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Safety and Efficacy of Sanaria's PfSPZ-CVac in Malian Adults

Primary Purpose

Plasmodium Falciparum Infection

Status
Completed
Phase
Phase 1
Locations
Mali
Study Type
Interventional
Intervention
Artesunate
Chloroquine
PfSPZ (NF54) Challenge
Placebo
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 Plasmodium Falciparum Infection focused on measuring Chloroquine Chemoprophylaxis, Efficacy, Immunogenicity, Malaria, Placebo, Plasmodium falciparum Sporozoites, Safety, Tolerability

Eligibility Criteria

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

Inclusion Criteria:

  1. A male or non-pregnant female aged 18-45 years inclusive at the time of screening.
  2. For women of childbearing potential, willingness not to become pregnant or breastfeed until one month after the last CQ dose*.

    *Pre-menopausal female participants will be referred to the local family planning clinic, which offers several means of contraception that are approved and recommended by the Mali Ministry of Health. Contraception (male or female condoms, diaphragm or cervical cap with spermicide, intrauterine device, or hormone-based contraceptive) should be started 30 days before the first vaccination and continue until 30 days after last vaccination.

  3. Written informed consent obtained from the participant before screening.
  4. Available and willing to participate in follow-up for the duration of study.
  5. Residing in Bougoula Hameau region and environs.
  6. In general good health based on clinical and laboratory investigation.

Exclusion Criteria:

  1. Previous vaccination with an investigational malaria vaccine.
  2. Use of an investigational or non-registered drug or vaccine other than the study vaccine(s) within 30 days before the first study vaccination, or planned use up to 30 days after last vaccination.
  3. Chronic administration (defined as more than 14 days) of immunosuppressants or other immune-modifying drugs within six months before the first vaccination*.

    *This includes any dose level of oral steroids, but not inhaled steroids or topical steroids.

  4. Planned administration/administration of a vaccine not foreseen by the study protocol within 30 days before the first study vaccination with the exception of tetanus toxoid.
  5. Confirmed or suspected immunosuppressive or immunodeficient condition.
  6. Confirmed or suspected autoimmune disease.
  7. History of allergic reactions or anaphylaxis to chloroquine, 4-aminoquinolone derivatives, artesunate and artemisinin derivatives, vaccinations or to any vaccine component.
  8. History of serious allergic reactions to any substance, requiring hospitalization or emergent medical care.
  9. History of allergy to any component of the PfSPZ Challenge product, including human serum albumin.
  10. Use or planned use of any drug with anti-malarial activity during the course of the study except for antimalarial medication administered by study clinicians.
  11. History of splenectomy.
  12. Confirmed pregnancy.
  13. Laboratory evidence of liver disease (ALT > upper limit of normal).
  14. Laboratory evidence of renal disease (serum or plasma creatinine > upper limit of normal).
  15. Laboratory evidence of hematologic disease (platelet count <114,000/mm^3 for males and <144,000/mm^3 for females, or hemoglobin <11.2 g/dL for males and <9.5 g/dL for females).
  16. Seropositive for hepatitis B surface antigen or hepatitis C virus (hepatitis C antibody).
  17. Seropositive for HIV.
  18. Sickle cell trait carriage or sickle cell disease.
  19. Administration of immunoglobulin and/or any blood products within the three months preceding the first study. vaccination or planned administration during the study period.
  20. Simultaneous participation in any other interventional clinical trial.
  21. Acute or chronic pulmonary, cardiovascular, hepatic, renal or neurological condition, severe malnutrition, or any other clinical findings that may increase the risk of participating in the study*.

    *As determined by the PI.

  22. Has evidence of increased cardiovascular disease risk (defined as > 10 percent, 5 year risk) as determined by the method of Gaziano*.

    *Risk factors include sex, age (years), systolic blood pressure (mm Hg), smoking status, body mass index (BMI, kg/mm^2), reported diabetes status, and blood pressure.

  23. Abnormal screening ECG*.

    *Pathologic Q wave and significant ST-T wave changes, left ventricular hypertrophy, non-sinus rhythm except isolated premature atrial or ventricular contractions, right or left bundle branch block, advanced A-V heart block (secondary or tertiary), QT/QTc interval >450 ms.

  24. Other condition that in the opinion of the PI would jeopardize the safety or rights of a participant in the trial or would render the participant unable to comply with the protocol.
  25. Documented history of non-febrile seizures or atypical (complex) febrile seizures.

Sites / Locations

  • University of Bamako - Epidemiology of Parasitic Diseases - Malaria Research and Training Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

204,800 PfSPZ of PfSPZ Challenge

NaCl placebo

Arm Description

204,800 PfSPZ of PfSPZ Challenge every 4 weeks x 3 doses by DVI, n=31

NaCl placebo every 4 weeks x 3 doses by DVI, n=31

Outcomes

Primary Outcome Measures

The number of serious adverse events (SAEs)
The number of solicited local and systemic adverse events (AE)
The number of unsolicited AEs related to study product
The severity of solicited local and systemic adverse events (AE)
The severity of unsolicited AEs related to study product

Secondary Outcome Measures

Antibody titers against P. falciparum circumsporozoite protein (CSP) and other P. falciparum proteins at serology time points
Markers of cell-mediated immunity as assessed by cells producing interferon gamma and/or IL-2
Time to P. falciparum parasitemia, detected by qPCR
Time to P. falciparum parasitemia, detected by qPCR
Time to P. falciparum parasitemia, detected by thick blood film microscopy
Time to P. falciparum parasitemia, detected by thick blood smear microscopy

Full Information

First Posted
December 15, 2016
Last Updated
November 27, 2019
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT02996695
Brief Title
Safety and Efficacy of Sanaria's PfSPZ-CVac in Malian Adults
Official Title
Safety, Tolerability, Immunogenicity and Protective Efficacy Against Naturally-Transmitted Malaria of Infectious, Cryopreserved Plasmodium Falciparum Sporozoites (PfSPZ Challenge) Administered by Direct Venous Inoculation Under Chloroquine Chemoprophylaxis (PfSPZ-CVac), in Malian Adults: A Randomized, Double Blind, Placebo-Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
July 19, 2017
Overall Recruitment Status
Completed
Study Start Date
April 6, 2017 (Actual)
Primary Completion Date
June 22, 2018 (Actual)
Study Completion Date
June 22, 2018 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
Single site, double-blinded, randomized, placebo-controlled clinical trial of PfSPZ-CVac safety, tolerability, immunogenicity and efficacy against naturally occurring malaria in malaria-exposed Malian adults. The overall goal of the study is to evaluate if a regimen of PfSPZ-CVac (PfSPZ Challenge under chemoprophylaxis) is safe, well-tolerated, and provides sterile protection against naturally-occurring malaria in malaria-experienced adults. The study population includes 62 healthy, malaria-experienced adults aged 18-45 years, inclusive, residing in Bougoula Hameau and surrounding villages, Mali. The primary objective of this study is to assess the safety and tolerability of PfSPZ Challenge compared to placebo among malaria-experienced adults taking chloroquine prophylaxis (PfSPZ-CVac)
Detailed Description
This is a single site, double-blinded, randomized, placebo-controlled clinical trial of PfSPZ-CVac safety, tolerability, immunogenicity and efficacy against naturally occurring malaria in malaria-exposed Malian adults. The overall goal of the study is to evaluate if a regimen of PfSPZ-CVac (PfSPZ Challenge under chemoprophylaxis) is safe, well-tolerated, and provides sterile protection against naturally-occurring malaria in malaria-experienced adults. Participants will receive three immunizing PfSPZ Challenge injections via direct venous inoculation (DVI) four weeks apart under chloroquine chemoprophylaxis. The PfSPZ Challenge dose will be 204,800 PfSPZ. This is based on results of studies in Europe and in Africa. In Tübingen, Germany, 100% of malaria-naïve adults who received three doses of 51,200 PfSPZ every four weeks under chloroquine chemoprophylaxis were protected against homologous controlled human malaria infection (CHMI). At the same time, studies of PfSPZ Vaccine in malaria-experienced adults in Mali and in Tanzania demonstrate that higher doses of PfSPZ are required to demonstrate immunogenicity and high grade protection in malaria-experienced adults that is comparable to that achieved in malaria-naïve adults studied in the USA. For this reason, the dose selected for this study is four-fold higher than the dose used for Tübingen, Germany. Controls will receive 0.9% sodium chloride (NaCl) as placebo. All participants will receive a standard chemoprophylactic regimen of chloroquine (CQ) for 10 weeks. Chloroquine will be given as a loading dose (600mg chloroquine base) two days before the first administration of PfSPZ Challenge, followed by weekly doses of chloroquine (300mg chloroquine base weekly). Participants will also be treated with a 7-day regimen of artesunate (200 mg per day) after the last PfSPZ Challenge dose of 204,800 sporozoites for malaria parasite clearance, one week after the last CQ dose is given. A total of 62 participants will be randomized in a 1:1 ratio to one of two groups and will be inoculated with PfSPZ Challenge or 0.9% NaCl by DVI so that a total of 62 adults will participate in the study. Participants will be recruited from the MRTC's Bougoula-Hameau site. All volunteers recruited will be healthy adults aged between 18 and 45 years. Safety and infectivity data will be collected. Volunteers, clinical and laboratory investigators will be blinded to group allocation. Participants will be followed every four weeks after the last vaccination as outpatients for active malaria diagnosis and treatment. Passive follow-up will be accomplished by continuous availability of study staff onsite to diagnose and treat malaria and other medical issues that arise. The primary objective of this study is to assess the safety and tolerability of PfSPZ Challenge compared to placebo among malaria-experienced adults taking chloroquine prophylaxis (PfSPZ-CVac). The secondary objectives are: 1. to assess the protective efficacy of PfSPZ-CVac against naturally transmitted P. falciparum malaria infection as diagnosed by thick blood smear microscopy, 2. To assess protective efficacy of PfSPZ-CVac against naturally transmitted P. falciparum malaria infection as diagnosed by qPCR, 3. to assess the expanded efficacy of PfSPZ-CVac compared to placebo, and 4. to examine the immune response to P. falciparum malaria infection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Plasmodium Falciparum Infection
Keywords
Chloroquine Chemoprophylaxis, Efficacy, Immunogenicity, Malaria, Placebo, Plasmodium falciparum Sporozoites, Safety, Tolerability

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
62 (Actual)

8. Arms, Groups, and Interventions

Arm Title
204,800 PfSPZ of PfSPZ Challenge
Arm Type
Experimental
Arm Description
204,800 PfSPZ of PfSPZ Challenge every 4 weeks x 3 doses by DVI, n=31
Arm Title
NaCl placebo
Arm Type
Placebo Comparator
Arm Description
NaCl placebo every 4 weeks x 3 doses by DVI, n=31
Intervention Type
Drug
Intervention Name(s)
Artesunate
Intervention Description
Artesunate is a succinic ester of artemether.
Intervention Type
Drug
Intervention Name(s)
Chloroquine
Intervention Description
4-aminoquinolone, antimalarial agent for oral administration
Intervention Type
Biological
Intervention Name(s)
PfSPZ (NF54) Challenge
Intervention Description
Cryopreserved Plasmodium falciparum (Pf) fully infectious sporozoites (SPZ) that have been developed to be used to infect volunteers in controlled human malaria infection (CHMI) to assess the efficacy of antimalarial drugs and vaccines. The PfSPZ (NF54) Challenge contains a laboratory malaria strain isolated from a Dutch traveler to Africa.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo
Primary Outcome Measure Information:
Title
The number of serious adverse events (SAEs)
Time Frame
45 days
Title
The number of solicited local and systemic adverse events (AE)
Time Frame
Day 12 after vaccination
Title
The number of unsolicited AEs related to study product
Time Frame
Day 12 after vaccination
Title
The severity of solicited local and systemic adverse events (AE)
Time Frame
Day 12 after vaccination
Title
The severity of unsolicited AEs related to study product
Time Frame
Day 12 after vaccination
Secondary Outcome Measure Information:
Title
Antibody titers against P. falciparum circumsporozoite protein (CSP) and other P. falciparum proteins at serology time points
Time Frame
Days 3, 15, 31, 43,59, 71-77,87,245,and 413
Title
Markers of cell-mediated immunity as assessed by cells producing interferon gamma and/or IL-2
Time Frame
Days 3, 15, 31, 43,59, 71-77,87,245,and 413
Title
Time to P. falciparum parasitemia, detected by qPCR
Time Frame
within six months after the last vaccination
Title
Time to P. falciparum parasitemia, detected by qPCR
Time Frame
within twelve months after the last vaccination
Title
Time to P. falciparum parasitemia, detected by thick blood film microscopy
Time Frame
within twelve months after the last vaccination
Title
Time to P. falciparum parasitemia, detected by thick blood smear microscopy
Time Frame
Within six months after the last vaccination

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: A male or non-pregnant female aged 18-45 years inclusive at the time of screening. For women of childbearing potential, willingness not to become pregnant or breastfeed until one month after the last CQ dose*. *Pre-menopausal female participants will be referred to the local family planning clinic, which offers several means of contraception that are approved and recommended by the Mali Ministry of Health. Contraception (male or female condoms, diaphragm or cervical cap with spermicide, intrauterine device, or hormone-based contraceptive) should be started 30 days before the first vaccination and continue until 30 days after last vaccination. Written informed consent obtained from the participant before screening. Available and willing to participate in follow-up for the duration of study. Residing in Bougoula Hameau region and environs. In general good health based on clinical and laboratory investigation. Exclusion Criteria: Previous vaccination with an investigational malaria vaccine. Use of an investigational or non-registered drug or vaccine other than the study vaccine(s) within 30 days before the first study vaccination, or planned use up to 30 days after last vaccination. Chronic administration (defined as more than 14 days) of immunosuppressants or other immune-modifying drugs within six months before the first vaccination*. *This includes any dose level of oral steroids, but not inhaled steroids or topical steroids. Planned administration/administration of a vaccine not foreseen by the study protocol within 30 days before the first study vaccination with the exception of tetanus toxoid. Confirmed or suspected immunosuppressive or immunodeficient condition. Confirmed or suspected autoimmune disease. History of allergic reactions or anaphylaxis to chloroquine, 4-aminoquinolone derivatives, artesunate and artemisinin derivatives, vaccinations or to any vaccine component. History of serious allergic reactions to any substance, requiring hospitalization or emergent medical care. History of allergy to any component of the PfSPZ Challenge product, including human serum albumin. Use or planned use of any drug with anti-malarial activity during the course of the study except for antimalarial medication administered by study clinicians. History of splenectomy. Confirmed pregnancy. Laboratory evidence of liver disease (ALT > upper limit of normal). Laboratory evidence of renal disease (serum or plasma creatinine > upper limit of normal). Laboratory evidence of hematologic disease (platelet count <114,000/mm^3 for males and <144,000/mm^3 for females, or hemoglobin <11.2 g/dL for males and <9.5 g/dL for females). Seropositive for hepatitis B surface antigen or hepatitis C virus (hepatitis C antibody). Seropositive for HIV. Sickle cell trait carriage or sickle cell disease. Administration of immunoglobulin and/or any blood products within the three months preceding the first study. vaccination or planned administration during the study period. Simultaneous participation in any other interventional clinical trial. Acute or chronic pulmonary, cardiovascular, hepatic, renal or neurological condition, severe malnutrition, or any other clinical findings that may increase the risk of participating in the study*. *As determined by the PI. Has evidence of increased cardiovascular disease risk (defined as > 10 percent, 5 year risk) as determined by the method of Gaziano*. *Risk factors include sex, age (years), systolic blood pressure (mm Hg), smoking status, body mass index (BMI, kg/mm^2), reported diabetes status, and blood pressure. Abnormal screening ECG*. *Pathologic Q wave and significant ST-T wave changes, left ventricular hypertrophy, non-sinus rhythm except isolated premature atrial or ventricular contractions, right or left bundle branch block, advanced A-V heart block (secondary or tertiary), QT/QTc interval >450 ms. Other condition that in the opinion of the PI would jeopardize the safety or rights of a participant in the trial or would render the participant unable to comply with the protocol. Documented history of non-febrile seizures or atypical (complex) febrile seizures.
Facility Information:
Facility Name
University of Bamako - Epidemiology of Parasitic Diseases - Malaria Research and Training Center
City
Sikasso
Country
Mali

12. IPD Sharing Statement

Citations:
PubMed Identifier
35928033
Citation
Coulibaly D, Kone AK, Traore K, Niangaly A, Kouriba B, Arama C, Zeguime A, Dolo A, Lyke KE, Plowe CV, Abebe Y, Potter GE, Kennedy JK, Galbiati SM, Nomicos E, Deye GA, Richie TL, James ER, Kc N, Sim BKL, Hoffman SL, Doumbo OK, Thera MA, Laurens MB; DMID 15-0052 PfSPZ-CVac Study Team. PfSPZ-CVac malaria vaccine demonstrates safety among malaria-experienced adults: A randomized, controlled phase 1 trial. EClinicalMedicine. 2022 Jul 30;52:101579. doi: 10.1016/j.eclinm.2022.101579. eCollection 2022 Oct.
Results Reference
derived

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Safety and Efficacy of Sanaria's PfSPZ-CVac in Malian Adults

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