention, Daqing, 163000, Heilongjiang, China
| | - Guangzhi Wang
- Pathology Department, Daqing People's Hospital, Daqing, 163000, Heilongjiang, China
| | - Heng Zhong
- Endocrinology Department, Heilongjiang Provincial Hospital, Harbin, 150036, Heilongjiang, China.
| |
Collapse
|
4
|
Sharma H, Parekh S, Pujari P, Shewale S, Desai S, Kawade A, Lalwani S, Ravi MD, Kamath V, Mahopatra J, Kulkarni G, Tayade D, Ramanan PV, Uttam KG, Rawal L, Gawande A, Kumar NR, Tiple N, Vagha J, Thakkar P, Khandgave P, Deshmukh BJ, Agarwal A, Dogar V, Gautam M, Jaganathan KS, Kumar R, Sharma I, Gairola S. A phase III randomized-controlled study of safety and immunogenicity of DTwP-HepB-IPV-Hib vaccine (HEXASIIL ®) in infants. NPJ Vaccines 2024; 9:41. [PMID: 38383584 PMCID: PMC10881502 DOI: 10.1038/s41541-024-00828-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
A fully liquid hexavalent containing Diphtheria (D), Tetanus (T) toxoids, whole cell Pertussis (wP), Hepatitis B (Hep B), type 1, 2, 3 of inactivated poliovirus (IPV) and Haemophilus influenzae type b (Hib) conjugate vaccine (DTwP-HepB-IPV-Hib vaccine, HEXASIIL®) was tested for lot-to-lot consistency and non-inferiority against licensed DTwP-HepB-Hib + IPV in an open label, randomized Phase II/III study. In Phase III part, healthy infants received DTwP-HepB-IPV-Hib or DTwP-HepB-Hib + IPV vaccines at 6, 10 and 14 weeks of age. Blood samples were collected prior to the first dose and 28 days, post dose 3. Non inferiority versus DTwP-HepB-Hib + IPV was demonstrated with 95% CIs for the treatment difference for seroprotection/seroconversion rates. For DTwP-HepB-IPV-Hib lots, limits of 95% CI for post-vaccination geometric mean concentration ratios were within equivalence limits (0.5 and 2). Vaccine was well-tolerated and no safety concerns observed.Clinical Trial Registration - CTRI/2019/11/022052.
Collapse
Affiliation(s)
- Hitt Sharma
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India.
| | - Sameer Parekh
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India
| | - Pramod Pujari
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India
| | - Sunil Shewale
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India
| | - Shivani Desai
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India
| | - Anand Kawade
- Department of Pediatrics, KEM Hospital Research Centre, Vadu, Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College & Hospital, Pune, India
| | - M D Ravi
- Department of Pediatrics, JSS Hospital, Mysuru, India
| | - Veena Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Jagannath Mahopatra
- Department of Pediatrics, Hamdard Institute of Medical Science and Research, New Delhi, India
| | - Ganesh Kulkarni
- Department of Pediatrics, Sanjeevani Children's Hospital, Aurangabad, India
| | - Deepak Tayade
- Department of Pediatrics, Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | | | | | - Lalit Rawal
- Department of Pediatrics, Grant Medical Foundation Ruby Hall Clinic, Pune, India
| | - Avinash Gawande
- Department of Pediatrics, Government Medical College and Hospital, Nagpur, India
| | - N Ravi Kumar
- Department of Pediatrics, Niloufer Hospital, Hyderabad, India
| | - Nishikant Tiple
- Department of Pediatrics, Government Medical College, Chandrapur, India
| | - Jayant Vagha
- Department of Pediatrics, Acharya Vinoba Bhave Rural Hospital, Wardha, India
| | | | | | | | - Anurag Agarwal
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vikas Dogar
- Department of Quality Control, Serum Institute of India Pvt. Ltd, Pune, India
| | - Manish Gautam
- Department of Quality Control, Serum Institute of India Pvt. Ltd, Pune, India
| | - K S Jaganathan
- Production Department, Serum Institute of India Pvt. Ltd, Pune, India
| | - Rakesh Kumar
- Production Department, Serum Institute of India Pvt. Ltd, Pune, India
| | - Inderjit Sharma
- Production Department, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sunil Gairola
- Department of Quality Control, Serum Institute of India Pvt. Ltd, Pune, India
| |
Collapse
|