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P KK, Chiteti SR, Aileni VK, Babji S, Blackwelder WC, Kumar A, Vagha J, Nayak U, Mitra M, D N, Kar S, Yadav S, Naidu S, Mahantshetti N, Khalatkar V, Mohapatra S, Purthi PK, Sharma P, Kannan A, Dhongade RK, Prasad SD, Ella R, Vadrevu KM. Phase III randomized clinical studies to evaluate the immunogenicity, lot-to-lot consistency, and safety of ROTAVAC® liquid formulations (ROTAVAC 5C & 5D) and non-inferiority comparisons with licensed ROTAVAC® (frozen formulation) in healthy infants. Hum Vaccin Immunother 2023; 19:2278346. [PMID: 37968237 PMCID: PMC10760372 DOI: 10.1080/21645515.2023.2278346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/28/2023] [Indexed: 11/17/2023] Open
Abstract
The WHO pre-qualified rotavirus vaccine, ROTAVAC®, is derived naturally from the neonatal 116E rotavirus strain, and stored at -20°C. As refrigerator storage is preferable, immunogenicity and safety of liquid formulations kept at 2-8°C, having excipients to stabilize the rotavirus, with or without buffers, were compared with ROTAVAC® in different clinical studies. Study-1, the pivotal trial for this entire product development work, was a randomized, single-blind trial with two operationally seamless phases: (i) an exploratory phase involving 675 infants in which two formulations, ROTAVAC 5C (LnHRV-1.5 mL and LnHRV-2.0 mL) containing buffer and excipients to stabilize the virus against gastric acidity and temperature, were compared with ROTAVAC®. As the immune response of ROTAVAC 5C (LnHRV-2.0 mL) was non-inferior to ROTAVAC®, it was selected for (ii) confirmatory phase, involving 1,302 infants randomized 1:1:1:1 to receive three lots of LnHRV-2.0 mL, or ROTAVAC®. Primary objectives were the evaluation of non-inferiority and lot-to-lot consistency. The secondary objectives were to assess the safety and interference with the concomitant pentavalent vaccine. As it was separately established that buffers are not required for ROTAVAC®, in Study-2, the safety and immunogenicity of ROTAVAC 5D® (with excipients) were compared with ROTAVAC® and lot-to-lot consistency was assessed in another study. All lots elicited consistent immune responses, did not interfere with UIP vaccines, and had reactogenicity similar to ROTAVAC®. ROTAVAC 5C and ROTAVAC 5D® were immunogenic and well tolerated as ROTAVAC®. ROTAVAC 5D® had comparable immunogenicity and safety profiles with ROTAVAC® and can be stored at 2-8°C, leading to WHO pre-qualification.Clinical Trials Registration: Clinical Trials Registry of India (CTRI): CTRI/2015/02/005577CTRI/2016/11/007481 and CTRI/2019/03/017934.
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Affiliation(s)
- Krishna Kumari P
- Medical Affairs Department, Bharat Biotech International Limited, Hyderabad, India
| | | | - Vinay K. Aileni
- Medical Affairs Department, Bharat Biotech International Limited, Hyderabad, India
| | - Sudhir Babji
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Ashok Kumar
- Department of Paediatrics, Banaras Hindu University, Varanasi, India
| | - Jayant Vagha
- Department of Paediatrics, Datta Megha Institute of Medical Sciences, Wardha, India
| | - Uma Nayak
- Department of Paediatrics, GMERS Medical College, Vadodara, India
| | - Monjori Mitra
- Department of Paediatrics, Institute of Child Health, Kolkata, India
| | - Narayanaappa D
- Department of Paediatrics, Jagadguru Shivarathreeshwara Medical College, Mysore, India
| | - Sonali Kar
- Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Sangeeta Yadav
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Swamy Naidu
- Department of Paediatrics, King George Hospital, Vishakapatnam, India
| | - Niranjan Mahantshetti
- Department of Paediatrics, Dr. Prabhakar Kore Medical College & Hospital, Belgaum, India
| | | | | | - P. K. Purthi
- Department of Paediatrics, Sri Ganga Ram Hospital, New Delhi, India
| | - Pawan Sharma
- Department of Paediatrics, Maharshi Hospital & Research Centre, Jaipur, India
| | - A. Kannan
- Department of Paediatrics, Meenakshi Mission Hospital, Chennai, India
| | | | - Sai D. Prasad
- Medical Affairs Department, Bharat Biotech International Limited, Hyderabad, India
| | - Raches Ella
- Medical Affairs Department, Bharat Biotech International Limited, Hyderabad, India
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Chilengi R, Mwila-Kazimbaya K, Chirwa M, Sukwa N, Chipeta C, Velu RM, Katanekwa N, Babji S, Kang G, McNeal MM, Meyer N, Gompana G, Hazra S, Tang Y, Flores J, Bhat N, Rathi N. Immunogenicity and safety of two monovalent rotavirus vaccines, ROTAVAC® and ROTAVAC 5D® in Zambian infants. Vaccine 2021; 39:3633-3640. [PMID: 33992437 PMCID: PMC8204902 DOI: 10.1016/j.vaccine.2021.04.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS ROTAVAC® (frozen formulation stored at -20 °C) and ROTAVAC 5D® (liquid formulation stable at 2-8 °C) are rotavirus vaccines derived from the 116E human neonatal rotavirus strain, developed and licensed in India. This study evaluated and compared the safety and immunogenicity of these vaccines in an infant population in Zambia. METHODS We conducted a phase 2b, open-label, randomized, controlled trial wherein 450 infants 6 to 8 weeks of age were randomized equally to receive three doses of ROTAVAC or ROTAVAC 5D, or two doses of ROTARIX®. Study vaccines were administered concomitantly with routine immunizations. Blood samples were collected pre-vaccination and 28 days after the last dose. Serum anti-rotavirus IgA antibodies were measured by ELISA, with WC3 and 89-12 rotavirus strains as viral lysates in the assays. The primary analysis was to assess non-inferiority of ROTAVAC 5D to ROTAVAC in terms of the geometric mean concentration (GMC) of serum IgA (WC3) antibodies. Seroresponse and seropositivity were also determined. Safety was evaluated as occurrence of immediate, solicited, unsolicited, and serious adverse events after each dose. RESULTS The study evaluated 388 infants in the per-protocol population. All three vaccines were well tolerated and immunogenic. The post-vaccination GMCs were 14.0 U/mL (95% CI: 10.4, 18.8) and 18.1 U/mL (95% CI: 13.7, 24.0) for the ROTAVAC and ROTAVAC 5D groups, respectively, yielding a ratio of 1.3 (95% CI: 0.9, 1.9), thus meeting the pre-set non-inferiority criteria. Solicited and unsolicited adverse events were similar across all study arms. No death or intussusception case was reported during study period. CONCLUSIONS Among Zambian infants, both ROTAVAC and ROTAVAC 5D were well tolerated and the immunogenicity of ROTAVAC 5D was non-inferior to that of ROTAVAC. These results are consistent with those observed in licensure trials in India and support use of these vaccines across wider geographical areas.
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Affiliation(s)
- R Chilengi
- Centre for Infectious Disease Research in Zambia, Zambia
| | | | - M Chirwa
- Centre for Infectious Disease Research in Zambia, Zambia
| | - N Sukwa
- Centre for Infectious Disease Research in Zambia, Zambia
| | - C Chipeta
- Centre for Infectious Disease Research in Zambia, Zambia
| | - R M Velu
- Centre for Infectious Disease Research in Zambia, Zambia
| | - N Katanekwa
- Centre for Infectious Disease Research in Zambia, Zambia
| | - S Babji
- The Wellcome Trust Research Laboratory, Vellore, India
| | - G Kang
- The Wellcome Trust Research Laboratory, Vellore, India
| | - M M McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - N Meyer
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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