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Safety and Protective Efficacy of IV Immunization With Cryopreserved PfSPZ Under A/P Chemoprophylaxis

Primary Purpose

Malaria

Status
Completed
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
atovaquone/proguanil 250mg/100mg (A/P)
PfSPZ Challenge (NF54)
NaCl 0,9%
Sponsored by
University Hospital Tuebingen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Malaria

Eligibility Criteria

18 Years - 45 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Healthy adults aged 18 to 45 years.
  • Able and willing (in the Investigator's opinion) to comply with all study requirements.
  • Willing to allow the investigators to discuss the volunteer's medical history with their general practitioner if required.
  • Residence in Tübingen or surroundings for the period of the trial.
  • Women only: Must agree to practice continuous effective contraception for the duration of the study (a method which results in a low failure rate; i.e. less than 1% per year).
  • Agreement to refrain from blood donation during the course of the study and after the end of their involvement in the study according to the local and national blood banking eligibility criteria (currently four years in Germany).
  • Provision of written informed consent to receive PfSPZ Challenge for immunization and subsequently for CHMI.
  • Reachable (24/7) by mobile phone during the immunization and CHMI period.
  • Willingness to take A/P during immunization and a curative antimalarial regimen following CHMI.
  • Agreement to stay overnight for observation during the period of intensive follow-up post-challenge if required.
  • Answer all questions on the informed consent quiz correctly.
  • A body mass index 18-35.

Exclusion Criteria:

  • History of P.falciparum malaria.
  • Planned travel to malaria endemic areas during the study period.
  • Use of systemic antibiotics with known antimalarial activity within 30 days of study enrollment (e.g. trimethoprim-sulfamethoxazole, doxycycline, tetracycline, clindamycin,erythromycin, fluoroquinolones, or azithromycin).
  • Receipt of an investigational product in the 90 days preceding enrollment, or planned receipt during the study period.
  • HIV infection.
  • Any confirmed or suspected immunosuppressive or immunodeficient state (e.g. repeated and/or unusual infections),history of infection caused by opportunistic organisms any infection or combination of infections that suggest underlying immunodeficiency, history of meningitis, encephalitis, septic shock, life-threatening soft tissue infection, more than one pneumonia, asplenia and/or chronic (more than 14 days) immunosuppressant medication within the past 6 months (inhaled and topical steroids are allowed)).
  • Use of immunoglobulins or blood products within 3 months prior to enrolment.
  • Known (or signs consistent with) sickle cell anemia, sickle cell trait, thalassemia or thalassemia trait, glucose-6-phosphate dehydrogenase deficiency.
  • Pregnancy, lactation or intention to become pregnant during the study.
  • Contraindications to the use of the following antimalarial medications: A/P, artemether-lumefantrine
  • History of cancer (except basal cell carcinoma of the skin and cervical carcinoma in situ).
  • History of serious psychiatric condition that may affect participation in the study
  • Any other serious chronic illness requiring hospital specialist supervision.
  • Suspected or known current alcohol abuse as defined by an alcohol intake of greater than 60 g (men) or 40 g (women) per day or a carbohydrate deficient transferrin (CDT) level ≥2.5%.
  • Suspected or known injected drug abuse in the 5 years preceding enrollment.
  • Positive for hepatitis B surface antigen (HBs-antigen).
  • Seropositive for hepatitis C virus (antibodies to HCV).
  • Falling in moderate risk or higher categories for fatal or non-fatal cardiovascular event within 5 years (>10%) determined by non-invasive criteria for cardiac risk 84.
  • Abnormal electrocardiogram on screening: pathologic Q wave and significant ST-T wave changes, left ventricular hypertrophy, clinically significant arrythmias, left bundle branch block, secondary or tertiary AV block
  • A QT/QTcB interval >450 ms.
  • Volunteers unable to be closely followed for social, geographic or psychological reasons.
  • CrCL <30ml/min
  • History of seizure (except uncomplicated febrile convulsion at childhood)
  • Immunization with more than 3 other vaccines within the past month
  • Any other significant disease, disorder, finding at medical history, biochemistry, hematology tests, urine analysis results or at clinical examination which, in the opinion of the investigator, may significantly increase the risk to the volunteer because of participation in the study, affect the ability of the volunteer to participate in the study or impair interpretation of the study data.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Experimental

    Placebo Comparator

    Arm Label

    51,200 PfSPZ

    150,000 PfSPZ

    Placebo

    Arm Description

    Three injections of 51,200 PfSPZ Challenge (P. falciparum strain: NF54) under chemoprophylaxis with atovaquone/proguanil 250mg/100mg (A/P) at 4 week intervals

    Three injections of 150,000 PfSPZ Challenge (P. falciparum strain: NF54) under chemoprophylaxis with atovaquone/proguanil 250mg/100mg (A/P) at 4 week intervals

    Three injections of NaCl 0,9% solution under chemoprophylaxis with atovaquone/proguanil 250mg/100mg (A/P) at 4 week intervals

    Outcomes

    Primary Outcome Measures

    Number or occurrence of related Grade 3 and 4 adverse events (AEs) and serious adverse events (SAEs)

    Secondary Outcome Measures

    Occurrence of any related AE
    Proportion of protected volunteers
    . Protection is defined as the absence of parasites in the peripheral blood for 28 days following first and second CHMI with PfSPZ Challenge (NF54) and PfSPZ Challenge (7G8) in volunteers receiving PfSPZ-CVac with A/P. Parasitemia is defined as at least one qPCR result above 100 parasites per mL among three positive results at least 12 hours apart or as a positive thick blood smear. Statistical testing is hierarchical: 1) protection against first CHMI, 2) protection against second CHMI.

    Full Information

    First Posted
    July 28, 2016
    Last Updated
    July 11, 2019
    Sponsor
    University Hospital Tuebingen
    Collaborators
    Sanaria Inc.
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02858817
    Brief Title
    Safety and Protective Efficacy of IV Immunization With Cryopreserved PfSPZ Under A/P Chemoprophylaxis
    Official Title
    Safety and Protective Efficacy of Intravenous Immunization With Cryopreserved Plasmodium Falciparum Sporozoites Under Atovaquone/Proguanil Chemoprophylaxis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    February 2018
    Overall Recruitment Status
    Completed
    Study Start Date
    November 28, 2016 (Actual)
    Primary Completion Date
    November 16, 2017 (Actual)
    Study Completion Date
    November 16, 2017 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    University Hospital Tuebingen
    Collaborators
    Sanaria Inc.

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    Single center, randomized, placebo-controlled, double-blinded trial using PfSPZ Challenge (NF54) under A/P chemoprophylaxis for immunization and PfSPZ Challenge (NF54) and PfSPZ Challenge (7G8) for repeat CHMI. A total of 30 adult, healthy, malaria naïve volunteers will receive three injections by Direct Venous Inoculation (DVI) of either placebo (n = 10), 51,200 PfSPZ Challenge (NF54) (n = 10), or 150,000 PfSPZ Challenge (NF54) (n = 10) under chemoprophylaxis with A/P at 4 week intervals. The placebo will be normal saline (0.9% NaCl). Ten weeks after the last dose of PfSPZ Challenge (NF54) for immunization, volunteers will undergo first CHMI and followed until asexual blood stage parasitemia, detected by quantitative real time PCR (qPCR) or thick blood smear microscopy. If parasitemic, they will be treated with A/P (used in this case as a standard treatment regimen). In the event of no parasitemia, volunteers will be followed until Day 28 post-CHMI and will not receive A/P. Sixteen to forty-four weeks after the last immunization, a second CHMI will be administered to assess longevity and cross-strain protection. All volunteers will be followed up to 28 days post-inoculation. Those developing parasitemia will be treated with A/P. Volunteers of Group A will have CHMI with PfSPZ Challenge (NF54) followed by PfSPZ Challenge (7G8). Volunteers of Group B will have CHMI with PfSPZ Challenge (NF54) or PfSPZ Challenge (7G8) followed by PfSPZ Challenge (7G8). In the case that protective efficacy in Group A is ≥75% CHMI sequence will be 7G8-7G8. In the case that protective efficacy against homologous Challenge in Group A is <75%, volunteers will receive the same sequence as in Group A (NF54-7G8).

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Malaria

    7. Study Design

    Primary Purpose
    Prevention
    Study Phase
    Phase 1
    Interventional Study Model
    Factorial Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    30 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    51,200 PfSPZ
    Arm Type
    Experimental
    Arm Description
    Three injections of 51,200 PfSPZ Challenge (P. falciparum strain: NF54) under chemoprophylaxis with atovaquone/proguanil 250mg/100mg (A/P) at 4 week intervals
    Arm Title
    150,000 PfSPZ
    Arm Type
    Experimental
    Arm Description
    Three injections of 150,000 PfSPZ Challenge (P. falciparum strain: NF54) under chemoprophylaxis with atovaquone/proguanil 250mg/100mg (A/P) at 4 week intervals
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Three injections of NaCl 0,9% solution under chemoprophylaxis with atovaquone/proguanil 250mg/100mg (A/P) at 4 week intervals
    Intervention Type
    Drug
    Intervention Name(s)
    atovaquone/proguanil 250mg/100mg (A/P)
    Other Intervention Name(s)
    Malarone
    Intervention Description
    Combination drug for chemo-prophylaxis or treatment of malaria
    Intervention Type
    Biological
    Intervention Name(s)
    PfSPZ Challenge (NF54)
    Intervention Description
    cryo-preserved Plasmodium falciparum sporozoites injected by venous inoculation
    Intervention Type
    Other
    Intervention Name(s)
    NaCl 0,9%
    Other Intervention Name(s)
    Placebo
    Intervention Description
    0.9% NaCl solution for injection
    Primary Outcome Measure Information:
    Title
    Number or occurrence of related Grade 3 and 4 adverse events (AEs) and serious adverse events (SAEs)
    Time Frame
    from time of first administration of A/P until the last follow up visit, 414 days after first administration
    Secondary Outcome Measure Information:
    Title
    Occurrence of any related AE
    Time Frame
    from time of first administration of A/P until the last follow up visit, 414 days after first administration
    Title
    Proportion of protected volunteers
    Description
    . Protection is defined as the absence of parasites in the peripheral blood for 28 days following first and second CHMI with PfSPZ Challenge (NF54) and PfSPZ Challenge (7G8) in volunteers receiving PfSPZ-CVac with A/P. Parasitemia is defined as at least one qPCR result above 100 parasites per mL among three positive results at least 12 hours apart or as a positive thick blood smear. Statistical testing is hierarchical: 1) protection against first CHMI, 2) protection against second CHMI.
    Time Frame
    From time of PfSPZ challenge administration until 28 days after PfSPZ challenge
    Other Pre-specified Outcome Measures:
    Title
    Time-to-parasitemia in volunteers who receive immunization using PfSPZ Challenge or placebo under A/P chemoprophylaxis and become parasitemic within 28 days following CHMI with PfSPZ Challenge (NF54) or PfSPZ Challenge (7G8).
    Time Frame
    Until 28 days after challenge
    Title
    Time-to-parasitemia in placebo recipients following 2nd versus 1st CHMI (carry-over effect).
    Time Frame
    Until 28 days after challenge

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    45 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Healthy adults aged 18 to 45 years. Able and willing (in the Investigator's opinion) to comply with all study requirements. Willing to allow the investigators to discuss the volunteer's medical history with their general practitioner if required. Residence in Tübingen or surroundings for the period of the trial. Women only: Must agree to practice continuous effective contraception for the duration of the study (a method which results in a low failure rate; i.e. less than 1% per year). Agreement to refrain from blood donation during the course of the study and after the end of their involvement in the study according to the local and national blood banking eligibility criteria (currently four years in Germany). Provision of written informed consent to receive PfSPZ Challenge for immunization and subsequently for CHMI. Reachable (24/7) by mobile phone during the immunization and CHMI period. Willingness to take A/P during immunization and a curative antimalarial regimen following CHMI. Agreement to stay overnight for observation during the period of intensive follow-up post-challenge if required. Answer all questions on the informed consent quiz correctly. A body mass index 18-35. Exclusion Criteria: History of P.falciparum malaria. Planned travel to malaria endemic areas during the study period. Use of systemic antibiotics with known antimalarial activity within 30 days of study enrollment (e.g. trimethoprim-sulfamethoxazole, doxycycline, tetracycline, clindamycin,erythromycin, fluoroquinolones, or azithromycin). Receipt of an investigational product in the 90 days preceding enrollment, or planned receipt during the study period. HIV infection. Any confirmed or suspected immunosuppressive or immunodeficient state (e.g. repeated and/or unusual infections),history of infection caused by opportunistic organisms any infection or combination of infections that suggest underlying immunodeficiency, history of meningitis, encephalitis, septic shock, life-threatening soft tissue infection, more than one pneumonia, asplenia and/or chronic (more than 14 days) immunosuppressant medication within the past 6 months (inhaled and topical steroids are allowed)). Use of immunoglobulins or blood products within 3 months prior to enrolment. Known (or signs consistent with) sickle cell anemia, sickle cell trait, thalassemia or thalassemia trait, glucose-6-phosphate dehydrogenase deficiency. Pregnancy, lactation or intention to become pregnant during the study. Contraindications to the use of the following antimalarial medications: A/P, artemether-lumefantrine History of cancer (except basal cell carcinoma of the skin and cervical carcinoma in situ). History of serious psychiatric condition that may affect participation in the study Any other serious chronic illness requiring hospital specialist supervision. Suspected or known current alcohol abuse as defined by an alcohol intake of greater than 60 g (men) or 40 g (women) per day or a carbohydrate deficient transferrin (CDT) level ≥2.5%. Suspected or known injected drug abuse in the 5 years preceding enrollment. Positive for hepatitis B surface antigen (HBs-antigen). Seropositive for hepatitis C virus (antibodies to HCV). Falling in moderate risk or higher categories for fatal or non-fatal cardiovascular event within 5 years (>10%) determined by non-invasive criteria for cardiac risk 84. Abnormal electrocardiogram on screening: pathologic Q wave and significant ST-T wave changes, left ventricular hypertrophy, clinically significant arrythmias, left bundle branch block, secondary or tertiary AV block A QT/QTcB interval >450 ms. Volunteers unable to be closely followed for social, geographic or psychological reasons. CrCL <30ml/min History of seizure (except uncomplicated febrile convulsion at childhood) Immunization with more than 3 other vaccines within the past month Any other significant disease, disorder, finding at medical history, biochemistry, hematology tests, urine analysis results or at clinical examination which, in the opinion of the investigator, may significantly increase the risk to the volunteer because of participation in the study, affect the ability of the volunteer to participate in the study or impair interpretation of the study data.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Peter G Kremsner, Prof
    Organizational Affiliation
    University Hospital Tübingen, Tübingen, Germany
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    Undecided

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    Safety and Protective Efficacy of IV Immunization With Cryopreserved PfSPZ Under A/P Chemoprophylaxis

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