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Toledo-Romaní ME, García-Carmenate M, Valenzuela-Silva C, Baldoquín-Rodríguez W, Martínez-Pérez M, Rodríguez-González M, Paredes-Moreno B, Mendoza-Hernández I, González-Mujica Romero R, Samón-Tabio O, Velazco-Villares P, Bacallao-Castillo JP, Licea-Martín E, Rodríguez-Ortega M, Herrera-Marrero N, Caballero-González E, Egües-Torres L, Duartes-González R, García-Blanco S, Pérez-Cabrera S, Huete-Ferreira S, Idalmis-Cisnero K, Fonte-Galindo O, Meliá-Pérez D, Rojas-Remedios I, Doroud D, Gouya MM, Biglari A, Fernández-Castillo S, Climent-Ruiz Y, Valdes-Balbín Y, García-Rivera D, Van der Stuyft P, Verez-Bencomo V. Safety and efficacy of the two doses conjugated protein-based SOBERANA-02 COVID-19 vaccine and of a heterologous three-dose combination with SOBERANA-Plus: a double-blind, randomised, placebo-controlled phase 3 clinical trial. Lancet Reg Health Am 2022; 18:100423. [PMID: 36618081 PMCID: PMC9803910 DOI: 10.1016/j.lana.2022.100423] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
Background SOBERANA-02 is a COVID-19 conjugate vaccine (recombinant RBD conjugated to tetanus toxoid). Phases 1/2 clinical trials demonstrated high immunogenicity, promoting neutralising IgG and specific T-cell response. A third heterologous dose of SOBERANA-Plus (RBD-dimer) further increased neutralising antibodies. The aim of this study is to evaluate the safety and efficacy of two immunisation regimes: two doses of SOBERANA-02 and a heterologous three-dose combination with SOBERANA-Plus added to it. Methods From March 8th to June 24th, 2021 we conducted in Havana, Cuba a multicentre randomised, double-blind, placebo-controlled, phase-3 trial evaluating a two doses SOBERANA-02 scheme and a heterologous scheme with one dose SOBERANA-Plus added to it (RPCEC00000354). Participants 19-80 years were randomly assigned to receiving 28 days apart either the two or three dose scheme or placebo. The main endpoint was vaccine efficacy in preventing the occurrence of RT-PCR confirmed symptomatic COVID-19 at least 14 days after the second or third dose in the per-protocol population. We also assessed efficacy against severe disease and, in all participants receiving at least one vaccine/placebo dose, safety for 28 days after each dose. Findings We included 44,031 participants (52.0% female, 48.0% male; median age 50 years, range 19-80 years; 7.0% black, 24.0% mixed-race, 59.0% white) in a context of initial Beta VOC predominance, with this variant being partially replaced by Delta near the trial's end. Vaccine efficacy in the heterologous combination was 92.0% (95%CI 80.4-96.7) against symptomatic disease. There were no severe COVID-19 cases in the vaccine group against 6 in the placebo group. Two doses of SOBERANA-02 was 69.7% (95%CI 56.5-78.9) and 74.9% (95%CI 33.7-90.5) efficacious against symptomatic and severe COVID-19, respectively. The occurrence of serious and severe adverse events (AE) was very rare and equally distributed between placebo and vaccine groups. Solicited AEs were slightly more frequent in the vaccine group but predominantly local and mostly mild and transient. Interpretation Our results indicate that the straightforward to manufacture SOBERANA vaccines are efficacious in a context of Beta and Delta VOC circulation, have a favourable safety profile, and may represent an attractive option for use in COVID-19 vaccination programmes. Funding This study received funds from the National Fund for Science and Technology (FONCI-CITMA-Cuba, contract 2020-20) of the Ministry of Science, Technology and Environment of Cuba.
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Affiliation(s)
- María Eugenia Toledo-Romaní
- “Pedro Kourí” Tropical Medicine Institute. Av “Novia del Mediodía”, Kv 6 1/2, La Lisa, Habana, 11400, Cuba,Corresponding author.
| | | | - Carmen Valenzuela-Silva
- Cybernetics, Mathematics and Physics Institute. 15th St #55, Vedado, Plaza de la Revolución, Havana, 10400, Cuba
| | | | - Marisel Martínez-Pérez
- Finlay Vaccine Institute. 21st Ave. N° 19810 between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Meiby Rodríguez-González
- Finlay Vaccine Institute. 21st Ave. N° 19810 between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Beatriz Paredes-Moreno
- Finlay Vaccine Institute. 21st Ave. N° 19810 between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Ivis Mendoza-Hernández
- National Coordinating Center for Clinical Trials. 5th Ave and 62, Miramar, Playa, Havana, Cuba
| | | | | | | | | | - Ernesto Licea-Martín
- Finlay Vaccine Institute. 21st Ave. N° 19810 between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Misladys Rodríguez-Ortega
- “Pedro Kourí” Tropical Medicine Institute. Av “Novia del Mediodía”, Kv 6 1/2, La Lisa, Habana, 11400, Cuba
| | - Nuris Herrera-Marrero
- “Pedro Kourí” Tropical Medicine Institute. Av “Novia del Mediodía”, Kv 6 1/2, La Lisa, Habana, 11400, Cuba
| | | | | | | | | | | | | | | | | | | | | | - Delaram Doroud
- Pasteur Institute of Iran. No. 69, Pasteur Ave., Tehran 1316943551, Islamic Republic of Iran
| | | | - Alireza Biglari
- Pasteur Institute of Iran. No. 69, Pasteur Ave., Tehran 1316943551, Islamic Republic of Iran
| | | | - Yanet Climent-Ruiz
- Finlay Vaccine Institute. 21st Ave. N° 19810 between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Yury Valdes-Balbín
- Finlay Vaccine Institute. 21st Ave. N° 19810 between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Dagmar García-Rivera
- Finlay Vaccine Institute. 21st Ave. N° 19810 between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | | | - Vicente Verez-Bencomo
- Finlay Vaccine Institute. 21st Ave. N° 19810 between 198 and 200 St, Atabey, Playa, Havana, Cuba,Corresponding author.
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Toledo-Romani ME, García-Carmenate M, Verdecia-Sánchez L, Pérez-Rodríguez S, Rodriguez-González M, Valenzuela-Silva C, Paredes-Moreno B, Sanchez-Ramirez B, González-Mugica R, Hernández-Garcia T, Orosa-Vázquez I, Díaz-Hernández M, Pérez-Guevara MT, Enriquez-Puertas J, Noa-Romero E, Palenzuela-Diaz A, Baro-Roman G, Mendoza-Hernández I, Muñoz Y, Gómez-Maceo Y, Santos-Vega BL, Fernandez-Castillo S, Climent-Ruiz Y, Rodríguez-Noda L, Santana-Mederos D, García-Vega Y, Chen GW, Doroud D, Biglari A, Boggiano-Ayo T, Valdés-Balbín Y, Rivera DG, García-Rivera D, Vérez-Bencomo V. Safety and immunogenicity of anti-SARS-CoV-2 heterologous scheme with SOBERANA 02 and SOBERANA Plus vaccines: Phase IIb clinical trial in adults. Med (N Y) 2022; 3:760-773.e5. [PMID: 35998623 PMCID: PMC9359498 DOI: 10.1016/j.medj.2022.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/17/2022] [Accepted: 08/02/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND SOBERANA 02 has been evaluated in phase I and IIa studies comparing homologous versus heterologous schedule (this one, including SOBERANA Plus). Here, we report results of immunogenicity, safety, and reactogenicity of SOBERANA 02 in a two- or three-dose heterologous scheme in adults. METHOD Phase IIb was a parallel, multicenter, adaptive, double-blind, randomized, and placebo-controlled trial. Subjects (n = 810) aged 19-80 years were randomized to receive two doses of SARS-CoV-2 RBD conjugated to tetanus toxoid (SOBERANA 02) and a third dose of dimeric RBD (SOBERANA Plus) 28 days apart; two production batches of active ingredients of SOBERANA 02 were evaluated. Primary outcome was the percentage of seroconverted subjects with ≥4-fold the anti-RBD immunoglobulin G (IgG) concentration. Secondary outcomes were safety, reactogenicity, and neutralizing antibodies. FINDINGS Seroconversion rate in vaccinees was 76.3% after two doses and 96.8% after the third dose of SOBERANA Plus (7.3% in the placebo group). Neutralizing IgG antibodies were detected against D614G and variants of concern (VOCs) Alpha, Beta, Delta, and Omicron. Specific, functional antibodies were detected 7-8 months after the third dose. The frequency of serious adverse events (AEs) associated with vaccination was very low (0.1%). Local pain was the most frequent AE. CONCLUSIONS Two doses of SOBERANA 02 were safe and immunogenic in adults. The heterologous combination with SOBERANA Plus increased neutralizing antibodies, detectable 7-8 months after the third dose. TRIAL REGISTRY https://rpcec.sld.cu/trials/RPCEC00000347 FUNDING: This work was supported by Finlay Vaccine Institute, BioCubaFarma, and the Fondo Nacional de Ciencia y Técnica (FONCI-CITMA-Cuba, contract 2020-20).
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Affiliation(s)
| | - Mayra García-Carmenate
- "19 de Abril" Polyclinic, Tulipan St. between Panorama y Oeste, Nuevo Vedado, Plaza de la Revolución, Havana 10400, Cuba
| | | | - Suzel Pérez-Rodríguez
- "19 de Abril" Polyclinic, Tulipan St. between Panorama y Oeste, Nuevo Vedado, Plaza de la Revolución, Havana 10400, Cuba
| | | | - Carmen Valenzuela-Silva
- Cybernetics, Mathematics and Physics Institute, 15th St. #55, Vedado, Plaza de la Revolución, Havana 10400, Cuba
| | - Beatriz Paredes-Moreno
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | | | - Raúl González-Mugica
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Tays Hernández-Garcia
- Center of Molecular Immunology, 15th Avenue and 216 St, Siboney, Playa, Havana, Cuba
| | - Ivette Orosa-Vázquez
- Center of Molecular Immunology, 15th Avenue and 216 St, Siboney, Playa, Havana, Cuba
| | | | | | | | - Enrique Noa-Romero
- National Civil Defense Research Laboratory, San José de las Lajas, Mayabeque, Cuba
| | | | - Gerardo Baro-Roman
- Centre for Immunoassays, 134 St. and 25, Cubanacán, Playa, Havana 11600 Cuba
| | - Ivis Mendoza-Hernández
- National Clinical Trials Coordinating Center, 5th Avenue and 62, Miramar, Playa, Havana, Cuba
| | - Yaima Muñoz
- National Clinical Trials Coordinating Center, 5th Avenue and 62, Miramar, Playa, Havana, Cuba
| | | | - Bertha Leysi Santos-Vega
- "19 de Abril" Polyclinic, Tulipan St. between Panorama y Oeste, Nuevo Vedado, Plaza de la Revolución, Havana 10400, Cuba
| | - Sonsire Fernandez-Castillo
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba,Corresponding author
| | - Yanet Climent-Ruiz
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Laura Rodríguez-Noda
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Darielys Santana-Mederos
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Yanelda García-Vega
- Center of Molecular Immunology, 15th Avenue and 216 St, Siboney, Playa, Havana, Cuba
| | - Guang-Wu Chen
- Chengdu Olisynn Biotech. Co. Ltd., Chengdu 610041, People’s Republic of China,State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, People’s Republic of China
| | - Delaram Doroud
- Pasteur Institute of Iran, No. 69, Pasteur Avenue, Tehran 1316943551, Islamic Republic of Iran
| | - Alireza Biglari
- Pasteur Institute of Iran, No. 69, Pasteur Avenue, Tehran 1316943551, Islamic Republic of Iran
| | - Tammy Boggiano-Ayo
- Center of Molecular Immunology, 15th Avenue and 216 St, Siboney, Playa, Havana, Cuba
| | - Yury Valdés-Balbín
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Daniel G. Rivera
- Laboratory of Synthetic and Biomolecular Chemistry, Faculty of Chemistry, University of Havana, Havana 10400, Cuba
| | - Dagmar García-Rivera
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba
| | - Vicente Vérez-Bencomo
- Finlay Vaccine Institute, 21st Avenue Nº 19810 Between 198 and 200 St, Atabey, Playa, Havana, Cuba,Corresponding author
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Eugenia-Toledo-Romaní M, Verdecia-Sánchez L, Rodríguez-González M, Rodríguez-Noda L, Valenzuela-Silva C, Paredes-Moreno B, Sánchez-Ramírez B, Pérez-Nicado R, González-Mugica R, Hernández-García T, Bergado-Baez G, Pi-Estopiñán F, Cruz-Sui O, Fraga-Quintero A, García-Montero M, Palenzuela-Díaz A, Baró-Román G, Mendoza-Hernández I, Fernandez-Castillo S, Climent-Ruiz Y, Santana-Mederos D, Ramírez Gonzalez U, García-Vega Y, Pérez-Massón B, Guang-Wu-Chen, Boggiano-Ayo T, Ojito-Magaz E, Rivera DG, Valdés-Balbín Y, García-Rivera D, Vérez-Bencomo V. Safety and immunogenicity of anti-SARS CoV-2 vaccine SOBERANA 02 in homologous or heterologous scheme: open label phase I and Phase IIa clinical trials. Vaccine 2022; 40:4220-4230. [PMID: 35691871 PMCID: PMC9167831 DOI: 10.1016/j.vaccine.2022.05.082] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 12/01/2022]
Abstract
Background SOBERANA 02 is a COVID-19 vaccine based on SARS-CoV-2 recombinant RBD conjugated to tetanus toxoid (TT). SOBERANA Plus antigen is dimeric-RBD. Here we report safety and immunogenicity from phase I and IIa clinical trials using two-doses of SOBERANA 02 and three-doses (homologous) or heterologous (with SOBERANA Plus) protocols. Method We performed an open-label, sequential and adaptive phase I to evaluate safety and explore the immunogenicity of SOBERANA 02 in two formulations (15 or 25 μg RBD-conjugated to 20 μg of TT) in 40 subjects, 19–59-years-old. Phase IIa was open-label including 100 volunteers 19–80-years, receiving two doses of SOBERANA 02–25 μg. In both trials, half of volunteers were selected to receive a third dose of the corresponding SOBERANA 02 and half received a heterologous dose of SOBERANA Plus. Primary outcome was safety. The secondary outcome was immunogenicity evaluated by anti-RBD IgG ELISA, molecular neutralization of RBD:hACE2 interaction, live-virus-neutralization and specific T-cells response. Results The most frequent adverse event (AE) was local pain, other AEs had frequencies ≤ 5%. No serious related-AEs were reported. Phase IIa confirmed the safety in 60 to 80-years-old subjects. In phase-I SOBERANA 02–25 µg elicited higher immune response than SOBERANA 02–15 µg and progressed to phase IIa. Phase IIa results confirmed the immunogenicity of SOBERANA 02–25 µg even in 60–80-years. Two doses of SOBERANA02-25 µg elicited an immune response similar to that of the Cuban Convalescent Serum Panel and it was higher after the homologous and heterologous third doses. The heterologous scheme showed a higher immunological response. Anti-RBD IgG neutralized the delta variant in molecular assay, with a 2.5-fold reduction compared to D614G neutralization. Conclusions SOBERANA 02 was safe and immunogenic in persons aged 19–80 years, eliciting neutralizing antibodies and specific T-cell response. Highest immune responses were obtained in the heterologous three doses protocol. Trial registry: https://rpcec.sld.cu/trials/RPCEC00000340, https://rpcec.sld.cu/trials/RPCEC00000347
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