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Assessment of Safety, Immunogenicity and Efficacy of R21/Matrix-M1 Malaria Vaccine in Healthy WOCBP in Mali

Primary Purpose

Healthy Women of Child Bearing Potential

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
R21/Matrix-M1
Saline and R21/Matrix-M1
Sterile isotonic (0.9%) normal saline
Sponsored by
European Vaccine Initiative
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Healthy Women of Child Bearing Potential

Eligibility Criteria

18 Years - 35 Years (Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria: Healthy females of childbearing potential aged ≥ 18 and ≤ 35 years Able and willing (in the Investigator's opinion) to comply with all study requirements. Agreement to release medical and other information concerning contra-indications for participation in the study, and to be attended by a study clinician for physical examination and any other clinical investigations. Provide written informed consent. Available for the duration of the study Must be willing to use reliable contraception (defined as: pharmacologic contraceptives [parental delivery] or pre-existing intrauterine or implantable device) from 21 days prior to study day 1 to 28 days after third vaccination and 21 days prior to the booster vaccination to 28 days after the booster vaccination. Report being interested in becoming pregnant within the next 1 year. Exclusion Criteria: Pregnancy at the time of enrollment or any subsequent vaccination, as determined by a positive urine or serum human chorionic gonadotropin (β-hCG) test. Biologically unable to become pregnant secondary to: surgical sterilization, premature ovarian insufficiency (defined as no menses for ≥12 months without an alternative medical cause). Behavioral, cognitive, or psychiatric disease that in the opinion of the investigator affects the ability of the participant to understand and comply with the study protocol. Hemoglobin (Hgb), WBC, absolute neutrophils, and platelets outside the local laboratory-defined limits of normal and ≥ Grade 2 (participants may be included at the investigator's discretion for 'not clinically significant' abnormal values). Alanine transaminase (ALT) or creatinine (Cr) level above the local laboratory-defined upper limit of normal and ≥ Grade 2 (participants may be included at the investigator's discretion for 'not clinically significant' abnormal values). Infected with human immunodeficiency virus (HIV). Known or documented sickle cell disease by history or lab test at screening (Note: known sickle cell trait is NOT exclusionary). Evidence of clinically significant neurologic, cardiac, pulmonary, hepatic, endocrine, rheumatologic, autoimmune, hematological, oncologic, or renal disease by history, physical examination, and/or laboratory studies including urinalysis. Participation in another research study involving receipt of an investigational product in the 30 days preceding enrolment or during the trial follow up period. Medical, occupational, or family problems as a result of alcohol or illicit drug use during the past 12 months. History of allergic disease or reactions likely to be exacerbated by any component of the vaccine. History of hereditary angioedema acquired angioedema, or idiopathic angioedema. History of a severe allergic reaction (Grade 2 or higher or per PI discretion) or anaphylaxis following administration of a vaccine. Severe asthma (defined as asthma that is unstable or required emergent care, urgent care, hospitalization, or intubation during the past two years, or that has required the use of oral or parenteral corticosteroids at any time during the past two years). Pre-existing autoimmune or antibody-mediated diseases including but not limited to: systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, Sjögren's syndrome, or autoimmune thrombocytopenia. Any confirmed or suspected immunosuppressive or immunodeficient state, including asplenia; recurrent, severe infections and chronic (more than 14 days) systemically active immunosuppressant medication within the past 6 months. Use of chronic (≥14 days) oral or IV corticosteroids (excluding topical or nasal) at immunosuppressive doses (i.e., prednisone ≥20 mg/day) or immunosuppressive drugs within 30 days of vaccination. Receipt of a live vaccine within the past 28 days or a killed vaccine within the past 14 days prior to Vaccination #1 and every subsequent vaccination day. Receipt of immunoglobulins and/or blood products within the past six months. Previous receipt of an investigational malaria vaccine in the last five years. Other condition(s) that, in the opinion of the investigator, would jeopardize the safety or rights of a participant participating in the trial, interfere with the evaluation of the study objectives, or would render the participant unable to comply with the protocol.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Active Comparator

    Active Comparator

    Active Comparator

    Arm Label

    Experimental-Standard Regime Malaria Vaccine Group1

    Experimental-Standard Regime Malaria Vaccine Group2

    Experimental-Standard Regime Group3

    Arm Description

    Participants receiving three doses of R21/Matrix-M1 malaria vaccine at months 0, 1 and 2.

    Participants receiving normal saline (placebo) at month 0 and two doses of R21/Matrix-M1 malaria vaccine at month 1 and 2

    Participants receiving three doses of normal saline (placebo) at months 0, 1 and 2

    Outcomes

    Primary Outcome Measures

    Incidence of local and systemic solicited adverse events (AEs)
    - Incidence of local and systemic solicited adverse events (AEs) graded by severity.
    Number of participants with P falciparum infection
    P. falciparum blood stage infection defined as time to first positive blood smear

    Secondary Outcome Measures

    Assessment of safety and tolerabilty
    Occurrence of unsolicited adverse events 28 days follow-up following the vaccination. Occurrence of serious adverse events for the whole study duration including in women who become pregnant.
    Anti-CSP antibody concentrations
    Immunological assessment measuring the anti-CSP antibody concentrations in healthy Malian women of child bearing potential
    Rate of P.falciparum infection during pregnancy
    P. falciparum blood stage infection defined as time to first positive blood smear during pregnancy
    Rate of P.falciparum infection
    P. falciparum blood stage infection defined as time to first positive blood smear.

    Full Information

    First Posted
    August 28, 2023
    Last Updated
    October 10, 2023
    Sponsor
    European Vaccine Initiative
    Collaborators
    University of Oxford, Malaria Research and Training Center, Bamako, Mali
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    1. Study Identification

    Unique Protocol Identification Number
    NCT06080243
    Brief Title
    Assessment of Safety, Immunogenicity and Efficacy of R21/Matrix-M1 Malaria Vaccine in Healthy WOCBP in Mali
    Official Title
    A Phase II Randomised, Controlled Trial to Evaluate the Safety, Immunogenicity and Efficacy of the R21/Matrix-M1 Malaria Vaccine in Healthy African Women of Childbearing Potential in Mali
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    February 1, 2025 (Anticipated)
    Primary Completion Date
    September 1, 2027 (Anticipated)
    Study Completion Date
    December 31, 2027 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    European Vaccine Initiative
    Collaborators
    University of Oxford, Malaria Research and Training Center, Bamako, Mali

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This will be a double-blind, individually randomised trial, to assess the safety, tolerability, immunogenicity, and protective efficacy of two and three doses of the R21/Matrix-M1 malaria vaccine or placebo given at 4 week intervals in healthy women of childbearing potential (WOCBP), who are on pregnancy prevention during vaccination, but report plans to become pregnant in the near future. Participants will be randomised in Year 1 into three groups in a 1:1:1 ratio: Arm 1 (n=110): will receive three doses of R21/Matrix-M1 malaria vaccine at months 0, 1 and 2. Arm 2 (n=110): will receive normal saline (placebo) at month 0 and two doses of R21/Matrix-M1 malaria vaccine at months 1 and 2. Arm 3 (n=110): will receive three of doses normal saline (placebo) at months 0, 1 and 2. In Year 2: Non-pregnant participants in arms 1 and 2 will be randomised in a 1:1 ratio to receive a booster dose of R21/Matrix-M1 malaria vaccine or placebo at the beginning of the malaria transmission season. Participants in the control group (arm 3) will receive normal saline (placebo). Initial follow-up will be for two years after dose three, with an efficacy analysis at 6, 12, 18 and 24 months after dose 3. Participants will be monitored for safety, tolerability, immunogenicity, and malaria infection during the follow-up period. Participants will also be monitored for pregnancy over 12 months post primary and booster vaccination and those who become pregnant will be followed during their pregnancy and for 1 year post-delivery (as well as their offspring) for safety and malaria infection
    Detailed Description
    The design will be a double blind, placebo-controlled study. Malian adult WOCBP between 18 and 35 years of age who consent to participate will be randomised to receive R21/Matrix-M1vaccine or normal saline to assess the safety, immunogenicity and protective efficacy of R21/Matrix-M1 Vaccine. Randomisation and Study Arms Consenting participants who have satisfied all the eligibility criteria and completed the baseline assessment will be individually randomised within the study groups using an electronic randomisation system into three arms in a 1:1:1 ratio. Arm 1: Participants will receive three doses of R21/Matrix-M1 malaria vaccine at months 0, 1 and 2. Arm 2: will receive normal saline (placebo) at month 0 and two doses of R21/Matrix-M1 malaria vaccine at month 1 and 2. Arm 3: will receive three doses of normal saline (placebo) at months 0, 1 and 2. Participants will be assessed for safety, immunogenicity and efficacy for 12 months. After 12 months non-pregnant participants in arms 1 and 2, will be randomised in a 1:1 ratio; half in each of these two arms will receive a booster dose of R21/Matrix-M1 vaccine and half will receive a placebo injection (normal saline) and be followed up for an additional 12 months. All injections will be administered intramuscularly in the deltoid region, preferably of the non-dominant arm. Post third injection, participants will be followed through the malaria transmission (rainy) season, approximately 6 months, and then the ensuing dry season for an additional 6 months. Participants will be monitored for safety, immunogenicity, and protective efficacy (malaria infection) during the follow-up period. For any women who become pregnant during the two-year period (first year and second year) of the trial, follow up will continue through the end of pregnancy, and any viable newborns/infants and their mothers will be followed through the first year of life.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Healthy Women of Child Bearing Potential

    7. Study Design

    Primary Purpose
    Prevention
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    330 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Experimental-Standard Regime Malaria Vaccine Group1
    Arm Type
    Active Comparator
    Arm Description
    Participants receiving three doses of R21/Matrix-M1 malaria vaccine at months 0, 1 and 2.
    Arm Title
    Experimental-Standard Regime Malaria Vaccine Group2
    Arm Type
    Active Comparator
    Arm Description
    Participants receiving normal saline (placebo) at month 0 and two doses of R21/Matrix-M1 malaria vaccine at month 1 and 2
    Arm Title
    Experimental-Standard Regime Group3
    Arm Type
    Active Comparator
    Arm Description
    Participants receiving three doses of normal saline (placebo) at months 0, 1 and 2
    Intervention Type
    Biological
    Intervention Name(s)
    R21/Matrix-M1
    Intervention Description
    10 µg of R21 and 50 µg of Matrix-M1
    Intervention Type
    Biological
    Intervention Name(s)
    Saline and R21/Matrix-M1
    Other Intervention Name(s)
    R21/Matrix-M1
    Intervention Description
    Saline and 10 µg of R21 and 50 µg of Matrix-M1
    Intervention Type
    Other
    Intervention Name(s)
    Sterile isotonic (0.9%) normal saline
    Other Intervention Name(s)
    Placebo
    Intervention Description
    Saline
    Primary Outcome Measure Information:
    Title
    Incidence of local and systemic solicited adverse events (AEs)
    Description
    - Incidence of local and systemic solicited adverse events (AEs) graded by severity.
    Time Frame
    Within 7 days after each vaccine administration and over 6 months post third vaccination
    Title
    Number of participants with P falciparum infection
    Description
    P. falciparum blood stage infection defined as time to first positive blood smear
    Time Frame
    Over 6 months post third vaccination
    Secondary Outcome Measure Information:
    Title
    Assessment of safety and tolerabilty
    Description
    Occurrence of unsolicited adverse events 28 days follow-up following the vaccination. Occurrence of serious adverse events for the whole study duration including in women who become pregnant.
    Time Frame
    Through study completion, an average of 26 months
    Title
    Anti-CSP antibody concentrations
    Description
    Immunological assessment measuring the anti-CSP antibody concentrations in healthy Malian women of child bearing potential
    Time Frame
    Through study completion. Timepoints: baseline, days 70, 84, 140, 196, 434, 448, 504 and 560
    Title
    Rate of P.falciparum infection during pregnancy
    Description
    P. falciparum blood stage infection defined as time to first positive blood smear during pregnancy
    Time Frame
    Over 9-months pregnancy
    Title
    Rate of P.falciparum infection
    Description
    P. falciparum blood stage infection defined as time to first positive blood smear.
    Time Frame
    Over 12-, 18- and 24-months post third vaccination
    Other Pre-specified Outcome Measures:
    Title
    Exploratory - number of participants with negative obstetric outcome
    Description
    negative maternal obstetric outcomes described as gestational diabetes, preterm premature rupture of membranes, third trimester hemorrhage, placental abruption, emergency C-section, post-partum hemorrhage, chorioamnionitis,miscarriage/stillbirth, intrauterine growth restriction, hypertensive diseases in pregnancy, preterm delivery
    Time Frame
    Over 9-months pregnancy
    Title
    Exploratory - Immunology
    Description
    Antibody levels to VAR2CSA
    Time Frame
    Through study completion, an average of 26 months
    Title
    Exploratory - Efficacy-Number of participants with symptomatic malaria
    Description
    - Symptomatic malaria defined as clinical or symptomatic malaria for this study is defined as the presence of asexual P. falciparum parasites at any parasitemia level and/or positive rapid diagnostic test with either an axillary temperature of 37.5 °C or more or one or more of the following symptoms: headache, myalgia, arthralgia, malaise, nausea, dizziness, or abdominal pain and will be reported as an AE
    Time Frame
    Through study completion, an average of 26 months
    Title
    Exploratory - Efficacy-Number of participants with subclinical malaria infection
    Description
    P. falciparum qPCR may be performed from all scheduled visits with a malaria blood smear noted to capture infections that remain below the detection limit for microscopy
    Time Frame
    Through study completion, an average of 26 months
    Title
    Exploratory - Efficacy-Number of participants with gametocytemia
    Description
    Blood smear microscopy to detect presence of P. falciparum gametocytes
    Time Frame
    Through study completion, an average of 26 months
    Title
    Exploratory - Efficacy-Number of participants with non P. falciparum malaria infection
    Description
    Blood smear microscopy to detect presence of non-P. falciparum parasites
    Time Frame
    Through study completion, an average of 26 months
    Title
    Exploratory - Efficacy-Number of infants with P falciparum infection
    Description
    P. falciparum blood stage infection at blood smear during infancy
    Time Frame
    From birth until 12 months of age
    Title
    Exploratory - Efficacy-number of participants with P falciparum placental infection
    Description
    - P. falciparum placental infection defined as any positive placental blood smear for P. falciparum.
    Time Frame
    Through study completion, an average of 26 months
    Title
    Exploratory - Number of babies with negative outcome
    Description
    negative neonatal outcome defined as neonatal death, low birth weight, small for gestational age, major malformations, hypoxic-ischemic encephalopathy, microcephaly, and APGAR score <7
    Time Frame
    Up to 1 year

    10. Eligibility

    Sex
    Female
    Gender Based
    Yes
    Gender Eligibility Description
    Healthy females of childbearing potential
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    35 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Healthy females of childbearing potential aged ≥ 18 and ≤ 35 years Able and willing (in the Investigator's opinion) to comply with all study requirements. Agreement to release medical and other information concerning contra-indications for participation in the study, and to be attended by a study clinician for physical examination and any other clinical investigations. Provide written informed consent. Available for the duration of the study Must be willing to use reliable contraception (defined as: pharmacologic contraceptives [parental delivery] or pre-existing intrauterine or implantable device) from 21 days prior to study day 1 to 28 days after third vaccination and 21 days prior to the booster vaccination to 28 days after the booster vaccination. Report being interested in becoming pregnant within the next 1 year. Exclusion Criteria: Pregnancy at the time of enrollment or any subsequent vaccination, as determined by a positive urine or serum human chorionic gonadotropin (β-hCG) test. Biologically unable to become pregnant secondary to: surgical sterilization, premature ovarian insufficiency (defined as no menses for ≥12 months without an alternative medical cause). Behavioral, cognitive, or psychiatric disease that in the opinion of the investigator affects the ability of the participant to understand and comply with the study protocol. Hemoglobin (Hgb), WBC, absolute neutrophils, and platelets outside the local laboratory-defined limits of normal and ≥ Grade 2 (participants may be included at the investigator's discretion for 'not clinically significant' abnormal values). Alanine transaminase (ALT) or creatinine (Cr) level above the local laboratory-defined upper limit of normal and ≥ Grade 2 (participants may be included at the investigator's discretion for 'not clinically significant' abnormal values). Infected with human immunodeficiency virus (HIV). Known or documented sickle cell disease by history or lab test at screening (Note: known sickle cell trait is NOT exclusionary). Evidence of clinically significant neurologic, cardiac, pulmonary, hepatic, endocrine, rheumatologic, autoimmune, hematological, oncologic, or renal disease by history, physical examination, and/or laboratory studies including urinalysis. Participation in another research study involving receipt of an investigational product in the 30 days preceding enrolment or during the trial follow up period. Medical, occupational, or family problems as a result of alcohol or illicit drug use during the past 12 months. History of allergic disease or reactions likely to be exacerbated by any component of the vaccine. History of hereditary angioedema acquired angioedema, or idiopathic angioedema. History of a severe allergic reaction (Grade 2 or higher or per PI discretion) or anaphylaxis following administration of a vaccine. Severe asthma (defined as asthma that is unstable or required emergent care, urgent care, hospitalization, or intubation during the past two years, or that has required the use of oral or parenteral corticosteroids at any time during the past two years). Pre-existing autoimmune or antibody-mediated diseases including but not limited to: systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, Sjögren's syndrome, or autoimmune thrombocytopenia. Any confirmed or suspected immunosuppressive or immunodeficient state, including asplenia; recurrent, severe infections and chronic (more than 14 days) systemically active immunosuppressant medication within the past 6 months. Use of chronic (≥14 days) oral or IV corticosteroids (excluding topical or nasal) at immunosuppressive doses (i.e., prednisone ≥20 mg/day) or immunosuppressive drugs within 30 days of vaccination. Receipt of a live vaccine within the past 28 days or a killed vaccine within the past 14 days prior to Vaccination #1 and every subsequent vaccination day. Receipt of immunoglobulins and/or blood products within the past six months. Previous receipt of an investigational malaria vaccine in the last five years. Other condition(s) that, in the opinion of the investigator, would jeopardize the safety or rights of a participant participating in the trial, interfere with the evaluation of the study objectives, or would render the participant unable to comply with the protocol.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Adrian Hill, MD
    Phone
    +44 (0)1865 280528
    Email
    adrian.hill@ndm.ox.ac.uk
    First Name & Middle Initial & Last Name or Official Title & Degree
    Alassane Dicko, MD
    Phone
    +223 20 22 81 09
    Email
    adicko@icermali.org
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Adrian Hill, MD
    Organizational Affiliation
    University of Oxford
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    33964223
    Citation
    Datoo MS, Natama MH, Some A, Traore O, Rouamba T, Bellamy D, Yameogo P, Valia D, Tegneri M, Ouedraogo F, Soma R, Sawadogo S, Sorgho F, Derra K, Rouamba E, Orindi B, Ramos Lopez F, Flaxman A, Cappuccini F, Kailath R, Elias S, Mukhopadhyay E, Noe A, Cairns M, Lawrie A, Roberts R, Valea I, Sorgho H, Williams N, Glenn G, Fries L, Reimer J, Ewer KJ, Shaligram U, Hill AVS, Tinto H. Efficacy of a low-dose candidate malaria vaccine, R21 in adjuvant Matrix-M, with seasonal administration to children in Burkina Faso: a randomised controlled trial. Lancet. 2021 May 15;397(10287):1809-1818. doi: 10.1016/S0140-6736(21)00943-0. Epub 2021 May 5.
    Results Reference
    result
    PubMed Identifier
    36087586
    Citation
    Datoo MS, Natama HM, Some A, Bellamy D, Traore O, Rouamba T, Tahita MC, Ido NFA, Yameogo P, Valia D, Millogo A, Ouedraogo F, Soma R, Sawadogo S, Sorgho F, Derra K, Rouamba E, Ramos-Lopez F, Cairns M, Provstgaard-Morys S, Aboagye J, Lawrie A, Roberts R, Valea I, Sorgho H, Williams N, Glenn G, Fries L, Reimer J, Ewer KJ, Shaligram U, Hill AVS, Tinto H. Efficacy and immunogenicity of R21/Matrix-M vaccine against clinical malaria after 2 years' follow-up in children in Burkina Faso: a phase 1/2b randomised controlled trial. Lancet Infect Dis. 2022 Dec;22(12):1728-1736. doi: 10.1016/S1473-3099(22)00442-X. Epub 2022 Sep 7.
    Results Reference
    result

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    Assessment of Safety, Immunogenicity and Efficacy of R21/Matrix-M1 Malaria Vaccine in Healthy WOCBP in Mali

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