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A phase III clinical trial to evaluate the safety and immunogenicity of 23-valent pneumococcal polysaccharide vaccine (PPV23) in healthy children, adults, and elderly.

ABSTRACT: To evaluate the safety and immunogenicity of a newly 23-valent pneumococcal polysaccharide vaccine (PPV23), a phase ? clinical trial was conducted in population aged ? 2 years. We conducted a randomized, double-blinded, active controlled trial, in which 1760 participants were randomly assigned in a 1:1 ratio to receive one dose of either the test vaccine or the control commercial vaccine. The surveillance period was 28 days. The 2-fold increase rate of anti-pneumococcal for 23 serotypes varied from 49.71% to 90.96% in the treatment group and from 44.52% to 88.24% in the control group. According to -10% non-inferiority margin and 95% confidence intervals of rate difference, all the 23 serotypes of the treatment group were non-inferiority to the control group. The 2-fold increase rate of anti-pneumococcal antibody were significantly higher in the treatment group for 11 serotypes including 1, 2, 3, 4, 10A, 11A, 14, 18C, 20, 22F, and 23F. Serious adverse events occurred in 2 in 879 (0.23%) participants in the treatment group and 2 in 880 (0.23%) participants in the control group, and all the adverse events were unrelated to the vaccination. The overall adverse reaction frequency showed no difference between the treatment (51.19%) and control group (47.95%), and most adverse reactions were mild or moderate in intensity. The newly PPV23 is immunologically non-inferior to the control commercial vaccine and well tolerated in healthy Chinese population aged ? 2 years. Trial registration: ClinicalTrial.gov identifier: NCT02451969.

SUBMITTER: Huang L

PROVIDER: S-EPMC6363133 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A phase III clinical trial to evaluate the safety and immunogenicity of 23-valent pneumococcal polysaccharide vaccine (PPV23) in healthy children, adults, and elderly.

Huang Lili L Wang Ling L Li Hong H Hu Yuansheng Y Ru Weiping W Han Weixiao W Shi Gang G Ye Qiang Q Han Zhen Z Xia Jielai J Xia Shengli S Xu Miao M Li Jing J

Human vaccines & immunotherapeutics 20180921 1

To evaluate the safety and immunogenicity of a newly 23-valent pneumococcal polysaccharide vaccine (PPV23), a phase Ⅲ clinical trial was conducted in population aged ≥ 2 years. We conducted a randomized, double-blinded, active controlled trial, in which 1760 participants were randomly assigned in a 1:1 ratio to receive one dose of either the test vaccine or the control commercial vaccine. The surveillance period was 28 days. The 2-fold increase rate of anti-pneumococcal for 23 serotypes varied f ...[more]

PMID: 30215583

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Project description:BackgroundRoutine vaccination of elderly people against pneumococcal diseases is recommended in many countries. National guidelines differ, recommending either the 23-valent polysaccharide vaccine (PPV23), the 13-valent conjugate vaccine (PCV13) or both. Considering the ongoing debate on the effectiveness of PPV23, we performed a systematic literature review and meta-analysis of the vaccine efficacy/effectiveness (VE) of PPV23 against invasive pneumococcal disease (IPD) and pneumococcal pneumonia in adults aged ≥60 years living in industrialized countries.MethodsWe searched for pertinent clinical trials and observational studies in databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. We assessed the risk of bias of individual studies using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. We rated the overall quality of the evidence by GRADE criteria. We performed meta-analyses of studies grouped by outcome and study design using random-effects models. We applied a sensitivity analysis excluding studies with high risk of bias.ResultsWe identified 17 eligible studies. Pooled VE against IPD (by any serotype) was 73% (95%CI: 10-92%) in four clinical trials, 45% (95%CI: 15-65%) in three cohort studies, and 59% (95%CI: 35-74%) in three case-control studies. After excluding studies with high risk of bias, pooled VE against pneumococcal pneumonia (by any serotype) was 64% (95%CI: 35-80%) in two clinical trials and 48% (95%CI: 25-63%) in two cohort studies. Higher VE estimates in trials (follow-up ~2.5 years) than in observational studies (follow-up ~5 years) may indicate waning protection. Unlike previous meta-analyses, we excluded two trials with high risk of bias regarding the outcome pneumococcal pneumonia, because diagnosis was based on serologic methods with insufficient specificity.ConclusionsOur meta-analysis revealed significant VE of PPV23 against both IPD and pneumococcal pneumonia by any serotype in the elderly, comparable to the efficacy of PCV13 against vaccine-serotype disease in a recent clinical trial in elderly people. Due to its broader serotype coverage and the decrease of PCV13 serotypes among adults resulting from routine infant immunization with PCV13, PPV23 continues to play an important role for protecting adults against IPD and pneumococcal pneumonia.

Project description:Streptococcus pneumoniae is an important pathogen causing invasive diseases such as sepsis, meningitis, and pneumonia. Vaccines have become the most effective way to prevent pneumococcal infections. This phase III trial was designed to evaluate the immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in Chinese healthy population aged >2 years. We conducted a randomized, double-blinded, active-controlled, multicenter trial in which 1660 healthy population (>2 years of age) were randomly assigned in a 1 : 1 ratio to receive 2 intramuscular doses of either the treatment vaccine or the active control vaccine, PNEUMOVAX 23. The surveillance period was 30 days. The primary end point was the 2-fold increase rate of anti-pneumococcal antibody for all 23 included serotypes in each group. In the intention-to-treat cohort, the 2-fold increase rate of anti-pneumococcal antibody for 23 included serotypes varied from 62.47% to 97.01% in the treatment group, and from 51.49% to 95.77% in the control group. According to -10% non-inferiority margin and 95% confidence intervals of rate difference, almost all included serotypes of the treatment group reached non-inferiority to control group except for serotype 6B, the lower limit of rate difference of which was -10.00%, equal to the non-inferiority margin. The 2-fold increase rates of anti-pneumococcal antibody were significantly higher in the treatment group for serotype 2, 3, 4, 10A, 11A and 20. Furthermore, for all 23 serotypes, IgG geometric mean concentrations (GMCs) at day 30 were significantly higher in treatment group for serotype 2, 3, 4, 9 V, 10A, 11A, 15 B, 18C, 19 A, 22 F and 33 F. Higher geometric mean fold increase (GMFI) were also observed in the treatment group correspondingly. Serious adverse events occurred in 3 of 830 participants in the treatment group (0.36%) and 2 of 830 participants in the control group (0.24%). No death occurred during the trial. The frequencies of both solicited and unsolicited adverse events (AEs) were small lower in the treatment group (34.34% vs 35.66% for solicited AEs, 4.34% vs 5.42% for unsolicited AEs). Both vaccines were well tolerated and most AEs were mild or moderate in intensity. The newly vaccine was well tolerated and immunologically non-inferior to the active control vaccine PNEUMOVAX 23 for all 23 vaccine serotypes in the Chinese population (>2 years of age).

Dataset Information

A phase III clinical trial to evaluate the safety and immunogenicity of 23-valent pneumococcal polysaccharide vaccine (PPV23) in healthy children, adults, and elderly.

Publications

A phase III clinical trial to evaluate the safety and immunogenicity of 23-valent pneumococcal polysaccharide vaccine (PPV23) in healthy children, adults, and elderly.

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