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MVA Post-Event: Administration Timing and Boost Study

Primary Purpose

Smallpox

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Placebo (subcutaneous)
Placebo (scarification)
Dryvax®
IMVAMUNE®
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Smallpox focused on measuring smallpox, vaccine, IMVAMUNE®

Eligibility Criteria

18 Years - 38 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • At least 18 years of age and born after 1971
  • Never received smallpox vaccination
  • Read, signed, and dated informed consent document
  • Available for follow-up for the planned duration of the study (one year after last immunization)
  • Acceptable medical history by screening evaluation and limited physical assessment
  • If the subject is female and of childbearing potential, negative serum pregnancy test at screening and negative urine or serum pregnancy test within 24 hours prior to vaccination
  • If the subject is female and of childbearing potential, she agrees to use acceptable contraception, and not become pregnant for the duration of the study

    1. A woman is considered of childbearing potential unless post-menopausal or surgically sterilized
    2. Acceptable contraception methods are restricted to effective devices (e.g., Intrauterine Devices (IUD)s, NuvaRing®) or licensed hormonal products with use of method for a minimum of 30 days prior to vaccination, and abstinence from sexual intercourse with men (vaginal penetration by a penis, coitus)
    3. Women who are not sexually active must agree to use one of the acceptable contraception methods if they are of childbearing potential
  • Negative enzyme linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV)
  • Alanine aminotransferase (ALT) <1.25 times institutional upper limit of normal
  • Negative hepatitis B surface antigen and negative antibody to hepatitis C virus
  • Negative urine glucose and urine protein <1 plus by dipstick or urinalysis Adequate renal function defined as a serum creatinine equal to or less than the institutional upper limit of normal by gender; and urine protein <30 mg/dL or trace proteinuria (by urinalysis or dip stick).
  • Electrocardiogram (ECG) in absence of clinical significance (e.g., complete left or right bundle branch block, incomplete left bundle branch block or sustained ventricular arrythmia, or two premature ventricular contractions (PVC's) in a row, or sympathetic tonus (ST) elevation consistent with ischemia)
  • Complete blood count (CBC): Hemoglobin equal to or above the lower limit of institutional normal; White blood cells greater than or equal to 3200 /mm^3 and equal to or below the upper limit of institutional normal Platelets equal to or above the lower limit of institutional normal
  • Weight: greater than or equal to 110 pounds

Exclusion Criteria:

  • History of immunodeficiency
  • Typical vaccinia scar
  • Known or suspected history of smallpox vaccination
  • Military service prior to 1991 or after January 2003
  • Known or suspected impairment of immunologic function including, but not limited to, clinically significant liver disease, diabetes mellitus, or moderate to severe kidney impairment
  • 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
  • Active autoimmune disease Persons with vitiligo or thyroid disease (e.g., taking thyroid hormone replacement) are not excluded.
  • History of myocardial infarction, angina, congestive heart failure, cardiomyopathy, stroke or transient ischemic attack, or other heart condition under the care of a doctor
  • 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 risk assessment tool (http://hin.nhlbi.nih.gov/atpiii/calculator.asp)
  • NOTE that this criterion applies only to subjects 20 years of age and older AND only if at least one of the following apply:

    1. have smoked a cigarette in the past month, and/or
    2. have hypertension (defined as systolic blood pressure >140 mm Hg) or are on antihypertensive medication, and/or
    3. 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.
  • Current use of immunosuppressive medication

    1. Corticosteroid nasal sprays are permissible
    2. Persons who are using a topical steroid can be enrolled after their therapy is completed
    3. Inhaled steroids for asthma are not permissible
  • Medical or psychiatric condition or occupational responsibilities that preclude subject compliance with the protocol
  • Any history of illegal injection drug use
  • Receipt of inactivated vaccine 14 days prior to vaccination
  • Receipt of live attenuated vaccine within 30 days prior to vaccination
  • Use of experimental agent within 30 days prior to vaccination
  • Receipt of blood products or immunoglobulin within six months prior to vaccination
  • Donation of a unit of blood within 56 days prior to vaccination or for the duration of the study
  • Acute febrile illness (greater than or equal to 100.5 degrees F) on the day of vaccination
  • Pregnant or lactating women
  • Eczema of any degree or history of eczema
  • People with atopic dermatitis, chronic exfoliative skin disorders/conditions, current Varicella zoster, or any acute skin disorders of large magnitude, e.g., laceration requiring sutures, burn greater than 2×2 cm
  • Any condition that, in the opinion of the investigator, might interfere with study objectives
  • Known allergy to IMVAMUNE® vaccine
  • Known allergy to egg or aminoglycoside
  • Study personnel

Sites / Locations

  • University of Iowa
  • University of Maryland Baltimore
  • Saint Louis University - Center for Vaccine Development
  • University of Rochester
  • Duke Health Center
  • Case Western Reserve University - John T. Carey Special Immunology Unit
  • The University of Texas Medical Branch

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Active Comparator

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Group C

Group D

Group E

Group F

Group B

Group A

Arm Description

Dryvax® vaccine or placebo on Day 0. This arm was discontinued from original protocol. Subjects already enrolled in this group will continue follow-up per protocol.

Standard dose IMVAMUNE® vaccine or placebo on Day 0 and Dryvax® vaccine or placebo on Day 7. This arm was discontinued from original protocol. Subjects already enrolled in this group will continue follow-up per protocol.

Dryvax® vaccine and standard dose IMVAMUNE® vaccine or 2 placebos on Day 0. This arm was discontinued from original protocol. Subjects already enrolled in this group will continue follow-up per protocol.

Standard dose IMVAMUNE® vaccine or placebo on Day 0.

Standard dose IMVAMUNE® vaccine or placebo on Days 0 and 28.

Standard dose IMVAMUNE® vaccine or placebo on Days 0 and 7.

Outcomes

Primary Outcome Measures

Determine whether the Geometric Mean Titer (GMT) of neutralizing antibody, among subjects receiving 2 doses of IMVAMUNE® (Days 0 and 7, Group A) is noninferior to that among subjects receiving 2 doses of IMVAMUNE® (Days 0 and 28, Group B).
Safety: adverse events and reactogenicity to the vaccine.

Secondary Outcome Measures

Using enzyme linked immunosorbent assay results, determine whether the GMT among subjects receiving a 2 dose regimen of IMVAMUNE® (Days 0 and 7, Group A) is noninferior to that among subjects receiving 2 doses of IMVAMUNE® (Days 0 and 28, Group B).

Full Information

First Posted
February 16, 2007
Last Updated
October 24, 2013
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT00437021
Brief Title
MVA Post-Event: Administration Timing and Boost Study
Official Title
Evaluation of IMVAMUNE® Smallpox Vaccine With Respect to Safety and Optimization of Immune Responses by Different Vaccination Regimens in Vaccinia-Naïve Adults
Study Type
Interventional

2. Study Status

Record Verification Date
March 2010
Overall Recruitment Status
Completed
Study Start Date
April 2007 (undefined)
Primary Completion Date
April 2009 (Actual)
Study Completion Date
April 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

5. Study Description

Brief Summary
The purpose of this study is to evaluate an investigational smallpox vaccine, called IMVAMUNE®, with respect to safety and immune (body's defense system) response. Participants will include healthy adults, age 18 or older born after 1971, who have not had smallpox vaccine before. Volunteers were originally assigned to 1 of 5 groups. In July 2007, a hold was placed on the Dryvax® groups and the study was modified. Volunteers, numbering 197, will be assigned by chance to one of 3 groups to be vaccinated twice with IMVAMUNE® vaccine or placebo (inactive substance) in Groups A and B, or to receive a single vaccination with IMVAMUNE® or placebo in Group F. Volunteers will complete a memory aid (diary) for 15 days following vaccination. Blood samples will be collected. Volunteers may participate for up to 425 days.
Detailed Description
The study will evaluate the IMVAMUNE® smallpox vaccine with respect to safety and optimization of immune responses by different vaccination regimens in vaccinia-naïve adults. Study subjects must be age 18 and older and born after 1971. Originally, 215 subjects were planned to be randomly assigned to 1 of 5 groups to be immunized twice with IMVAMUNE® vaccine or placebo subcutaneously in Groups A and B, or Dryvax® or placebo by scarification in Group C or both IMVAMUNE® and Dryvax® or 2 placebos in Groups D and Group E. In July, 2007, enrollment was halted at the request of Center for Biologics Evaluation and Research (CBER). At that time, enrollment included zero subjects in Group A, 2 subjects in Group B, 8 subjects in Group C, 6 subjects in Group D, and 4 subjects in Group E. CBER placed an official hold on the enrollment into the Groups that would administer Dryvax®, i.e., Groups C, D and E. Subjects previously enrolled into Groups C, D, and E will be followed according to the protocol. The protocol has been modified as follows. One hundred and ninety-five subjects will be randomly assigned to 1 of 3 groups to be immunized twice with IMVAMUNE® vaccine or placebo subcutaneously in Groups A and B, or to receive a single immunization with IMVAMUNE® or placebo subcutaneously in Group F. (NOTE: A total of 197 subjects will be randomly assigned to Groups A, B, and F as 2 subjects were previously enrolled in Group B.) Group A will receive IMVAMUNE® vaccine or placebo on Days 0 and 7. Group B will receive IMVAMUNE® vaccine or placebo on Days 0 and 28. Group F will receive a single dose of IMVAMUNE® at Day 0. All subjects will complete a memory aid for 15 days following each vaccination. Groups C, D, and E will have the appropriate reactogenicity information collected until the vaccination lesion, if present is well dried. Adverse events will be collected for 28 days after each vaccination. Specimens will be collected for immunologic assays at the noted clinic visits, as well as 1 year post last vaccination. Serious adverse events will be collected throughout the study period. The primary safety objective is to evaluate the safety of IMVAMUNE® given as a single dose, IMVAMUNE® given in a 2 dose prime-boost regimen at Day 0 and 7 or Day 0 and 28, IMVAMUNE® followed by a boost with Dryvax®, and IMVAMUNE® given simultaneously with Dryvax®. The primary immunogenicity objective is to determine if the Geometric Mean Titer (GMT) of neutralizing antibody [using Modified Vaccinia Ankara (MVA) as the target antigen] among subjects receiving a regimen of 2 doses of IMVAMUNE® (1×10^8, Days 0 and 7, Group A) is non-inferior to that among subjects receiving 2 doses of IMVAMUNE® (1×10^8, Days 0 and 28, Group B) at Day 14 following the 2nd dose. The secondary immunogenicity objective is to determine if the GMT, as assessed by enzyme linked immunosorbent assay (ELISA) (using MVA as the target antigen), among subjects receiving a regimen of 2 doses of IMVAMUNE® (1×10^8, Days 0 and 7, Group A) is non-inferior to that among subjects receiving 2 doses of IMVAMUNE® (1×10^8, Days 0 and 28, Group B) at Day 14 following the 2nd dose. The tertiary immunogenicity objective is to characterize the kinetics, magnitude, and duration of cellular and humoral immune responses to IMVAMUNE® alone or IMVAMUNE® as a prime followed by a boost with IMVAMUNE® or Dryvax®, or Dryvax® alone.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Smallpox
Keywords
smallpox, vaccine, IMVAMUNE®

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
206 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group C
Arm Type
Active Comparator
Arm Description
Dryvax® vaccine or placebo on Day 0. This arm was discontinued from original protocol. Subjects already enrolled in this group will continue follow-up per protocol.
Arm Title
Group D
Arm Type
Experimental
Arm Description
Standard dose IMVAMUNE® vaccine or placebo on Day 0 and Dryvax® vaccine or placebo on Day 7. This arm was discontinued from original protocol. Subjects already enrolled in this group will continue follow-up per protocol.
Arm Title
Group E
Arm Type
Experimental
Arm Description
Dryvax® vaccine and standard dose IMVAMUNE® vaccine or 2 placebos on Day 0. This arm was discontinued from original protocol. Subjects already enrolled in this group will continue follow-up per protocol.
Arm Title
Group F
Arm Type
Experimental
Arm Description
Standard dose IMVAMUNE® vaccine or placebo on Day 0.
Arm Title
Group B
Arm Type
Experimental
Arm Description
Standard dose IMVAMUNE® vaccine or placebo on Days 0 and 28.
Arm Title
Group A
Arm Type
Experimental
Arm Description
Standard dose IMVAMUNE® vaccine or placebo on Days 0 and 7.
Intervention Type
Drug
Intervention Name(s)
Placebo (subcutaneous)
Intervention Description
0.9 percent (weight/volume) sodium chloride injection, United States Pharmacopeia [Sterile Saline Placebo (SSP)].
Intervention Type
Drug
Intervention Name(s)
Placebo (scarification)
Intervention Description
Physiologic normal saline for injection.
Intervention Type
Biological
Intervention Name(s)
Dryvax®
Intervention Description
Dryvax® Vaccinia Vaccine (~10^5 [plaque forming units (pfu)/dose] given via scarification, titer 10^8 pfu per mL after reconstitution).
Intervention Type
Biological
Intervention Name(s)
IMVAMUNE®
Intervention Description
IMVAMUNE® Vaccinia Vaccine delivered by subcutaneous (SC) route at titer 1X10^8 Tissue Culture Infections Dose50 per 0.5 mL dose.
Primary Outcome Measure Information:
Title
Determine whether the Geometric Mean Titer (GMT) of neutralizing antibody, among subjects receiving 2 doses of IMVAMUNE® (Days 0 and 7, Group A) is noninferior to that among subjects receiving 2 doses of IMVAMUNE® (Days 0 and 28, Group B).
Time Frame
At Day 14 following the 2nd dose of vaccine.
Title
Safety: adverse events and reactogenicity to the vaccine.
Time Frame
Duration of study.
Secondary Outcome Measure Information:
Title
Using enzyme linked immunosorbent assay results, determine whether the GMT among subjects receiving a 2 dose regimen of IMVAMUNE® (Days 0 and 7, Group A) is noninferior to that among subjects receiving 2 doses of IMVAMUNE® (Days 0 and 28, Group B).
Time Frame
At Day 14 following the 2nd dose of vaccine.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
38 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: At least 18 years of age and born after 1971 Never received smallpox vaccination Read, signed, and dated informed consent document Available for follow-up for the planned duration of the study (one year after last immunization) Acceptable medical history by screening evaluation and limited physical assessment If the subject is female and of childbearing potential, negative serum pregnancy test at screening and negative urine or serum pregnancy test within 24 hours prior to vaccination If the subject is female and of childbearing potential, she agrees to use acceptable contraception, and not become pregnant for the duration of the study A woman is considered of childbearing potential unless post-menopausal or surgically sterilized Acceptable contraception methods are restricted to effective devices (e.g., Intrauterine Devices (IUD)s, NuvaRing®) or licensed hormonal products with use of method for a minimum of 30 days prior to vaccination, and abstinence from sexual intercourse with men (vaginal penetration by a penis, coitus) Women who are not sexually active must agree to use one of the acceptable contraception methods if they are of childbearing potential Negative enzyme linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) Alanine aminotransferase (ALT) <1.25 times institutional upper limit of normal Negative hepatitis B surface antigen and negative antibody to hepatitis C virus Negative urine glucose and urine protein <1 plus by dipstick or urinalysis Adequate renal function defined as a serum creatinine equal to or less than the institutional upper limit of normal by gender; and urine protein <30 mg/dL or trace proteinuria (by urinalysis or dip stick). Electrocardiogram (ECG) in absence of clinical significance (e.g., complete left or right bundle branch block, incomplete left bundle branch block or sustained ventricular arrythmia, or two premature ventricular contractions (PVC's) in a row, or sympathetic tonus (ST) elevation consistent with ischemia) Complete blood count (CBC): Hemoglobin equal to or above the lower limit of institutional normal; White blood cells greater than or equal to 3200 /mm^3 and equal to or below the upper limit of institutional normal Platelets equal to or above the lower limit of institutional normal Weight: greater than or equal to 110 pounds Exclusion Criteria: History of immunodeficiency Typical vaccinia scar Known or suspected history of smallpox vaccination Military service prior to 1991 or after January 2003 Known or suspected impairment of immunologic function including, but not limited to, clinically significant liver disease, diabetes mellitus, or moderate to severe kidney impairment 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 Active autoimmune disease Persons with vitiligo or thyroid disease (e.g., taking thyroid hormone replacement) are not excluded. History of myocardial infarction, angina, congestive heart failure, cardiomyopathy, stroke or transient ischemic attack, or other heart condition under the care of a doctor 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 risk assessment tool (http://hin.nhlbi.nih.gov/atpiii/calculator.asp) 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. Current use of immunosuppressive medication Corticosteroid nasal sprays are permissible Persons who are using a topical steroid can be enrolled after their therapy is completed Inhaled steroids for asthma are not permissible Medical or psychiatric condition or occupational responsibilities that preclude subject compliance with the protocol Any history of illegal injection drug use Receipt of inactivated vaccine 14 days prior to vaccination Receipt of live attenuated vaccine within 30 days prior to vaccination Use of experimental agent within 30 days prior to vaccination Receipt of blood products or immunoglobulin within six months prior to vaccination Donation of a unit of blood within 56 days prior to vaccination or for the duration of the study Acute febrile illness (greater than or equal to 100.5 degrees F) on the day of vaccination Pregnant or lactating women Eczema of any degree or history of eczema People with atopic dermatitis, chronic exfoliative skin disorders/conditions, current Varicella zoster, or any acute skin disorders of large magnitude, e.g., laceration requiring sutures, burn greater than 2×2 cm Any condition that, in the opinion of the investigator, might interfere with study objectives Known allergy to IMVAMUNE® vaccine Known allergy to egg or aminoglycoside Study personnel
Facility Information:
Facility Name
University of Iowa
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
University of Maryland Baltimore
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
Facility Name
Saint Louis University - Center for Vaccine Development
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63104
Country
United States
Facility Name
University of Rochester
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States
Facility Name
Duke Health Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27704
Country
United States
Facility Name
Case Western Reserve University - John T. Carey Special Immunology Unit
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106-5083
Country
United States
Facility Name
The University of Texas Medical Branch
City
Galveston
State/Province
Texas
ZIP/Postal Code
77555
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
23664987
Citation
Frey SE, Winokur PL, Salata RA, El-Kamary SS, Turley CB, Walter EB Jr, Hay CM, Newman FK, Hill HR, Zhang Y, Chaplin P, Tary-Lehmann M, Belshe RB. Safety and immunogenicity of IMVAMUNE(R) smallpox vaccine using different strategies for a post event scenario. Vaccine. 2013 Jun 24;31(29):3025-33. doi: 10.1016/j.vaccine.2013.04.050. Epub 2013 May 9.
Results Reference
result

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MVA Post-Event: Administration Timing and Boost Study

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