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The purpose of this study is to evaluate the production of antibodies to a new conjugate vaccine, NmVac4-A/C/Y/W-135-DT, as a measure of vaccine effectiveness, compared to the production of antibodies to a similar, licensed meningococcal (Groups A, C, Y, W-135) polysaccharide diphtheria toxoid (DT) conjugate vaccine. The investigators will also evaluate the safety of NmVac4-A/C/Y/W-135-DT™ conjugate vaccine compared to the licensed vaccine. The hypothesis is that the test vaccine is comparable to the licensed active control vaccine.
Meningococcal disease is a potentially life-threatening bacterial infection. The disease most commonly is expressed as either meningococcal meningitis, an inflammation of the membranes surrounding the brain and spinal cord, or meningococcemia, the presence of bacteria in the blood. The most common symptoms include high fever, headache, neck stiffness, confusion, nausea, vomiting, lethargy, and rash. If not treated the disease can progress rapidly and can lead to shock and death, often within hours of the onset of symptoms. The disease is fatal at a rate of 10%. Of patients who recover, 10% have permanent hearing loss or other serious sequelae.
Neisseria meningitidis capsular polysaccharides are poor immunogens. However, conjugation of bacterial polysaccharides to immunogenic carrier proteins generally results in conjugates that induce strong anti-polysaccharide T-helper cell dependent immune responses, creating a longer-lasting immune response and thus protection against meningococcal infection.
The sponsor's small size Phase 1 clinical trial comprised 60 subjects. Therefore, additional data is needed to confirm the previous data with a statistically powered Phase 2 clinical trial. The present study aims to evaluate subject responses to single doses, administered in adult subjects, to determine further safety and immunogenicity of the vaccine. This study compares safety and antibody production induced by one intramuscular injection of either NmVac4-A/C/Y/W-135-DT or a licensed meningococcal (Groups A, C, Y, W-135) polysaccharide diphtheria toxoid conjugate vaccine. The primary immunogenicity endpoint will be seroresponse, based on antibody titer ≥1:8 for subjects with titer <1:8 at baseline or a 4-fold rise in antibody levels, 4 weeks after a single injection . The number and proportion of subjects achieving seroresponse will be tabulated by serogroup for each vaccine group. A non-inferiority test will be used to determine if the immune response elicited by NmVac4 A/C/Y/W-135-DT™ is not less than a specified difference in percent seroconversion from the licensed control vaccine. Participants will attend a screening visit up to 6 weeks prior to vaccination (day 0), then will attend study visits for 4 weeks. There will be a study phone call at days 2-3, then a post-study call to subjects to assess safety at 26 weeks.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Test Vaccine | Experimental | NmVac4-A/C/Y/W-135-DT™ conjugate vaccine |
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| US Licensed Vaccine | Active Comparator | Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Test Vaccine | Biological | NmVac4-A/C/Y/W-135-DT™ conjugate is a vaccine in liquid form composed of purified polysaccharides (PS) conjugated to diphtheria toxoid. Single intramuscular 0.5 mL dose contains 4 µg each of Serogroup A, C, W-135, and Y PS conjugated to approximately 26 µg total diphtheria toxoid. |
| Measure | Description | Time Frame |
|---|---|---|
| Seroresponse (Percent Seroconversion). | Rise in antibody titers in serum at 4 weeks after vaccination, compared to baseline titer for meningococcal serogroups A, C, Y, and W-135. Serum Bactericidal Assay with human complement: Antibody titer ≥1:8 for subjects with titer <1:8 at baseline or a 4-fold rise in antibody levels. | Week 4 after injection |
| Measure | Description | Time Frame |
|---|---|---|
| Solicited Adverse Events From Diary Cards | Local and systemic rates from Diary Cards filled by the participants. | Day 0 to Day 7 after vaccination |
| Non Solicited Adverse Events | Non solicited local and systemic adverse Event (AE) rates throughout the course of the study, based on laboratory test results, vital signs, examination and questioning the subjects. |
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Inclusion Criteria (IC):
Exclusion Criteria (EC):
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| Name | Affiliation | Role |
|---|---|---|
| Alberto Yataco, MD | IRC Clinics, | Principal Investigator |
| Jeffrey E Atkinson, MD | Chesapeake Research Group | Principal Investigator |
| Myron I Murdock, MD | Mid Atlantic Urology Associates LLC | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mid Atlantic Urology Associates LLC | Greenbelt | Maryland | 20770 | United States | ||
| Chesapeake Research Group |
Other common reasons for screen failure were inability to re-schedule within enrollment window after trial start was delayed (101 subjects, 18.1 % of screen failures) and lost to follow up 65 subjects (11.6%). These two reasons account for 166 (29.7%) subjects who met IC/EC, but did not enter the trial.
Participants recruited and were enrolled at three sites in Maryland between October 21, 2013 and May 22, 2014. The sites screened 1086 subjects with 559 screen failures. The majority, 390 subjects (69.8 %), failed due to inclusion or exclusion criteria (IC/EC). The most common failure criterion was Laboratory abnormalities (150 subjects, 26.8 %).
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| ID | Title | Description |
|---|---|---|
| FG000 | Test Vaccine | NmVac4-A/C/Y/W-135-DT™ conjugate vaccine |
| FG001 | US Licensed Vaccine | Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| US Licensed Vaccine | Biological | Meningococcal (Groups A,C,Y,W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine 0.5 mL dose, intramuscular. Single dose contains 4 µg each Serogroup A, C, W-135 and Y conjugated to approximately 48 µg total diphtheria toxoid. |
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| up to 6 months |
| Pasadena |
| Maryland |
| 21122 |
| United States |
| IRC Clinics | Towson | Maryland | 21204 | United States |
| COMPLETED |
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| NOT COMPLETED |
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Population contains all randomized subjects. Two randomized subjects could not be vaccinated. Three subjects, one female and 3 males received incorrect vaccine. They are listed according to randomized treatment in the baseline population, but were analyzed according to the actual vaccine received in the safety population (secondary outcomes).
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| ID | Title | Description |
|---|---|---|
| BG000 | Test Vaccine | NmVac4-A/C/Y/W-135-DT™ conjugate vaccine |
| BG001 | US Licensed Vaccine | Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race/Ethnicity, Customized | Number | Participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Primary | Seroresponse (Percent Seroconversion). | Rise in antibody titers in serum at 4 weeks after vaccination, compared to baseline titer for meningococcal serogroups A, C, Y, and W-135. Serum Bactericidal Assay with human complement: Antibody titer ≥1:8 for subjects with titer <1:8 at baseline or a 4-fold rise in antibody levels. | Per Protocol Population | Posted | Number | 95% Confidence Interval | percentage of per protocol participants | Week 4 after injection |
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| Secondary | Solicited Adverse Events From Diary Cards | Local and systemic rates from Diary Cards filled by the participants. | Safety Population: All vaccinated participants, grouped by actual vaccine received. | Posted | Number | percentage of participants | Day 0 to Day 7 after vaccination |
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| Secondary | Non Solicited Adverse Events | Non solicited local and systemic adverse Event (AE) rates throughout the course of the study, based on laboratory test results, vital signs, examination and questioning the subjects. | Safety Population: All vaccinated participants, grouped by actual vaccine received. | Posted | Number | participants | up to 6 months |
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Solicited AEs: vaccination day and 7 days following vaccination (participant diary cards, Outcome 2). AEs were also collected at each visit (4 weeks) and by phone calls 2-3 day following vaccination and at 6 months following vaccination (Outcome 3).
Methods: standard questionnaire, investigator assessment, laboratory testing, scheduled telephone calls.
Solicited AEs (secondary outcome 2) and non solicited AEs (secondary outcome 3) are included in the other adverse event totals. All AEs meeting the 4% threshold except increased blood pressure were solicited AEs from diary cards.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Test Vaccine | NmVac4-A/C/Y/W-135-DT™ conjugate vaccine | 0 | 265 | 173 | 265 | ||
| EG001 | US Licensed Vaccine | Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine | 1 | 260 | 141 | 260 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Cerebrovascular Accident | Nervous system disorders | MedDRA 15.1 | Non-systematic Assessment | Not associated with the vaccine. All 3 Serious Adverse Events affected the same subject. |
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| Blood Creatinine Increased | Investigations | MedDRA 15.1 | Systematic Assessment | Not associated with the vaccine. All 3 Serious Adverse Events affected the same subject. |
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| Glomerular Filtration Rate Decreased | Investigations | MedDRA 15.1 | Systematic Assessment | Not associated with the vaccine. All 3 Serious Adverse Events affected the same subject. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Tenderness around injection site | General disorders | MedDRA 15.1 | Systematic Assessment | Local from Dairy Cards |
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| Pain around injection site | General disorders | MedDRA 15.1 | Systematic Assessment | Local from Dairy Cards |
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| Myalgia | Musculoskeletal and connective tissue disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Headache | Nervous system disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Fatigue | General disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Hardness around injection site | General disorders | MedDRA 15.1 | Systematic Assessment | Local from Dairy Cards |
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| Swelling around injection site | General disorders | MedDRA 15.1 | Systematic Assessment | Local from Dairy Cards |
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| Malaise | General disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Diarrhea | Gastrointestinal disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Arthralgia | Musculoskeletal and connective tissue disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Nausea | Gastrointestinal disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Chills | General disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Anorexia | Metabolism and nutrition disorders | MedDRA 15.1 | Systematic Assessment | Systemic from Dairy Cards |
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| Blood Pressure Systolic Increased | Investigations | MedDRA 15.1 | Systematic Assessment | Systemic |
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Three subjects, 1 female and 2 males, received incorrect vaccine. They are listed according to randomized treatment in the baseline population, but were analyzed according to the actual vaccine received in the safety population (outcomes 2 and 3).
All abstracts, presentations or manuscripts, and any data analyses conducted independently by the Investigator must be submitted in advance to the sponsor for review and approval. The sponsor will not unreasonably withhold publication of study findings. The objective of this policy is to ensure consistency between data filed with a regulatory authority and those appearing in the publication.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Regulatory Affairs Director | JN-International Medical Corporation | 4028843477 | dr_orten@jn-vaccines.org |
| ID | Term |
|---|---|
| D008585 | Meningitis, Meningococcal |
| D008589 | Meningococcal Infections |
| D002494 | Central Nervous System Infections |
| D008581 | Meningitis |
| ID | Term |
|---|---|
| D016920 | Meningitis, Bacterial |
| D020806 | Central Nervous System Bacterial Infections |
| D001424 | Bacterial Infections |
| D001423 | Bacterial Infections and Mycoses |
| D007239 | Infections |
| D016870 | Neisseriaceae Infections |
| D016905 | Gram-Negative Bacterial Infections |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D000090862 | Neuroinflammatory Diseases |
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| Male |
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| American Indian/ Alaska Native |
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| Caucasian |
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| Black/ African-American |
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| Native Hawaiian/Pacific Islander |
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| Hispanic or Latino |
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| Other |
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| Serogroup Y |
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| Serogroup W-135 |
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The assumptions for the sample size calculations were: 1) Seroconversion for the control vaccine (Menactra) is 40-80% and 2) the true treatments are theoretically equal and 3) the power of detecting non-inferiority is 90%.
| The hypothesis was that the test vaccine is comparable to the licensed active control vaccine. Differences between treatment groups were described using exact two-sided 95% confidence intervals on differences in % seroconversion between the two treatment groups (test vaccine minus reference vaccine) for each serogroup. If the lower bound of the difference is ≥ -15%, then the test vaccine meets the preliminary criterion for non-inferiority. | Percentage Difference | -6.0 | 2-Sided | 95 | -14.6 | 2.6 | Serogroup C | Yes | Non-Inferiority or Equivalence | The assumptions for the sample size calculations were: 1) Seroconversion for the control vaccine (Menactra) is 40-80% and 2) the true treatments are theoretically equal and 3) the power of detecting non-inferiority is 90%. |
| The hypothesis was that the test vaccine is comparable to the licensed active control vaccine. Differences between treatment groups were described using exact two-sided 95% confidence intervals on differences in % seroconversion between the two treatment groups (test vaccine minus reference vaccine) for each serogroup. If the lower bound of the difference is ≥ -15%, then the test vaccine meets the preliminary criterion for non-inferiority. | Percentage Difference | -1.0 | 2-Sided | 95 | -9.9 | 7.9 | Serogroup Y | Yes | Non-Inferiority or Equivalence | The assumptions for the sample size calculations were: 1) Seroconversion for the control vaccine (Menactra) is 40-80% and 2) the true treatments are theoretically equal and 3) the power of detecting non-inferiority is 90%. |
| The hypothesis was that the test vaccine is comparable to the licensed active control vaccine. Differences between treatment groups were described using exact two-sided 95% confidence intervals on differences in % seroconversion between the two treatment groups (test vaccine minus reference vaccine) for each serogroup. If the lower bound of the difference is ≥ -15%, then the test vaccine meets the preliminary criterion for non-inferiority. | Percentage Difference | 0.3 | 2-Sided | 95 | -8.5 | 9.1 | Serogroup W-135 | Yes | Non-Inferiority or Equivalence | The assumptions for the sample size calculations were: 1) Seroconversion for the control vaccine (Menactra) is 40-80% and 2) the true treatments are theoretically equal and 3) the power of detecting non-inferiority is 90%. |
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