Phase II Trial to Assess Safety and Immunogenicity of IMVAMUNE®

• ClinicalTrials.gov Identifier: NCT01827371
• Recruitment Status: Completed
• First Posted: April 9, 2013
• Results First Posted: December 11, 2015
• Last Update Posted: September 7, 2016
• Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
• Information provided by (Responsible Party): National Institute of Allergy and Infectious Diseases (NIAID)

Study Description

Brief Summary:

Imvamune (licensed name of MVA being developed as a smallpox vaccine) has been tested in over 2,000 individuals and is on path for licensure. This study will be a Phase II to evaluate three different immunization schedules and two different modes of delivery. The study will look at condensed schedules. Study will randomize subjects to one of four arms.

Condition or disease	Intervention/treatment	Phase
Smallpox	Biological: MVA Smallpox Vaccine	Phase 2

Detailed Description:

This is a Phase II, randomized, open-label immunogenicity and safety study of different immunization schedules and delivery systems (syringe and needle vs. the Stratis™) in healthy, vaccinia-naïve adults 18 years to 40 years of age, inclusive. Approximately 352 subjects will be enrolled and randomized to one of four study arms. Study Arm A (N=88) will receive a two dose regimen of IMVAMUNE® (1x10^8 TCID50/0.5 mL per dose) via the SC route using a syringe and needle on Day 1 and 29. Study Arm B (N=88) will receive a two dose regimen of IMVAMUNE® (1x10^8 TCID50/0.5 mL per dose) via the SC route using a syringe and needle on Day 1 and 15. Study Arm C (N=88) will receive a two dose regimen of IMVAMUNE® (1x10^8 TCID50/0.5 mL) via the SC route using a syringe and needle on Day 1 and 22. Study Arm D (N=88) will receive a two dose regimen of IMVAMUNE® (1x10^8 TCID50/0.5 mL) via the SC route using the Stratis™ on Day 1 and 29. Immunogenicity assessments will be performed using ELISA and PRNT. Safety assessments will be done via solicited injection site and systemic reactions. Unsolicited AEs will be collected until 28 days post last injection and SAEs for the duration of the subjects' study participation. Safety laboratory assessments will be performed at baseline and 14 days after each vaccination. Primary outcome measures: For each subject, the peak PRNT will be defined as the highest titer among all available measurements post second vaccination; Occurrence of solicited local injection site reactions in subjects receiving vaccine via the Stratis™ compared to syringe and needle administration as collected on the memory aid and by in clinic assessment. Parent protocol to sub-study 13-0027.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 435 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Prevention
• Official Title: A Phase II, Randomized, Open-Label Study to Evaluate the Safety and Immunogenicity of IMVAMUNE® Using Three Immunization Schedules and Two Modes of Delivery
• Study Start Date: June 2013
• Actual Primary Completion Date: April 2015
• Actual Study Completion Date: April 2015

Arms and Interventions

Arm	Intervention/treatment
Experimental: Arm C; 88 subjects receive IMVAMUNE® 1x10^8 TCID50/0.5 mL subcutaneously (SC) via syringe and needle on Days 1 and 22.	Biological: MVA Smallpox Vaccine; Subjects receive two dose regimen of IMVAMUNE® (1x10^8 TCID50/0.5 mL per dose) via the SC route using either a syringe and needle or the Stratis™ system. Arm A receives doses via syringe and needle on days 1 and 29; Arm B receives doses via syringe and needle on days 1 and 15, Arm C receives doses via syringe and needle on days 1 and 22, Arm D receives doses via Stratis on days 1 and 29.
Experimental: Arm B; 88 subjects receive IMVAMUNE® 1x10^8 TCID50/0.5 mL subcutaneously (SC) via syringe and needle on Days 1 and 15.	Biological: MVA Smallpox Vaccine; Subjects receive two dose regimen of IMVAMUNE® (1x10^8 TCID50/0.5 mL per dose) via the SC route using either a syringe and needle or the Stratis™ system. Arm A receives doses via syringe and needle on days 1 and 29; Arm B receives doses via syringe and needle on days 1 and 15, Arm C receives doses via syringe and needle on days 1 and 22, Arm D receives doses via Stratis on days 1 and 29.
Experimental: Arm A; 88 subjects receive IMVAMUNE® 1x10^8 TCID50/0.5 mL subcutaneously (SC) via syringe and needle on Days 1 and 29.	Biological: MVA Smallpox Vaccine; Subjects receive two dose regimen of IMVAMUNE® (1x10^8 TCID50/0.5 mL per dose) via the SC route using either a syringe and needle or the Stratis™ system. Arm A receives doses via syringe and needle on days 1 and 29; Arm B receives doses via syringe and needle on days 1 and 15, Arm C receives doses via syringe and needle on days 1 and 22, Arm D receives doses via Stratis on days 1 and 29.
Experimental: Arm D; 88 subjects receive IMVAMUNE® 1x10^8 TCID50/0.5 mL subcutaneously (SC) via Stratis™ on Days 1 and 29.	Biological: MVA Smallpox Vaccine; Subjects receive two dose regimen of IMVAMUNE® (1x10^8 TCID50/0.5 mL per dose) via the SC route using either a syringe and needle or the Stratis™ system. Arm A receives doses via syringe and needle on days 1 and 29; Arm B receives doses via syringe and needle on days 1 and 15, Arm C receives doses via syringe and needle on days 1 and 22, Arm D receives doses via Stratis on days 1 and 29.

Outcome Measures

Primary Outcome Measures :

1. Geometric Mean Peak Plaque Reduction Neutralization Titer (PRNT) After Second Vaccination [ Time Frame: Day 7 through Day 31 after 2nd vaccination ]
   Blood was collected from all participants at 8, 15, 22 and 29 days after receipt of the second vaccination for assessment of plaque reduction neutralization titers. The peak titer for each participant was defined as the highest titer among all available measurements post second vaccination. The geometric mean for each group was then assessed from individual participants' peak titers.
2. Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration [ Time Frame: 15 days after each vaccination ]
   Participants maintained a memory aid to record daily the occurrence of local injection site reactions for 15 days after vaccination based on their interference with daily activities (pain and itchiness at injection site, underarm pain and swelling) or based on a quantitative measurement of the reaction (redness, swelling). In the subjective grading scale, severe reactions prevented daily activities, moderate reactions interfered with but did not prevent daily activities, and mild reactions were present but did not interfere with daily activities. For the quantitative scale, severe reactions greater than 30 millimeters (mm), moderate reactions were 15-30mm, and mild reactions were 1-15mm. Participants are counted by the maximum severity on any of the 15 days, and for this outcome measure, only those reporting moderate or severe events are counted. Formal comparisons by Fisher's Exact test were conducted for Arm D (Stratis, Day 1,29) compared to A

Secondary Outcome Measures :

1. Geometric Mean Peak ELISA Titer After Second Vaccination [ Time Frame: Day 7 through 31 after the 2nd vaccination ]
   Blood was collected from all participants at 8, 15, 22 and 29 days after receipt of the second vaccination for assessment of antibody titers by ELISA. The peak titer for each participant was defined as the highest titer among all available measurements post second vaccination. The geometric mean for each group was then assessed from individual participants' peak titers.
2. Number of Subjects Experiencing Serious Adverse Events (SAEs) Associated With IMVAMUNE [ Time Frame: Day 1 after the first vaccination through 180 days after the 2nd vaccination. ]
   Serious adverse events included any untoward medical occurrence that resulted in death; was life threatening; was a persistent/significant disability/incapacity; required inpatient hospitalization or prolongation thereof; was a congenital anomaly/birth defect; or may have jeopardized the participant, or required intervention to prevent one of the outcomes. Association with IMVAMUNE was determined by the investigator and defined as "Related", meaning a reasonable possibility that the study product caused the adverse event. Reasonable possibility was defined as there being evidence to suggest a causal relationship between the study product and the adverse event.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 40 Years (Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

1. 18 to 40 years of age, inclusive.
2. Read, signed, and dated informed consent document.
3. Available for follow-up for the planned duration of the study (six months after last immunization).
4. Acceptable medical history by screening evaluation and limited physical assessment.
5. If the subject is female and of childbearing potential, negative serum or urine pregnancy test at screening and within 24 hours prior to vaccination.

6. If the subject is female and of childbearing potential*, she agrees to practice abstinence** or use acceptable contraception*** through 56 days after the last vaccination in order to avoid pregnancy:

   * a woman is considered of childbearing potential unless post-menopausal (>/= 1 year without menses) or surgically sterilized (tubal ligation, bilateral oophorectomy, or hysterectomy)

   **No sexual intercourse with men (vaginal penetration by a penis, coitus)

   ***Acceptable contraception methods are restricted to effective devices (IUDs, NuvaRing®) or licensed hormonal products with use of method for a minimum of 30 days prior to vaccination, condoms with spermicidal agents, monogamous relationship with a vasectomized partner who has been vasectomized for 6 months or more prior to study entry, or successful Essure placement with documented confirmation test at least 3 months after the procedure, and any other FDA-approved contraceptive method

7. Negative test for HIV.
8. Alanine Aminotransferase (ALT) <1.25 times the central lab upper limit of normal.
9. Negative hepatitis B surface antigen and negative antibody to hepatitis C virus.
10. Negative urine glucose and negative or trace urine protein by dipstick or urinalysis.
11. Adequate renal function (defined as a serum creatinine not exceeding the central lab's upper limit of normal).

12. Electrocardiogram (ECG) with no clinically significant abnormalities*

    * e.g., complete left or right bundle branch block, incomplete left bundle branch block or sustained ventricular arrhythmia, or two PVC's in a row, or ST elevation consistent with ischemia)

13. Acceptable hematology parameters:

    • Hemoglobin (Hgb) equal or above the lower limit of central lab normal (sex-specific);
    • White Blood Cell (WBC) > 3,800 and < 10,900/mm^3;
    • Platelets >/=120,000/mm^3
14. Body mass index >/=18.5-< 35.
15. Be able to understand and comply with planned study procedures.

Exclusion Criteria:

1. History of immunodeficiency.
2. Typical vaccinia scar.
3. Known or suspected history of smallpox vaccination including MVA alone or as a vector, as well as other investigational smallpox vaccines.
4. Military service prior to 1991 or after January 2003.
5. Known or suspected significant underlying illness including, but not limited to, clinically significant liver disease, diabetes mellitus, or moderate to severe kidney impairment.
6. Malignancy (not including squamous cell skin cancer or basal cell skin cancer unless at the vaccination site) or history of skin cancer at the vaccination site.
7. Active autoimmune disease. Persons with vitiligo or thyroid disease (e.g., taking thyroid hormone replacement) are not excluded.

8. History of myocardial infarction, angina, congestive heart failure, cardiomyopathy, stroke or transient ischemic attack, or other heart condition under the care of a doctor*

   *Subjects with a not clinically relevant heart murmur, i.e., without any pathological ECG/arrhythmias or under treatment are not excluded.

9. Systolic blood pressure >/= 150mmHg or diastolic blood pressure >/= 100mmHg.

10. Ten percent or greater risk of developing a myocardial infarction or coronary death within the next 10 years using the National Cholesterol Education Program's (NCEP) risk assessment tool*

    *NOTE that this criterion applies only to subjects 20 years of age and older AND only if at least one of the following apply:

    • have smoked a cigarette in the past month, and/or
    • have hypertension (defined as systolic blood pressure >140 mm Hg) or are on antihypertensive medication, and/or
    • have a family history of coronary heart disease in male first-degree relative (father or brother) <55 years of age or a female first-degree relative (mother or sister) <65 years of age

    URL for NCEP risk assessment tool: http://cvdrisk.nhlbi.nih.gov/calculator.asp (if a subject has an HDL of greater than 100mg/dl please enter 100 in the tool)

11. High-dose corticosteroid use for greater than 2 weeks duration within three months prior to vaccination or current use of immunosuppressive medication:

    • >5 mg prednisone or equivalent is considered high dose and immunosuppressive
    • Corticosteroid nasal sprays for allergic rhinitis are permissible
    • Persons who are using a topical steroid for mild uncomplicated dermatitis such as poison ivy or contact dermatitis may be enrolled the day after their therapy is completed
    • Inhaled steroids for asthma are not permissible
    • Oral/parenteral corticosteroids given for non-chronic conditions not expected to recur are permissible if the length of therapy was </= 14 days with completion at least 30 days prior to enrollment.
12. Medical or psychiatric condition or occupational responsibilities that preclude subject compliance with the protocol.
13. Any history of illegal injection drug use.
14. Receipt or planned receipt of inactivated vaccine from 14 days prior to the first vaccination through 14 days post second vaccination.
15. Receipt or planned receipt of any other live attenuated vaccine within 30 days prior to the first vaccination through 30 days post second vaccination.
16. Use of any other experimental agent within 30 days prior to vaccination and for the duration of the subject's participation in the study.
17. Receipt of blood products or immunoglobulin, including Rhogam, within six months prior to vaccination.
18. Donation of a unit of blood within 56 days prior to vaccination or planned donation prior to 28-days following the last vaccination.
19. Pregnant or breastfeeding women.
20. Active exfoliative skin disorders/conditions, current varicella zoster virus infection, or any acute skin disorders of large magnitude, e.g., laceration requiring sutures, burn greater than 2×2 cm.
21. Any condition that, in the opinion of the investigator, might interfere with assessing the study objectives.
22. Known allergy to egg, aminoglycoside (including gentamicin) or chicken.
23. Study personnel.
24. Allergic reaction to any vaccine.

Contacts and Locations

Locations

United States, Georgia

Emory Vaccine Center - The Hope Clinic

Decatur, Georgia, United States, 30030-1705

United States, Iowa

University of Iowa - Vaccine Research and Education Unit

Iowa City, Iowa, United States, 52242-2600

United States, Maryland

University of Maryland Medical System - General Clinical Research Center (GCRC)

Baltimore, Maryland, United States, 21201-1544

United States, Missouri

Saint Louis University - Center for Vaccine Development

Saint Louis, Missouri, United States, 63104-1015

United States, Texas

Baylor College of Medicine - Molecular Virology and Microbiology

Houston, Texas, United States, 77030-3411

United States, Washington

Group Health Research Institute - Seattle - Vaccines and Infectious Diseases

Seattle, Washington, United States, 98101-1466

Sponsors and Collaborators

National Institute of Allergy and Infectious Diseases (NIAID)

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Jackson LA, Frey SE, El Sahly HM, Mulligan MJ, Winokur PL, Kotloff KL, Campbell JD, Atmar RL, Graham I, Anderson EJ, Anderson EL, Patel SM, Fields C, Keitel W, Rouphael N, Hill H, Goll JB. Safety and immunogenicity of a modified vaccinia Ankara vaccine using three immunization schedules and two modes of delivery: A randomized clinical non-inferiority trial. Vaccine. 2017 Mar 23;35(13):1675-1682. doi: 10.1016/j.vaccine.2017.02.032. Epub 2017 Feb 27.

• Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
• ClinicalTrials.gov Identifier: NCT01827371
• Other Study ID Numbers: 11-0021; HHSN272200800004C
• First Posted: April 9, 2013
• Results First Posted: December 11, 2015
• Last Update Posted: September 7, 2016
• Last Verified: May 2015

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):

Smallpox, vaccine, IMVAMUNE, Stratis, parent protocol

Additional relevant MeSH terms:

Smallpox; Poxviridae Infections; DNA Virus Infections; Virus Diseases; Infections