Clinical Trial of the 24-valent Pneumococcal Polysaccharide Conjugate Vaccine (CRM197/Tetanus Toxoid)

Official title

A Randomized, Blinded, Dose-Exploratory, Positive-Control Clinical Trial Evaluating the Safety and Immunogenicity of the 24-Valent Pneumococcal Polysaccharide Conjugate Vaccine (CRM197/Tetanus Toxoid) Following Administration in Individuals Aged 2 Months (Minimum 6 Weeks) and Older

Overview

This clinical trial consists of Phase I and Phase II. The objective is to evaluate the safety and immunogenicity of the 24-valent pneumococcal polysaccharide conjugate vaccine (CRM197/tetanus toxoid) in individuals aged 2 months (minimum 6 weeks) and older.

Detailed description

Phase I employs a randomized, blinded, dose-escalation, positive-control design with a total sample size of 310 participants. The study population is divided into five age groups: the 18-49 age group is an open-label design with M and H dose groups; The 7-23-month, 2-5-year-old, and ≥50-year-old groups will use a positive-control, blinded design with M and H dose groups; the 2-month-old (minimum 6 weeks) group will use a positive-control, dose-escalation, and blinded design with L, M, and H dose groups. The Phase II study was divided into two age groups. The ≥50-year-old group: a randomized, blinded, active-controlled design with a total sample size of 160 participants, who were randomly assigned to the treatment and control groups in a 1:1 ratio; the 2-month-old (minimum 6 weeks) group: a randomized, blinded, active-controlled design with a total sample size of 384 participants. Participants were randomly assigned in a 3:1 ratio to the treatment groups (doses L, M, and H) and the control group.

Interventions

• Biological 24-valent pneumococcal polysaccharide conjugate vaccine (CRM197/tetanus toxoid) (referred to as PCV24) (dose M)
  1 dose ( 0.5ml) of PCV24 vaccine (dose M)
• Biological PCV24 vaccine (dose H)
  1 dose ( 0.5ml) of PCV24 vaccine (dose H)
• Biological PCV24 vaccine (dose M)
  1 dose ( 0.5ml) of PCV24 vaccine (dose M)
• Biological 23-valent pneumococcal polysaccharide vaccine (referred to as PPV23)
  1 dose ( 0.5ml) of PPV23 vaccine
• Biological PCV24 vaccine (dose M)
  1 dose ( 0.5ml) of PCV24 vaccine (dose M)
• Biological 13-valent pneumococcal polysaccharide conjugate vaccine (referred to as PCV13)
  1 dose ( 0.5ml) of PCV13 vaccine
• Biological PCV24 vaccine (dose H)
  1 dose ( 0.5ml) of PCV24 vaccine (dose H)
• Biological PPV23 vaccine
  1 dose ( 0.5ml) of PPV23 vaccine
• Biological PCV24 vaccine (dose H)
  1 dose ( 0.5ml) of PCV24 vaccine (dose H)
• Biological PCV13 vaccine
  1 dose ( 0.5ml) of PCV13 vaccine

Primary outcome measures

• Phase I: Incidence of adverse reactions [Time frame: Within 7 days of receiving each dose of the vaccine]
• Phase I: Incidence of adverse reactions [Time frame: Within 30 days of receiving each dose of the vaccine]
• Phase I: Incidence of serious adverse event (SAE) [Time frame: Within 180 days of receiving the first dose of the vaccine through completion of the full vaccination series for each group]
• Phase I: Incidence of abnormalities in urinalysis [Time frame: 4 days after vaccination]
• Phase I: Incidence of abnormalities in complete blood count [Time frame: 4 days after vaccination]
• Phase I: Incidence of abnormalities in blood chemistry [Time frame: 4 days after vaccination]
• Phase I: Incidence of abnormalities in coagulation function [Time frame: 4 days after vaccination]
• Phase II (≥50 years old group): Geometric mean concentration (GMC) of serotype-specific pneumococcal IgG antibodies [Time frame: 30 days after vaccination]
• Phase II (≥50 years old group): ≥4-fold increase of serotype-specific pneumococcal IgG antibodies [Time frame: 30 days after vaccination]
• Phase II (≥50 years old group): Geometric mean increment (GMI) of serotype-specific pneumococcal IgG antibodies [Time frame: 30 days after vaccination]

Secondary outcome measures (12)

• Phase I: Incidence of adverse reactions [Time frame: Within 30 days of receiving each dose of the vaccine]
• Phase I (2-month-old group [minimum 6 weeks]): Positive rate of vaccine-serotype-specific pneumococcal IgG antibodies (antibody concentration ≥ 0.35 μg/ml) [Time frame: 30 days after the primary series, 30 and 180 days after the booster dose]
• Phase I (2-month-old group [minimum 6 weeks]): Proportion with vaccine-serotype-specific pneumococcal IgG antibody concentrations ≥ 1.0 μg/ml [Time frame: 30 days after the primary series, 30 and 180 days after the booster dose]
• Phase I (2-month-old group [minimum 6 weeks]): GMC of serotype-specific pneumococcal IgG antibodies [Time frame: 30 days after the primary series, 30 and 180 days after the booster dose]
• Phase I (2-month-old group [minimum 6 weeks]): GMI of serotype-specific pneumococcal IgG antibodies [Time frame: 30 days after the primary series, 30 and 180 days after the booster dose]
• Phase I (2-month-old group [minimum 6 weeks]): Serotype-specific pneumococcal OPA antibody titers [Time frame: 30 days after the primary series; 30 days after the booster dose]
• Phase I (2-month-old group [minimum 6 weeks]): Proportion of serotype-specific pneumococcal OPA antibody titers ≥1:8 [Time frame: 30 days after the primary series; 30 days after the booster dose]
• Phase I (≥50 years old group): GMC of Serotype-specific pneumococcal IgG antibody [Time frame: 30 days after vaccination]
• Phase I (≥50 years old group): ≥4-fold increaseof Serotype-specific pneumococcal IgG antibody [Time frame: 30 days after vaccination]
• Phase I (≥50 years old group): GMI of Serotype-specific pneumococcal IgG antibody [Time frame: 30 days after vaccination]
• Phase I (≥50 years old group): Serotype-specific pneumococcal OPA antibody titers [Time frame: 30 days after vaccination]
• Phase I (≥50 years old group): Proportion of serotype-specific pneumococcal OPA antibody titers ≥1:8 [Time frame: 30 days after vaccination]

Eligibility criteria

Inclusion criteria

Phase I:

• Individuals aged 2 months (minimum 6 weeks), 7 months to 5 years, and 18 years and older who are willing to provide identification
• The trial participant and/or guardian (legal representative) has voluntarily signed the informed consent form after providing informed consent
• Children aged 5 and under who have not previously received a pneumococcal vaccine
• People aged 18 and older who have not received a pneumonia vaccine in the past five years

Phase II (age ≥50 group):

• People aged 50 and older who are willing to provide identification documents
• The trial participants voluntarily signed the informed consent form after providing their informed consent
• People aged 50 and older who have not received a pneumonia vaccine in the past five years

Phase II (2-month-old group (minimum 6 weeks)):

• Individuals aged 2 months or older (minimum 6 weeks) who are willing to provide identification documents
• The guardian (authorized representative) of the trial participant has voluntarily signed the informed consent form after providing informed consent.
• Infants aged 2 months (minimum 6 weeks) who have not previously received a pneumococcal vaccine

Exclusion criteria

• Exclusion criteria for the first dose:
• Preterm birth (delivery before 37 weeks of gestation), low birth weight (<2500 g at birth), history of labor abnormalities or resuscitation due to asphyxia; (Applicable to individuals in Phase I and Phase II who are 2 months of age or older (minimum 6 weeks))
• Patients with abnormal results in pre-vaccination blood tests (including complete blood count, blood chemistry, and coagulation function) or urinalysis, which the investigator determines to be clinically significant; (Applicable only to Phase I participants aged 2 years (or 7 months) and older)
• Individuals who are allergic to the active ingredient of the vaccine, any of its inactive ingredients, or substances used in the manufacturing process; or those who have previously experienced an allergic reaction after receiving a similar vaccine; Individuals with a history of severe allergic reactions to vaccines (such as acute allergic reactions, angioedema, or difficulty breathing), or a history of severe allergic reactions to any vaccine, food, or medication, including urticaria, anaphylactic shock, eczema, allergic respiratory distress, angioedema, or a history of asthma
• Individuals with uncontrolled hypertension (as measured on-site: systolic blood pressure ≥160 mmHg and diastolic blood pressure ≥100 mmHg); (Applicable to Stage II participants aged 50 and older and Stage I participants aged 18 and older)
• Women of childbearing age with a positive urine pregnancy test; participants who are breastfeeding; or participants or their partners who plan to become pregnant within the next 6 months; (Applicable to the Phase II group aged 50 or older and the Phase I group aged 18 or older)
• History of epilepsy, seizures (excluding febrile seizures), convulsions, or brain disorders \[such as congenital brain malformations, traumatic brain injury, brain tumors, cerebral hemorrhage, cerebral infarction (excluding cerebral infarctions without sequelae and lacunar infarctions), brain infections, chemical poisoning, and other conditions causing damage to brain neural tissue\], or a history of mental illness or a family history thereof; or those with other progressive neurological diseases
• Have been diagnosed with a congenital or acquired immunodeficiency, HIV infection, lymphoma, leukemia, systemic lupus erythematosus (SLE), juvenile rheumatoid arthritis (JRA), or other autoimmune diseases
• Known or suspected acute illness or severe chronic disease (including severe respiratory disease, severe cardiovascular disease, liver or kidney disease, severe skin disease, malignant tumors, etc.); or currently experiencing an acute exacerbation of a chronic condition
• Clinically diagnosed coagulation disorders (such as coagulation factor deficiencies, coagulation disorders, or platelet abnormalities) or significant bruising or bleeding disorders
• Asplenia, functional asplenia, and asplenia or splenectomy resulting from any cause
• Patients who have received immunosuppressive therapy within 6 months prior to vaccination or who are scheduled to receive such therapy between enrollment and 1 month after completion of the vaccination series (e.g., long-term systemic corticosteroid use for ≥14 days at a dose >2 mg/kg/day or ≥20 mg/day of prednisone or prednisone-equivalent dose) (excluding topical corticosteroids such as inhaled, nasal spray, intra-articular, eye drops, or ointments; topical use must not exceed the dose recommended in the product label or result in any signs of systemic exposure). Individuals who have used long-acting immunomodulatory drugs (e.g., infliximab) within 6 months prior to the first dose or who plan to use such drugs during the trial (applicable to the Phase II group aged ≥50 years and the Phase I group aged 7 months and older)
• Received blood products (excluding hepatitis B immunoglobulin) within 3 months prior to receiving the investigational drug
• Participation in any other clinical trial involving a drug or vaccine within the 6 months prior to enrollment, or currently participating in such a trial, or plans to participate in such a trial during the study period
• Received an injectable live attenuated vaccine within 14 days prior to receiving the investigational drug, or received any other vaccine within 7 days
• Underarm temperature of 37.3°C or higher prior to vaccination
• According to the researchers' assessment, the trial participants had other factors that made them unsuitable for participation in the clinical trial

Exclusion criteria for the 2nd, 3rd, and 4th doses:

• Individuals who experienced a severe allergic reaction following the previous dose of the vaccine
• Individuals who experienced a serious adverse reaction causally related to a previous dose of the vaccine
• Other potential causes ruled out by the researchers

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Quadruple blind

Primary purpose

Prevention

Study locations

China · 2 centers

• Ningling County Center for Disease Control and Prevention — Shangqiu
• Xiangcheng County Center for Disease Control and Prevention — Xuchang

Identifiers

NCT: NCT07600983 · CTP-PCV24-001

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗