Dose, Safety, Tolerability and Immunogenicity of a Stabilized Prefusion RSV F Subunit Protein Vaccine, VRC-RSVRGP084-00-VP (DS-Cav1), Alone or With Alum Adjuvant, in Healthy Adults

NCT ID: NCT03049488

Last Updated: 2020-10-23

Study Results

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Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1

Total Enrollment

95 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-02-22

Study Completion Date

2019-10-03

Brief Summary

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Background:

Respiratory Syncytial Virus (RSV) is a virus that infects the lungs and breathing passages. Healthy adults who are infected generally have mild cold symptoms for a week or two. But it can also be serious, especially for infants and older adults. It can be spread by direct or indirect contact with respiratory secretions. Researchers want to study a new vaccine to prevent RSV.

Objective:

To see if a vaccine for RSV is safe and if it causes side effects.

Eligibility:

Healthy adults 18-50 years old

Design:

Volunteers were screened in a separate screening protocol.

Subjects had 13 visits over 1 year.

Some subjects received just vaccine. Some received vaccine mixed with alum adjuvant.

All subjects received their dose by injection in the upper arm. They received up to two doses, one at the beginning of the study and another 12 weeks later.

Subjects were monitored for 1 hour after injection and called to check on their safety 1 day after.

Subjects recorded their temperature and side effects for 7 days after each vaccination.

Subjects were provided with a thermometer to measure their temperature and a ruler to measure any changes if these occurred on their skin at the injection site.

At all visits, subjects were checked for health changes or problems. They may have had blood drawn.

At some visits, subjects had samples collected from their nose and mouth.

Detailed Description

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Study Design:

This is a Phase I, open-label, dose escalation study to evaluate the dose, safety, tolerability, and immunogenicity of VRC-RSVRGP084-00-VP vaccine alone or with alum adjuvant in a 2-injection regimen. The hypotheses are that the vaccine will be safe and tolerable for human administration, and will induce detectable immune response. The primary objective is to evaluate the safety and tolerability of the investigational vaccine at 3 dose levels administered alone or with alum adjuvant in healthy adults. Secondary objectives relate to humoral and cellular immunogenicity of the investigational vaccine regimen.

Product Description:

VRC-RSVRGP084-00-VP (DS-Cav1) was developed by VRC, NIAID and is composed of the respiratory syncytial virus (RSV) fusion (F) glycoprotein ectodomain assembled as a trimer stabilized in its prefusion native conformation with a foldon trimerization domain at the C-terminus and 4 internal mutations designated DS-Cav1 (4.1DHFR\_RSVAF). The sequence is based on the RSV A2 strain from subtype A. The product was provided at a concentration of 0.5 mg/mL in 3 mL glass vials filled to 1.2 mL. Adjuvant was an aluminum hydroxide suspension (alum) provided in a sterile, pyrogen-free suspension at a concentration of 5 mg/mL in 3 mL glass vials filled to 0.7 mL. The alum dose was 500 mcg and was field mixed.

Subjects:

Healthy adult subjects ages 18-50 years

Study Plan:

Subjects were randomized into DS-Cav1 or DS-Cav1 plus alum in each dose during the study. Dose continuation and dose escalation evaluations occurred to ensure the safety data support proceeding to the higher doses. Subjects were evaluated for safety and immune responses through blood and mucosal sample collection at specified timepoints throughout the study.

VRC 317 Study Schema:

* Group: 1; Subjects: 15; Dose: 50mcg; Day 0: DS-Cav1; Week 12 \[1\]: DS-Cav1
* Group: 2; Subjects: 15; Dose: 50mcg; Day 0: DS-Cav1 + alum; Week 12 \[1\]: DS-Cav1 + alum
* Group: 3; Subjects: 15; Dose: 150mcg; Day 0: DS-Cav1; Week 12 \[1\]: DS-Cav1
* Group: 4; Subjects: 15; Dose: 150mcg; Day 0: DS-Cav1 + alum; Week 12 \[1\]: DS-Cav1 + alum
* Group: 5; Subjects: 15; Dose: 500mcg; Day 0: DS-Cav;1 Week 12 \[1\]: DS-Cav1
* Group: 6; Subjects: 15; Dose: 500mcg; Day 0: DS-Cav1 + alum; Week 12 \[1\]: DS-Cav1 + alum

All DS-Cav1 vaccinations were administered with needle and syringe into the deltoid muscle.

Total Planned Subjects: 90 (Up to 100 subjects could have been enrolled if needed to evaluate safety or immunogenicity.)

• \[1\] Week 12 dose: Optional for the last 5 subjects enrolled in each group who received the Day 0 injection and any additional subjects needed to evaluate safety or immunogenicity of a single injection.

Duration:

The study schedule required 13 clinic visits and a telephone contact after each injection.

Conditions

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Respiratory Syncytial Virus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Group 1: DS-Cav1 (50 mcg)

DS-Cav1 (50 mcg) administered intramuscularly (IM) by Needle/Syringe (Day 0 and Week 12\*)

\*To evaluate the safety or immunogenicity of a single vaccine dose, the Week 12 dose was optional for the last 5 subjects who enrolled in this group and received the Day 0 injection.

Group Type EXPERIMENTAL

VRC-RSVRGP084-00-VP

Intervention Type BIOLOGICAL

VRC-RSVRGP084-00-VP is an investigational respiratory syncytial virus (RSV) vaccine.

Group 2: DS-Cav1 (50 mcg) + alum

DS-Cav1 (50 mcg) + alum administered IM by Needle/Syringe (Day 0 and Week 12\*)

\*To evaluate the safety or immunogenicity of a single vaccine dose, the Week 12 dose was optional for the last 5 subjects who enrolled in this group and received the Day 0 injection.

Group Type EXPERIMENTAL

VRC-RSVRGP084-00-VP

Intervention Type BIOLOGICAL

VRC-RSVRGP084-00-VP is an investigational respiratory syncytial virus (RSV) vaccine.

Aluminum Hydroxide Suspension

Intervention Type OTHER

Aluminum Hydroxide Suspension, alum, is an adjuvant.

Group 3: DS-Cav1 (150 mcg)

DS-Cav1 (150 mcg) administered IM by Needle/Syringe (Day 0 and Week 12\*)

\*The Week 12 dose was optional for the last 5 subjects who enrolled in this group and received the Day 0 injection, and for 5 additional subjects who were enrolled to evaluate the safety or immunogenicity of a single vaccine dose.

Group Type EXPERIMENTAL

VRC-RSVRGP084-00-VP

Intervention Type BIOLOGICAL

VRC-RSVRGP084-00-VP is an investigational respiratory syncytial virus (RSV) vaccine.

Group 4: DS-Cav1 (150 mcg) + alum

DS-Cav1 (150 mcg) + alum administered IM by Needle/Syringe (Day 0 and Week 12\*)

\*To evaluate the safety or immunogenicity of a single vaccine dose, the Week 12 dose was optional for the last 5 subjects who enrolled in this group and received the Day 0 injection.

Group Type EXPERIMENTAL

VRC-RSVRGP084-00-VP

Intervention Type BIOLOGICAL

VRC-RSVRGP084-00-VP is an investigational respiratory syncytial virus (RSV) vaccine.

Aluminum Hydroxide Suspension

Intervention Type OTHER

Aluminum Hydroxide Suspension, alum, is an adjuvant.

Group 5: DS-Cav1 (500 mcg)

DS-Cav1 (500 mcg) administered IM by Needle/Syringe (Day 0 and Week 12\*)

\*To evaluate the safety or immunogenicity of a single vaccine dose, the Week 12 dose was optional for the last 5 subjects who enrolled in this group and received the Day 0 injection.

Group Type EXPERIMENTAL

VRC-RSVRGP084-00-VP

Intervention Type BIOLOGICAL

VRC-RSVRGP084-00-VP is an investigational respiratory syncytial virus (RSV) vaccine.

Group 6:DS-Cav1 (500 mcg) + alum

DS-Cav1 (500 mcg) + alum administered IM by Needle/Syringe (Day 0 and Week 12\*)

\*To evaluate the safety or immunogenicity of a single vaccine dose, the Week 12 dose was optional for the last 5 subjects who enrolled in this group and received the Day 0 injection.

Group Type EXPERIMENTAL

VRC-RSVRGP084-00-VP

Intervention Type BIOLOGICAL

VRC-RSVRGP084-00-VP is an investigational respiratory syncytial virus (RSV) vaccine.

Aluminum Hydroxide Suspension

Intervention Type OTHER

Aluminum Hydroxide Suspension, alum, is an adjuvant.

Interventions

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VRC-RSVRGP084-00-VP

VRC-RSVRGP084-00-VP is an investigational respiratory syncytial virus (RSV) vaccine.

Intervention Type BIOLOGICAL

Aluminum Hydroxide Suspension

Aluminum Hydroxide Suspension, alum, is an adjuvant.

Intervention Type OTHER

Other Intervention Names

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DS-Cav1 Alum

Eligibility Criteria

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Inclusion Criteria

1. 18 to 50 years of age.
2. Willing and able to complete the informed consent process.
3. Available for clinic visits through 44 weeks after enrollment.
4. Able to provide proof of identity to the satisfaction of the study clinician completing the enrollment process.
5. Willing to donate blood and mucosal samples to be stored and used for future research.
6. In good general health without clinically significant medical history.
7. Physical examination and laboratory results without clinically significant findings and a Body Mass Index (BMI) less than or equal to 40 within the 56 days prior to enrollment. Laboratory criteria within 56 days prior to enrollment:
8. White Blood Cell (WBC) and differential either within institutional normal range or accompanied by Principal Investigator (PI) or designee approval.
9. Platelets = 125,000-500,000/mm\^3.
10. Hemoglobin within institutional normal range.
11. Creatinine less than or equal to 1.1 x upper limit of normal (ULN).
12. Alanine aminotransferase (ALT) less than or equal to 1.25 x ULN.
13. Negative for HIV infection by an FDA approved method of detection.

Criteria applicable to women of childbearing potential:
14. Negative result on a human chorionic gonadotropin pregnancy test on day of enrollment before receiving study product.
15. Agree to use effective means of birth control from at least 21 days before enrollment through 4 weeks after the last injection.

Exclusion Criteria

Criteria applicable to women of childbearing potential:

1. Breast-feeding or planning to become pregnant through 4 weeks after the last injection.

Subject has received any of the following:
2. More than 10 days of systemic immunosuppressive medications or cytotoxic medications within the 4 weeks prior to enrollment or any within the 14 days prior to enrollment.
3. Blood products within 16 weeks prior to enrollment.
4. Live attenuated vaccines within 4 weeks prior to enrollment.
5. Inactivated vaccines within 2 weeks prior to enrollment.
6. Investigational research agents within 4 weeks prior to enrollment or planning to receive investigational products while on the study.
7. Current allergen immunotherapy with antigen injections, unless on maintenance schedule.
8. Current anti-tuberculosis(TB) prophylaxis or therapy.

Subject has any of the following:
9. Serious reactions to vaccines that preclude receipt of study injections as determined by the investigator.
10. Hereditary angioedema, acquired angioedema, or idiopathic forms of angioedema.
11. Asthma that is not well controlled.
12. Diabetes mellitus (type I or II), with the exception of gestational diabetes.
13. Thyroid disease that is not well controlled.
14. Hypertension that is not well controlled.
15. Evidence of autoimmune disease or immunodeficiency.
16. Idiopathic urticaria within the past year.
17. Bleeding disorder diagnosed by a doctor (e.g. factor deficiency, coagulopathy, or platelet disorder requiring special precautions) or significant bruising or bleeding difficulties with IM injections or blood draws.
18. Malignancy that is active or history of malignancy that is likely to recur during the study.
19. Seizure disorder other than: 1) febrile seizures, 2) seizures secondary to alcohol withdrawal more than 3 years ago, or 3) seizures that have not required treatment within the last 3 years.
20. Asplenia, functional asplenia or any condition resulting in the absence or removal of the spleen.
21. Psychiatric condition that precludes compliance with the protocol; past or present psychoses; or within 5 years prior to enrollment, a history of suicide plan or attempt.
22. Any medical, psychiatric, or social condition that, in the judgment of the investigator, is a contraindication to protocol participation or impairs a subject s ability to give informed consent.
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Grace L Chen, M.D.

Role: PRINCIPAL_INVESTIGATOR

National Institute of Allergy and Infectious Diseases (NIAID)

Locations

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National Institutes of Health Clinical Center

Bethesda, Maryland, United States

Site Status

Countries

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United States

References

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Ruckwardt TJ, Morabito KM, Graham BS. Determinants of early life immune responses to RSV infection. Curr Opin Virol. 2016 Feb;16:151-157. doi: 10.1016/j.coviro.2016.01.003. Epub 2016 Mar 15.

Reference Type BACKGROUND
PMID: 26986236 (View on PubMed)

Ngwuta JO, Chen M, Modjarrad K, Joyce MG, Kanekiyo M, Kumar A, Yassine HM, Moin SM, Killikelly AM, Chuang GY, Druz A, Georgiev IS, Rundlet EJ, Sastry M, Stewart-Jones GB, Yang Y, Zhang B, Nason MC, Capella C, Peeples ME, Ledgerwood JE, McLellan JS, Kwong PD, Graham BS. Prefusion F-specific antibodies determine the magnitude of RSV neutralizing activity in human sera. Sci Transl Med. 2015 Oct 14;7(309):309ra162. doi: 10.1126/scitranslmed.aac4241.

Reference Type BACKGROUND
PMID: 26468324 (View on PubMed)

Graham BS, Modjarrad K, McLellan JS. Novel antigens for RSV vaccines. Curr Opin Immunol. 2015 Aug;35:30-8. doi: 10.1016/j.coi.2015.04.005. Epub 2015 Jun 10.

Reference Type BACKGROUND
PMID: 26070108 (View on PubMed)

Crank MC, Ruckwardt TJ, Chen M, Morabito KM, Phung E, Costner PJ, Holman LA, Hickman SP, Berkowitz NM, Gordon IJ, Yamshchikov GV, Gaudinski MR, Kumar A, Chang LA, Moin SM, Hill JP, DiPiazza AT, Schwartz RM, Kueltzo L, Cooper JW, Chen P, Stein JA, Carlton K, Gall JG, Nason MC, Kwong PD, Chen GL, Mascola JR, McLellan JS, Ledgerwood JE, Graham BS; VRC 317 Study Team. A proof of concept for structure-based vaccine design targeting RSV in humans. Science. 2019 Aug 2;365(6452):505-509. doi: 10.1126/science.aav9033.

Reference Type BACKGROUND
PMID: 31371616 (View on PubMed)

Chang LA, Phung E, Crank MC, Morabito KM, Villafana T, Dubovsky F, Falloon J, Esser MT, Lin BC, Chen GL, Graham BS, Ruckwardt TJ. A prefusion-stabilized RSV F subunit vaccine elicits B cell responses with greater breadth and potency than a postfusion F vaccine. Sci Transl Med. 2022 Dec 21;14(676):eade0424. doi: 10.1126/scitranslmed.ade0424. Epub 2022 Dec 21.

Reference Type DERIVED
PMID: 36542692 (View on PubMed)

Ruckwardt TJ, Morabito KM, Phung E, Crank MC, Costner PJ, Holman LA, Chang LA, Hickman SP, Berkowitz NM, Gordon IJ, Yamshchikov GV, Gaudinski MR, Lin B, Bailer R, Chen M, Ortega-Villa AM, Nguyen T, Kumar A, Schwartz RM, Kueltzo LA, Stein JA, Carlton K, Gall JG, Nason MC, Mascola JR, Chen G, Graham BS; VRC 317 study team. Safety, tolerability, and immunogenicity of the respiratory syncytial virus prefusion F subunit vaccine DS-Cav1: a phase 1, randomised, open-label, dose-escalation clinical trial. Lancet Respir Med. 2021 Oct;9(10):1111-1120. doi: 10.1016/S2213-2600(21)00098-9. Epub 2021 Apr 14.

Reference Type DERIVED
PMID: 33864736 (View on PubMed)

Provided Documents

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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Related Links

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Other Identifiers

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17-I-0058

Identifier Type: OTHER

Identifier Source: secondary_id

170058

Identifier Type: -

Identifier Source: org_study_id

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