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Efficacy, Safety and Immunogenicity Evaluation of MTBVAC in Newborns in Sub-Saharan Africa (MTBVACN3)

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ClinicalTrials.gov Identifier: NCT04975178
Recruitment Status : Not yet recruiting
First Posted : July 23, 2021
Last Update Posted : August 31, 2022
Sponsor:
Collaborators:
TuBerculosis Vaccine Initiative
University of Cape Town
Institut Pasteur de Madagascar
Biomedical Research Center EPLS
Universidad de Zaragoza
University of Stellenbosch
University of KwaZulu
Wits Health Consortium (Pty) Ltd
Information provided by (Responsible Party):
Biofabri, S.L

Brief Summary:
The objective of this project is to demonstrate safety, immunogenicity and improved efficacy of the new live attenuated M. tuberculosis vaccine called MTBVAC in a Phase 3 efficacy trial in HIV-uninfected infants born to HIV-infected and HIV-uninfected mothers as compared to standard of care BCG vaccination. The proposal builds upon a group of TB vaccine development partners in Europe and sub-Saharan Africa established in a previous EDCTP-supported project. It creates an expanded consortium of clinical trial partners for the optimal implementation of a large infant efficacy trial of MTBVAC in high TB incidence settings. New capacity for efficacy trials in infants will be a valuable resource for the TB vaccine development community. The proposal will create a network of institutions in three TB endemic African countries with enhanced laboratory capacity to conduct TB vaccine immunology studies and to bio-bank samples to discover immune correlates of vaccine-mediated protection.

Condition or disease Intervention/treatment Phase
Tuberculosis Biological: MTBVAC Biological: BCG Phase 3

Detailed Description:

A new effective tuberculosis (TB) vaccine is essential to achieve World Health Organization End TB goals and eliminate TB by 2050. The optimal long-term strategy would be a combination of serial mass campaigns in adults, coupled with universal newborn vaccination. Newborns are the only human population without prior mycobacterial exposure in TB endemic countries and we hypothesize that live attenuated mycobacterial vaccines will offer better protection to this naïve population compared to adults.

The objective of this project is to demonstrate safety, immunogenicity and improved efficacy of the new live attenuated M. tuberculosis vaccine called MTBVAC in a Phase 3 efficacy trial in HIV-uninfected infants born to HIV-infected and HIV-uninfected mothers as compared to standard of care BCG vaccination. The proposal builds upon a group of TB vaccine development partners in Europe and sub-Saharan Africa established in a previous EDCTP-supported project. It creates an expanded consortium of clinical trial partners for the optimal implementation of a large infant efficacy trial of MTBVAC in high TB incidence settings. New capacity for efficacy trials in infants will be a valuable resource for the TB vaccine development community. The proposal will create a network of institutions in three TB endemic African countries with enhanced laboratory capacity to conduct TB vaccine immunology studies and to bio-bank samples to discover immune correlates of vaccine-mediated protection.

MTBVAC is a novel TB vaccine candidate based on an attenuated M. tuberculosis clinical isolate of the Euro-American lineage. Attenuation is based on two independent, stable genetic deletions of the genes phoP and fadD26 coding for two major virulence factors, the transcription factor PhoP and the cell-wall lipids PDIM, respectively. The hypothesis is that MTBVAC will provide improved protection, as individuals latently infected with live M.tuberculosis have an 80% lower chance of developing TB, and as MTBVAC contains most of the genes deleted from BCG and presents a wider collection of antigens to the host immune system. Preclinical studies in different animal models indicated that MTBVAC is safe and is able to induce an improved protection compared to BCG.

Phase 1 studies showed that MTBVAC was safe and immunogenic in naïve adults and newborns, and evoked an immune response that exceeded the magnitude of BCG-induced immune responses. Larger dose-defining Phase 2a studies in newborns and in adults at extended dose-ranges to confirm these findings will be finalised in early 2021, and allow selection of a vaccine dose to progress into the proposed multi-centre efficacy trial in infants.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 6960 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Safety and immunogenicity in 60 HUU infants at six sites (total 360 HUU infants) will be randomised to receive BCG/MTBVAC in a 1:1 fashion. Safety and immunogenicity in 100 HEU neonates randomised to receive BCG/MTBVAC in a 1:1 fashion will also be evaluated at four South African sites. Further enrolment of HUU infants into the efficacy cohort will be initiated without waiting for favourable review by DSMB. Enrolment of HEU infants into the efficacy cohort will be initiated only after favourable unblinded review of D84 safety data by the DSMB.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: MTBVAC and BCG vaccine will be prepared, and allocation concealed by the site pharmacist. All other site staff will be blinded to vaccine allocation, throughout the follow-up period. Data pertaining to the MTBVAC vaccine and to BCG control will be collected in an observer-blinded manner. Blinding will be maintained throughout the vaccination and follow-up portions of the vaccine trial. No set of individual codes will be held at Biofabri's Headquarters. Biofabri's Headquarters will be able to access the individual randomization code from the SATVI Pharmacy randomization register. The code will be broken by the Site's Pharmacist (Study Contact for Emergency Code Break) only in the case of medical events that the investigator/physician in charge of the participant feels cannot be treated without knowing the identity of the study vaccine(s). The Site's Pharmacist is responsible for unblinding the treatment assignment in accordance with specified time frames for expedited reporting of SAEs.
Primary Purpose: Prevention
Official Title: Randomised, Double-Blind, Controlled Phase 3 Trial to Evaluate the Efficacy, Safety and Immunogenicity of MTBVAC Administered in Healthy HIV Unexposed and HIV Exposed Uninfected Newborns in Tuberculosis-Endemic Regions of Sub-Saharan Africa
Estimated Study Start Date : September 2022
Estimated Primary Completion Date : June 2027
Estimated Study Completion Date : September 2029

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: MTBVAC

Both MTBVAC and BCG vaccines are administered by intradermal route in the left deltoid region. One 0.05 mL reconstituted dose of MTBVAC will be defined based on the phase IIa results.

MTBVAC is manufactured by Biofabri. MTBVAC is formulated (1.5 - 8.5 x104 CFU/dose, 1.5 - 8.5 x105 CFU/dose or 1.5 - 8.5 x106 CFU/dose (to be selected) and presented as a lyophilised pellet in 20 dose vials (0.05 mL/dose, after reconstitution with sterile water for injection). MTBVAC vaccine will be released and distributed by BIOFABRI, and imported to the sites following approval by the local regulatory authority. MTBVAC vials should be stored in the site pharmacy between -20°C and -40ºC. A single vaccine vial will be used for each participant.

Biological: MTBVAC
MTBVAC is a novel TB vaccine candidate based on an attenuated M. tuberculosis clinical isolate of the Euro-American lineage. Attenuation is based on two independent, stable genetic deletions of the genes phoP and fadD26 coding for two major virulence factors, the transcription factor PhoP and the cell-wall lipids PDIM, respectively. We hypothesize that MTBVAC will provide improved protection, as individuals latently infected with live M.tuberculosis have an 80% lower chance of developing TB, and as MTBVAC contains most of the genes deleted from BCG and presents a wider collection of antigens to the host immune system. Preclinical studies in different animal models indicated that MTBVAC is safe and is able to induce an improved protection compared to BCG.

Active Comparator: BCG

BCG is a live attenuated M. bovis strain developed 100 years ago and is used as a preventive vaccine against tuberculosis. It is administered at birth.

One 0.05 mL reconstituted dose of BCG contains 2.5 x 105 CFU. The control vaccine will be the BCG vaccine available and recommended in South Africa at time of the trial.

BCG vaccine produced by AJ Biologics (formerly Staten Serum Institute) is the only BCG vaccine (Danish strain) currently licensed for routine use in South Africa. The recommended BCG injection volume for newborn infants (0.05 mL, after reconstitution with BCG diluent) contains approximately 2.5 x 105 CFU (range 1-4 x 105 CFU). BCG vaccine vials should be stored in the site pharmacy at 2-8ºC.

Biological: BCG
BCG is a live attenuated M. bovis strain developed 100 years ago and is used as a preventive vaccine against tuberculosis. It is administered at birth.




Primary Outcome Measures :
  1. Prevention of tuberculosis disease in healthy HIV-uninfected (HU) and HIV-exposed uninfected (HEU) neonates [ Time Frame: Minimum of 24 months to a maximum 72 months; or until study end in South Africa. ]
    Diagnosis of confirmed or unconfirmed TB disease from the time of randomization.


Secondary Outcome Measures :
  1. Number of participants with treatment-related adverse events as defined in protocol. [ Time Frame: Minimum of 24 months to a maximum 72 months; or until study end in South Africa. ]
    • Solicited injection site reaction adverse events: pain, redness, swelling, ulceration, drainage, and regional lymphadenopathy.
    • Solicited systemic adverse events: fever, irritability, vomiting, diarrhea, drowsiness, poor feeding, skin rash.
    • Unsolicited adverse events and serious adverse events.

  2. Immunogenicity analysis in HU and HEU infants [ Time Frame: Minimum of 24 months to a maximum 72 months; or until study end in South Africa. ]
    Frequencies and co-expression patterns of CD4 and CD8 T cells in whole blood.


Other Outcome Measures:
  1. Biobank samples [ Time Frame: Minimum of 24 months to a maximum 72 months; or until study end in South Africa. ]
    Biobank samples for future immunogenicity studies.



Information from the National Library of Medicine

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Ages Eligible for Study:   5 Minutes to 7 Days   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Male or female newborns within seven days of birth.
  • Written informed maternal consent, including permission to access maternal antenatal, postnatal, and infant medical records.
  • Infant participants and their caregivers available for trial follow-up and display the willingness and capacity to comply with trial procedures.
  • Newborns must be in good general health during pregnancy and delivery, as assessed by medical history and targeted physical examination.
  • Birth weight ≥ 2450 grams.
  • Apgar score at 5 minutes ≥ 7.
  • A maternal HIV test result (rapid test, enzyme-linked immunosorbent assay (ELISA), or Polymerase chain reaction (PCR)) taken within 30 days of delivery, or within seven days post-partum must be available and documented if HIV uninfected. If the mother is HIV infected, then she must be on antiretroviral (ARV) therapy as per in-country guidelines with a viral load of <50 copies/mL (within six months of labour).
  • Estimated gestational age ≥ 37 weeks.
  • Mother has not participated in a clinical trial within three months prior to the infant's birth.
  • Mother has never participated in a TB vaccine trial before.
  • Infant may not participate in any other clinical trials.

Exclusion Criteria:

Receipt of BCG vaccination prior to enrolment.

  • Significant antenatal, intrapartum, or postpartum complications that may affect the health of the newborn.
  • Skin condition, bruising or birth mark at the intended injection site.
  • Maternal HIV test (rapid test, ELISA, or PCR) result not available.
  • HIV exposed Newborn's HIV PCR result positive or not available.
  • Maternal history of TB during pregnancy.
  • History of close/household contact with a TB patient, antenatal or postnatal, whether maternal, other family member or another household member who has not yet completed TB treatment.
  • Clinically suspected neonatal sepsis.
  • Any severe congenital malformation.
  • History or evidence of any systemic disease on examination, or any illness that in the opinion of the Investigator may interfere with the evaluation of the safety and immunogenicity of the vaccine. Neonatal jaundice not considered clinically significant is not an exclusion.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04975178


Contacts
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Contact: Ingrid Murillo Jelsbak +34 986 33 04 00 ext 307 ingrid.murillo@biofabri.es
Contact: Sara Barja +34 986 33 04 00 ext 306 sara.barja@biofabri.es

Sponsors and Collaborators
Biofabri, S.L
TuBerculosis Vaccine Initiative
University of Cape Town
Institut Pasteur de Madagascar
Biomedical Research Center EPLS
Universidad de Zaragoza
University of Stellenbosch
University of KwaZulu
Wits Health Consortium (Pty) Ltd
Investigators
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Principal Investigator: Mark Hatherill University of Cape Town, Faculty of Health Sciences
Publications:
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Responsible Party: Biofabri, S.L
ClinicalTrials.gov Identifier: NCT04975178    
Other Study ID Numbers: MTBVACN3
First Posted: July 23, 2021    Key Record Dates
Last Update Posted: August 31, 2022
Last Verified: August 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Tuberculosis
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections
Bacterial Infections and Mycoses
Infections