Comparative Study of Two Vaccination Schedules for the Subunit Herpes Zoster Vaccine in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disease Patients Treated With Anti-CD20 Therapy: an Open-label Randomised Controlled Trial (TACTIC)
Immunocompromised individuals, such as patients with multiple sclerosis (MS) or diseases of the neuromyelitis optica spectrum (NMOSD) treated with an anti-CD20 monoclonal antibody, present an increased risk of shingles. The immunogenicity - and therefore the clinical effectiveness - of the recombinant vaccine against the varicella zoster virus based on glycoprotein E, recently recommended according to two-dose schedule two months apart in immunocompromised patients aged ≥ 18 years, could be significantly decreased when administered one month before and one month after the infusion of anti-CD20.
We hypothesize that, in patients with MS or NMOSD treated with anti-CD20 administered every six months, a two-dose M0-M6 vaccination schedule consisting of deferring the second dose six months after the first infusion, that is, five months after the anti-CD20 infusion, could improve vaccine immunogenicity and, consequently, the effectiveness of the vaccine.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
Shingles, caused by reactivation of varicella zoster virus (VZV), is a common condition in immunocompromised people. Its prevention, which has long remained a medical need unmet among these patients, was improved thanks to the availability of the recombinant glycoprotein-based VZV vaccine E (gE). Based on demonstrated clinical efficacy and safety profile in the general population as well as in immunocompromised patients, this vaccine is recommended in France according to a two-person schedule doses spaced two months apart in immunocompromised patients aged ≥ 18 years. However, further studies are needed in order to optimize vaccination strategies according to the different types of immunosuppression.
Patients with MS or NMOSD, who are at increased risk of herpes zoster, are extensively treated with anti-CD20 monoclonal antibodies, which are known to significantly alter immune responses to vaccines, in particular when vaccination is carried out early after the infusion of anti-CD20.
We hypothesize that in patients with MS or NMOSD treated with anti-CD20 administered every six months, a two-dose M0-M6 vaccination schedule, consisting of deferring the second dose to six months after the first, that is, five months after the anti-CD20 infusion, could improve vaccine immunogenicity and, consequently, the effectiveness of the vaccine.
In this phase IV randomized, controlled, open-label, parallel-group trial, we will compare, within a homogeneous population of patients with MS or NMOSD receiving antiCD20, the humoral response induced by a two-dose vaccination schedule administered at 2 months (M0-M2, "2-month" or standard group) or 6 months (M0-M6, "6-month" or experimental group). After the screening and inclusion phase, patients randomized to the M0-M2 (standard) and M0-M6 (experimental) groups will receive a first dose of recombinant herpes zoster vaccine (RZV) one month before the next scheduled infusion of anti-CD20 monoclonal antibodies (M1). The second dose of RZV will be given at either 2 months ("2-month group", M2) or 6 months ("6-month group", M6). Patients will receive their usual anti-CD20 monoclonal antibody infusions at the appropriate time M1, M7 and M13. The primary outcome will be evaluated one month after the second vaccine dose (M3 for the "2 months" group and M7 for the "6 months" group). The kinetics, intensity, and persistence of humoral and cellular immune responses, as well as safety, will be analyzed as criteria for secondary judgments during the scheduled follow-up visits until M13.
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Fase 4
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Jonathan Ciron, MD
- Numero di telefono: +33 05 61 77 91 06
- Email: ciron.j@chu-toulouse.fr
Luoghi di studio
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Besançon, Francia, 25 000
- Jean Minjoz University Hospital
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Investigatore principale:
- Eric Berger, MD
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Contatto:
- Eric Berger, MD
- Numero di telefono: +33 03 81 66 80 98
- Email: eberger@chu-besancon.fr
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Bordeaux, Francia, 33 000
- Pellegrin Hospital Group
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Contatto:
- Aurélie Ruet, PHD
- Numero di telefono: +33 05 56 79 55 21
- Email: aurelie.ruet@chu-bordeaux.fr
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Investigatore principale:
- Aurélie Ruet, PHD
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Caen, Francia, 14 033
- Côte de Nacre University Hospital
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Contatto:
- Pierre Branger, MD
- Numero di telefono: +33 02 31 06 46 17
- Email: branger-p@chu-caen.fr
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Investigatore principale:
- Pierre Branger, MD
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Clermont-Ferrand, Francia, 63 000
- Gabriel Montpied Hospital
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Contatto:
- Pierre Clavelou, PHD
- Numero di telefono: +33 04 73 75 22 01
- Email: pclavelou@chu-clermontferrand.fr
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Investigatore principale:
- Pierre Clavelou, MD
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Créteil, Francia, 94 000
- GCS CHIC Henri Mondor
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Investigatore principale:
- Alain Creange, PHD
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Contatto:
- Alain Creange, PHD
- Numero di telefono: +33 01 49 81 23 15
- Email: alain.creange@hmn.ap-hop-paris.fr
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Dijon, Francia, 21 000
- Dijon Hospital University
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Contatto:
- Thibault Moreau, PHD
- Numero di telefono: +33 03 80 29 37 53
- Email: thibault.moreau@chu-dijon.fr
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Investigatore principale:
- Thibault Moreau, PHD
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Grenoble, Francia, 38 700
- Nord Hospital - Grenoble University Hospital
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Investigatore principale:
- Olivier Casez, MD
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Contatto:
- Olivier Casez, MD
- Numero di telefono: +33 06 63 58 02 77
- Email: ocasez@chu-grenoble.fr
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Libourne, Francia, 33 500
- Libourne Hospital Center
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Contatto:
- Arnaud Gagnol, MD
- Numero di telefono: +33 05 57 55 70 05
- Email: arnaud.gagnol@ch-libourne.fr
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Investigatore principale:
- Arnaud Gagnol, MD
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Lille, Francia, 59 037
- Roger Salengro Hospital - Lille University Hospital
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Contatto:
- Hélène Zephir, PHD
- Numero di telefono: +33 03 20 44 57 65
- Email: helene.ZEPHIR@chu-lille.fr
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Investigatore principale:
- Hélène Zephir, PHD
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Lille, Francia, 59 400
- Catholics Institut Hospitals Group
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Contatto:
- Arnaud Kwiatkowski, PHD
- Numero di telefono: +33 03 20 87 49 01
- Email: Kwiatkowski.Arnaud@ghicl.net
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Investigatore principale:
- Arnaud Kwiatkowski, PHD
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Lyon, Francia, 69 002
- Lyon Civil Hospices
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Contatto:
- Sandra Vukusic, PHD
- Numero di telefono: +33 04 72 68 13 13
- Email: sandra.vukusic@chu-lyon.fr
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Investigatore principale:
- Sandra Vukusic, PHD
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Montpellier, Francia, 34 295
- Gui de Chauliac Hospital - Montpellier University Hospital
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Contatto:
- Xavier Ayrignac, PHD
- Numero di telefono: +33 04 67 33 95 18
- Email: x-ayrignac@chu-montpellier.fr
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Investigatore principale:
- Xavier Ayrignac, PHD
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Nantes, Francia, 44 800
- Laennec Hospital
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Investigatore principale:
- Sandrine Wiertlewski, MD
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Contatto:
- Sandrine Wiertlewski, MD
- Numero di telefono: +33 02 40 16 52 85
- Email: sandrine.wiertlewski@chu-nantes.fr
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Nice, Francia, 06 000
- Pasteur Hospital
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Contatto:
- Mikael Cohen, PHD
- Numero di telefono: +33 04 92 03 79 01
- Email: cohen.m@chu-nice.fr
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Investigatore principale:
- Mikael Cohen, PHD
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Nîmes, Francia, 30 900
- Nîmes University Hospital
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Contatto:
- Eric Thouvenot, PHD
- Numero di telefono: +33 04 66 68 32 61
- Email: eric.thouvenot@chu-nimes.fr
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Investigatore principale:
- Eric Thouvenot, PHD
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Paris, Francia, 75 012
- 15/20 Hospital
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Contatto:
- Dalia Dimitri-Boulos, MD
- Numero di telefono: +33 01 40 02 16 29
- Email: ddimitriboulos@15-20.fr
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Investigatore principale:
- Dalia Dimitri-Boulos, MD
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Paris, Francia, 75 013
- Pitié Salpetrière Hospital
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Contatto:
- Céline Louapre, PHD
- Numero di telefono: +33 01 42 16 57 66
- Email: celine.louapre@aphp.fr
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Investigatore principale:
- Céline Louapre, PHD
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Paris, Francia, 75 019
- Adolphe de Rothschild Hospital
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Investigatore principale:
- Marine Boudot de La Motte, MD
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Contatto:
- Marine Boudot de La Motte, MD
- Numero di telefono: +33 01 48 03 68 52
- Email: mboudotdelamotte@for.paris.fr
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Poissy, Francia, 78 300
- Intercommunal Hospital Center of Poissy Saint-Germain
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Investigatore principale:
- Olivier Heinzlef, MD
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Contatto:
- Olivier Heinzlef, MD
- Numero di telefono: +33 01 39 27 41 92
- Email: olivier.heinzlef@ght-yvelinesnord.fr
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Poitiers, Francia, 86 000
- La Miletrie University Hospital
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Contatto:
- Amélie Dos Santos, MD
- Numero di telefono: +33 05 49 44 44 44
- Email: Amelie.DOS-SANTOS@chu-poitiers.fr
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Investigatore principale:
- Amélie Dos Santos, MD
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Rennes, Francia, 35 000
- Pontchaillou Hospital
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Contatto:
- Laure Michel, PHD
- Numero di telefono: +33 02 99 28 42 66
- Email: Laure.MICHEL@chu-rennes.fr
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Investigatore principale:
- Laure Michel, PHD
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Rouen, Francia, 76 000
- Charles Nicolle Hospital
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Contatto:
- Maxime Guillaume, MD
- Numero di telefono: +33 02 32 88 89 90
- Email: Maxime.Guillaume@chu-rouen.fr
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Investigatore principale:
- Maxime Guillaume, MD
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Toulouse, Francia, 31 300
- Purpan Hospital
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Investigatore principale:
- Jonathan Ciron, MD
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Contatto:
- Jonathan Ciron, MD
- Numero di telefono: +33 05 61 77 91 06
- Email: ciron.j@chu-toulouse.fr
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Tours, Francia, 37 000
- Tours Hospital University
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Investigatore principale:
- Inès Doghri, MD
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Contatto:
- Inès Doghri, MD
- Numero di telefono: +33 02 47 47 80 23
- Email: I.DOGHRI@chu-tours.fr
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Descrizione
Inclusion Criteria:
- Patients with Multiple Sclerosis (any clinical form) or Neuromyelitis optica spectrum disease seropositive for aquaporin-4 antibodies (AQP4+)
- Aged 18 years or more
- Treated with anti-CD20 mAbs (Rituximab IV or Ocrelizumab IV or SC) since < 2 years with dosing intervals of 6 months (and for Rituximab, treated with 1g per infusion)
- Planned to receive the same anti-CD20 mAbs with dosing intervals of 6 months during the 13 months of the study (and for Rituximab, planned to receive 1g per infusion)
- Known history in the medical file of varicella, or VZV IgG serology known to evidence a prior infection
- Affiliated or beneficiary of a social security scheme
- Written and informed consent
- Understands and agrees to comply with the study procedures
Exclusion Criteria:
- Temporary contraindication to vaccination (concurrent episode of acute fever >38.5°C)
- Shingles in the last 12 months or VZV vaccination in the last 5 years
- Patients already treated or supposed to be treated with Ofatumumab (another anti-CD20 mAbs but delivered with a monthly subcutaneous injection)
- Patients who received high dose corticosteroids (methylprednisolone at a dose of ≥ 500 mg, administered over 1 to 5 days) in the 3 months prior to inclusion
- Patients who have been exposed to Cladribine in the prior 12 months
- Patients who received or were scheduled to receive any vaccination, except for influenza and SARS-CoV-2 vaccines during the epidemic season, within 2 weeks prior to the 2 RZV injections and up to 4 weeks after the second RZV injection
- Hypersensitivity to the active substance or to one of the excipients
- Patient protected by the law (guardianship, curatorship)
- Pregnancy or breast-feeding
- Women of childbearing potential (WOCBP) without effective contraception throughout the duration of the trial
- Criteria related to the use of ancillary anti-CD20 treatments (Rituximab and Ocrelizumab):
Hypersensitivity to the active substance or to any of the excipients Severe, active infections Severe immunodeficiency Severe heart failure or severe uncontrolled heart disease Known progressive malignancies
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Comparatore attivo: 2 months arm
Patients will receive the standard vaccination schedule in two doses in 2 months.
|
Patients randomized to the "2 months" vaccination group will receive their first dose of RZV vaccine one month before the next scheduled infusion anti-CD20 monoclonal antibody (M0 corresponding to the visit during the first dose of vaccine, M1 at the time of scheduled anti-CD20 infusion). The second dose of RZV vaccine will be administered 2 months later. Patients will receive their regular anti-CD20 infusions at times M1, M7, and M13. |
|
Sperimentale: 6 months arm
Patients will receive a vaccination schedule in two doses in 6 months.
|
Patients randomized to the "6 months" vaccination group will receive their first dose of RZV vaccine one month before the next scheduled infusion anti-CD20 monoclonal antibody (M0 corresponding to the visit during the first dose of vaccine, M1 at the time of scheduled anti-CD20 infusion). The second dose of RZV vaccine will be administered 6 months later. Patients will receive their regular anti-CD20 infusions at times M1, M7, and M13. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Humoral vaccine response rate for IgG anti-VZV gE response
Lasso di tempo: 3 months for the " 2 months " group and 7 months for the " 6 months " group
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It will be defined as the proportion of patients with at least a 4-fold increase in anti-VZV gE antibody titers (measured by ELISA) at 1 month after the 2nd vaccine dose compared to baseline (M0), or seroconversion for those who were seronegative at M0.
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3 months for the " 2 months " group and 7 months for the " 6 months " group
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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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The humoral response in terms of Geometric Mean Titer (GMT) at 1 month after the 2nd vaccine dose.
Lasso di tempo: 3 months for the " 2 months " group and 7 months for the " 6 months " group
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It will be assessed by the ratio (M0-M6 versus M0-M2 groups) of the adjusted Geometric Mean Titer (GMT) of anti-VZV gE IgG at 1 month after the 2nd vaccine dose. The adjusted GMT will correspond to the GMT at 1 month after the 2nd vaccine dose conditionally to the means of the log transformed GMT before vaccination at baseline (M0) calculated across the treatment groups. |
3 months for the " 2 months " group and 7 months for the " 6 months " group
|
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Composite criteria of the humoral response up to M13
Lasso di tempo: 13 months
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The kinetics, intensity and persistance will be assessed by the Geometric Mean Titer (GMT) of anti-VZV gE IgG measured at baseline (M0) and up to M13: before the 2nd vaccine dose, 1 month after the 2nd vaccine dose, and prior to the next anti CD20 infusions at M7 and M13.
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13 months
|
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Composite criteria of the cellular response at 1 month after the 2nd vaccine dose
Lasso di tempo: 3 months for the " 2 months " group and 7 months for the " 6 months " group
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It will be assessed by the cellular vaccine response rate for gE-specific CD4[AIM+] T response measured 1 month after the 2nd vaccine dose. The cellular VRR is defined as the proportion of patients with a proportion of gE-specific CD4[AIM+] T cells at least 2 times above the cutoff after vaccination. The proportion of gE-specific CD4[AIM+] T cells among CD4 T cells is defined by the proportion of CD4 T cells expressing at least one Activation-Induced Marker (AIM), as detected by flow cytometry, following in vitro stimulation with a peptide pool covering the entire ectodomain of gE. The AIM include CD69, CD25, OX40, CD40L, and CD137. We will determine the cut-off of gE-specific CD4[AIM+] T cells by assessing cellular immune responses across a range of non-vaccinated, healthy individuals. |
3 months for the " 2 months " group and 7 months for the " 6 months " group
|
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Composite criteria of the cellular response at M13
Lasso di tempo: 13 months
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The kinetics, intensity and persistance of the cellular response up to M13 will be assessed by the proportion of gE-specific CD4[AIM+] T cells among CD4 T cells measured at baseline (M0) and up to M13 : before the 2nd vaccine dose, 1 month after the 2nd vaccine dose, and prior to the next anti-CD20 infusions at M7 and M13.
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13 months
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The vaccine safety
Lasso di tempo: from M0 to month 13
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The safety will be assessed by the adverse events including serious adverse events collected during the study.
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from M0 to month 13
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Altre misure di risultato
Altre misure di risultato
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Composite criteria of the predicted humoral response at M20
Lasso di tempo: 20 months
|
Predicted humoral vaccine response rate will be assessed by the predicted humoral vaccine response rates at M20 of the M0-M6 RZV vaccine schedule ("6 months" group) and the M0-M2 RZV vaccine schedule ("2 months" group). Anti-VZV gE IgG at M20 will be assessed by the adjusted Geometric Mean Titers of anti-VZV gE IgG at M20 of the M0-M6 RZV vaccine schedule ("6 months" group) and the M0-M2 RZV vaccine schedule ("2 months" group). |
20 months
|
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The overall predicted humoral exposure from M0 to M20
Lasso di tempo: 20 months
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It will be assessed by the areas under the curve (AUC) of anti-VZV gE IgG titers between M0 and M20 of the M0-M6 RZV vaccine schedule ("6 months" group) and the M0-M2 RZV vaccine schedule ("2 months" group).
|
20 months
|
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The predicted cellular response at M20
Lasso di tempo: 20 months
|
It will be assessed by the predicted cellular vaccine rate response proportions of gE specific CD4[AIM+] T cells among CD4 T cells of the M0-M6 RZV vaccine schedule ("6 months" group) and the M0-M2 RZV vaccine schedule ("2 months" group).
|
20 months
|
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The overall predicted cellular exposure from M0 to M20
Lasso di tempo: 20 months
|
It will be assessed by the areas under the curve (AUC) of gE-specific CD4[AIM+] T cells among CD4 T cells between M0 and M20 of the M0-M6 RZV vaccine schedule ("6 months" group) and the M0-M2 RZV vaccine schedule ("2 months" group).
|
20 months
|
|
Composite criteria of the associated factors with early and persistent, humoral and cellular vaccine responses
Lasso di tempo: 20 months
|
The factors which will be studied are : age, sex, number of prior anti-CD20 infusions, type of latest DMT before anti-CD20 therapy, albumin and gammaglobulin levels, Ig G levels, leukocyte counts, T and B cell immunophenotyping, and immune exhaustion and immunosenescence markers throughout the study.
|
20 months
|
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The correlation between the titers of anti-VZV gE IgG by ELISA and the titers of total IgG anti-VZV by the commercial Diasorin serological test.
Lasso di tempo: 20 months
|
It will be assessed by the correlation between ELISA gE titer and the total anti-VZV glycoproteins IgG measured by the Liaison XL® Diasorin serological test.
|
20 months
|
Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Investigatore principale: Jonathan Ciron, MD, University Hospital, Toulouse
Studiare le date dei record
Studia le date principali
Inizio studio (Stimato)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Infezione da virus della varicella zoster
- Malattie del sistema nervoso
- Malattie autoimmuni
- Malattie del sistema immunitario
- Infezioni
- Malattie virali
- Malattie autoimmuni demielinizzanti, SNC
- Malattie autoimmuni del sistema nervoso
- Malattie demielinizzanti
- Infezioni da virus del DNA
- Infezioni da Herpesviridae
- Sclerosi multipla
- Fuoco di Sant'Antonio
- Varicella
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- RC31/25/0535
- 2025 (Sovvenzione/contratto NIH degli Stati Uniti: Faculty of Social Sciences Scientific Grant at the University of Gdańsk)
- PHRC 24-0185 (Altro numero di sovvenzione/finanziamento: French Ministry of Health)
- 2025-525106-37-00 (Altro identificatore: ID-RCB)
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Informazioni su farmaci e dispositivi, documenti di studio
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