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Kundro M, Losso M, Macchia A, Pastor I, Alonso Serena M, Gestoso C, Moreno Macías L, Crupi F, Acosta M, Ivalo S, Ghioldi M, Bouzas M, Mammana L, Zapiola I, Mazzitelli I, Varese A, Geffner J, Biscayart C, Angeleri P, Lopez E, Gentile A, Ferrante D, de Quiros FGB. Safety and immunogenicity of heterologous COVID-19 vaccine regimens to deal with product shortage: A randomised clinical trial in an elderly population. Public Health Pract (Oxf) 2022; 4:100313. [PMID: 36090797 PMCID: PMC9444309 DOI: 10.1016/j.puhip.2022.100313] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/04/2022] [Accepted: 08/26/2022] [Indexed: 01/03/2023] Open
Abstract
Objectives In a context of COVID-19 vaccine shortages, this study sought to evaluate the safety and efficacy of receiving one dose of Gam-COVID-Vac rAd26 followed by a second COVID-19 vaccine dose of either Gam-COVID-Vac rAd5, ChAdOx1 nCoV-19 or BBIBP-CorV in a cohort of older adults. Study design Single-centre, randomised, open label, non-inferiority trial. Methods Adults aged ≥65 years who had received one dose of Gam-COVID-Vac rAd26 were randomised in a 1:1:1 ratio to receive a second-dose COVID-19 vaccination of either Gam-COVID-Vac rAd5, ChAdOx1 nCoV-19 or BBIBP-CorV. The primary outcome was the assessment of the humoral immune response to vaccination (i.e. antibody titres of SARS-CoV-2 spike protein at 28 days after second-dose vaccination). In addition, neutralising antibody titres at day 28 for the three schedules were measured. Results Of 85 participants who were enrolled in the study between 26 and July 30, 2021, 31 individuals were randomised to receive Gam-COVID-Vac rAd5, 27 to ChAdOx1 nCoV-19 and 27 to BBIBP-CorV. The mean age of participants was 68.2 years (SD 2.9) and 49 (57.6%) were female. Participants who received Gam-COVID-Vac rAd5 and ChAdOx1 nCoV1-19 showed significantly increased anti-S titres at 28 days after second-dose vaccination, but this magnitude of difference was not observed for those who received BBIBP-CorV. The ratio between the geometric mean at day 28 and baseline within each group was 11.8 (6.98-19.89) among patients assigned to Gam-COVID-Vac rAd26/rAd5, 4.81 (2.14-10.81) for the rAd26/ChAdOx1 nCoV-19 group and 1.53 (0.74-3.20) for the rAd26/BBIBP-CorV group. All of the schedules were shown to be safe. Conclusions The findings in this study contribute to the scarce information published on the safety and immunogenicity of Gam-COVID-Vac heterologous regimens and will help the development of guidelines and vaccine programme management.
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Affiliation(s)
- M.A. Kundro
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina,Corresponding author. Área de Investigación en Enfermedades Emergentes Departamento de Medicina Hospital J.M. Ramos Mejía Urquiza 609.Buenos Aires. Argentina.
| | - M.H. Losso
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - A. Macchia
- Ministerio de Salud del Gobierno de la Ciudad Autónoma de Buenos Aires, Argentina
| | - I. Pastor
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - M. Alonso Serena
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - C. Gestoso
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - L. Moreno Macías
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - F. Crupi
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - M.C. Acosta
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - S. Ivalo
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - M. Ghioldi
- Área de Investigación en Enfermedades Emergentes, Hospital General de Agudos “J.M. Ramos Mejía”, Ciudad Autónoma de Buenos Aires, Argentina
| | - M.B. Bouzas
- Unidad de Virología, División Análisis Clínicos, Hospital de Infecciosas “Francisco J. Muñiz", Ciudad Autónoma de Buenos Aires, Argentina
| | - L. Mammana
- Unidad de Virología, División Análisis Clínicos, Hospital de Infecciosas “Francisco J. Muñiz", Ciudad Autónoma de Buenos Aires, Argentina
| | - I. Zapiola
- Unidad de Virología, División Análisis Clínicos, Hospital de Infecciosas “Francisco J. Muñiz", Ciudad Autónoma de Buenos Aires, Argentina
| | - I. Mazzitelli
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - A. Varese
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - J. Geffner
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - C. Biscayart
- Subsecretaría de Planificación Sanitaria, Ministerio de Salud de la Ciudad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - P. Angeleri
- Subsecretaría de Planificación Sanitaria, Ministerio de Salud de la Ciudad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - E. Lopez
- Departamento de Medicina, Hospital de Niños “Ricardo Gutiérrez”, Ciudad Autónoma de Buenos Aires, Argentina
| | - A. Gentile
- Departamento de Epidemiología, Hospital de Niños “Ricardo Gutiérrez”, Ciudad Autónoma de Buenos Aires, Argentina
| | - D. Ferrante
- Ministerio de Salud del Gobierno de la Ciudad Autónoma de Buenos Aires, Argentina
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Ivalo S, Read J, Losso M, Gladstone D, Hakim A, Ballivian J. Loss-to-Follow Up and Other Outcomes among HIV-Infected Women in Buenos Aires, Argentina, Previously Enrolled in NISDI Perinatal Cohort Studies. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Belloso W, Ivalo S, Benetucci J, Pugliese D, Garone D, Cahn P, Krolewiecki A, Casiro A, Cassetti I, Bologna R, Duran A, Toibaro J, Rieger A, Vago B, Clumeck N, Kabeya K, Cooper C, Dufresne S, Lalonde R, Walmsley S, Gerstoft J, Mathiesen L, Nielsen H, Obel N, Pedersen C, Lazzarin A, Castagna A, Bruun JN, Gatell JM, Arnaiz J, Blaxhult A, Flamholc L, Gisslén M, Vernazza P, Bingham J, Peters B, Gazzard B, Nelson M, Johnson M, Youle M, Weber J, Scullard G, Brar I, Bouzi V, Brutus A, Jayaweera DT, Mogyoros M, Rodwick BM, Stein D, Wiznia A, Schwartz R, Vandenberg-Wolf MG, Tedaldi E, Dragsted UB, Gerstoft J, Youle M, Fox Z, Losso M, Benetucci J, Jayaweera DT, Rieger A, Bruun JN, Castagna A, Gazzard B, Walmsley S, Hill A, Lundgren JD. A Randomized Trial to Evaluate Lopinavir/Ritonavir versus Saquinavir/Ritonavir in HIV-1-Infected Patients: The Maxcmin2 Trial. Antivir Ther 2005. [DOI: 10.1177/135965350501000608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the rate of protocol-defined treatment failure and safety of lopinavir/ritonavir (LPV/r) and saquinavir/ritonavir (SAQ/r). Design Open-label, prospective, randomized (1:1), international multi-centre trial. Methods Adult HIV-1-infected patients were assigned LPV/r 400/100 mg twice daily or SAQ/r 1000/100 mg twice daily with two or more nucleoside reverse transcriptase inhibitors (NRTIs)/non-NRTIs. All patients, whether on or off the assigned treatment, were followed for 48 weeks. Results Of 339 randomized patients, 324 initiated assigned treatment (intention-to-treat/exposed [ITT/e] population). At 48 weeks, treatment failure occurred in 29/163 (18%) and 53/161 (33%) of patients in the LPV/r and SAQ/r arms, respectively (ITT/e, P=0.002, log rank test). In an analysis that also considered those patients who discontinued treatment as having failed treatment (ITT/e/discontinuation=failure), 40/161 (25%) LPV/r-treated individuals versus 63/161 (39%) SAQ/R-treated individuals failed treatment ( P=0.005, log rank test). Discontinuation of the assigned treatment occurred in 23/163 (14%) patients in the LPV/r-treated group, compared with 48/161 (30%) in the SAQ/r-treated group (ITT/e; P=0.001). The primary reasons for premature discontinuation were non-fatal adverse events (LPV/r: 12/163; SAQ/r: 21/161) and patients’ choice (LPV/r: 7/163; SAQ/r: 8/161). In the on-treatment analysis of time to treatment failure, no difference was observed between the two arms ( P=0.27, log rank test). Conclusion LPV/r had better antiretroviral effects compared with SAQ/r at the doses and in the formulations studied. This may have been a result of patients’ preferences and ability to adhere to assigned therapy, rather than a result of differences in the intrinsic potency of the study protease inhibitors.
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Affiliation(s)
| | | | - S Ivalo
- Hospital Italiano de Buenos Aires
| | | | | | | | | | | | | | | | | | | | | | - A Rieger
- University of Vienna Medical School, AKH
| | - B Vago
- University of Vienna Medical School, AKH
| | | | | | | | | | | | | | | | | | | | - N Obel
- Aarhus University Hospital
| | | | | | | | | | | | | | | | | | - M Gisslén
- Sahlgrenska University Hospital/Östra
| | | | | | | | - B Gazzard
- Chelsea and Westminster Healthcare Trust
| | - M Nelson
- Chelsea and Westminster Healthcare Trust
| | | | | | | | | | - I Brar
- Henry Ford Hospital Center
| | - V Bouzi
- Brookdale University Hospital
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- Royal Free Hospital, London, United Kingdom
| | - Zoe Fox
- Hvidovre University Hospital, Copenhagen, Denmark
| | | | | | | | - Armin Rieger
- University of Vienna Medical School - AKH, Vienna, Austria
| | | | | | - Brian Gazzard
- Chelsea and Westminster Healthcare Trust, London, United Kingdom
| | - Sharon Walmsley
- Toronto Hospital, University Health Network, Toronto, Canada
| | - Andrew Hill
- University of Liverpool, Liverpool, United Kingdom
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