A Phase 1/2 interventional study of RH5.1/ ASO1 in Malaria, sponsored by University of Oxford. Completed at 2 sites in United Kingdom. Open to participants aged 18 Years to 45 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2022-02-18.
Sponsored by University of Oxford · Phase 1/2, Interventional, and Prevention
This is an open-label, multi-centre Phase I/IIa dose escalation blood-stage malaria CHMI trial to assess the safety, immunogenicity and efficacy of the candidate malaria vaccine RH5.1/AS01. All volunteers recruited will be healthy, malaria naïve adults aged between 18 and 45 years.
Volunteers will be recruited and vaccinated at the CCVTM, Oxford; Guys and St Thomas' NIHR CRF, London; and the NIHR WTCRF, Southampton for the Phase Ia part of the trial, and at the CCVTM, Oxford and Guys and St Thomas' NIHR CRF, London for the Phase IIa stage.
This is a descriptive phase I trial to assess the safety and immunogenicity of the RH5.1/AS01 vaccine in healthy volunteers at different doses, and to establish whether the RH5.1/AS01 vaccine can demonstrate a reduced parasite multiplication rate in vaccinated subjects compared to infectivity controls in a blood-stage controlled human malaria infection model.
There will be 6 study groups across two phases of the trial, with a total of 66 - 78 volunteers.
Vaccination of groups will be sequential from Group 1 to Group 3. Group 3 and 4 can be recruited simultaneously. Volunteers will be able to choose which group they are allocated to.
The vaccination dose for Group 5 has been decided following the analysis of safety and exploratory immunology assays from Groups 1, 2 and 4. They will undergo blood-stage CHMI 2 weeks after the final vaccination and will be followed up until approximately 6 months after the final vaccination.
Group 6 volunteers will be infectivity controls, so will not receive any vaccinations.
Volunteers will be recruited and undergo screening visits, vaccination and clinic visits post-vaccination at their local trial site. Procedures will be performed on the visit time points indicated in the schedule of attendances.. Additional procedures or laboratory tests may be performed, at the discretion of the Investigators.
1,315 studies on the registry are indexed under Malaria; 86 are open to participants now.
This study's enrollment of 88 is below the median of 220 across 1,041 interventional studies indexed under Malaria.
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Additional Inclusion Criteria for Groups 5 - 6
Exclusion Criteria:
Additional exclusion criteria for groups 5 - 6
The study is designed to assess a 'standard' protein-in-adjuvant vaccination regimen- 2µg RH5.1/ 0.5mL AS01- of 3 doses given four weeks apart, with dose escalation to assess the best dose in healthy adults.
Biological: RH5.1/ ASO1
The dose used will be- 10µg RH5.1/ 0.5mL AS01. The total number of volunteers recruited to Groups 1 and 2 will be decided based on the immunogenicity of the vaccines at the 2 µg and 10 µg doses. If the doses are immunogenic the groups (1 and 2) will be recruited to a total of 12 volunteers.
Biological: RH5.1/ ASO1
Group 3 will receive 50µg RH5.1/ 0.5mL AS0 The ultimate aim is to assess the safety and immunogenicity of giving the 'standard' first two doses of the vaccine followed by a delayed fractional dose (10 µg).
Biological: RH5.1/ ASO1
Group 3 and 4 will be recruited simultaneously. The dose of vaccine for this group is same as that of 3 (50µg RH5.1/ 0.5mL AS01)
Biological: RH5.1/ ASO1
The vaccination dose for Group 5 was decided following the analysis of safety and exploratory immunology assays from Groups 1, 2 and 4. The dose of vaccine for this group is the same as that of group 2 (10µg RH5.1/ 0.5mL AS01).
Biological: RH5.1/ ASO1
Group 6 volunteers will be infectivity controls, so will not receive any vaccinations. Groups 5 and 6 will only be recruited once at least 6 volunteers in Group 4 have completed all vaccinations.
Group 7 are Group 5 volunteers who will receive a fourth dose of IMP (10µg RH5.1/ 0.5mL AS01)
Biological: RH5.1/ ASO1
Group 8 are infectivity controls who were originally in Group 6.
Group 9 are new infectivity controls
The RH5.1 protein consists of the entire full-length ectodomain of the PfRH5 antigen (amino acids E26 - Q526) with the sequence based on the 3D7 clone of P. falciparum. The AS01 adjuvant system has been developed and manufactured by GlaxoSmithKline (GSK) Biologicals and is presented as a liquid solution in a monodose glass vial. AS01 is a liposome-based Adjuvant System with a specific aim to improve cell-mediated immunity.
Efficacy of the RH5.1/AS01 Vaccine by Demonstrating a Reduced PMR in Vaccinated Subjects Compared to Infectivity Controls Against 3D7 Clone Parasites in a CHMI Model.
PCR-derived parasite multiplication rate (PMR) will be the primary efficacy endpoint for the Phase IIa stage of the trial, and comparison of the endpoint between the Groups 5 and 6 will constitute the primary analysis for efficacy.
Time frame: Measured during CHMI
Safety of RH5.1/AS01 in Healthy Malaria-naïve Adults in the UK.
Solicited and unsolicited adverse events collected passively and actively for 28 days post each vaccination. Number of volunteers reporting any unsolicited AEs post-any vaccination, as reported to investigators or in electronic diaries.
Time frame: 8 months
the in Vitro Growth Inhibition Activity (GIA) Against 3D7 Clone P. Falciparum Parasites of IgG Purified From the Serum of Vaccinees.
The specific endpoints for GIA in vitro will be assessed from a titration of the purified IgG in the assay.
Time frame: 2 weeks post final vaccination
the Humoral Immunogenicity of RH5.1/AS01 Using Different Vaccine Doses and Vaccination Regimens.
Antibody responses to the RH5.1 protein generated by vaccination
Time frame: 2 weeks post final vaccination
the Cellular Immunogenicity of RH5.1/AS01 Using Different Vaccine Doses and Vaccination Regimens.
T cell responses to the RH5.1 protein generated by vaccination
Time frame: 2 weeks post final vaccination
Immunological Readouts for Association With a Reduced Parasite Multiplication Rate.
Statistical correlation between anti-RH5 antibody responses induced by the RH5.1 vaccine and PMR. A non-linear regression curve for all samples combined is available in the trial manuscript ; data is not presented here.
Time frame: 8 months
| Milestone | Group 1-Phase Ia | Group 2- Phase Ia | Group 3-Phase Ia | Group 4-Phase Ia | Group 5-Phase IIa | Group 6-Phase IIa | Group 7-Phase IIa | Group 8 -Phase IIa | Group 9 -Phase IIa |
|---|---|---|---|---|---|---|---|---|---|
| Started | 12 | 12 | 12 | 14 | 17 | 15 | 0 | 0 | 6 |
| Completed | 12 | 11 | 11 | 10 | 14 | 14 | 0 | 0 | 4 |
| Not completed | 0 | 1 | 1 | 4 | 3 | 1 | 0 | 0 | 2 |
| Withdrew: Withdrawal by subject | 0 | 1 | 1 | 4 | 1 | 1 | 0 | 0 | 2 |
| Withdrew: Adverse event | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 0 |
| Milestone | Group 1-Phase Ia | Group 2- Phase Ia | Group 3-Phase Ia | Group 4-Phase Ia | Group 5-Phase IIa | Group 6-Phase IIa | Group 7-Phase IIa | Group 8 -Phase IIa | Group 9 -Phase IIa |
|---|---|---|---|---|---|---|---|---|---|
| Started | 0 | 0 | 0 | 0 | 0 | 0 | 9 | 8 | 0 |
| Completed | 0 | 0 | 0 | 0 | 0 | 0 | 8 | 8 | 0 |
| Not completed | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
| Withdrew: Pregnancy | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
PCR-derived parasite multiplication rate (PMR) will be the primary efficacy endpoint for the Phase IIa stage of the trial, and comparison of the endpoint between the Groups 5 and 6 will constitute the primary analysis for efficacy.
| Parisite multiplication rate (PMR) | Group 1-Phase Ia | Group 2- Phase Ia | Group 3-Phase Ia | Group 4-Phase Ia | Group 5-Phase IIa | Group 6-Phase IIa | Group 7-Phase IIa | Group 8 -Phase IIa | Group 9 -Phase IIa |
|---|---|---|---|---|---|---|---|---|---|
| Efficacy of the RH5.1/AS01 Vaccine by Demonstrating a Reduced PMR in Vaccinated Subjects Compared to Infectivity Controls Against 3D7 Clone Parasites in a CHMI Model. | — | — | — | — | 8.12 ± 1.13 | 9.75 ± 2.46 | 7.62 ± 1.44 | — | 11.22 ± 1.92 |
Solicited and unsolicited adverse events collected passively and actively for 28 days post each vaccination. Number of volunteers reporting any unsolicited AEs post-any vaccination, as reported to investigators or in electronic diaries.
| Participants | Group 1-Phase Ia | Group 2- Phase Ia | Group 3-Phase Ia | Group 4-Phase Ia | Group 5-Phase IIa | Group 7-Phase IIa |
|---|---|---|---|---|---|---|
| Safety of RH5.1/AS01 in Healthy Malaria-naïve Adults in the UK. | 9 | 11 | 9 | 10 | 14 | 3 |
The specific endpoints for GIA in vitro will be assessed from a titration of the purified IgG in the assay.
| percentage of growth inhibition | Group 1-Phase Ia | Group 2- Phase Ia | Group 3-Phase Ia | Group 4-Phase Ia | Group 5-Phase IIa | Group 6-Phase IIa | Group 7-Phase IIa | Group 8 -Phase IIa | Group 9 -Phase IIa |
|---|---|---|---|---|---|---|---|---|---|
| the in Vitro Growth Inhibition Activity (GIA) Against 3D7 Clone P. Falciparum Parasites of IgG Purified From the Serum of Vaccinees. | 75.2 ± 20.25 | 69.9 ± 11.65 | 71.3 ± 13.76 | 71.6 ± 13.18 | — | — | — | — | — |
Antibody responses to the RH5.1 protein generated by vaccination
| ug/mL | Group 1-Phase Ia | Group 2- Phase Ia | Group 3-Phase Ia | Group 4-Phase Ia | Group 5-Phase IIa | Group 6-Phase IIa | Group 7-Phase IIa | Group 8 -Phase IIa | Group 9 -Phase IIa |
|---|---|---|---|---|---|---|---|---|---|
| the Humoral Immunogenicity of RH5.1/AS01 Using Different Vaccine Doses and Vaccination Regimens. | 86.9 ± 51.75 | 88.1 ± 40.11 | 124.4 ± 81.62 | 95.6 ± 56.07 | — | — | — | — | — |
T cell responses to the RH5.1 protein generated by vaccination
| SFU per million PBMC | Group 1-Phase Ia | Group 2- Phase Ia | Group 3-Phase Ia | Group 4-Phase Ia | Group 5-Phase IIa | Group 6-Phase IIa | Group 7-Phase IIa | Group 8 -Phase IIa | Group 9 -Phase IIa |
|---|---|---|---|---|---|---|---|---|---|
| the Cellular Immunogenicity of RH5.1/AS01 Using Different Vaccine Doses and Vaccination Regimens. | 570 ± 439.4 | 140.7 ± 343.9 | 277.3 ± 328.4 | 713.3 ± 396.4 | — | — | — | — | — |
Statistical correlation between anti-RH5 antibody responses induced by the RH5.1 vaccine and PMR. A non-linear regression curve for all samples combined is available in the trial manuscript ; data is not presented here.
Results for this outcome have not been posted.
Collected over Data on solicted adverse events were collected for 7 days after vaccinated and unsolicited adverse events for 28 days post-vaccination. Data on serious adverse events and adverse events of special interest were collected for the study duration. Study duration was 240 days post first vaccination in groups 1, 2 and 4, 366 days post first vaccination in group 3 and 90 days post challenge in groups 5 and 7. Non-serious events are listed at a 1% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Group 1 | 0/12 (0%) | 0/12 (0%) | 9/12 (75%) |
| Group 2 | 0/12 (0%) | 0/12 (0%) | 11/12 (91.7%) |
| Group 3 | 0/12 (0%) | 1/12 (8.3%) | 9/12 (75%) |
| Group 4 | 0/14 (0%) | 0/14 (0%) | 10/14 (71.4%) |
| Group 5 | 0/17 (0%) | 1/17 (5.9%) | 14/17 (82.4%) |
| Group 6 | 0/15 (0%) | 0/15 (0%) | 0/15 (0%) |
| Group 7 | 0/9 (0%) | 1/9 (11.1%) | 3/9 (33.3%) |
| Group 8 | 0/8 (0%) | 0/8 (0%) | 0/8 (0%) |
| Group 9 | 0/6 (0%) | 0/6 (0%) | 0/6 (0%) |
| Event | Group 1 | Group 2 | Group 3 | Group 4 | Group 5 | Group 6 | Group 7 | Group 8 | Group 9 |
|---|---|---|---|---|---|---|---|---|---|
| PregnancyPregnancy, puerperium and perinatal conditions | 0/12 | 0/12 | 0/12 | 0/14 | 0/17 | 0/15 | 1/9 | 0/8 | 0/6 |
| PsoriasisSkin and subcutaneous tissue disorders | 0/12 | 0/12 | 1/12 | 0/14 | 0/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| TonsilectomySurgical and medical procedures | 0/12 | 0/12 | 0/12 | 0/14 | 1/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| Event | Group 1 | Group 2 | Group 3 | Group 4 | Group 5 | Group 6 | Group 7 | Group 8 | Group 9 |
|---|---|---|---|---|---|---|---|---|---|
| CoughRespiratory, thoracic and mediastinal disorders | 0/12 | 6/12 | 1/12 | 2/14 | 3/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| Back PainMusculoskeletal and connective tissue disorders | 3/12 | 1/12 | 1/12 | 0/14 | 0/17 | 0/15 | 1/9 | 0/8 | 0/6 |
| HeadacheGeneral disorders | 2/12 | 3/12 | 2/12 | 2/14 | 3/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| Oropharyngeal painGeneral disorders | 0/12 | 3/12 | 0/12 | 2/14 | 4/17 | 0/15 | 1/9 | 0/8 | 0/6 |
| RhinitisGeneral disorders | 0/12 | 2/12 | 3/12 | 2/14 | 4/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| RhinorrhoeaGeneral disorders | 0/12 | 3/12 | 0/12 | 0/14 | 1/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| Local ReactionGeneral disorders | 2/12 | 1/12 | 2/12 | 3/14 | 1/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| NauseaGastrointestinal disorders | 0/12 | 2/12 | 2/12 | 0/14 | 1/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| InsomniaGeneral disorders | 2/12 | 0/12 | 1/12 | 1/14 | 0/17 | 0/15 | 0/9 | 0/8 | 0/6 |
| AthralgiaMusculoskeletal and connective tissue disorders | 0/12 | 0/12 | 0/12 | 0/14 | 0/17 | 0/15 | 1/9 | 0/8 | 0/6 |
| Age, Categorical(Participants) | Group 1 | Group 2 | Group 3 | Group 4 | Group 5 | Group 6 | Group 9 | Total |
|---|---|---|---|---|---|---|---|---|
| <=18 years | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Between 18 and 65 years | 12 | 12 | 12 | 14 | 17 | 15 | 6 | 88 |
| >=65 years | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Age, Continuous(Years) | Group 1 | Group 2 | Group 3 | Group 4 | Group 5 | Group 6 | Group 9 | Total |
|---|---|---|---|---|---|---|---|---|
| Mean | 32 (22 to 42) | 28 (18 to 45) | 29 (25 to 41) | 31 (18 to 45) | 27 (21 to 39) | 27 (20 to 33) | 24 (21 to 28) | 29 (18 to 45) |
| Sex: Female, Male(Participants) | Group 1 | Group 2 | Group 3 | Group 4 | Group 5 | Group 6 | Group 9 | Total |
|---|---|---|---|---|---|---|---|---|
| Female | 9 | 7 | 8 | 9 | 12 | 6 | 4 | 55 |
| Male | 3 | 5 | 4 | 5 | 5 | 9 | 2 | 33 |
| Race and Ethnicity Not Collected(Participants) | Group 1 | Group 2 | Group 3 | Group 4 | Group 5 | Group 6 | Group 9 | Total |
|---|---|---|---|---|---|---|---|---|
| Count of participants | — | — | — | — | — | — | — | 0 |
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Ran from Oct 2016 to primary completion in Jun 2019, 32 months.
Results were first posted in Feb 2022, 2 years 7 months after primary completion.
Of 25 phase 1/2 interventional studies under Malaria, half reached primary completion within 25 months of starting (the median), counting those still running; a quarter within 9 and three quarters within 48. This study's 32 months is above that.
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