Phase 1 Trial of a Malaria Vaccine in Young Kenyan Children

Double-blind,Randomized,Controlled,Dose Escalation Phase 1 Trial in 12-47 Month Old Children in Western Kenya to Evaluate the Safety and Immunogenicity of WRAIR's MSP-1(FMP1) Malaria Vaccine Adjuvanted in GSK's AS02A Versus Rabies Vaccine.

To assess the safety and reactogenicity of the FMP-1/AS02A malaria vaccine in malaria-exposed children living in western Kenya and aged 12-47 months

Study Overview

• Status: Completed
• Conditions: Plasmodium Falciparum Malaria
• Intervention / Treatment: Biological: FMP1/AS02A Malaria vaccine; Biological: Imovax Rabies vaccine

Detailed Description

Study consists of 3 cohorts (12 to 23 months, 24 to 35 months, and 36 to 47 months). Within each cohort subjects were randomized in a 2:1 ration to receive one of three dose levels of FMP1/AS02A (Cohort A, 10 ug; Cohort B, 25 ug; Cohort C, 50 ug) or Imovax Rabies vaccine. Immunization was staggered among dose cohorts; subjects in Cohort B received their first immunization only after the Local Medical Monitor and Data Safety Monitoring Board reviewed Cohort A safety data for the eight-day follow-up period following their first immunization. The same procedure was followed for the immunization of Cohort C. This will be conducted in western Kenya a the Walter Reed Project Lumbewa Clinic.

• Study Type: Interventional
• Enrollment (Actual): 135
• Phase: Phase 1

Contacts and Locations

Study Locations

• Kenya
  • Nyanza Province
    • Kombewa, Nyanza Province, Kenya
      • Walter Reed Project Kombewa Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 year to 3 years (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• A healthy male or female child, 12 to 47 months of age at the time of screening.
• Written informed consent obtained from at least one parent before study start.
• Available to participate for the duration of the study (12 months).

Exclusion Criteria:

• Acute disease at the time of entry into the study
• Axillary temperature of 37.5 degrees C
• Respiratory rate 50
• Serum ALT 45 IU/l (i.e., > 1.5 X ULN)
• Decreased renal function: serum creatinine levels > 92.2 mM/l (> 1.1 mg/dl).
• Significant anemia (Hgb <8 gm/dL).
• Thrombocytopenia (Platelets < 100,000 per mm3)
• Impaired immunity: (Absolute lymphocyte count [ALC] for 1 year olds < 4.0 x 103/mm3; for 2 year olds < 3.0 x 103/mm3; for 3 year olds < 2.0 103/mm3.
• History of homozygous sickle cell disease (SS).
• Malnutrition (Z score; Malnutrition = Weight for height < - 3 z scores)
• Blood transfusion or use of blood-based product in previous 6 months.
• Prior receipt of a rabies vaccine or an investigational malaria vaccine.
• Use of any investigational drug or vaccine other than the study vaccine within 30 days preceding the first dose of study vaccine, or planned use up to 30 days after the third dose.
• Administration of chronic (defined as more than 14 days) immunosuppressants or other immune-modifying drugs within six months of vaccination. (For cortico-steroids, this will mean prednisone, or equivalent, greater than or equal to 0.5 mg/kg/day. Inhaled and topical steroids are allowed).
• Administration or anticipated administration of a vaccine not foreseen by the study protocol within 30 days of the first dose of vaccine(s) with the exception of tetanus toxoid.
• Previous vaccination with a vaccine containing MPL or QS21 (e.g., RTS,S).
• Any confirmed or suspected immunosuppressive or immunodeficient condition, including human immunodeficiency virus (HIV) infection. (No HIV testing will be undertaken as part of this study.)
• History of allergic reactions or anaphylaxis to immunizations or to any vaccine components.
• History of surgical splenectomy.
• Administration of immunoglobulins or any blood products within the 3 months preceding the first dose of study vaccine or planned administration during the study period.
• Simultaneous participation in any other clinical trial.
• Acute or chronic cardiovascular, pulmonary, hepatic or renal condition, which in the opinion of the PI may increase the risk to the subject from participating in the study.
• Any other condition or circumstance that in the opinion of the investigator may pose a threat to the subject.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: FMP1/AS02A Malaria vaccine 10ug; Subject vaccinated with 10 ug of FMP1/AS02A on days 0, 29 and 57	Biological: FMP1/AS02A Malaria vaccine; Subjects vaccinated with FMP1/AS02 vaccine
Experimental: FMP1/AS02A Malaria vaccine 25 ug; Subject vaccinated with 25 ug of FMP1/AS02A on days 14, 42, and 70	Biological: FMP1/AS02A Malaria vaccine; Subjects vaccinated with FMP1/AS02 vaccine
Experimental: FMP1/AS02A Malaria vaccine 50 ug; Subject vaccinated with 50 ug of FMP1/AS02A on days 28, 56 and 84	Biological: FMP1/AS02A Malaria vaccine; Subjects vaccinated with FMP1/AS02 vaccine
Active Comparator: Imovax Rabies Vaccine; Subject vaccinated with Imovax Rabies Vaccine on corresponding FMP1/AS021 vaccination days	Biological: Imovax Rabies vaccine; Subjects vaccinated on corresponding FMP1/AS02A vaccination days

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Occurrence of Solicited Symptoms During a 8 Day Follow-up Period After Each Vaccination	Occurrence of any, local, or general solicited symptoms during the 8 day follow-up period	40 days
Occurrence of Unsolicited Symptoms During a 30 Day Follow-up Period After Each Vaccination	Occurrence of unsolicited symptoms during a 30 day follow-up period after each vaccination (day of vaccination and the 29 subsequent days)	90 days
Occurrence of Serious Adverse Events During an 8 Month Follow-up Period Following the First Dose of Study Vaccine	Occurrence of solicited and unsolicited serious adverse events during an 8 month follow-up period following the first dose of study vaccine	8 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anti-FMP1 Antibody Titer Responses	Antibody responses to FMP1 by ELISA following immunization with the study vaccine through 364 days following the first dose of study vaccine	364 days

Collaborators and Investigators

• Sponsor: U.S. Army Medical Research and Development Command
• Collaborators: GlaxoSmithKline; United States Agency for International Development (USAID); Walter Reed Army Institute of Research (WRAIR); Kenya Medical Research Institute; The PATH Malaria Vaccine Initiative (MVI)
• Investigators: Principal Investigator: Mark R. Withers, M.D., MPH, USAMRU-K

Publications and helpful links

General Publications

• Pichyangkul S, Gettayacamin M, Miller RS, Lyon JA, Angov E, Tongtawe P, Ruble DL, Heppner DG Jr, Kester KE, Ballou WR, Diggs CL, Voss G, Cohen JD, Walsh DS. Pre-clinical evaluation of the malaria vaccine candidate P. falciparum MSP1(42) formulated with novel adjuvants or with alum. Vaccine. 2004 Sep 28;22(29-30):3831-40. doi: 10.1016/j.vaccine.2004.07.023.
• Ockenhouse CF, Angov E, Kester KE, Diggs C, Soisson L, Cummings JF, Stewart AV, Palmer DR, Mahajan B, Krzych U, Tornieporth N, Delchambre M, Vanhandenhove M, Ofori-Anyinam O, Cohen J, Lyon JA, Heppner DG; MSP-1 Working Group. Phase I safety and immunogenicity trial of FMP1/AS02A, a Plasmodium falciparum MSP-1 asexual blood stage vaccine. Vaccine. 2006 Apr 5;24(15):3009-17. doi: 10.1016/j.vaccine.2005.11.028. Epub 2005 Nov 28.
• Stoute JA, Gombe J, Withers MR, Siangla J, McKinney D, Onyango M, Cummings JF, Milman J, Tucker K, Soisson L, Stewart VA, Lyon JA, Angov E, Leach A, Cohen J, Kester KE, Ockenhouse CF, Holland CA, Diggs CL, Wittes J, Heppner DG Jr; MSP-1 Malaria Vaccine Working Group. Phase 1 randomized double-blind safety and immunogenicity trial of Plasmodium falciparum malaria merozoite surface protein FMP1 vaccine, adjuvanted with AS02A, in adults in western Kenya. Vaccine. 2007 Jan 2;25(1):176-84. doi: 10.1016/j.vaccine.2005.11.037. Epub 2005 Dec 7.
• Angov E, Aufiero BM, Turgeon AM, Van Handenhove M, Ockenhouse CF, Kester KE, Walsh DS, McBride JS, Dubois MC, Cohen J, Haynes JD, Eckels KH, Heppner DG, Ballou WR, Diggs CL, Lyon JA. Development and pre-clinical analysis of a Plasmodium falciparum Merozoite Surface Protein-1(42) malaria vaccine. Mol Biochem Parasitol. 2003 May;128(2):195-204. doi: 10.1016/s0166-6851(03)00077-x.

Study record dates

Study Major Dates

• Study Start: June 1, 2003
• Primary Completion (Actual): July 1, 2004
• Study Completion (Actual): July 1, 2005

Study Registration Dates

• First Submitted: April 20, 2006
• First Submitted That Met QC Criteria: April 20, 2006
• First Posted (Estimate): April 24, 2006

Study Record Updates

• Last Update Posted (Actual): October 2, 2017
• Last Update Submitted That Met QC Criteria: May 4, 2017
• Last Verified: May 1, 2017

More Information

Terms related to this study

• Keywords: Malaria; Plasmodium falciparum; Vaccine; Phase 1; Merozoite surface protein-1; AS02A; MSP-1; Falciparum malaria protein 1; FMP-1
• Additional Relevant MeSH Terms: Infections; Vector Borne Diseases; Parasitic Diseases; Protozoan Infections; Malaria; Malaria, Falciparum; Physiological Effects of Drugs; Immunologic Factors; Vaccines
• Other Study ID Numbers: WRAIR 1030; HSRRB Log No. A-12094 (Other Identifier: IRB); KEMRI SSC No. 761 (Other Identifier: Ethics Committee); HSPC No. HS171 (Other Identifier)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Kenya Medical Research Institute; WRAIR; The Path Malaria Vaccine Initiative; United States Agency for International Development; GlaxoSmith Kline