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Peterson J, Drazan D, Czajka H, Maguire J, Pregaldien JL, Seppa II, Maansson R, O'Neill R, Balmer P, Jodar L, Jansen KU, Anderson AS, Perez JL, Beeslaar J. Immunogenicity and safety of a pentavalent meningococcal ABCWY vaccine in adolescents and young adults: an observer-blind, active-controlled, randomised trial. Lancet Infect Dis 2023; 23:1370-1382. [PMID: 37579773 DOI: 10.1016/s1473-3099(23)00191-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Meningococcal serogroups A, B, C, W, and Y cause nearly all meningococcal disease, and comprehensive protection requires vaccination against all five serogroups. We aimed to assess the immunogenicity and safety of a pentavalent MenABCWY vaccine comprising two licensed vaccines-meningococcal serogroup B-factor H binding protein vaccine (MenB-FHbp) and a quadrivalent meningococcal serogroup ACWY tetanus toxoid conjugate vaccine (MenACWY-TT)-compared with two doses of MenB-FHbp and a single dose of quadrivalent meningococcal serogroup ACWY CRM197-conjugate vaccine (MenACWY-CRM) as the active control. We previously reported the primary safety and immunogenicity data relating to the two-dose MenB-FHbp schedule. Here we report secondary outcomes and ad-hoc analyses relating to MenABCWY immunogenicity and safety. METHODS We did an observer-blind, active-controlled trial at 68 sites in the USA, Czech Republic, Finland, and Poland. Healthy individuals (aged 10-25 years) who had or had not previously received a MenACWY vaccine were randomly assigned (1:2) using an interactive voice or web-based response system, stratified by previous receipt of a MenACWY vaccine, to receive 0·5 mL of MenABCWY (months 0 and 6) and placebo (month 0) or MenB-FHbp (months 0 and 6) and MenACWY-CRM (month 0) via intramuscular injection into the upper deltoid. All individuals were masked to group allocation, except staff involved in vaccine dispensation, preparation, and administration; and protocol adherence. Endpoints for serogroups A, C, W, and Y included the proportion of participants who achieved at least a four-fold increase in serum bactericidal antibody using human complement (hSBA) titres between baseline and 1 month after each vaccination. For serogroup B, secondary endpoints included the proportion of participants who achieved at least a four-fold increase in hSBA titres from baseline for each of four primary test strains and the proportion of participants who achieved titres of at least the lower limit of quantitation against all four test strains combined at 1 month after the second dose. Endpoints for serogroups A, C, W, and Y were assessed in the modified intent-to-treat (mITT) population, which included all randomly assigned participants who received at least one vaccine dose and had at least one valid and determinate MenB or serogroup A, C, W, or Y assay result before vaccination up to 1 month after the second dose, assessed in ACWY-experienced and ACWY-naive participants separately. Secondary endpoints for serogroup B were analysed in the evaluable immunogenicity population, which included all participants in the mITT population who were randomly assigned to the group of interest, received all investigational products as randomly assigned, had blood drawn for assay testing within the required time frames, had at least one valid and determinate MenB assay result after the second vaccination, and had no important protocol deviations; outcomes were assessed in both ACWY-experienced and ACWY-naive populations combined. Non-inferiority of MenABCWY to MenACWY-CRM and MenB-FHbp was determined using a -10% non-inferiority margin for these endpoints. Reactogenicity and adverse events were assessed among all participants who received at least one vaccine dose and who had available safety data. This trial is registered with Clinicaltrials.gov, NCT03135834, and is complete. FINDINGS Between April 24 and November 10, 2017, 1610 participants (809 MenACWY-naive; 801 MenACWY-experienced) were randomly assigned: 544 to receive MenABCWY and placebo (n=272 MenACWY-naive; n=272 MenACWY-experienced) and 1066 to receive MenB-FHbp and MenACWY-CRM (n=537 MenACWY-naive; n=529 MenACWY-experienced). Among MenACWY-naive or MenACWY-experienced MenABCWY recipients, 75·5% (95% CI 69·8-80·6; 194 of 257; serogroup C) to 96·9% (94·1-98·7; 254 of 262; serogroup A) and 93·0% (88·4-96·2; 174 of 187; serogroup Y) to 97·4% (94·4-99·0; 224 of 230; serogroup W) achieved at least four-fold increases in hSBA titres against serogroups ACWY after dose 1 or 2, respectively, in ad-hoc analyses. Additionally, 75·8% (71·5-79·8; 320 of 422) to 94·7% (92·1-96·7; 396 of 418) of MenABCWY and 67·4% (64·1-70·6; 563 of 835) to 95·0% (93·3-96·4; 782 of 823) of MenB-FHbp recipients achieved at least four-fold increases in hSBA titres against MenB strains after dose 2 in secondary analyses; 79·9% (334 of 418; 75·7-83·6) and 74·3% (71·2-77·3; 605 of 814), respectively, achieved composite responses. MenABCWY was non-inferior to MenACWY-CRM (single dose) and to MenB-FHbp in ad-hoc analyses based on the proportion of participants with at least a four-fold increase in hSBA titres from baseline and (for MenB-FHbp only) composite responses. Reactogenicity events after vaccination were similarly frequent across groups, were mostly mild or moderate, and were unaffected by MenACWY experience. No adverse events causing withdrawals were related to the investigational product. Serious adverse events were reported in four (1·5%; 0·4-3·7) MenACWY-naive individuals in the MenABCWY group versus six (2·2%; 0·8-4·8) among MenACWY-experienced individuals in the MenABCWY group and 14 (1·3%; 0·7-2·2) in the active control group (MenACWY-experienced and MenACWY-naive individuals combined); none of these were considered related to the investigational product. INTERPRETATION MenABCWY immune responses were robust and non-inferior to MenACWY-CRM and MenB-FHbp administered separately, and MenABCWY was well tolerated. The favourable benefit-risk profile supports further MenABCWY evaluation as a simplified schedule compared with current adolescent meningococcal vaccination programmes. FUNDING Pfizer.
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Affiliation(s)
| | - Daniel Drazan
- General Practice for Children and Adolescents, Jindrichuv Hradec, Czech Republic
| | - Hanna Czajka
- College of Medical Sciences, University of Rzeszow, Rzeszow, Poland; Individual Specialist Medical Practice, Krakow, Poland
| | - Jason Maguire
- Pfizer Vaccine Research and Development, Pearl River, NY, USA.
| | | | - IIkka Seppa
- Tampere University Vaccine Research Center, Tampere, Finland
| | - Roger Maansson
- Pfizer Vaccine Research and Development, Collegeville, PA, USA
| | - Robert O'Neill
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
| | - Paul Balmer
- Pfizer Vaccine Medical Development and Scientific/Clinical Affairs, Collegeville, PA, USA
| | - Luis Jodar
- Pfizer Vaccine Medical Development and Scientific/Clinical Affairs, Collegeville, PA, USA
| | | | | | - John L Perez
- Pfizer Vaccine Research and Development, Collegeville, PA, USA
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Marshall HS, Vesikari T, Richmond PC, Wysocki J, Szenborn L, Beeslaar J, Maguire JD, Balmer P, O'Neill R, Anderson AS, Prégaldien JL, Maansson R, Jiang HQ, Perez JL. Safety and immunogenicity of a primary series and booster dose of the meningococcal serogroup B-factor H binding protein vaccine (MenB-FHbp) in healthy children aged 1-9 years: two phase 2 randomised, controlled, observer-blinded studies. Lancet Infect Dis 2023; 23:103-116. [PMID: 36087588 DOI: 10.1016/s1473-3099(22)00424-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The meningococcal serogroup B-factor H binding protein vaccine (MenB-FHbp) is licensed for use in children aged 10 years or older for protection against invasive serogroup B meningococcal disease. Because young children are at increased risk of invasive meningococcal disease, MenB-FHbp clinical data in this population are needed. METHODS We conducted two phase 2 randomised, controlled, observer-blinded studies including healthy toddlers (age 12-23 months) across 26 Australian, Czech, Finnish, and Polish centres, and older children (age 2-9 years) across 14 Finnish and Polish centres. Exclusion criteria included previous vaccinations against serogroup B meningococcus or hepatitis A virus (HAV), and chronic antibiotic use. Toddlers were randomly allocated (2:1) via an interactive response technology system to receive either 60 μg or 120 μg MenB-FHbp or HAV vaccine and saline (control). Older children were randomly allocated (3:1) to receive 120 μg MenB-FHbp or control, with stratification by age group (2-3 years and 4-9 years). All vaccinations were administered as three doses (0, 2, and 6 months, with only saline given at 2 months in the control group). Toddlers who received 120 μg MenB-FHbp could receive a 120 μg booster dose 24 months after the end of the primary series. The percentages of participants with serum bactericidal activity using human complement (hSBA) titres at or above the lower limit of quantification (LLOQ; all greater than the 1:4 correlate of protection) against four test strains of serogroup B meningococcus 1 month after the third dose (primary immunogenicity endpoint) were measured in the evaluable immunogenicity populations (participants who received the vaccine as randomised, had available and determinate hSBA results, and had no major protocol violations). Not all participants were tested against all strains because of serum sample volume constraints. The frequencies of reactogenicity and adverse events after each dose were recorded in the safety population (all participants who received at least one dose and had safety data available). These studies are registered with ClinicalTrials.gov (NCT02534935 and NCT02531698) and are completed. FINDINGS Between Aug 31, 2015, and Aug 22, 2016, for the toddler study and between Aug 27, 2015, and March 7, 2016, for the older children study, we enrolled and randomly allocated 396 toddlers (60 μg MenB-FHbp group n=44; 120 μg MenB-FHbp group n=220; control group n=132) and 400 older children (120 μg MenB-FHbp group n=294; control group n=106). 1 month after the third dose, the proportions of participants with hSBA titres at or above the LLOQ ranged across test strains from 85·0% (95% CI 62·1-96·8; 17 of 20 participants) to 100·0% (82·4-100·0; 19 of 19) in toddlers receiving 60 μg MenB-FHbp, and from 71·6% (61·4-80·4; 68 of 95) to 100·0% (96·2-100·0; 95 of 95) in toddlers receiving 120 μg MenB-FHbp, and from 79·1% (71·2-85·6; 106 of 134) to 100·0% (97·4-100·0; 139 of 139) in children aged 2-9 years receiving 120 μg MenB-FHbp. hSBA titres peaked at 1 month after the third primary dose of MenB-FHbp and then declined over time. 24 months after the third dose in the toddler study, the proportions with hSBA titres at or above the LLOQ ranged from 0·0% (0·0-17·6; 0 of 19 participants) to 41·2% (18·4-67·1; seven of 17) in those who received 60 μg MenB-FHbp and from 3·7% (0·8-10·4; three of 81) to 22·8% (14·1-33·6; 18 of 79) in those who received 120 μg MenB-FHbp. 1 month after the booster dose in toddlers, the proportions with hSBA titres at or above the LLOQ were higher than at 1 month after the primary series. MenB-FHbp reactogenicity was mostly transient and of mild to moderate severity. Adverse event frequency was similar between the MenB-FHbp and control groups and less frequent following MenB-FHbp booster than following primary doses. Two participants from the toddler study (both from the 120 μg MenB-FHbp group) and four from the older children study (three from the 120 μg MenB-FHbp group and one from the control group) were withdrawn from the study because of adverse events. INTERPRETATION MenB-FHbp was well tolerated and induced protective immune responses in a high proportion of participants. These findings support a favourable MenB-FHbp immunogenicity and reactogenicity profile in young children, a population at increased risk of adverse invasive meningococcal disease outcomes. FUNDING Pfizer.
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Affiliation(s)
- Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, SA, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
| | | | - Peter C Richmond
- University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, WA, Australia; Perth Children's Hospital, Nedlands, WA, Australia
| | - Jacek Wysocki
- Poznań University of Medical Sciences, Poznań, Poland
| | - Leszek Szenborn
- Clinical Department of Pediatric Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Jason D Maguire
- Pfizer Vaccine Clinical Research and Development, Pearl River, NY, USA
| | - Paul Balmer
- Pfizer Vaccine Medical Development and Scientific/Clinical Affairs, Collegeville, PA, USA
| | - Robert O'Neill
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
| | | | | | - Roger Maansson
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
| | - Han-Qing Jiang
- Pfizer Vaccine Clinical Research and Development, Pearl River, NY, USA
| | - John L Perez
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
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Beeslaar J, Mather S, Absalon J, Eiden JJ, York LJ, Crowther G, Maansson R, Maguire JD, Peyrani P, Perez JL. Safety data from the MenB-FHbp clinical development program in healthy individuals aged 10 years and older. Vaccine 2022; 40:1872-1878. [PMID: 35164991 DOI: 10.1016/j.vaccine.2022.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The MenB-FHbp vaccine (Trumenba®) is licensed in various countries for the prevention of meningococcal serogroup B disease in individuals ≥ 10 years of age. The clinical development program included 11 completed trials where, in each trial, MenB-FHbp had an acceptable safety profile after a primary vaccination series was administered to individuals 10-65 years of age. However, the detection of potential rare events was limited because of individual clinical trial size. The current safety analysis evaluates pooled reactogenicity and other adverse events (AEs) reported in these trials to identify new safety signals not detectable in individual trials. METHODS Eleven trials contributed safety data, of which 10 recorded local and systemic reactogenicity events; 8 of the trials were controlled, and reactogenicity data were pooled for 7 of these 8 trials. Additional AE evaluations included immediate AEs (IAEs), medically attended AEs (MAEs), serious AEs (SAEs), newly diagnosed chronic medical conditions (NDCMCs), and autoimmune or neuroinflammatory conditions. RESULTS Local and systemic reactions were more frequent in the MenB-FHbp group (n = 15,294) compared with controls (n = 5509), although most reactions were transient and mild to moderate in severity. Frequencies of IAEs, SAEs, MAEs, NDCMCs, and autoimmune or neuroinflammatory conditions were similar between the MenB-FHbp and control groups. CONCLUSIONS MenB-FHbp demonstrated a favorable safety and tolerability profile in the clinical development program of > 15,000 vaccine recipients ≥ 10 years of age. No new safety signals were identified in the pooled analysis compared with data from the individual trials. Continued postmarketing safety surveillance is important for the identification of rare events. Clinicaltrials.gov: NCT01299480; NCT000808028; NCT00879814; NCT00780806; NCT01352845; NCT01352793; NCT01461993; NCT01323270; NCT01830855; NCT01461980; NCT01768117.
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Affiliation(s)
- Johannes Beeslaar
- Pfizer Vaccine Clinical Research and Development, Horizon Building, Honey Lane, Hurley, SL6 6RJ, UK.
| | - Susan Mather
- Pfizer Worldwide Research and Development, 500 Arcola Rd, Collegeville, PA, USA.
| | - Judith Absalon
- Pfizer Vaccine Clinical Research and Development, 401 North Middletown Rd, Pearl River, NY, USA.
| | - Joseph J Eiden
- Pfizer Vaccine Clinical Research and Development, 401 North Middletown Rd, Pearl River, NY, USA.
| | - Laura J York
- Pfizer Vaccine Medical Development, Scientific & Clinical Affairs, 500 Arcola Rd, Collegeville, PA, USA.
| | - Graham Crowther
- Pfizer Vaccine Clinical Research and Development, Horizon Building, Honey Lane, Hurley, SL6 6RJ, UK.
| | - Roger Maansson
- Pfizer Vaccine Clinical Research and Development, 500 Arcola Rd, Collegeville, PA, USA.
| | - Jason D Maguire
- Pfizer Vaccine Clinical Research and Development, 401 North Middletown Rd, Pearl River, NY, USA.
| | - Paula Peyrani
- Pfizer Vaccine Clinical Research and Development, 500 Arcola Rd, Collegeville, PA, USA.
| | - John L Perez
- Pfizer Vaccine Clinical Research and Development, 500 Arcola Rd, Collegeville, PA, USA.
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Drazan D, Czajka H, Maguire JD, Pregaldien JL, Maansson R, O'Neill R, Anderson AS, Balmer P, Beeslaar J, Perez JL. A phase 3 study to assess the immunogenicity, safety, and tolerability of MenB-FHbp administered as a 2-dose schedule in adolescents and young adults. Vaccine 2021; 40:351-358. [PMID: 34961633 DOI: 10.1016/j.vaccine.2021.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The MenB-FHbp vaccine is licensed to prevent meningococcal serogroup B disease on either a 2-dose (0, 6 months) or 3-dose (0, 1-2, 6 months) series. This phase 3 study further assessed the immunogenicity and safety of the 2-dose MenB-FHbp schedule. METHODS Subjects 10-25 years of age received MenB-FHbp (months 0, 6) and the quadrivalent meningococcal conjugate vaccine MenACWY-CRM (month 0). Primary immunogenicity endpoints included percentages of subjects achieving ≥ 4-fold increases from baseline in serum bactericidal antibody using human complement (hSBA) titers for 4 diverse, vaccine-heterologous primary serogroup B test strains and titers ≥ lower limit of quantitation (LLOQ; 1:8 or 1:16) for all 4 primary strains combined (composite response) after dose 2; a titer ≥ 1:4 is the accepted correlate of protection. Percentages of participants with hSBA titers ≥ LLOQ for 10 additional vaccine-heterologous strains were also assessed; positive predictive values of primary strain responses for secondary strain responses were determined. Safety was assessed. RESULTS Overall, 1057 subjects received dose 1 and 946 received dose 2 of MenB-FHbp. Percentages of participants achieving ≥ 4-fold increases in hSBA titers against each primary strain after dose 2 ranged from 67.4% to 95.0% and the composite response was 74.3%. Primary strain responses were highly predictive of secondary strain responses. Most reactogenicity events were mild-to-moderate in severity and did not lead to withdrawal from the study. Adverse events (AEs) considered by the investigator to be related to vaccination occurred in 4.2% (44/1057) of subjects, and there were no serious AEs or newly diagnosed chronic medical conditions considered related to vaccination. CONCLUSIONS MenB-FHbp administered at 0, 6 months was well tolerated and induced protective bactericidal antibody responses against diverse serogroup B strains. Findings provide further support for the continued use of MenB-FHbp on a 2-dose schedule in this population.
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Affiliation(s)
- Daniel Drazan
- General Practice for Children and Adolescents, Jindrichuv Hradec, Czech Republic
| | - Hanna Czajka
- Faculty of Medicine, University of Rzeszów, Rzeszów, Poland and Individual Specialist Medical Practice, Krakow, Poland
| | - Jason D Maguire
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA.
| | | | - Roger Maansson
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Robert O'Neill
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | - Paul Balmer
- Vaccine Medical and Scientific Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | - John L Perez
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
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Østergaard L, Vesikari T, Senders SD, Flodmark CE, Kosina P, Jiang HQ, Maguire JD, Absalon J, Jansen KU, Harris SL, Maansson R, Balmer P, Beeslaar J, Perez JL. Persistence of hSBA titers elicited by the meningococcal serogroup B vaccine menB-FHbp for up to 4 years after a 2- or 3-dose primary series and immunogenicity, safety, and tolerability of a booster dose through 26 months. Vaccine 2021; 39:4545-4554. [PMID: 34215452 DOI: 10.1016/j.vaccine.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND To demonstrate extended protection against meningococcal serogroup B (MenB) disease after MenB-FHbp (bivalent rLP2086) vaccination, this study evaluated immunopersistence through 26 months following MenB-FHbp boosting after 2 or 3 primary doses in adolescents. STUDY DESIGN This phase 3, open-label study was an extension of 3 phase 2 studies with participants aged 11-18 years randomized to receive primary MenB-FHbp vaccination following 1 of 5 dosing schedules or control. A booster dose was administered 48 months after the primary series. Immunopersistence through 48 months after the last primary dose (persistence stage) and 26 months postbooster (booster stage) was determined by serum bactericidal assays using human complement (hSBAs) against 4 vaccine-heterologous test strains. Safety evaluations included adverse events (AEs) and local and systemic reactions. RESULTS Overall, 698 and 304 subjects enrolled in the persistence and booster stages, respectively. hSBA titers declined in all groups during 12 months postprimary vaccination, then remained stable through 48 months. One month postbooster, 93.4-100.0% of subjects achieved hSBA titers ≥ lower limit of quantitation against each test strain; percentages at 12 and 26 months postbooster were higher than at similar time points following primary vaccination. Primary and booster MenB-FHbp vaccinations were well tolerated, with ≤ 12.5% of subjects reporting AEs during each stage. The most common local (reported by 84.4-93.8% of subjects) and systemic (68.8-76.6%) reactions to the booster were injection site pain and fatigue and headache, respectively; ≤ 3.7% of subjects reported severe systemic events. CONCLUSION Protective hSBA titers initially declined but were retained by many subjects for 4 years irrespective of primary MenB-FHbp vaccination schedule. Boosting at 48 months after primary vaccination was safe, well tolerated, and induced immune responses indicative of immunological memory that persisted through 26 months. Booster vaccination during late adolescence may prolong protection against MenB disease.
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Affiliation(s)
- Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark.
| | - Timo Vesikari
- Nordic Research Network Ltd, Biokatu 10, 33520 Tampere, Finland
| | - Shelly D Senders
- Senders Pediatrics, 2054 South Green Road, South Euclid, OH, USA
| | - Carl-Erik Flodmark
- Department of Pediatrics, Entrance 108, Skåne University Hospital in Malmö, 205 02 Malmö, Sweden
| | - Pavel Kosina
- Department of Infectious Diseases, University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Han-Qing Jiang
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Jason D Maguire
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Judith Absalon
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Kathrin U Jansen
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Shannon L Harris
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Roger Maansson
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA, USA
| | - Paul Balmer
- Pfizer Vaccine Medical and Scientific Affairs, 500 Arcola Road, Collegeville, PA, USA
| | - Johannes Beeslaar
- Pfizer UK Vaccine Research and Development, Horizon Building, Honey Lane, Hurley SL6 6RJ, UK
| | - John L Perez
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA, USA
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Peterson J, Drazan D, Czajka H, Maguire J, Pregaldien JL, Seppa I, Maansson R, O’Neill R, Anderson AS, Balmer P, Beeslaar J, Perez JL. 6. Pentavalent Meningococcal (MenABCWY) Vaccine is Safe and Well Tolerated With Immunogenicity Noninferior to Coadministered MenB-FHbp and MenACWY-CRM in a Phase 2 Study of Healthy Adolescents and Young Adults. Open Forum Infect Dis 2020. [PMCID: PMC7776022 DOI: 10.1093/ofid/ofaa439.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Meningococcal serogroups A, B, C, W and Y cause nearly all meningococcal disease globally. Vaccination is complicated by different dosing recommendations for serogroup B (MenB) and quadrivalent (MenACWY) vaccines, which could be solved with a single pentavalent vaccine. This study in adolescents and young adults evaluated a new pentavalent MenABCWY vaccine that combines 2 licensed vaccines, MenB-FHbp (Trumenba®; bivalent rLP2086) and MenACWY-TT (Nimenrix®), into a single vaccine.
Methods
In this ongoing, randomized, controlled, observer-blinded, multicenter study (NCT03135834), MenB vaccine-naive and MenACWY-naive or -experienced healthy 10–25-year-olds were randomized 1:2 to MenABCWY (Month 0,6) or MenB-FHbp (Month 0,6) and MenACWY-CRM (Month 0). Immune responses were measured by serum bactericidal activity assays with human complement (hSBA) against serogroup A, C, W and Y strains and 4 diverse, vaccine-heterologous MenB strains. Endpoints included percentages of subjects achieving ≥ 4-fold rises in titers from baseline. Noninferiority of immune responses was assessed at the 10% margin (95% CI lower limit > −10%). Safety was assessed.
Results
Following dose 2, high percentages of MenABCWY (n=543) and MenB-FHbp (n=1057) recipients achieved ≥ 4-fold rises against each of the 4 MenB strains (75.8−94.7% vs 67.4−95.0%) and titers reaching at least the lower limit of quantification against all 4 strains combined (79.9% vs 74.3%; Figure 1A). MenABCWY was noninferior to MenB-FHbp for all 5 endpoints. MenABCWY was also noninferior to a single MenACWY-CRM dose with 75.5−96.9% and 93.0−97.4% of MenABCWY recipients after dose 1 or 2, respectively, achieving ≥ 4-fold rises against serogroup A, C, W and Y depending on prior MenACWY experience (Figure 1B). Local reactions and systemic events after MenABCWY or MenB-FHbp were similarly frequent, mostly mild/moderate in severity (Figure 2), and unaffected by MenACWY experience.
Figure 1. Immune Responses as Measured in hSBA to (A) MenB Test Strains at 1 Month After Dose 2 and (B) MenA, MenC, MenW, and MenY Test Strains at 1 Month After Doses 1 and 2
Figure 2. (A) Local Reactions and (B) Systemic Events Reported Within 7 Days After Any Dose
Conclusion
MenABCWY 4-fold immune responses from baseline were robust and noninferior to MenB-FHbp and MenACWY-CRM administered separately. Vaccination was safe and well tolerated. The favorable benefit-risk profile supports further MenABCWY development as a simplified alternative to current meningococcal vaccination practices. Funded by Pfizer.
Disclosures
James Peterson, MD, Pfizer (Scientific Research Study Investigator) Daniel Drazan, MD, Pfizer (Scientific Research Study Investigator) Hanna Czajka, MD, PhD, Pfizer (Scientific Research Study Investigator) Jason Maguire, MD, Pfizer (Employee, Shareholder) Jean-Louis Pregaldien, MS, Pfizer (Employee, Shareholder) Ilkka Seppa, MD, Pfizer (Scientific Research Study Investigator) Roger Maansson, MS, Pfizer (Employee, Shareholder) Robert O’Neill, PhD, Pfizer (Employee, Shareholder) Annaliesa S. Anderson, PhD, Pfizer (Employee, Shareholder) Paul Balmer, PhD, Pfizer Inc (Employee, Shareholder) Johannes Beeslaar, MD, Pfizer (Employee, Shareholder) John L. Perez, MD, MA, Pfizer Inc (Employee, Shareholder)
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Affiliation(s)
| | - Daniel Drazan
- General Practice for Children and Adolescents, Jindrichuv Hradec, Jihocesky kraj, Czech Republic
| | - Hanna Czajka
- Individual Specialist Medical Practice, University of Rzeszow, Krakow, Malopolskie, Poland
| | - Jason Maguire
- Pfizer Vaccine Clinical Research and Development, Pearl River NY, Pearl River, NY
| | | | - Ilkka Seppa
- Tampere University, Tampere, Pirkanmaa, Finland
| | - Roger Maansson
- Pfizer Vaccine Clinical Research and Development, Collegeville PA, Collegeville, PA
| | - Robert O’Neill
- Pfizer Inc, Brussels, Brussels Hoofdstedelijk Gewest, Belgium
| | | | - Paul Balmer
- Pfizer Inc, Brussels, Brussels Hoofdstedelijk Gewest, Belgium
| | - Johannes Beeslaar
- Pfizer Vaccine Clinical Research and Development, Hurley, Berkshire UK, Hurley, Berkshire, England, United Kingdom
| | - John L Perez
- Pfizer Inc, Brussels, Brussels Hoofdstedelijk Gewest, Belgium
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Beeslaar J, Absalon J, Anderson AS, Eiden JJ, Balmer P, Harris SL, Jones TR, O'Neill RE, Pregaldien JL, Radley D, Maansson R, Ginis J, Srivastava A, Perez JL. MenB-FHbp Vaccine Protects Against Diverse Meningococcal Strains in Adolescents and Young Adults: Post Hoc Analysis of Two Phase 3 Studies. Infect Dis Ther 2020; 9:641-656. [PMID: 32700260 PMCID: PMC7452968 DOI: 10.1007/s40121-020-00319-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Two phase 3 studies in adolescents and young adults demonstrated that MenB-FHbp, a meningococcal serogroup B (MenB) vaccine, elicits protective immune responses after 2 or 3 doses based on serum bactericidal antibody assays using human complement (hSBA) against 4 primary and 10 additional diverse, vaccine-heterologous MenB test strains. Lower limits of quantitation (LLOQs; titers 1:8 or 1:16; titers ≥ 1:4 correlate with protection) were used to evaluate responses to individual strains and all 4 primary strains combined (composite response). A post hoc analysis evaluated percentages of subjects with protective responses to as many as 8 strains combined (4 primary plus additional strains). Methods Immune responses were measured using hSBAs against 4 primary strains in adolescents (n = 1509, MenB-FHbp; n = 898, hepatitis A virus vaccine/saline) and young adults (n = 2480, MenB-FHbp; n = 824, saline) receiving MenB-FHbp or control at 0, 2, and 6 months. Ten additional strains were evaluated in subsets of subjects from approximately 1800 MenB-FHbp recipients across both studies. Percentages of subjects with hSBA titers ≥ LLOQ for different numbers of primary strains or primary plus additional strains combined (7 or 8 strains total per subset) were determined before vaccination, 1 month post-dose 2, and 1 month post-dose 3. Results Across the panel of primary plus additional strains, at 1 month post-dose 3, titers ≥ LLOQ were elicited in 93.7–95.7% of adolescents and 91.7–95.0% of young adults for ≥ 5 test strains combined and in 70.5–85.8% of adolescents and 67.5–81.4% of young adults for ≥ 7 strains combined. Among adolescents, 99.8%, 99.0%, 92.8%, and 82.7% had titers ≥ LLOQ against at least 1, 2, 3, and all 4 primary strains, respectively; corresponding percentages for young adults were 99.7%, 97.7%, 94.0%, and 84.5%. Conclusions Results support the ability of MenB-FHbp to provide broad coverage against MenB strains expressing diverse FHbp variants. Trial Registration ClinicalTrials.gov identifiers NCT01830855, NCT01352845. Electronic supplementary material The online version of this article (10.1007/s40121-020-00319-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Beeslaar
- Vaccine Clinical Research and Development, Pfizer Ltd UK, Hurley, UK.
| | - Judith Absalon
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | - Joseph J Eiden
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Paul Balmer
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Shannon L Harris
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Thomas R Jones
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Robert E O'Neill
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | - David Radley
- Vaccine Clinical Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Roger Maansson
- Vaccine Clinical Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - John Ginis
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Amit Srivastava
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - John L Perez
- Vaccine Clinical Research and Development, Pfizer Inc, Collegeville, PA, USA
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Beeslaar J, Peyrani P, Maguire J, Eiden J, Palmer P, Maansson R, Crowther G, Perez JL. 2722. Effects of Sex, Age, and Race on Immunogenicity of MenB-FHbp, a Bivalent Meningococcal B Vaccine: A Pooled Evaluation of Clinical Trial Data. Open Forum Infect Dis 2019. [PMCID: PMC6809720 DOI: 10.1093/ofid/ofz360.2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background MenB-FHbp (bivalent rLP2086), a meningococcal serogroup B vaccine, is approved in several countries for adolescents and young adults. MenB-FHbp elicited robust immune responses and had an acceptable safety profile during an extensive clinical development program. Because immune responses to vaccines can vary by subject demographics, this subgroup analysis pooled data across 7 randomized MenB-FHbp clinical studies to evaluate potential differences in immunogenicity by sex, age, or race/ethnicity in a larger dataset relative to individual studies. Methods Data from subjects who received 120 µg MenB-FHbp at 0, 2, and 6 months and had valid immunogenicity results for 4 vaccine-heterologous test strains were included. Immune responses were evaluated by serum bactericidal assays using human complement (hSBA). Immunogenicity endpoints (assessed 1 month after dose 3) were percentages of subjects achieving ≥ 4-fold rise in hSBA titer against each strain, percentages achieving hSBA titers ≥ the lower limit of quantification (LLOQ) against each strain and against all 4 strains combined (composite response), geometric mean hSBA titers against each strain, and percentages achieving hSBA titers ≥ 1:4 (correlate of protection) against each strain. Results This analysis included 8026 subjects aged 10‒25 years (51.7% males, 80.7% adolescents aged 10‒18 years, 87.0% white, 9.3% black, 0.8% Asian, 3.0% other race). One month after dose 3, percentages of subjects achieving a ≥ 4-fold rise from baseline titer against each strain and achieving a composite response were similar across age and race (table). A marginally greater percentage of males vs. females achieved ≥ 4-fold rise in titer against each strain, but these differences were not considered clinically meaningful because of the high percentages of responders in both groups. Conclusion MenB-FHbp immunogenicity was similar across sex, age, and race in this pooled analysis, with high percentages of responders in all evaluated subgroups. The marginally lower response rates among females compared with males were not considered clinically meaningful. These findings support currently recommended MenB-FHbp vaccination practices without modification by sex, age, or race. Funding: Pfizer ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Johannes Beeslaar
- Pfizer Vaccine Clinical Research and Development, Hurley, Berkshire, UK
| | | | - Jason Maguire
- Pfizer Vaccine Clinical Research and Development, Pearl River, New York
| | - Joseph Eiden
- Pfizer Vaccine Clinical Research and Development, Pearl River, New York
| | - Paul Palmer
- Pfizer Vaccine Medical Development, Scientific & Clinical Affairs, Collegeville, Pennsylvania
| | - Roger Maansson
- Pfizer Vaccine Clinical Research and Development, Collegeville, Pennsylvania
| | - Graham Crowther
- Pfizer Vaccine Clinical Research and Development, Hurley, Berkshire, UK
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Vesikari T, Østergaard L, Beeslaar J, Absalon J, Eiden JJ, Jansen KU, Jones TR, Harris SL, Maansson R, Munson S, O'Neill RE, York LJ, Perez JL. Persistence and 4-year boosting of the bactericidal response elicited by two- and three-dose schedules of MenB-FHbp: A phase 3 extension study in adolescents. Vaccine 2019; 37:1710-1719. [PMID: 30770221 DOI: 10.1016/j.vaccine.2018.11.073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/25/2018] [Accepted: 11/26/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND The period of heightened risk of invasive meningococcal disease in adolescence extends for >10 years. This study aimed to evaluate persistence of the immune response to the serogroup B meningococcal (MenB) vaccine MenB-FHbp (Trumenba®, Bivalent rLP2086) under two- and three-dose primary vaccination schedules, both of which are approved in the United States and the European Union, and to assess safety and immunogenicity of a booster dose. METHODS This was an open-label extension study of a phase 2 randomized MenB-FHbp study (primary study). This interim analysis includes data through 1 month after booster vaccination. In the primary study, adolescents 11-18 years of age were randomized using an interactive voice or web-based response system to receive 120 μg MenB-FHbp under 0-, 1-, 6-month; 0-, 2-, 6-month; 0-, 6-month; 0-, 2-month; or 0-, 4-month schedules (termed study groups for the current analysis). For the primary study, participants were blinded to their vaccine study group allocation, but investigators and the study sponsor were unblinded. Immune responses in subjects from the primary study were evaluated through 48 months after primary vaccination (persistence stage; 17 sites in Czech Republic, Denmark, Germany, and Sweden). Safety and immunogenicity of a booster dose given at 48 months after primary vaccination (booster stage; 14 sites in Czech Republic, Denmark, and Sweden) were also assessed. Immune responses were evaluated in serum bactericidal assays with human complement (hSBAs) using four MenB test strains representative of disease-causing MenB strains in the United States and Europe and expressing factor H binding proteins (FHbps) heterologous to the vaccine antigens. The primary immunogenicity endpoints were the proportions of subjects with hSBA titers greater than or equal to the assays' lower limit of quantitation (LLOQ; 1:8 or 1:16 depending on strain) at 12, 18, 24, 36, and 48 months after primary vaccination (persistence stage) and 1 and 48 months after the primary vaccination series and 1 month after receipt of the booster dose (booster stage). Safety evaluations during the booster stage included local reactions and systemic events by severity, antipyretic use, adverse events (AEs), immediate AEs, serious AEs (SAEs), medically attended AEs (MAEs), newly diagnosed chronic medical conditions (NDCMCs), and missed days of school and work because of AEs. The modified intent-to-treat (mITT) population was used for immunogenicity evaluations in the persistence stage. The booster stage immunogenicity evaluations used the evaluable immunogenicity population; analyses were also performed in the mITT population. For the persistence stage, safety evaluations included subjects with at least one blood draw, whereas for the booster stage, they included subjects who received the booster dose and had available safety data. This trial is registered at ClinicalTrials.gov number NCT01543087. FINDINGS A total of 465 subjects were enrolled in the persistence stage, and 271 subjects were enrolled in the booster stage. Sera for the extension phase of this interim analysis were collected from September 7, 2012 to December 7, 2015. One month after primary vaccination, 73.8-100.0% of subjects depending on study group responded with hSBA titers ≥LLOQ. Response rates declined during the 12 months after last primary vaccination and then remained stable through 48 months, with 18.0-61.3% of subjects depending on study group having hSBA titers ≥LLOQ at this time point. One month after receipt of the booster dose, 91.9-100.0% of subjects depending on study group had hSBA titers ≥LLOQ against the four primary strains individually and 91.8-98.2% had hSBA titers ≥LLOQ against all four strains combined (composite response). Geometric mean titers were higher after booster vaccination than at 1 month after primary vaccination. Immune responses were generally similar across study groups, regardless of whether a two- or three-dose primary series was received. None of the AEs (2.2-6.9% of subjects depending on study group) or NDCMCs (1.8-5.0%) that were reported during the persistence stage were considered related to the investigational product. Local reactions and systemic events were reported by 84.4-93.8% and 68.8-76.6% of subjects depending on study group, respectively, in the booster stage; these were generally similar across study groups, transient, and less frequent than after any primary vaccination. Additionally, there was no general progressive worsening in severity of reactogenicity events (ie, potentiation; ≤3 subjects per group), and reactogenicity events did not lead to any study withdrawals. No NDCMCs or immediate AEs were reported during the booster stage. AEs were reported by 3.7-12.5% of subjects depending on study group during the booster stage. The two possibly related AEs included a mild worsening of psoriasis and a severe influenza-like illness that resolved in 10 days. INTERPRETATION Immune responses declined after the primary vaccination series; however, a substantially greater number of subjects retained protective responses at 48 months after primary vaccination compared with subjects having protective responses before vaccination. Persistence trends were similar across all 5 study groups regardless of whether a two- or three-dose primary schedule was received. Furthermore, a booster dose given 48 months after primary vaccination was safe, well-tolerated, and elicited robust immune responses indicative of immunologic memory; these responses were similar between two- and three-dose primary schedule study groups. Use of a booster dose may help further extend protection against MenB disease in adolescents. FUNDING Pfizer Inc.
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Affiliation(s)
- Timo Vesikari
- Vaccine Research Center, University of Tampere Medical School, Biokatu 10, 33520 Tampere, Finland
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| | - Johannes Beeslaar
- Pfizer UK Vaccine Research and Development, Horizon Building, Honey Lane, Hurley SL6 6RJ, UK.
| | - Judith Absalon
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Joseph J Eiden
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Kathrin U Jansen
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Thomas R Jones
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Shannon L Harris
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Roger Maansson
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA 19426, USA
| | - Samantha Munson
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA 19426, USA
| | - Robert E O'Neill
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Laura J York
- Pfizer Vaccine Medical Development, Scientific & Clinical Affairs, 500 Arcola Road, Collegeville, PA 19426, USA
| | - John L Perez
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA 19426, USA
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Maansson R, Radley D, Jiang Q, Beeslaar J, Patterson S, Absalon J, Perez J. Modeling excess zeroes in an integrated analysis of vaccine safety. Hum Vaccin Immunother 2018; 14:1530-1533. [PMID: 29393713 DOI: 10.1080/21645515.2018.1433972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
In prophylactic vaccine studies in healthy populations, many subjects do not experience a single adverse event (AE). Thus, the number of AEs observed in such clinical trials may be difficult to model because of an excess of zeroes relative to the parametric distributions assumed. To determine which type of modeling provides a better fit for observed AE data, a variety of models were applied to data from an integrated safety database from clinical trials of the meningococcal vaccine MenB-FHbp (Trumenba®, bivalent rLP2086; Pfizer Inc, Philadelphia, PA). MenB-FHbp was the first vaccine approved in the United States to prevent meningococcal serogroup B disease in individuals aged 10 to 25 years. Specifically, this report presents an integrated analysis of AEs from 8 randomized controlled trials that compared MenB-FHbp to placebo or active controls. The number of AEs occurring from dose one to 30 days after the last dose was analyzed. Six models were compared: standard Poisson and negative binomial models and their corresponding zero-inflation and hurdle models. Models were evaluated for their ability to predict the number of AEs and by goodness-of-fit statistics. Models based on the Poisson distribution were a poor fit. The zero-inflated negative binomial model and negative binomial hurdle model provided the closest fit. These results suggest that zero-inflated or hurdle models may provide a better fit to AE data from healthy populations compared with conventional parametric models.
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Affiliation(s)
- Roger Maansson
- a Pfizer Vaccine Clinical Research and Development , Collegeville , PA , USA
| | - David Radley
- b Pfizer Vaccine Research and Development , Pearl River , NY , USA
| | - Qin Jiang
- c Pfizer Innovative Health , Collegeville , PA , USA
| | | | - Scott Patterson
- e Statistical Innovation, Sanofi Pasteur , Swiftwater , PA , USA
| | - Judith Absalon
- b Pfizer Vaccine Research and Development , Pearl River , NY , USA
| | - John Perez
- a Pfizer Vaccine Clinical Research and Development , Collegeville , PA , USA
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Beeslaar J, Absalon J, Balmer P, Srivastava A, Maansson R, York LJ, Perez JL. Clinical data supporting a 2-dose schedule of MenB-FHbp, a bivalent meningococcal serogroup B vaccine, in adolescents and young adults. Vaccine 2018; 36:4004-4013. [PMID: 29861182 DOI: 10.1016/j.vaccine.2018.05.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/19/2022]
Abstract
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is a potentially devastating condition that can result in death and is associated with serious long-term sequelae in survivors. Vaccination is the preferred preventative strategy. Quadrivalent polysaccharide-based vaccines that protect against infection caused by meningococcal serogroups A, C, W, and Y are not effective against meningococcal serogroup B (MenB), which was responsible for approximately 60% and 35% of confirmed IMD cases in the European Union and the United States in 2016, respectively. A recombinant protein MenB vaccine (MenB-FHbp [bivalent rLP2086; Trumenba®]) has been approved for protection against MenB infection in persons 10-25 years of age in the United States and Canada and for individuals ≥10 years of age in the European Union and Australia. In these regions, MenB-FHbp is approved as a 2- or 3-dose primary vaccination schedule. This report will review the current evidence supporting administration of MenB-FHbp as a 2-dose primary vaccination schedule. Different contexts in which a 2- or 3-dose primary vaccination schedule might be preferred (eg, routine prospective vaccination vs outbreak control) are reviewed.
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Affiliation(s)
| | - Judith Absalon
- Pfizer Vaccine Clinical Research and Development, Pearl River, NY, USA
| | - Paul Balmer
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
| | | | - Roger Maansson
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
| | - Laura J York
- Pfizer Vaccines Medical Development, Scientific & Clinical Affairs, Collegeville, PA, USA
| | - John L Perez
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
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Ostergaard L, Vesikari T, Absalon J, Beeslaar J, Ward BJ, Senders S, Eiden JJ, Jansen KU, Anderson AS, York LJ, Jones TR, Harris SL, O'Neill R, Radley D, Maansson R, Prégaldien JL, Ginis J, Staerke NB, Perez JL. A Bivalent Meningococcal B Vaccine in Adolescents and Young Adults. N Engl J Med 2017; 377:2349-2362. [PMID: 29236639 DOI: 10.1056/nejmoa1614474] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND MenB-FHbp is a licensed meningococcal B vaccine targeting factor H-binding protein. Two phase 3 studies assessed the safety of the vaccine and its immunogenicity against diverse strains of group B meningococcus. METHODS We randomly assigned 3596 adolescents (10 to 18 years of age) to receive MenB-FHbp or hepatitis A virus vaccine and saline and assigned 3304 young adults (18 to 25 years of age) to receive MenB-FHbp or saline at baseline, 2 months, and 6 months. Immunogenicity was assessed in serum bactericidal assays that included human complement (hSBAs). We used 14 meningococcal B test strains that expressed vaccine-heterologous factor H-binding proteins representative of meningococcal B epidemiologic diversity; an hSBA titer of at least 1:4 is the accepted correlate of protection. The five primary end points were the proportion of participants who had an increase in their hSBA titer for each of 4 primary strains by a factor of 4 or more and the proportion of those who had an hSBA titer at least as high as the lower limit of quantitation (1:8 or 1:16) for all 4 strains combined after dose 3. We also assessed the hSBA responses to the primary strains after dose 2; hSBA responses to the 10 additional strains after doses 2 and 3 were assessed in a subgroup of participants only. Safety was assessed in participants who received at least one dose. RESULTS In the modified intention-to-treat population, the percentage of adolescents who had an increase in the hSBA titer by a factor of 4 or more against each primary strain ranged from 56.0 to 85.3% after dose 2 and from 78.8 to 90.2% after dose 3; the percentages of young adults ranged from 54.6 to 85.6% and 78.9 to 89.7%, after doses 2 and 3, respectively. Composite responses after doses 2 and 3 in adolescents were 53.7% and 82.7%, respectively, and those in young adults were 63.3% and 84.5%, respectively. Responses to the 4 primary strains were predictive of responses to the 10 additional strains. Most of those who received MenB-FHbp reported mild or moderate pain at the vaccination site. CONCLUSIONS MenB-FHbp elicited bactericidal responses against diverse meningococcal B strains after doses 2 and 3 and was associated with more reactions at the injection site than the hepatitis A virus vaccine and saline. (Funded by Pfizer; ClinicalTrials.gov numbers, NCT01830855 and NCT01352845 ).
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Affiliation(s)
- Lars Ostergaard
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Timo Vesikari
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Judith Absalon
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Johannes Beeslaar
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Brian J Ward
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Shelly Senders
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Joseph J Eiden
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Kathrin U Jansen
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Annaliesa S Anderson
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Laura J York
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Thomas R Jones
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Shannon L Harris
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Robert O'Neill
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - David Radley
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Roger Maansson
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Jean-Louis Prégaldien
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - John Ginis
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - Nina B Staerke
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
| | - John L Perez
- From Aarhus University Hospital, Aarhus, Denmark (L.O., N.B.S.); Vaccine Research Center, University of Tampere Medical School, Tampere, Finland (T.V.); Pfizer Vaccine Clinical Research and Development (J.A., J.J.E.) and Pfizer Vaccine Research and Development (K.U.J., A.S.A., T.R.J., S.L.H., R.O.), Pearl River, NY; Pfizer Vaccine Clinical Research and Development, Hurley, United Kingdom (J.B.); Research Institute of the McGill University Health Center, Montreal (B.J.W.); Senders Pediatrics, South Euclid, OH (S.S.); Pfizer Vaccine Medical Development, Scientific and Clinical Affairs (L.J.Y.) and Pfizer Vaccine Clinical Research and Development (D.R., R.M., J.G., J.L.P.), Collegeville, PA; and Pfizer Vaccine Clinical Research and Development, Brussels (J.-L.P.)
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13
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Petersen LK, Restrepo J, Moreira ED, Iversen OE, Pitisuttithum P, Van Damme P, Joura EA, Olsson SE, Ferris D, Block S, Giuliano AR, Bosch X, Pils S, Cuzick J, Garland SM, Huh W, Kjaer SK, Bautista OM, Hyatt D, Maansson R, Moeller E, Qi H, Roberts C, Luxembourg A. Impact of baseline covariates on the immunogenicity of the 9-valent HPV vaccine - A combined analysis of five phase III clinical trials. Papillomavirus Res 2017; 3:105-115. [PMID: 28720442 PMCID: PMC5883201 DOI: 10.1016/j.pvr.2017.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/02/2017] [Accepted: 03/13/2017] [Indexed: 12/04/2022]
Abstract
BACKGROUND The immunogenicity profile of the 9-valent HPV (9vHPV) vaccine was evaluated across five phase III clinical studies conducted in girls and boys 9-15 years of age and young women 16-26 years of age. The effect of baseline characteristics of subjects on vaccine-induced HPV antibody responses was assessed. METHODS Immunogenicity data from 11,304 subjects who received ≥1 dose of 9vHPV vaccine in five Phase III studies were analyzed. Vaccine was administered as a 3-dose regimen. HPV antibody titers were assessed 1 month after dose 3 using a competitive Luminex immunoassay and summarized as geometric mean titers (GMTs). Covariates examined were age, gender, race, region of residence, and HPV serostatus and PCR status at day 1. RESULTS GMTs to all 9 vaccine HPV types decreased with age at vaccination initiation, and were otherwise generally similar among the demographic subgroups defined by gender, race and region of residence. For all subgroups defined by race or region of residence, GMTs were higher in girls and boys than in young women. Vaccination of subjects who were seropositive at day 1 to a vaccine HPV type resulted in higher GMTs to that type, compared with those in subjects who were seronegative for that type at day 1. CONCLUSIONS 9vHPV vaccine immunogenicity was robust among subjects with differing baseline characteristics. It was generally comparable across subjects of different races and from different regions. Greater immunogenicity in girls and boys versus young women (the population used to establish 9vHPV vaccine efficacy in clinical studies) indicates that the anti-HPV responses generated by the vaccine in adolescents from all races or regions were sufficient to induce high-level protective efficacy. This immunogenicity profile supports a widespread 9vHPV vaccination program and early vaccination.
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Affiliation(s)
- Lone K Petersen
- Aarhus University Hospital, Department of Obstetrics and Gynecology, Aarhus, Denmark
| | - Jaime Restrepo
- Fundación Centro de Investigación Clínica CIC, Medellín, Colombia
| | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil
| | - Ole-Erik Iversen
- Department of Clinical Science, University of Bergen and Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | | | - Pierre Van Damme
- Center for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
| | - Elmar A Joura
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | | | - Daron Ferris
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA, USA
| | - Stan Block
- Kentucky Pediatric and Adult Research, Inc., Bardstown, KY, USA
| | | | | | - Sophie Pils
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, London, UK
| | - Suzanne M Garland
- Royal Women's Hospital, University of Melbourne and Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Warner Huh
- Division of Gynecologic Oncology, University of Alabama, Birmingham, USA
| | - Susanne K Kjaer
- Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, Denmark
| | | | | | | | | | - Hong Qi
- Merck & Co., Inc., Kenilworth, NJ, USA
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14
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Vesikari T, Senders S, Absalon J, Eiden JJ, Jansen KU, Beeslaar JF, York LJ, Jones TR, Maansson R, Harris SL, O'Neill RE, Ginis J, Anderson AS, Perez JL. Immunogenicity of MenB-FHbp (Bivalent rLP2086), a Meningococcal Serogroup B Vaccine, in US Adolescents: Results From a Phase 3 Trial. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Timo Vesikari
- Vaccine Research Center, University of Tampere, Tampere, Finland
| | | | | | | | | | | | - Laura J. York
- Pfizer Medical Development and Scientific Affairs, Collegeville, Pennsylvania
| | | | | | | | | | - John Ginis
- Pfizer Vaccine Research, Collegeville, Pennsylvania
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15
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Luxembourg A, Brown D, Bouchard C, Giuliano AR, Iversen OE, Joura EA, Penny ME, Restrepo JA, Romaguera J, Maansson R, Moeller E, Ritter M, Chen J. Phase II studies to select the formulation of a multivalent HPV L1 virus-like particle (VLP) vaccine. Hum Vaccin Immunother 2016; 11:1313-22. [PMID: 25912208 DOI: 10.1080/21645515.2015.1012010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Our objective was to develop a multivalent prophylactic HPV vaccine that protects against infection and disease caused by HPV16/18 (oncogenic types in existing prophylactic vaccines) plus additional oncogenic types by conducting 3 Phase II studies comparing the immunogenicity (i.e., anti-HPV6/11/16/18 geometric mean titers [GMT]) and safety of 7 vaccine candidates with the licensed quadrivalent HPV6/11/16/18 vaccine (qHPV vaccine) in young women ages 16-26. In the first study (Study 1), subjects received one of 3 dose formulations of an 8-valent HPV6/11/16/18/31/45/52/58 vaccine or qHPV vaccine (control). In Study 2, subjects received one of 3 dose formulations (termed low-, mid-, and high-dose formulations, respectively) of a 9-valent HPV6/11/16/18/31/33/45/52/58 vaccine (9vHPV vaccine) or qHPV vaccine (control). In Study 3, subjects concomitantly received qHPV vaccine plus 5-valent HPV31/33/45/52/58 or qHPV vaccine plus placebo (control). All vaccines were administered at day 1/month 2/month 6. In studies 1 and 3, anti-HPV6/11/16/18 GMTs at month 7 were non-inferior in the experimental arms compared with the control arm; however, there was a trend for lower antibody responses for all 4 HPV types. In Study 2, this immune interference was overcome with the mid- and high-dose formulations of the 9vHPV vaccine by increasing antigen and adjuvant doses. In all 3 studies, all vaccine candidates were strongly immunogenic with respect to HPV31/33/45/52/58 and were well tolerated. Based on the totality of the results, the middle dose formulation of the 9vHPV vaccine was selected for Phase III evaluation. Each 0.5mL dose contains 30μg/40μg/60μg/40μg/20μg/20μg/20μg/20μg/20μg of HPV6/11/16/18/31/33/45/52/58 virus-like particles, and 500μg of amorphous aluminum hydroxyphosphate sulfate adjuvant.ClinicalTrials.gov numbers NCT00260039, NCT00543543, and NCT00551187.
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Castellsagué X, Giuliano A, Goldstone S, Guevara A, Mogensen O, Palefsky J, Group T, Shields C, Liu K, Maansson R, Luxembourg A, Kaplan S. Immunogenicity and safety of the 9-valent HPV vaccine in men. Vaccine 2015; 33:6892-901. [DOI: 10.1016/j.vaccine.2015.06.088] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
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17
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Schilling A, Parra MM, Gutierrez M, Restrepo J, Ucros S, Herrera T, Engel E, Huicho L, Shew M, Maansson R, Caldwell N, Luxembourg A, Ter Meulen AS. Coadministration of a 9-Valent Human Papillomavirus Vaccine With Meningococcal and Tdap Vaccines. Pediatrics 2015; 136:e563-72. [PMID: 26240207 DOI: 10.1542/peds.2014-4199] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study in 11- to 15-year-old boys and girls compared the immunogenicity and safety of GARDASIL 9 (9-valent human papillomavirus [9vHPV] vaccine) administered either concomitantly or nonconcomitantly with 2 vaccines routinely administered in this age group (Menactra [MCV4; Neisseria meningitidis serotypes A/C/Y/W-135] or Adacel [Tdap; diphtheria/tetanus/acellular pertussis]). METHODS Participants received 9vHPV vaccine at day 1 and months 2 and 6; the concomitant group (n = 621) received MCV4/Tdap concomitantly with 9vHPV vaccine at day 1; the nonconcomitant group (n = 620) received MCV4/Tdap at month 1. Antibodies to HPV-, MCV4-, and Tdap-relevant antigens were determined. Injection-site and systemic adverse events (AEs) were monitored for 15 days after any vaccination; serious AEs were monitored throughout the study. RESULTS The geometric mean titers for all HPV types in 9vHPV vaccine 4 weeks after dose 3, proportion of subjects with a fourfold rise or greater in titers for 4 N meningitidis serotypes 4 weeks after injection with MCV4, proportion of subjects with antibody titers to diphtheria and tetanus ≥0.1 IU/mL, and geometric mean titers for pertussis antigens 4 weeks after injection with Tdap were all noninferior in the concomitant group compared with the nonconcomitant group. Injection-site swelling occurred more frequently in the concomitant group. There were no vaccine-related serious AEs. CONCLUSIONS Concomitant administration of 9vHPV vaccine with MCV4/Tdap was generally well tolerated and did not interfere with the antibody response to any of these vaccines. This strategy would minimize the number of visits required to deliver each vaccine individually.
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Affiliation(s)
- Andrea Schilling
- Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile;
| | | | | | - Jaime Restrepo
- Fundacion Centro de Investigacion Clinica CIC, Medellín, Colombia
| | - Santiago Ucros
- Centro de Investigaciones en Salud, Fundacion Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Eli Engel
- Bayview Research Group, Valley Village, California
| | - Luis Huicho
- Instituto Nacional de Salud del Niño, Lima, Perú
| | - Marcia Shew
- Indiana University School of Medicine/Department of Pediatrics, Indianapolis, Indiana; and
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18
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Van Damme P, Olsson SE, Block S, Castellsague X, Gray GE, Herrera T, Huang LM, Kim DS, Pitisuttithum P, Chen J, Christiano S, Maansson R, Moeller E, Sun X, Vuocolo S, Luxembourg A. Immunogenicity and Safety of a 9-Valent HPV Vaccine. Pediatrics 2015; 136:e28-39. [PMID: 26101366 DOI: 10.1542/peds.2014-3745] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Prophylactic vaccination of youngwomen aged 16 to 26 years with the 9-valent (6/11/16/18/31/33/45/52/58) human papillomavirus (HPV) virus-like particle (9vHPV) vaccine prevents infection and disease. We conducted a noninferiority immunogenicity study to bridge the findings in young women to girls and boys aged 9 to 15 years. METHODS Subjects (N = 3066) received a 3-dose regimen of 9vHPV vaccine administered at day 1, month 2, and month 6. Anti-HPV serologic assays were performed at day 1 and month 7. Noninferiority required that the lower bound of 2-sided 95% confidence intervals of geometric mean titer ratios (boys:young women or girls:young women) be >0.67 for each HPV type. Systemic and injection-site adverse experiences (AEs) and serious AEs were monitored. RESULTS At 4 weeks after dose 3, >99% of girls, boys, and young women seroconverted for each vaccine HPV type. Increases in geometric mean titers to HPV types 6/11/16/18/31/33/45/52/58 were elicited in all vaccine groups. Responses in girls and boys were noninferior to those of young women. Persistence of anti-HPV responses was demonstrated through 2.5 years after dose 3. Administration of the 9vHPV vaccine was generally well tolerated. A lower proportion of girls (81.9%) and boys (72.8%) than young women (85.4%) reported injection-site AEs, most of which were mild to moderate in intensity. CONCLUSIONS These data support bridging the efficacy findings with 9vHPV vaccine in young women 16 to 26 years of age to girls and boys 9 to 15 years of age and implementing gender-neutral HPV vaccination programs in preadolescents and adolescents.
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Affiliation(s)
- Pierre Van Damme
- Center for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium;
| | | | - Stanley Block
- Kentucky Pediatric/Adult Research, Inc, Bardstown, Kentucky
| | - Xavier Castellsague
- Institut Català d'Oncologia, IDIBELL, CIBERESP, L'Hospitalet De Llobregat, Catalonia, Spain
| | - Glenda E Gray
- Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Li-Min Huang
- Division of Infectious Diseases, Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Dong Soo Kim
- Division of Infectious Disease and Immunology, Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea
| | | | - Joshua Chen
- Merck and Company, Inc, Whitehouse Station, New Jersey
| | | | | | - Erin Moeller
- Merck and Company, Inc, Whitehouse Station, New Jersey
| | - Xiao Sun
- Merck and Company, Inc, Whitehouse Station, New Jersey
| | - Scott Vuocolo
- Merck and Company, Inc, Whitehouse Station, New Jersey
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19
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Luxembourg A, Moreira ED, Samakoses R, Kim KH, Sun X, Maansson R, Moeller E, Christiano S, Chen J. Phase III, randomized controlled trial in girls 9-15 years old to evaluate lot consistency of a novel nine-valent human papillomavirus L1 virus-like particle vaccine. Hum Vaccin Immunother 2015; 11:1306-12. [PMID: 26086587 PMCID: PMC4514432 DOI: 10.1080/21645515.2015.1009819] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/15/2014] [Accepted: 01/26/2015] [Indexed: 10/23/2022] Open
Abstract
A 9-valent human papillomavirus (6/11/16/18/31/33/45/52/58) VLP (9vHPV) vaccine has recently been proven highly efficacious in preventing disease associated with vaccine HPV types in a pivotal Phase III study. The demonstration of lot-to-lot consistency to confirm the reliability of the manufacturing process is a regulatory requirement for vaccine licensure in the United States. A randomized trial was conducted to demonstrate that three lots of 9vHPV vaccine elicit equivalent antibody response for all 9 vaccine types. The study required thorough planning because it required success on 27 separate statistical comparisons. An innovative statistical approach was used taking into account between-lot variance for more conservative power calculations. The study demonstrated equivalence of three lots of 9vHPV vaccine for all 9 vaccine types.
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Affiliation(s)
| | - Edson D Moreira
- Hospital Santo Antônio; Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation; Brazilian Ministry of Health; Bahia, Brazil
| | | | - Kyung-Hyo Kim
- Department of Pediatrics; Ewha Womans University School of Medicine; Seoul, Korea
| | - Xiao Sun
- Merck & Co., Inc.; Kenilworth, NJ, USA
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20
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Dillner J, Kjaer SK, Wheeler CM, Sigurdsson K, Iversen OE, Hernandez-Avila M, Perez G, Brown DR, Koutsky LA, Tay EH, García P, Ault KA, Garland SM, Leodolter S, Olsson SE, Tang GWK, Ferris DG, Paavonen J, Lehtinen M, Steben M, Bosch FX, Joura EA, Majewski S, Muñoz N, Myers ER, Villa LL, Taddeo FJ, Roberts C, Tadesse A, Bryan JT, Maansson R, Lu S, Vuocolo S, Hesley TM, Barr E, Haupt R. Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial. BMJ 2010; 341:c3493. [PMID: 20647284 PMCID: PMC2907480 DOI: 10.1136/bmj.c3493] [Citation(s) in RCA: 271] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the prophylactic efficacy of the human papillomavirus (HPV) quadrivalent vaccine in preventing low grade cervical, vulvar, and vaginal intraepithelial neoplasias and anogenital warts (condyloma acuminata). DESIGN Data from two international, double blind, placebo controlled, randomised efficacy trials of quadrivalent HPV vaccine (protocol 013 (FUTURE I) and protocol 015 (FUTURE II)). The trials were to be 4 years in length, and the results reported are from final study data of 42 months' follow-up. SETTING Primary care centres and university or hospital associated health centres in 24 countries and territories around the world. PARTICIPANTS 17 622 women aged 16-26 years enrolled between December 2001 and May 2003. Major exclusion criteria were lifetime number of sexual partners (>4), history of abnormal cervical smear test results, and pregnancy. INTERVENTION Three doses of quadrivalent HPV vaccine (for serotypes 6, 11, 16, and 18) or placebo at day 1, month 2, and month 6. MAIN OUTCOME MEASURES Vaccine efficacy against cervical, vulvar, and vaginal intraepithelial neoplasia grade I and condyloma in a per protocol susceptible population that included subjects who received all three vaccine doses, tested negative for the relevant vaccine HPV types at day 1 and remained negative through month 7, and had no major protocol violations. Intention to treat, generally HPV naive, and unrestricted susceptible populations were also studied. RESULTS In the per protocol susceptible population, vaccine efficacy against lesions related to the HPV types in the vaccine was 96% for cervical intraepithelial neoplasia grade I (95% confidence interval 91% to 98%), 100% for both vulvar and vaginal intraepithelial neoplasia grade I (95% CIs 74% to 100%, 64% to 100% respectively), and 99% for condyloma (96% to 100%). Vaccine efficacy against any lesion (regardless of HPV type) in the generally naive population was 30% (17% to 41%), 75% (22% to 94%), and 48% (10% to 71%) for cervical, vulvar, and vaginal intraepithelial neoplasia grade I, respectively, and 83% (74% to 89%) for condyloma. CONCLUSIONS Quadrivalent HPV vaccine provided sustained protection against low grade lesions attributable to vaccine HPV types (6, 11, 16, and 18) and a substantial reduction in the burden of these diseases through 42 months of follow-up. TRIAL REGISTRATIONS NCT00092521 and NCT00092534.
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Olsson SE, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G, Brown DR, Koutsky LA, Tay EH, García P, Ault KA, Garland SM, Leodolter S, Tang GWK, Ferris DG, Paavonen J, Lehtinen M, Steben M, Bosch FX, Dillner J, Joura EA, Majewski S, Muñoz N, Myers ER, Villa LL, Taddeo FJ, Roberts C, Tadesse A, Bryan J, Maansson R, Vuocolo S, Hesley TM, Saah A, Barr E, Haupt RM. Evaluation of quadrivalent HPV 6/11/16/18 vaccine efficacy against cervical and anogenital disease in subjects with serological evidence of prior vaccine type HPV infection. Hum Vaccin 2009; 5:696-704. [PMID: 19855170 DOI: 10.4161/hv.5.10.9515] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In the quadrivalent (types 6/11/16/18) HPV vaccine (GARDASIL/SILGARD) clinical program, 73% of women aged 16-26 were naïve to all vaccine HPV types. In these women, prophylactic administration of the vaccine was highly effective in preventing HPV 6/11/16/18-related cervical disease. Of the remaining women, 15% of had evidence of past infection with one or more vaccine HPV types (seropositive and DNA negative) at the time of enrollment. Here we present an analysis in this group of women to determine the efficacy of the HPV 6/11/16/18 vaccine against new cervical and external anogenital disease related to the same vaccine HPV type which had previously been cleared. Vaccine tolerability in this previously infected population was also assessed. METHODS 18,174 women were enrolled into 3 clinical studies. The data presented comprise a subset of these subjects (n = 2,617) who were HPV seropositive and DNA negative at enrollment (for >or=1 vaccine type). In each study, subjects were randomized in a 1:1 ratio to receive HPV 6/11/16/18 vaccine or placebo at day 1, month 2 and month 6 (without knowledge of baseline HPV status). Procedures performed for efficacy data evaluation included detailed genital examination, Pap testing, and collection of cervicovaginal and external genital specimens. Analyses of efficacy were carried out in a population stratified by HPV serology and HPV DNA status at enrollment. RESULTS Subjects were followed for an average of 40 months. Seven subjects in the placebo group developed cervical disease, and eight subjects developed external genital disease related to a vaccine HPV type they had previously encountered. No subject receiving HPV 6/11/16/18 vaccine developed disease to a vaccine HPV type to which they were seropositive and DNA negative at enrolment. CONCLUSIONS These results suggest that natural HPV infection-elicited antibodies may not provide complete protection over time, however the immune response to the HPV 6/11/16/18 vaccine appears to prevent reinfection or reactivation of disease with vaccine HPV types. Vaccine-related adverse experiences were higher among subjects receiving vaccine, mostly due to increased injection site adverse experiences.
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Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G, Brown DR, Koutsky LA, Tay EH, García P, Ault KA, Garland SM, Leodolter S, Olsson SE, Tang GWK, Ferris DG, Paavonen J, Lehtinen M, Steben M, Bosch FX, Dillner J, Joura EA, Majewski S, Muñoz N, Myers ER, Villa LL, Taddeo FJ, Roberts C, Tadesse A, Bryan J, Maansson R, Lu S, Vuocolo S, Hesley TM, Saah A, Barr E, Haupt RM. A pooled analysis of continued prophylactic efficacy of quadrivalent human papillomavirus (Types 6/11/16/18) vaccine against high-grade cervical and external genital lesions. Cancer Prev Res (Phila) 2009; 2:868-78. [PMID: 19789295 DOI: 10.1158/1940-6207.capr-09-0031] [Citation(s) in RCA: 214] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Quadrivalent human papillomavirus (HPV) vaccine has been shown to provide protection from HPV 6/11/16/18-related cervical, vaginal, and vulvar disease through 3 years. We provide an update on the efficacy of the quadrivalent HPV vaccine against high-grade cervical, vaginal, and vulvar lesions based on end-of-study data from three clinical trials. Additionally, we stratify vaccine efficacy by several baseline characteristics, including age, smoking status, and Papanicolaou (Pap) test results. A total of 18,174 females ages 16 to 26 years were randomized and allocated into one of three clinical trials (protocols 007, 013, and 015). Vaccine or placebo was given at baseline, month 2, and month 6. Pap testing was conducted at regular intervals. Cervical and anogenital swabs were collected for HPV DNA testing. Examination for the presence of vulvar and vaginal lesions was also done. Endpoints included high-grade cervical, vulvar, or vaginal lesions (CIN 2/3, VIN 2/3, or VaIN 2/3). Mean follow-up time was 42 months post dose 1. Vaccine efficacy against HPV 6/11/16/18-related high-grade cervical lesions in the per-protocol and intention-to-treat populations was 98.2% [95% confidence interval (95% CI), 93.3-99.8] and 51.5% (95% CI, 40.6-60.6), respectively. Vaccine efficacy against HPV 6/11/16/18-related high-grade vulvar and vaginal lesions in the per-protocol and intention-to-treat populations was 100.0% (95% CI, 82.6-100.0) and 79.0% (95% CI, 56.4-91.0), respectively. Efficacy in the intention-to-treat population tended to be lower in older women, women with more partners, and women with abnormal Pap test results. The efficacy of quadrivalent HPV vaccine against high-grade cervical and external anogenital neoplasia remains high through 42 months post vaccination.
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Affiliation(s)
- Susanne K Kjaer
- Department of Virus, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society/Rigshospitalet, Copenhagen, Denmark.
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