search
Back to results

Safety and Immunogenicity of the Malaria Vaccine, R21/MatrixM, in Healthy Thai Adults (R21/Matrix-M)

Primary Purpose

Malaria,Falciparum

Status
Recruiting
Phase
Phase 2
Locations
Thailand
Study Type
Interventional
Intervention
R21/Matrix-M vaccination
DHA-PIP
PQ
Sponsored by
University of Oxford
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Malaria,Falciparum focused on measuring Malaria vaccine, Immunogenicity of the malaria vaccine, Immunologic response to malaria vaccine

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria

The participant is eligible to enter the study if all of the following apply:

  1. Participant is a healthy adult, aged 18 to 55 years (inclusive), of Thai origin.
  2. Participant is willing and able to give informed consent to participate in the trial
  3. Able, in the investigator's opinion, and willing to comply with the study requirements and follow-up.
  4. Women of childbearing potential: must agree to practice continuous, effective contraception for the duration of the trial, and have a negative pregnancy test before each vaccination. (Costs for contraceptives will be reimbursed by the trial.)

Exclusion criteria

The following criteria should be checked at the time of study entry. If ANY exclusion criterion applies, the subject must not be included in the study:

  1. Pregnancy or breastfeeding, or planned pregnancy during the course of the study.
  2. Presence of any medical condition (physical or mental) which, may place the participant at undue risk or interfere with the results of the study*. Including: serious cardiac, renal, hepatic or neurological disease, severe malnutrition
  3. Any confirmed or suspected immunosuppressive or immunodeficient condition. Including: history of splenectomy, human immunodeficiency virus (HIV) infection
  4. Chronic administration (>14 days in total) of immunosuppressants or other immune-modifying drugs within six months of enrollment. Including: oral corticosteroids equivalent to prednisone > 20 mg/day (a)
  5. History of an autoimmune disease
  6. Hepatitis B surface antigen (HBsAg) detected in serum.
  7. Screening electrocardiogram (ECG) demonstrating a QTc interval ≥ 450 ms
  8. Seropositivity for hepatitis C virus (antibodies to HCV) at screening (b)
  9. Finding on safety laboratory values as defined below:

    • AST > 2 x upper normal limit
    • ALT > 2 x upper normal limit
    • Anaemia (Hb < 10 g/dL),
    • Platelets < 100,000
    • Total bilirubin > 2 x upper normal limit
  10. Abnormalities of examination or investigations at screening. Including: hepatomegaly, right upper quadrant abdominal pain or tenderness, abnormal blood tests (as defined in the protocol which are not listed above)
  11. Positive malaria parasitaemia at screening or baseline (Month 0, Day 0).
  12. Receipt or planned receipt of an investigational medical product or participation in an interventional clinical trial during the study period
  13. Contraindications to the use of artemisinins, piperaquine or primaquine*. Including: use of medications with known potential interactions, prior allergic reactions to one or more components of the drug regimen.
  14. History of allergic disease or reactions likely to be exacerbated by any component of the vaccine (e.g. egg products)
  15. History of clinically significant contact dermatitis.
  16. Contraindication to intramuscular (IM) injection*
  17. Administration of a vaccine not included in the study protocol within 30 days of a study vaccine (c).
  18. History of anaphylaxis post-vaccination.
  19. Administration of immunoglobulins and/or any blood products during the period starting three months before the first dose of study vaccine or planned administration during the study period.

    • subject to the investigator's judgement

Exceptions:

a Inhaled and topical steroids. b Participation in hepatitis C vaccine study with confirmed negative HCV antibodies prior to participation in that study, and negative HCV RNA PCR at screening for this study c The following vaccinations may be administered more than 7 days before or after a study vaccination: polio, diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Bacillus Calmette-Guérin (BCG vaccine), measles, influenza, pneumococcal disease, COVID-19 or yellow fever

Sites / Locations

  • Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

R21/Matrix-M + DHA-PIP+PQ

R21/Matrix-M only

DHA-PIP+PQ only

Arm Description

The R21/Matrix-M vaccine (IM injection) + co-formulated Dihydroartemisinin/Piperaquine tablets + one single low dose of Primaquine

The R21/Matrix-M vaccine (IM injection) only

Co-formulated Dihydroartemisinin/Piperaquine tablets + one single low dose of Primaquine

Outcomes

Primary Outcome Measures

Occurrence of adverse events (AEs), according to the Medical Dictionary for Regulatory Activities (MedRA) classification.
Occurrence of serious adverse events (SAEs), according to the MedRA classification.

Secondary Outcome Measures

For Arms 1 and 2, the concentration of antibodies against Plasmodium falciparum circumsporozoite (anti-NANP total IgG antibody)circumsporozoite (anti-circumsporoziote antibody)
For Arms 1 and 2, the concentration of antibodies against Plasmodium falciparum circumsporozoite (anti-NANP total IgG antibody)
For Arms 1 and 2, the concentration of antibodies against Plasmodium falciparum circumsporozoite (anti-NANP total IgG antibody)
For Arms 1 and 2, the concentration of antibodies against Plasmodium falciparum circumsporozoite (anti-NANP total IgG antibody)
Exploratory immunology endpoints including but not limited to cellular immunity
Exploratory immunology endpoints including but not limited to cellular immunity
Exploratory immunology endpoints including but not limited to cellular immunity
Exploratory immunology endpoints including but not limited to cellular immunity
For Arms 1 and 3, piperaquine levels following the administration of the antimalarials with or without vaccine

Full Information

First Posted
January 10, 2022
Last Updated
June 15, 2023
Sponsor
University of Oxford
search

1. Study Identification

Unique Protocol Identification Number
NCT05252845
Brief Title
Safety and Immunogenicity of the Malaria Vaccine, R21/MatrixM, in Healthy Thai Adults
Acronym
R21/Matrix-M
Official Title
A Randomized, Open Label, Single Centre, Phase 2 Trial of the Malaria Vaccine, R21/Matrix-M, to Assess Safety and Immunogenicity of the Vaccine in Thai Adults
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 4, 2023 (Actual)
Primary Completion Date
June 8, 2023 (Actual)
Study Completion Date
September 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Oxford

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
Malaria remains one of the leading causes of morbidity and mortality worldwide. Plasmodium falciparum is a complex pathogen with numerous immune evasion mechanisms which has added layers of complexity to the development of safe and protective vaccines. There remains an urgent need to identify and develop more protective and more affordable vaccine candidates that could achieve the World Health Organization (WHO) goal of 75% efficacy against clinical malaria. R21 is a novel pre-erythrocytic candidate malaria vaccine. R21 includes Hepatitis B surface antigen (HBsAg) fused to the C-terminus and central repeats of the circumsporozoite protein of P. falciparum (CSP), which self-assemble into virus-like particles in yeast. R21 lacks the excess HBsAg found and comprises only fusion protein moieties. R21/MatrixM (MM) had a favourable safety profile and was well tolerated. The majority of adverse events were mild, with the most common event being fever. None of the serious adverse events were attributed to the vaccine. At one year, vaccine efficacy remained high, at 77%. Participants vaccinated with R21/MM showed high titres of malaria-specific anti- Asn-Ala-Asn-Pro (NANP) antibodies 28 days after the third vaccination, which were almost doubled with the higher adjuvant dose. Titres waned but were boosted to levels similar to peak titres after the primary series of vaccinations after a fourth dose administered one year later. Currently, there are no safety and immunogenicity data for the use of R21/MatrixM in Asian populations. This trial will generate the required data for the use of this vaccine in Asia. For integration with the current targeted malaria elimination (TME) activities, which provide mass drug administrations at months M0, M1, and M2, it would be most efficient and practical to provide the vaccine at the same intervals. In summary: The investigators propose to conduct a safety and immunogenicity trial of R21/MatrixM in Thai adults. The major aims of this study are to 1) assess the safety and immunogenicity of R21/MatrixM in Thai adults 2) confirm that the co-administration of antimalarial drugs with the malaria vaccine R21/MatrixM does not reduce the immunogenicity of the vaccine and 3) assess the absorption and pharmacokinetics of antimalarial drugs piperaquine, and a single low dose of primaquine (SLDPQ) when co-administered with R21/MatrixM. This is a randomized, open label, single centre, Phase 2 study. 120 healthy non-pregnant Thai adults, aged 18-55 years, inclusive, will be recruited. Each participant will be randomized into one of the following study arms in a ratio of 5:5:2, as follows: R21/MatrixM + Dihydroartimisinin (DHA)-Piperaquine (PIP)+ primaquine (PQ) (Group 1, n=50) will receive R21/MatrixM + 3 doses DHA-PIP+PQ at Month 0, Month 1 and Month 2 R21/MatrixM only (Group 2, n=50) will receive R21/MatrixM standard dose at Month 0, Month 1 and Month 2 DHA-PIP+PQ only (Group 3, n=20) will receive 3 doses DHA-PIP+PQ at Month 0, Month 1 and Month 2
Detailed Description
This is a randomized, open label, single centre, Phase 2 study. Screening and eligibility assessment (Screening visit) All potential volunteers will have a screening visit, which may take place up to 30 days prior to enrolment. Once informed consent is given, a screening number will be assigned in sequential order. Screening numbers will be issued consecutively (e.g. R21-001, R21-002, R21-003, …) Enrolment, baseline assessment, regimen allocation, and first vaccination (Month 0 / Day 0 visit; Baseline visit) All inclusion and exclusion criteria will be checked before enrolment in the study. Physical examination will be performed. Any new medical issues or symptoms that have arisen will be assessed. Blood will be collected for baseline P. falciparum testing, haemoglobin and biochemistry. Participants with parasitaemia or anaemia will be treated according to national guidelines. Blood will be collected and stored for measurement of antibodies against P. falciparum circumsporozoite (anti-circumsporozoite antibody) until shipment to the reference laboratory. Urine will be collected from women of child-bearing age for immediate pregnancy test. Enrolment, baseline assessment, regimen allocation, and first vaccination (Month 0 / Day 0 visit; Baseline visit) All inclusion and exclusion criteria will be checked before enrolment in the study. Physical examination will be performed. Any new medical issues or symptoms that have arisen will be assessed. Blood will be collected for baseline P. falciparum testing, haemoglobin and biochemistry. Blood will be collected and stored for measurement of antibodies against P. falciparum circumsporozoite (anti-circumsporozoite antibody) until shipment to the reference laboratory. Urine will be collected from women of child-bearing age for immediate pregnancy test. If all inclusion criteria are fulfilled and none of the exclusion criteria apply, the patient will be enrolled into the study and a case record form (CRF) specific to each participant completed. Regimen allocation and administration of the vaccine(s) will be on Day 0. The randomization lists will be prepared by Mahidol-Oxford Tropical Medicine Research Unit (MORU). Randomization numbers will be generated in blocks, for the 3 study arms in a ratio of 5:5:2, as follows: R21/MatrixM + DHA-PIP+PQ (Group 1) R21/MatrixM alone (Group 2) DHA-PIP+PQ alone (Group 3) Study participants will be assigned the next available randomization number on the list, and thus will be randomly allocated to Group 1, 2, or 3. This is an open-label study. Participants and clinical investigators will not be blinded to group allocation. Subjects will then be vaccinated by intramuscular (IM) needle injection into the deltoid region of the arm. Subjects in Groups 1 and 3 will also receive anti-malarial medications. The study participants will be observed closely for at least 30 minutes following the administration of each study vaccine, with appropriate medical treatment readily available in case of an anaphylactic reaction. Subsequent vaccination visits (Month 1 / Day 0 and Month 2 / Day 0 visits) Physical examination will be performed. Any new medical issues or symptoms that have arisen will be assessed. Blood will be collected for P. falciparum testing. Participants with parasitaemia or anaemia will be treated according to national guidelines. Blood will be collected and stored for measurement of antibodies against P. falciparum circumsporozoite (anti-circumsporozoite) until shipment to the reference laboratory. Urine will be collected from women of child-bearing age for immediate pregnancy test. Before vaccination, the on-going eligibility of the volunteer will be reviewed. All participants will attend the clinic for vaccination visits, will be observed closely for at least 30 minutes following the administration of each study vaccine. Follow up assessments Follow-up assessments (visits not involving vaccination) will be done at month 3 and month 6 after the first vaccination. Blood tests Blood will be drawn at the time points indicated in the schedule of procedures and the following laboratory assays performed: At screening: Haematology: haemoglobin (Hb), leukocytes (white blood cells [WBC]) and platelets (PLT). Biochemistry: alanine aminotransferase (ALT), aspartate aminotransferase (AST) and creatinine (CREA). Diagnostic serology: HBsAg, HCV antibodies, HIV antibodies (Counselling will be given prior to testing blood for these blood-borne viruses) P. falciparum testing At M0, D0: P. falciparum testing, Haematology: Hb, WBC, PLT, Biochemistry: ALT, AST, CREA, anti-circumsporozoite antibody; Pharmacokinetics (piperaquine and primaquine drug levels will be assessed if additional data are required) At M0, D1: Pharmacokinetics (piperaquine and primaquine drug levels) At M0, D2: Pharmacokinetics (piperaquine drug levels) At M0, D7: Haematology: Hb, WBC, PLT; Biochemistry: ALT, AST, CREA; Pharmacokinetics (piperaquine drug levels) At M1, D0: P. falciparum testing, anti-circumsporozoite antibody; Pharmacokinetics (piperaquine drug levels) At M1, D1: Pharmacokinetics (piperaquine and primaquine drug levels) At M1, D2: Pharmacokinetics (piperaquine drug levels) At M1, D7: Haematology: Hb, WBC, PLT; Biochemistry: ALT, AST, CREA; Pharmacokinetics (piperaquine drug levels) At M2, D0: P. falciparum testing, anti-circumsporozoite antibody; Pharmacokinetics (piperaquine drug levels) At M2, D1: Pharmacokinetics (piperaquine and primaquine drug levels) At M2, D2: Pharmacokinetics (piperaquine drug levels) At M2, D7: Haematology: Hb, WBC, PLT; Biochemistry: ALT, AST, CREA; Pharmacokinetics (piperaquine drug levels) At M3: P. falciparum testing, Haematology: Hb, WBC, PLT; Biochemistry: ALT, AST, CREA; anti-circumsporozoite antibody At M6: P. falciparum testing, anti-circumsporozoite antibody

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malaria,Falciparum
Keywords
Malaria vaccine, Immunogenicity of the malaria vaccine, Immunologic response to malaria vaccine

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
120 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
R21/Matrix-M + DHA-PIP+PQ
Arm Type
Experimental
Arm Description
The R21/Matrix-M vaccine (IM injection) + co-formulated Dihydroartemisinin/Piperaquine tablets + one single low dose of Primaquine
Arm Title
R21/Matrix-M only
Arm Type
Experimental
Arm Description
The R21/Matrix-M vaccine (IM injection) only
Arm Title
DHA-PIP+PQ only
Arm Type
Active Comparator
Arm Description
Co-formulated Dihydroartemisinin/Piperaquine tablets + one single low dose of Primaquine
Intervention Type
Biological
Intervention Name(s)
R21/Matrix-M vaccination
Intervention Description
R21/Matrix-M is the standard formulation of the vaccine (Once prepared, a standard dose of R21/Matrix-M contains approximately 5 µg of R21 antigen, in 0.5 mL of liquid adjuvant containing 50 µg MatrixM). The reconstituted vaccine will be administered by slow IM injection on Day 0 at Study Months 0, 1 and 2.
Intervention Type
Drug
Intervention Name(s)
DHA-PIP
Intervention Description
Dihydroartemisinin/piperaquine tablets for adult patients each contain 40 mg dihydroartemisinin and 320 mg piperaquine with a therapeutic dose range between 2-10 mg/kg/day dihydroartemisinin and 16-26 mg/kg/dose piperaquine. Participants will receive three rounds of antimalarial drugs - each round starting on the day of vaccination (Day 0) at Study Months 0, 1 and 2. Each round consists of three daily doses of co-formulated dihydroartemisinin/piperaquine on Day 0, 1, and 2.
Intervention Type
Drug
Intervention Name(s)
PQ
Intervention Description
Each participant will receive a single low dose primaquine on the day of vaccination (Day 0) at Month 0, Month 1, and Month 2. One single low dose primaquine of approximately 0.25 mg/kg will be administered.
Primary Outcome Measure Information:
Title
Occurrence of adverse events (AEs), according to the Medical Dictionary for Regulatory Activities (MedRA) classification.
Time Frame
From the date of the first vaccination to 29 days after the last vaccination
Title
Occurrence of serious adverse events (SAEs), according to the MedRA classification.
Time Frame
During the whole study period, i.e. during a 6-month follow-up period from the receipt of first vaccination
Secondary Outcome Measure Information:
Title
For Arms 1 and 2, the concentration of antibodies against Plasmodium falciparum circumsporozoite (anti-NANP total IgG antibody)circumsporozoite (anti-circumsporoziote antibody)
Time Frame
One month after the first dose (at Study Month 1)
Title
For Arms 1 and 2, the concentration of antibodies against Plasmodium falciparum circumsporozoite (anti-NANP total IgG antibody)
Time Frame
One month after the second dose (at Study Month 2)
Title
For Arms 1 and 2, the concentration of antibodies against Plasmodium falciparum circumsporozoite (anti-NANP total IgG antibody)
Time Frame
One month after the third dose (at Study Month 3)
Title
For Arms 1 and 2, the concentration of antibodies against Plasmodium falciparum circumsporozoite (anti-NANP total IgG antibody)
Time Frame
Six months after the first dose (at Study Month 6)
Title
Exploratory immunology endpoints including but not limited to cellular immunity
Time Frame
One month after the first dose (at Study Month 1)
Title
Exploratory immunology endpoints including but not limited to cellular immunity
Time Frame
One month after the second dose (at Study Month 2)
Title
Exploratory immunology endpoints including but not limited to cellular immunity
Time Frame
One month after the third dose (at Study Month 3)
Title
Exploratory immunology endpoints including but not limited to cellular immunity
Time Frame
Six months after the first dose (at Study Month 6)
Title
For Arms 1 and 3, piperaquine levels following the administration of the antimalarials with or without vaccine
Time Frame
On day 0, 1, 2, and 7 of study month 0, 1, and 2

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria The participant is eligible to enter the study if all of the following apply: Participant is a healthy adult, aged 18 to 55 years (inclusive), of Thai origin. Participant is willing and able to give informed consent to participate in the trial Able, in the investigator's opinion, and willing to comply with the study requirements and follow-up. Women of childbearing potential: must agree to practice continuous, effective contraception for the duration of the trial, and have a negative pregnancy test before each vaccination. (Costs for contraceptives will be reimbursed by the trial.) Exclusion criteria The following criteria should be checked at the time of study entry. If ANY exclusion criterion applies, the subject must not be included in the study: Pregnancy or breastfeeding, or planned pregnancy during the course of the study. Presence of any medical condition (physical or mental) which, may place the participant at undue risk or interfere with the results of the study*. Including: serious cardiac, renal, hepatic or neurological disease, severe malnutrition Any confirmed or suspected immunosuppressive or immunodeficient condition. Including: history of splenectomy, human immunodeficiency virus (HIV) infection Chronic administration (>14 days in total) of immunosuppressants or other immune-modifying drugs within six months of enrollment. Including: oral corticosteroids equivalent to prednisone > 20 mg/day (a) History of an autoimmune disease Hepatitis B surface antigen (HBsAg) detected in serum. Screening electrocardiogram (ECG) demonstrating a QTc interval ≥ 450 ms Seropositivity for hepatitis C virus (antibodies to HCV) at screening (b) Finding on safety laboratory values as defined below: AST > 2 x upper normal limit ALT > 2 x upper normal limit Anaemia (Hb < 10 g/dL), Platelets < 100,000 Total bilirubin > 2 x upper normal limit Abnormalities of examination or investigations at screening. Including: hepatomegaly, right upper quadrant abdominal pain or tenderness, abnormal blood tests (as defined in the protocol which are not listed above) Positive malaria parasitaemia at screening or baseline (Month 0, Day 0). Receipt or planned receipt of an investigational medical product or participation in an interventional clinical trial during the study period Contraindications to the use of artemisinins, piperaquine or primaquine*. Including: use of medications with known potential interactions, prior allergic reactions to one or more components of the drug regimen. History of allergic disease or reactions likely to be exacerbated by any component of the vaccine (e.g. egg products) History of clinically significant contact dermatitis. Contraindication to intramuscular (IM) injection* Administration of a vaccine not included in the study protocol within 30 days of a study vaccine (c). History of anaphylaxis post-vaccination. Administration of immunoglobulins and/or any blood products during the period starting three months before the first dose of study vaccine or planned administration during the study period. subject to the investigator's judgement Exceptions: a Inhaled and topical steroids. b Participation in hepatitis C vaccine study with confirmed negative HCV antibodies prior to participation in that study, and negative HCV RNA PCR at screening for this study c The following vaccinations may be administered more than 7 days before or after a study vaccination: polio, diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Bacillus Calmette-Guérin (BCG vaccine), measles, influenza, pneumococcal disease, COVID-19 or yellow fever
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lorenz von Seidlein, MD
Phone
+66 9 2648 6322
Email
Lorenz@tropmedres.ac
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lorenz von Seidlein, MD
Organizational Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University
City
Bangkok
ZIP/Postal Code
10400
Country
Thailand
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Podjanee Jittamala, MD
Email
podjanee@tropmedres.ac
First Name & Middle Initial & Last Name & Degree
Borimas Hanboonkunuprakarn, MD
Email
Borimas@tropmedres.ac

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
All personal details of participants will be de-identified. These data including laboratory investigation results will be stored and may be shared with other researchers to apply in their research in accordance with the MORU data sharing policy.

Learn more about this trial

Safety and Immunogenicity of the Malaria Vaccine, R21/MatrixM, in Healthy Thai Adults

We'll reach out to this number within 24 hrs