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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)

2026年9月7日 更新者：University Hospital, Toulouse

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.

調査の概要

状態

まだ募集していません

条件

介入・治療

詳細な説明

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.

研究の種類

介入

入学 (推定)

160

段階

  • フェーズ 4

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

研究場所

  • フランス
      • Besançon、フランス、25 000
        • Jean Minjoz University Hospital
        • 主任研究者：
          • Eric Berger, MD
        • コンタクト：
      • Bordeaux、フランス、33 000
        • Pellegrin Hospital Group
        • コンタクト：
        • 主任研究者：
          • Aurélie Ruet, PHD
      • Caen、フランス、14 033
        • Côte de Nacre University Hospital
        • コンタクト：
        • 主任研究者：
          • Pierre Branger, MD
      • Clermont-Ferrand、フランス、63 000
        • Gabriel Montpied Hospital
        • コンタクト：
        • 主任研究者：
          • Pierre Clavelou, MD
      • Créteil、フランス、94 000
        • GCS CHIC Henri Mondor
        • 主任研究者：
          • Alain Creange, PHD
        • コンタクト：
      • Dijon、フランス、21 000
        • Dijon Hospital University
        • コンタクト：
        • 主任研究者：
          • Thibault Moreau, PHD
      • Grenoble、フランス、38 700
        • Nord Hospital - Grenoble University Hospital
        • 主任研究者：
          • Olivier Casez, MD
        • コンタクト：
      • Libourne、フランス、33 500
        • Libourne Hospital Center
        • コンタクト：
        • 主任研究者：
          • Arnaud Gagnol, MD
      • Lille、フランス、59 037
        • Roger Salengro Hospital - Lille University Hospital
        • コンタクト：
        • 主任研究者：
          • Hélène Zephir, PHD
      • Lille、フランス、59 400
        • Catholics Institut Hospitals Group
        • コンタクト：
        • 主任研究者：
          • Arnaud Kwiatkowski, PHD
      • Lyon、フランス、69 002
        • Lyon Civil Hospices
        • コンタクト：
        • 主任研究者：
          • Sandra Vukusic, PHD
      • Montpellier、フランス、34 295
        • Gui de Chauliac Hospital - Montpellier University Hospital
        • コンタクト：
        • 主任研究者：
          • Xavier Ayrignac, PHD
      • Nantes、フランス、44 800
        • Laennec Hospital
        • 主任研究者：
          • Sandrine Wiertlewski, MD
        • コンタクト：
      • Nice、フランス、06 000
        • Pasteur Hospital
        • コンタクト：
        • 主任研究者：
          • Mikael Cohen, PHD
      • Nîmes、フランス、30 900
        • Nîmes University Hospital
        • コンタクト：
        • 主任研究者：
          • Eric Thouvenot, PHD
      • Paris、フランス、75 012
        • 15/20 Hospital
        • コンタクト：
        • 主任研究者：
          • Dalia Dimitri-Boulos, MD
      • Paris、フランス、75 013
        • Pitié Salpetrière Hospital
        • コンタクト：
        • 主任研究者：
          • Céline Louapre, PHD
      • Paris、フランス、75 019
        • Adolphe de Rothschild Hospital
        • 主任研究者：
          • Marine Boudot de La Motte, MD
        • コンタクト：
      • Poissy、フランス、78 300
        • Intercommunal Hospital Center of Poissy Saint-Germain
        • 主任研究者：
          • Olivier Heinzlef, MD
        • コンタクト：
      • Poitiers、フランス、86 000
        • La Miletrie University Hospital
        • コンタクト：
        • 主任研究者：
          • Amélie Dos Santos, MD
      • Rennes、フランス、35 000
        • Pontchaillou Hospital
        • コンタクト：
        • 主任研究者：
          • Laure Michel, PHD
      • Rouen、フランス、76 000
        • Charles Nicolle Hospital
        • コンタクト：
        • 主任研究者：
          • Maxime Guillaume, MD
      • Toulouse、フランス、31 300
        • Purpan Hospital
        • 主任研究者：
          • Jonathan Ciron, MD
        • コンタクト：
      • Tours、フランス、37 000
        • Tours Hospital University
        • 主任研究者：
          • Inès Doghri, MD
        • コンタクト：

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

  • 大人
  • 高齢者

健康ボランティアの受け入れ

いいえ

説明

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

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
アクティブコンパレータ：2 months arm
Patients will receive the standard vaccination schedule in two doses in 2 months.
生物学的：Two-dose M0-M2 vaccination schedule

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.
実験的：6 months arm
Patients will receive a vaccination schedule in two doses in 6 months.
生物学的：Two-dose M0-M6 vaccination schedule

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.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Humoral vaccine response rate for IgG anti-VZV gE response
時間枠：3 months for the " 2 months " group and 7 months for the " 6 months " group
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.
3 months for the " 2 months " group and 7 months for the " 6 months " group

二次結果の測定

結果測定
メジャーの説明
時間枠
The humoral response in terms of Geometric Mean Titer (GMT) at 1 month after the 2nd vaccine dose.
時間枠：3 months for the " 2 months " group and 7 months for the " 6 months " group

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
Composite criteria of the humoral response up to M13
時間枠：13 months
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.
13 months
Composite criteria of the cellular response at 1 month after the 2nd vaccine dose
時間枠：3 months for the " 2 months " group and 7 months for the " 6 months " group

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
Composite criteria of the cellular response at M13
時間枠：13 months
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.
13 months
The vaccine safety
時間枠：from M0 to month 13
The safety will be assessed by the adverse events including serious adverse events collected during the study.
from M0 to month 13

その他の成果指標

結果測定
メジャーの説明
時間枠
Composite criteria of the predicted humoral response at M20
時間枠：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
The overall predicted humoral exposure from M0 to M20
時間枠：20 months
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
The predicted cellular response at M20
時間枠：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
The overall predicted cellular exposure from M0 to M20
時間枠：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
時間枠：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
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.
時間枠：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

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

University Hospital, Toulouse

捜査官

  • 主任研究者：Jonathan Ciron, MD、University Hospital, Toulouse

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (推定)

2026年10月20日

一次修了 (推定)

2030年6月20日

研究の完了 (推定)

2030年11月30日

試験登録日

最初に提出

2026年9月7日

QC基準を満たした最初の提出物

2026年9月7日

最初の投稿 (実際)

2026年9月14日

学習記録の更新

投稿された最後の更新 (実際)

2026年9月14日

QC基準を満たした最後の更新が送信されました

2026年9月7日

最終確認日

2026年9月1日

詳しくは

本研究に関する用語

キーワード

追加の関連 MeSH 用語

その他の研究ID番号

  • RC31/25/0535
  • 2025 (米国 NIH グラント/契約：Faculty of Social Sciences Scientific Grant at the University of Gdańsk)
  • PHRC 24-0185 (その他の助成金/資金番号：French Ministry of Health)
  • 2025-525106-37-00 (その他の識別子：ID-RCB)

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

未定

医薬品およびデバイス情報、研究文書

米国FDA規制医薬品の研究

いいえ

米国FDA規制機器製品の研究

いいえ

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