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Enhancing Influenza Vaccination in Seniors With TLR (Toll Like Receptor) Agonists

Primary Purpose

Influenza Vaccination in Seniors

Status
Completed
Phase
Phase 1
Locations
Canada
Study Type
Interventional
Intervention
resiquimod
placebo gel
Sponsored by
University of British Columbia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Influenza Vaccination in Seniors focused on measuring influenza, human, influenza vaccines, older adults, immune response

Eligibility Criteria

65 Years - 75 Years (Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • written informed consent provided by the subject, who can be male or female
  • subjects who the investigator believes can and will comply with the requirements of the protocol (i.e. return for follow-up visits, record safety observations and able to converse with study personnel including by personal telephone
  • male or female age 65-75 years at visit 1
  • in generally good health (stable chronic conditions acceptable), living independently or with minimal assistance (clinical frailty score 1-5) and able to attend clinic appointments
  • receipt of influenza vaccination for the 2012-2013 influenza season

Exclusion Criteria:

  • receipt of any live vaccine within 4 weeks or inactivated vaccine within one week of visit 1 or planned administration of any non-study vaccines between visits 1 and 2
  • systemic hypersensitivity to influenza vaccine, hen's eggs or other vaccine constituent e.g. neomycin sulphate, kanamycin, formalin
  • severe reaction to any previous influenza vaccine or vaccine component
  • bleeding disorder, including anticoagulant therapy or thrombocytopenia, that contraindicates IM (intramuscular) injection or blood collection (does not include daily low dose ASA (acetylsalicylic acid), Plavix, and certain other mild anticoagulants with minimal bleeding risk)
  • incapacity to provide fully informed consent or be attentive to follow-up observations, resulting from cognitive impairment, abuse of alcohol, or drug addiction
  • lack of telephone access, inadequate fluency in English, uncertain availability during the 4 week study participation
  • immune compromise resulting from disease or immunosuppressive systemic medication use within 3 months of visit 1
  • receipt of blood or blood products within 3 months of visit 1
  • unstable medical conditions, as indicated by a requirement for hospitalization or a substantial medication change to stabilize said condition within 3 months.
  • personal frailty, determined by Clinical Frailty score of 6-7 (moderately frail or severely frail)or failure on the TUG test (Timed Up and Go time greater than 10 seconds) or inability to walk 1/4 mile, based on self report
  • history of Guillain-Barre Syndrome
  • psoriasis
  • recent or current febrile illness with oral temperature greater or equal to 38.0 degrees centigrade or other moderate to severe illness within the previous 48 hours (may vaccinate once condition has resolved)

Sites / Locations

  • University of British Columbia Vancouver General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Intanza+resiquimod gel

Intanza + placebo gel

Arm Description

Intanza 15mcg intradermal injection + resiquimod gel applied to the vaccination site immediately post vaccination.

Intanza 15mcg intradermal injection + placebo gel applied to the vaccination site immediately post vaccination.

Outcomes

Primary Outcome Measures

Reactogenicity of the vaccine regimens
Reactogenicity of the vaccine regimens (Intanza+resiquimod gel; Intanza+placebo gel) will be collected from Day 0 (pre vaccination) to Day 7. The change from Day 0 to Day 7 will be measured. The following information will be collected and compared 1) local pain (none, mild, moderate, severe; 2) injection site redness, swelling, induration measured in millimeters; itchiness present or not 3) bruising; 4) fever-values greater than or equal to 38.0 will be considered fever; 5) general symptoms-shivering, sweating nausea, vomiting diarrhea will be measured for presence or absence; 6) general symptoms-myalgia (muscle aches), arthralgia (joint aches), malaise (feeling unwell), tiredness/fatigue, headache and sleep disturbance will be measured as mild, moderate or severe
HAI (hemagglutination inhibition)titres
The primary immunologic outcome will be the 28 day post vaccination immune (HAI, hemagglutination immune assay titer)responses to the 3 vaccine strains present in each vaccine, assessed by the EMEA/CHMP (European Medicines Evaluation/Committee on Human Medicinal Products) Agency criteria for evaluation on immune response to influenza vaccines in persons over 60 years of age. The measurements include seroconversion rate (CHMP threshold greater than 30%), geometric mean titre (GMT) fold-increase or ratio (threshold greater than 2) and seroprotection rate (threshold greater than 60%). Whether the CHMP threshold for each measurement is met or exceeded per strain will be noted between products as descriptive information.
Granzyme B levels and Interferon gamma to interleukin 10 ratios
The day 0 (pre vaccination) and day 28 Granzyme B levels and Interferon gamma to interleukin 10 ratios will be measured and the change in levels from Day 0 to Day 28 will be compared in the 2 groups: 1) Intanza+resiquimod gel; 2) Intanza+placebo gel

Secondary Outcome Measures

Change in Microneutralization titres
Microneutralization titers will be measured in serum for the 3 virus strains in the influenza vaccine and compared at Day 0 (pre vaccination) and Day 28.
baseline Granzyme B Activity
Differences between baseline Granzyme B activity in lysates of PBMC's (peripheral blood mononuclear cells) and Granzyme B levels,interferon gamma to interleukin-10 ratios and HAI (hemagglutination inhibition) titres will be compared.

Full Information

First Posted
November 21, 2012
Last Updated
August 27, 2013
Sponsor
University of British Columbia
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1. Study Identification

Unique Protocol Identification Number
NCT01737580
Brief Title
Enhancing Influenza Vaccination in Seniors With TLR (Toll Like Receptor) Agonists
Official Title
Enhancing Influenza Vaccination in Seniors With TLR (Toll Like Receptor) Agonists
Study Type
Interventional

2. Study Status

Record Verification Date
August 2013
Overall Recruitment Status
Completed
Study Start Date
April 2013 (undefined)
Primary Completion Date
June 2013 (Actual)
Study Completion Date
June 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of British Columbia

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The application of the TLR7/8 (Toll Like Receptor) agonist gel (immune response helper) resiquimod will enhance the immune response to the intradermal influenza vaccine in seniors 65-75 years of age.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Influenza Vaccination in Seniors
Keywords
influenza, human, influenza vaccines, older adults, immune response

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
59 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intanza+resiquimod gel
Arm Type
Active Comparator
Arm Description
Intanza 15mcg intradermal injection + resiquimod gel applied to the vaccination site immediately post vaccination.
Arm Title
Intanza + placebo gel
Arm Type
Placebo Comparator
Arm Description
Intanza 15mcg intradermal injection + placebo gel applied to the vaccination site immediately post vaccination.
Intervention Type
Drug
Intervention Name(s)
resiquimod
Other Intervention Name(s)
R-848
Intervention Type
Drug
Intervention Name(s)
placebo gel
Primary Outcome Measure Information:
Title
Reactogenicity of the vaccine regimens
Description
Reactogenicity of the vaccine regimens (Intanza+resiquimod gel; Intanza+placebo gel) will be collected from Day 0 (pre vaccination) to Day 7. The change from Day 0 to Day 7 will be measured. The following information will be collected and compared 1) local pain (none, mild, moderate, severe; 2) injection site redness, swelling, induration measured in millimeters; itchiness present or not 3) bruising; 4) fever-values greater than or equal to 38.0 will be considered fever; 5) general symptoms-shivering, sweating nausea, vomiting diarrhea will be measured for presence or absence; 6) general symptoms-myalgia (muscle aches), arthralgia (joint aches), malaise (feeling unwell), tiredness/fatigue, headache and sleep disturbance will be measured as mild, moderate or severe
Time Frame
Day 0 - Day 28
Title
HAI (hemagglutination inhibition)titres
Description
The primary immunologic outcome will be the 28 day post vaccination immune (HAI, hemagglutination immune assay titer)responses to the 3 vaccine strains present in each vaccine, assessed by the EMEA/CHMP (European Medicines Evaluation/Committee on Human Medicinal Products) Agency criteria for evaluation on immune response to influenza vaccines in persons over 60 years of age. The measurements include seroconversion rate (CHMP threshold greater than 30%), geometric mean titre (GMT) fold-increase or ratio (threshold greater than 2) and seroprotection rate (threshold greater than 60%). Whether the CHMP threshold for each measurement is met or exceeded per strain will be noted between products as descriptive information.
Time Frame
Day 28 post vaccination
Title
Granzyme B levels and Interferon gamma to interleukin 10 ratios
Description
The day 0 (pre vaccination) and day 28 Granzyme B levels and Interferon gamma to interleukin 10 ratios will be measured and the change in levels from Day 0 to Day 28 will be compared in the 2 groups: 1) Intanza+resiquimod gel; 2) Intanza+placebo gel
Time Frame
Day 0 and Day 28 post vaccination
Secondary Outcome Measure Information:
Title
Change in Microneutralization titres
Description
Microneutralization titers will be measured in serum for the 3 virus strains in the influenza vaccine and compared at Day 0 (pre vaccination) and Day 28.
Time Frame
Day 0 and Day 28 post vaccination
Title
baseline Granzyme B Activity
Description
Differences between baseline Granzyme B activity in lysates of PBMC's (peripheral blood mononuclear cells) and Granzyme B levels,interferon gamma to interleukin-10 ratios and HAI (hemagglutination inhibition) titres will be compared.
Time Frame
Day 0 and Day 28 post vaccination

10. Eligibility

Sex
All
Minimum Age & Unit of Time
65 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: written informed consent provided by the subject, who can be male or female subjects who the investigator believes can and will comply with the requirements of the protocol (i.e. return for follow-up visits, record safety observations and able to converse with study personnel including by personal telephone male or female age 65-75 years at visit 1 in generally good health (stable chronic conditions acceptable), living independently or with minimal assistance (clinical frailty score 1-5) and able to attend clinic appointments receipt of influenza vaccination for the 2012-2013 influenza season Exclusion Criteria: receipt of any live vaccine within 4 weeks or inactivated vaccine within one week of visit 1 or planned administration of any non-study vaccines between visits 1 and 2 systemic hypersensitivity to influenza vaccine, hen's eggs or other vaccine constituent e.g. neomycin sulphate, kanamycin, formalin severe reaction to any previous influenza vaccine or vaccine component bleeding disorder, including anticoagulant therapy or thrombocytopenia, that contraindicates IM (intramuscular) injection or blood collection (does not include daily low dose ASA (acetylsalicylic acid), Plavix, and certain other mild anticoagulants with minimal bleeding risk) incapacity to provide fully informed consent or be attentive to follow-up observations, resulting from cognitive impairment, abuse of alcohol, or drug addiction lack of telephone access, inadequate fluency in English, uncertain availability during the 4 week study participation immune compromise resulting from disease or immunosuppressive systemic medication use within 3 months of visit 1 receipt of blood or blood products within 3 months of visit 1 unstable medical conditions, as indicated by a requirement for hospitalization or a substantial medication change to stabilize said condition within 3 months. personal frailty, determined by Clinical Frailty score of 6-7 (moderately frail or severely frail)or failure on the TUG test (Timed Up and Go time greater than 10 seconds) or inability to walk 1/4 mile, based on self report history of Guillain-Barre Syndrome psoriasis recent or current febrile illness with oral temperature greater or equal to 38.0 degrees centigrade or other moderate to severe illness within the previous 48 hours (may vaccinate once condition has resolved)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jan P Dutz, MD
Organizational Affiliation
University of British Columbia
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of British Columbia Vancouver General Hospital
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V5Z 1M9
Country
Canada

12. IPD Sharing Statement

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Enhancing Influenza Vaccination in Seniors With TLR (Toll Like Receptor) Agonists

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