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Dose Escalating Study of Intramuscular Invaplex[AR-DETOX]

Primary Purpose

Diarrhea

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Invaplex[AR-DETOX]
Placebo
Sponsored by
PATH
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Diarrhea focused on measuring Shigella flexneri 2a, Enteric, Shigella

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Healthy, adult, male or female, age 18 to 50 years (inclusive) at the time of enrollment.
  • Completion and review of comprehension test (achieved ≥ 70% accuracy, two attempts allowed).
  • Provide written informed consent before initiation of any study procedures.
  • Agrees to complete all study visits and procedures and to provide a screening stool sample.
  • Women of childbearing capacity: Negative pregnancy test with understanding (through informed consent process) to not become pregnant during the study or within three (3) months following the last vaccine dose.

Exclusion Criteria:

  • Health problems (for example, chronic medical conditions such as psychiatric conditions, diabetes mellitus, hypertension, or any other conditions that might place the subjects at increased risk of adverse events) - study clinicians, in consultation with the Principal Investigator (PI), will use clinical judgment on a case-by-case basis to assess safety risks under this criterion. The PI will consult with the Research Monitor as appropriate.
  • History of autoimmune disorders, cardiovascular and renal disease.
  • Use of immunosuppressive medications (systemic corticosteroids or chemotherapeutics that may influence antibody development), or immunosuppressive illness, including immunoglobulin A (IgA) deficiency (defined by serum IgA < 7 mg/dL).
  • Women who are pregnant or planning to become pregnant during the study period plus 3 months beyond the last vaccine dose and currently nursing women.
  • Participation in research involving another investigational product (defined as receipt of an investigational product or exposure to an invasive investigational device) 30 days before planned date of first vaccination or anytime throughout the duration of the study until the last in-clinic study safety visit.
  • Positive blood test for hepatitis B surface antigen (HBsAG), hepatitis C virus antibody (HCV Ab), human immunodeficiency virus (HIV)-1/HIV-2 antibody.
  • Clinically significant abnormalities on basic laboratory screening tests.
  • Systemic antimicrobial treatment (i.e., topical treatments are not an exclusion) within 1 week before administration of the first vaccine dose.
  • Allergies that may increase the risk of adverse events (AEs).
  • Regular use (weekly or more often) of antidiarrheal, anti-constipation, or antacid therapy.
  • Abnormal stool pattern (fewer than 3 stools per week or more than 3 stools per day) on a regular basis; loose or liquid stools on other than an occasional basis.
  • Personal or family history of an inflammatory arthritis.
  • Positive blood test for human leukocyte antigen (HLA) B27 (associated with increased risk of reactive arthritis secondary to Shigella infection)
  • History of allergy to any vaccine.
  • Exclusionary skin disease history/findings that would confound assessment or prevent appropriate local monitoring of AEs, or possibly increase the risk of a local AE.
  • Serum immunoglobulin G (IgG) titer > 2500 to Shigella flexneri 2a lipopolysaccharide antigen (LPS).
  • History of microbiologically confirmed Shigella infection.
  • Received previous licensed or experimental Shigella vaccine or live Shigella challenge.
  • Travel to countries where Shigella or other enteric infections are endemic (most of the developing world) within two years prior to dosing (clinician judgement).
  • Occupation involving handling of Shigella bacteria currently, or in the past 3 years.

Sites / Locations

  • Walter Reed Army Institute of Research Clinical Trials Center (WRAIR CTC)

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

Invaplex[AR-Detox] 2.5 μg

Invaplex[AR-Detox] 10 μg

Invaplex[AR-Detox] 25 μg

Placebo

Arm Description

Participants received an intramuscular injection of 2.5 μg Invaplex[AR-DETOX] vaccine on Days 1, 22, and 43.

Participants received an intramuscular injection of 10 μg Invaplex[AR-DETOX] vaccine on Days 1, 22, and 43.

Participants received an intramuscular injection of 25 μg Invaplex[AR-DETOX] vaccine on Days 1, 22, and 43.

Participants received an intramuscular injection of placebo solution on Days 1, 22, and 43.

Outcomes

Primary Outcome Measures

Percentage of Participants With Adverse Events
All adverse events (AEs) were assessed for severity by the investigator according to the following scale: Grade 1 (Mild): Does not interfere with routine activities, minimal level of discomfort; Grade 2 (Moderate): Interferes with routine activities, moderate level of discomfort; Grade 3 (Severe): Unable to perform routine activities, significant level of discomfort; Grade 4 (Potentially life-threatening): Hospitalization or ER visit for potentially life-threatening event. An AE was considered "serious" if it resulted in any of the following outcomes: Death Life-threatening AE Inpatient hospitalization or prolongation of existing hospitalization Persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions Congenital anomaly/birth defect. The Investigator assessed the relationship of each adverse event to study drug.
Number of Participants With Solicited Adverse Events Up to 7 Days After Dose 1
The solicited AEs for this study included: Site pain Site tenderness Swelling Induration (determined by investigator exam) Site redness Pruritus Fever Nausea Vomiting Abdominal pain Diarrhea (loose stools) Appetite change Fatigue Headache Myalgias (general pain or soreness in muscles) Arthralgias (general pain in joints) Malaise
Number of Participants With Solicited Adverse Events Up to 7 Days After Dose 2
The solicited AEs for this study included: Site pain Site tenderness Swelling Induration (determined by investigator exam) Site redness Pruritus Fever Nausea Vomiting Abdominal pain Diarrhea (loose stools) Appetite change Fatigue Headache Myalgias (general pain or soreness in muscles) Arthralgias (general pain in joints) Malaise
Number of Participants With Solicited Adverse Events After Dose 3
The solicited AEs for this study included: Site pain Site tenderness Swelling Induration (determined by investigator exam) Site redness Pruritus Fever Nausea Vomiting Abdominal pain Diarrhea (loose stools) Appetite change Fatigue Headache Myalgias (general pain or soreness in muscles) Arthralgias (general pain in joints) Malaise
Number of Participants With Unsolicited Adverse Events After Each Dose

Secondary Outcome Measures

Geometric Mean Titer (GMT) of Serum Immunoglobulin A (IgA) Antibodies to Invaplex
Geometric Mean Titer (GMT) of Serum Immunoglobulin G (IgG) Antibodies to Invaplex
Geometric Mean Titer (GMT) of Immunoglobulin A Antibodies to Invaplex in α4β7+ Antibody in Lymphocyte Supernatant (ALS)
Geometric Mean Titer of Immunoglobulin G Antibodies to Invaplex in α4β7+ Antibody in Lymphocyte Supernatant
Percentage of Participants With a ≥ 4-fold Increase in Serum IgA Antibodies From Baseline
Seroconversion was defined as ≥ 4-fold increase in antibody titer from Baseline.
Percentage of Participants With a ≥ 4-fold Increase in Serum IgG Antibodies From Baseline
Seroconversion was defined as ≥ 4-fold increase in antibody titer from Baseline.
Percentage of Participants With a ≥ 4-fold Increase in ALS IgA From Baseline
Seroconversion was defined as ≥ 4-fold increase in antibody titer from Baseline.
Percentage of Participants With a ≥ 4-fold Increase in ALS IgG From Baseline
Seroconversion was defined as ≥ 4-fold increase in antibody titer from Baseline.
Geometric Mean Fold-rise (GMFR) in Serum IgA From Baseline
Geometric Mean Fold-rise in Serum IgG From Baseline
Geometric Mean Fold-rise in ALS IgA From Baseline
Geometric Mean Fold-rise in ALS IgG From Baseline

Full Information

First Posted
March 4, 2019
Last Updated
July 7, 2021
Sponsor
PATH
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1. Study Identification

Unique Protocol Identification Number
NCT03869333
Brief Title
Dose Escalating Study of Intramuscular Invaplex[AR-DETOX]
Official Title
A Phase 1 Double-blind, Placebo-controlled, Dose Escalating Study of Intramuscular Detoxified Shigella Flexneri 2a Artificial Invasin Complex (Invaplex[AR-DETOX]) Vaccine
Study Type
Interventional

2. Study Status

Record Verification Date
May 2020
Overall Recruitment Status
Completed
Study Start Date
March 18, 2019 (Actual)
Primary Completion Date
June 12, 2020 (Actual)
Study Completion Date
June 12, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
PATH

4. Oversight

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

5. Study Description

Brief Summary
The main purpose of this study is to evaluate the safety of a Shigella flexneri 2a detoxified artificial invasin complex (Invaplex[AR-Detox]) vaccine candidate administered by intramuscular immunization.
Detailed Description
This is a randomized, double-blind, placebo-controlled, Phase 1 clinical trial in which a total of 60 volunteers will receive one of three doses of Invaplex[AR-DETOX] or placebo (saline). The vaccine will be administered via intramuscular (IM) injection on study days 1, 22, and 43. Each participant will receive the same formulation at each vaccination dependent upon group assignment. The study will be initiated with the lowest dose level (2.5 μg) and will proceed to the next highest dose in an escalating fashion. All safety data will be summarized and reviewed by the Protocol Safety Review Team (PSRT) prior to dose-escalation. Specimens will be collected at prescribed intervals to examine systemic and mucosal immune responses. Vaccine safety will be actively monitored during vaccination and for 28 days following the third vaccine dose.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diarrhea
Keywords
Shigella flexneri 2a, Enteric, Shigella

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Invaplex[AR-Detox] 2.5 μg
Arm Type
Experimental
Arm Description
Participants received an intramuscular injection of 2.5 μg Invaplex[AR-DETOX] vaccine on Days 1, 22, and 43.
Arm Title
Invaplex[AR-Detox] 10 μg
Arm Type
Experimental
Arm Description
Participants received an intramuscular injection of 10 μg Invaplex[AR-DETOX] vaccine on Days 1, 22, and 43.
Arm Title
Invaplex[AR-Detox] 25 μg
Arm Type
Experimental
Arm Description
Participants received an intramuscular injection of 25 μg Invaplex[AR-DETOX] vaccine on Days 1, 22, and 43.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Participants received an intramuscular injection of placebo solution on Days 1, 22, and 43.
Intervention Type
Biological
Intervention Name(s)
Invaplex[AR-DETOX]
Intervention Description
Detoxified Shigella flexneri 2a Artificial Invasin Complex (Invaplex[AR-Detox]) Vaccine
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Saline
Primary Outcome Measure Information:
Title
Percentage of Participants With Adverse Events
Description
All adverse events (AEs) were assessed for severity by the investigator according to the following scale: Grade 1 (Mild): Does not interfere with routine activities, minimal level of discomfort; Grade 2 (Moderate): Interferes with routine activities, moderate level of discomfort; Grade 3 (Severe): Unable to perform routine activities, significant level of discomfort; Grade 4 (Potentially life-threatening): Hospitalization or ER visit for potentially life-threatening event. An AE was considered "serious" if it resulted in any of the following outcomes: Death Life-threatening AE Inpatient hospitalization or prolongation of existing hospitalization Persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions Congenital anomaly/birth defect. The Investigator assessed the relationship of each adverse event to study drug.
Time Frame
From first dose up to 28 days following the third immunization (71 days)
Title
Number of Participants With Solicited Adverse Events Up to 7 Days After Dose 1
Description
The solicited AEs for this study included: Site pain Site tenderness Swelling Induration (determined by investigator exam) Site redness Pruritus Fever Nausea Vomiting Abdominal pain Diarrhea (loose stools) Appetite change Fatigue Headache Myalgias (general pain or soreness in muscles) Arthralgias (general pain in joints) Malaise
Time Frame
7 days after the first immunization (Days 1 to 7)
Title
Number of Participants With Solicited Adverse Events Up to 7 Days After Dose 2
Description
The solicited AEs for this study included: Site pain Site tenderness Swelling Induration (determined by investigator exam) Site redness Pruritus Fever Nausea Vomiting Abdominal pain Diarrhea (loose stools) Appetite change Fatigue Headache Myalgias (general pain or soreness in muscles) Arthralgias (general pain in joints) Malaise
Time Frame
7 days after the second immunization (Days 22 to 28)
Title
Number of Participants With Solicited Adverse Events After Dose 3
Description
The solicited AEs for this study included: Site pain Site tenderness Swelling Induration (determined by investigator exam) Site redness Pruritus Fever Nausea Vomiting Abdominal pain Diarrhea (loose stools) Appetite change Fatigue Headache Myalgias (general pain or soreness in muscles) Arthralgias (general pain in joints) Malaise
Time Frame
7 days after the third immunization (Days 43 to 49)
Title
Number of Participants With Unsolicited Adverse Events After Each Dose
Time Frame
Dose 1: Days 1 to 21; Dose 2: Days 22 to 42; Dose 3: Days 43 to 71
Secondary Outcome Measure Information:
Title
Geometric Mean Titer (GMT) of Serum Immunoglobulin A (IgA) Antibodies to Invaplex
Time Frame
Days 1 (Baseline), 22, 43, 50, 57 and 71.
Title
Geometric Mean Titer (GMT) of Serum Immunoglobulin G (IgG) Antibodies to Invaplex
Time Frame
Days 1 (Baseline), 22, 43, 50, 57 and 71.
Title
Geometric Mean Titer (GMT) of Immunoglobulin A Antibodies to Invaplex in α4β7+ Antibody in Lymphocyte Supernatant (ALS)
Time Frame
Days 1 (Baseline), 8, 29, and 50
Title
Geometric Mean Titer of Immunoglobulin G Antibodies to Invaplex in α4β7+ Antibody in Lymphocyte Supernatant
Time Frame
Days 1 (Baseline), 8, 29, and 50
Title
Percentage of Participants With a ≥ 4-fold Increase in Serum IgA Antibodies From Baseline
Description
Seroconversion was defined as ≥ 4-fold increase in antibody titer from Baseline.
Time Frame
Days 1 (Baseline), 22 43, 50, 57 and 71
Title
Percentage of Participants With a ≥ 4-fold Increase in Serum IgG Antibodies From Baseline
Description
Seroconversion was defined as ≥ 4-fold increase in antibody titer from Baseline.
Time Frame
Days 1 (Baseline), 22 43, 50, 57 and 71
Title
Percentage of Participants With a ≥ 4-fold Increase in ALS IgA From Baseline
Description
Seroconversion was defined as ≥ 4-fold increase in antibody titer from Baseline.
Time Frame
Days 1 (Baseline), 8, 29, and 50
Title
Percentage of Participants With a ≥ 4-fold Increase in ALS IgG From Baseline
Description
Seroconversion was defined as ≥ 4-fold increase in antibody titer from Baseline.
Time Frame
Days 1 (Baseline), 8, 29, and 50
Title
Geometric Mean Fold-rise (GMFR) in Serum IgA From Baseline
Time Frame
Days 1 (Baseline), 22, 43, 50, 57 and 71.
Title
Geometric Mean Fold-rise in Serum IgG From Baseline
Time Frame
Days 1 (Baseline), 22, 43, 50, 57 and 71.
Title
Geometric Mean Fold-rise in ALS IgA From Baseline
Time Frame
Days 1 (Baseline), 8, 29, and 50
Title
Geometric Mean Fold-rise in ALS IgG From Baseline
Time Frame
Days 1 (Baseline), 8, 29, and 50

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Healthy, adult, male or female, age 18 to 50 years (inclusive) at the time of enrollment. Completion and review of comprehension test (achieved ≥ 70% accuracy, two attempts allowed). Provide written informed consent before initiation of any study procedures. Agrees to complete all study visits and procedures and to provide a screening stool sample. Women of childbearing capacity: Negative pregnancy test with understanding (through informed consent process) to not become pregnant during the study or within three (3) months following the last vaccine dose. Exclusion Criteria: Health problems (for example, chronic medical conditions such as psychiatric conditions, diabetes mellitus, hypertension, or any other conditions that might place the subjects at increased risk of adverse events) - study clinicians, in consultation with the Principal Investigator (PI), will use clinical judgment on a case-by-case basis to assess safety risks under this criterion. The PI will consult with the Research Monitor as appropriate. History of autoimmune disorders, cardiovascular and renal disease. Use of immunosuppressive medications (systemic corticosteroids or chemotherapeutics that may influence antibody development), or immunosuppressive illness, including immunoglobulin A (IgA) deficiency (defined by serum IgA < 7 mg/dL). Women who are pregnant or planning to become pregnant during the study period plus 3 months beyond the last vaccine dose and currently nursing women. Participation in research involving another investigational product (defined as receipt of an investigational product or exposure to an invasive investigational device) 30 days before planned date of first vaccination or anytime throughout the duration of the study until the last in-clinic study safety visit. Positive blood test for hepatitis B surface antigen (HBsAG), hepatitis C virus antibody (HCV Ab), human immunodeficiency virus (HIV)-1/HIV-2 antibody. Clinically significant abnormalities on basic laboratory screening tests. Systemic antimicrobial treatment (i.e., topical treatments are not an exclusion) within 1 week before administration of the first vaccine dose. Allergies that may increase the risk of adverse events (AEs). Regular use (weekly or more often) of antidiarrheal, anti-constipation, or antacid therapy. Abnormal stool pattern (fewer than 3 stools per week or more than 3 stools per day) on a regular basis; loose or liquid stools on other than an occasional basis. Personal or family history of an inflammatory arthritis. Positive blood test for human leukocyte antigen (HLA) B27 (associated with increased risk of reactive arthritis secondary to Shigella infection) History of allergy to any vaccine. Exclusionary skin disease history/findings that would confound assessment or prevent appropriate local monitoring of AEs, or possibly increase the risk of a local AE. Serum immunoglobulin G (IgG) titer > 2500 to Shigella flexneri 2a lipopolysaccharide antigen (LPS). History of microbiologically confirmed Shigella infection. Received previous licensed or experimental Shigella vaccine or live Shigella challenge. Travel to countries where Shigella or other enteric infections are endemic (most of the developing world) within two years prior to dosing (clinician judgement). Occupation involving handling of Shigella bacteria currently, or in the past 3 years.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ramiro Gutierrez, MD, MPH
Organizational Affiliation
Naval Medical Research Center (NMRC)
Official's Role
Principal Investigator
Facility Information:
Facility Name
Walter Reed Army Institute of Research Clinical Trials Center (WRAIR CTC)
City
Silver Spring
State/Province
Maryland
ZIP/Postal Code
20910
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Dose Escalating Study of Intramuscular Invaplex[AR-DETOX]

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