A Clinical Study Investigating the Safety and Immune Responses After Immunization With Investigational Monkeypox Vaccines

• ClinicalTrials.gov Identifier: NCT05988203
• Recruitment Status: Recruiting
• First Posted: August 14, 2023
• Last Update Posted: March 13, 2024
• Sponsor: BioNTech SE
• Information provided by (Responsible Party): BioNTech SE

Study Description

Brief Summary:

This is a dose-escalation, Phase I/II trial evaluating the safety, tolerability, reactogenicity and immunogenicity of the investigational RNA-based multivalent vaccine candidate BNT166a for active immunization against monkeypox (mpox).

This trial will start with the two substudies, i.e., substudy A (SSA) and substudy B (SSB).

This trial will be initiated with the dose-escalation SSA. In substudy A and substudy B, dosing will start with an initial sentinel group, followed by the expansion cohort.

This study was initially planned to investigate two vaccine candidates (the quadrivalent BNT166a and the trivalent BNT166c). The sponsor decided to not activate the groups with BNT166c.

Condition or disease	Intervention/treatment	Phase
Monkeypox	Biological: BNT166a	Phase 1

Detailed Description:

Substudy A is a dose-escalation, Phase I substudy to assess the reactogenicity, safety and immunogenicity of up to three dose levels of the multivalent vaccine candidate BNT166a in ~48 healthy participants with no prior history of known or suspected smallpox vaccination (vaccinia-naïve participants). Two doses will be given ~31 days apart.

Substudy B is a Phase I substudy to assess the reactogenicity, safety and immunogenicity of the multivalent vaccine candidate BNT166a in ~16 healthy participants with prior history of smallpox vaccination (vaccinia-experienced). Two doses will be given ~31 days apart.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 64 participants
• Allocation: Randomized
• Intervention Model: Sequential Assignment
• Masking: None (Open Label)
• Primary Purpose: Prevention
• Official Title: A Randomized, Partially Observer-blind, Dose-escalation, Phase I/II Trial Evaluating the Safety and Immunogenicity of Investigational RNA-based Mpox Vaccine Candidates
• Actual Study Start Date: September 21, 2023
• Estimated Primary Completion Date: October 2024
• Estimated Study Completion Date: May 2025

Arms and Interventions

Arm	Intervention/treatment
Experimental: SSA - BNT166a; Escalating dose levels	Biological: BNT166a; Multivalent ribonucleic acid (RNA)-based vaccine for active immunization against monkeypox administered as intramuscular injection.
Experimental: SSB - BNT166a; One dose level	Biological: BNT166a; Multivalent ribonucleic acid (RNA)-based vaccine for active immunization against monkeypox administered as intramuscular injection.

Outcome Measures

Primary Outcome Measures :

1. SSA and SSB - Proportion (%) of participants reporting solicited local reactions at the injection site (pain, erythema/redness, induration/swelling) up to 7 days after each investigational medicinal product (IMP) dose for each group [ Time Frame: Up to 7 day after each IMP dose ]
   For each group
2. SSA and SSB - Proportion (%) of participants reporting solicited systemic events (vomiting, diarrhea, headache, fatigue, myalgia, arthralgia, chills, and fever) up to 7 days after each IMP dose for each group [ Time Frame: Up to 7 day after each IMP dose ]
   For each group
3. SSA and SSB - Proportion (%) of participants with at least one unsolicited adverse event (AE) occurring from Dose 1 to 28 days after the dose [ Time Frame: From Dose 1 to 28 days after Dose 1 ]
   For each group
4. SSA and SSB - Proportion (%) of participants with at least one unsolicited AE occurring from Dose 2 to 28 days after the dose [ Time Frame: From Dose 2 to 28 days after Dose 2 ]
   For each group
5. SSA and SSB - Proportion (%) of participants with at least one serious adverse event (SAE) occurring from Dose 1 to 24 weeks after Dose 2 [ Time Frame: From Dose 1 to 24 weeks after Dose 2 ]
   For each group
6. SSA and SSB - Proportion (%) of participants with worsening grading shifts in hematology and chemistry laboratory values between baseline and 1 week after Dose 1, before Dose 2, 1 week and 1 month after Dose 2 [ Time Frame: From baseline to 1 month after Dose 2 ]
   For each group

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• Have given informed consent by signing and dating the informed consent form (ICF) before initiation of any trial-specific procedures.
• Are willing and able to comply with scheduled visits, treatment schedule, laboratory tests, and other requirements of the trial, including the prohibited concomitant medications. This includes that they are able to understand and follow trial-related instructions.
• SSA only: Are 18 through 45 years of age (inclusive) at the time of informed consent.
• SSB only: Are 50 through 65 years of age (inclusive) at the time of informed consent.
• Have a body mass index over 18.5 kg/m^2 and under 30 kg/m^2 and weigh at least 50 kg at Visit 0.
• Are healthy, in the clinical judgment of the investigator based on volunteer-reported medical history data, physical examination, 12-lead electrocardiogram (ECG), vital signs, and clinical laboratory test results.
• SSA only: Have no prior history of known or suspected smallpox vaccination and no detectable smallpox vaccination characteristic scar (vaccinia-naïve participants).
• SSB only: Have a history of prior smallpox vaccination (i.e., are vaccinia-experienced), determined based on medical records and/or presence of smallpox vaccination characteristic scar. The most recent smallpox vaccination should have been received before 1980.
• Agree not to enroll in another trial with an IMP starting from Visit 0 and until the end of this trial (Visit 12).
• Negative human immunodeficiency virus (HIV)-1 and HIV-2 antigen/antibody blood test result at Visit 0.
• Negative Hepatitis B surface antigen test result and negative anti Hepatitis C virus antibodies (anti-HCV), or negative Hepatitis C virus (HCV) polymerase chain reaction (PCR) test result if the anti-HCV is positive at Visit 0.
• Volunteers of childbearing potential (VOCBP) must not be pregnant. VOCBP and men who are sexually active with partners of childbearing potential and their sexual partners born female should use a highly effective form of contraception from at least 28 days prior to Dose 1 up to at least 90 days after receiving the last dose of trial treatment, and should agree not to donate eggs (ova, oocytes) or sperm.

Exclusion Criteria:

• History of mpox, smallpox or vaccinia infection based on volunteer-reported medical history.
• Pregnant, breastfeeding, planning pregnancy or planning to father children starting from Visit 0 and continuously until 90 days after receiving Dose 2.
• History of known or suspected severe adverse reaction including allergic reaction (e.g., anaphylaxis) to vaccines or to vaccine components such as lipids.

• Current or history of the following medical conditions at Visit 0 or Visit 1:

  • Uncontrolled, moderate or severe asthma; asthma severity as defined in the US National Asthma Education and Prevention Program Expert Panel report
  • Chronic obstructive pulmonary disease.
  • Diabetes mellitus type 1 or type 2, including cases controlled with diet alone (Not excluded: history of isolated gestational diabetes).
  • Hypertension: If a person has hypertension, exclude for blood pressure that is not well controlled. Well controlled blood pressure is defined as consistently ≤140 mm Hg systolic and ≤90 mm Hg diastolic, with or without medication, with only isolated, brief instances of higher readings, which must be <150 mm Hg systolic and <100 mm Hg.
  • Systolic blood pressure ≥150 mm Hg or diastolic blood pressure ≥100 mm Hg.
  • Malignancy, excluding localized basal or squamous cell cancer.
  • Cardiovascular diseases, (e.g., myocarditis, pericarditis, coronary heart disease, myocardial infarction, congestive heart failure, cardiomyopathy or clinically significant arrhythmias, stroke or transient ischemic attack).
  • Bleeding disorders (e.g., factor deficiency, coagulopathy, or platelet disorder).
  • Seizure disorder: History of seizure(s) within past 3 years; use of medications in order to prevent or treat seizure(s) at any time within the past 3 years.
  • Estimated glomerular filtration rate <60 mL/min/1.73 m^2.
  • Chronic liver disease.
• Schizophrenia, major depressive disorder, suicidal ideation. Such psychiatric illnesses, as bipolar disorder, autism and attention deficit-hyperactivity disorder that at the discretion of the investigator could interfere with participation and follow-up as outlined by the trial.

• Current or history of the following diseases associated with immune dysregulation:

  • Known or suspected immunodeficiency.
  • History of solid organ or bone marrow transplantation.
  • Asplenia: any condition resulting in the absence of a functional spleen.
  • Currently existing or history of any autoimmune disease.
• At Visit 0, any screening hematology and/or blood chemistry laboratory value that meets the definition of a Grade ≥1 abnormality (according to the toxicity grading scale; see separate criteria for indirect bilirubin and troponin I). Individuals with any stable Grade 1 abnormalities may be considered eligible at the discretion of the investigator. A stable Grade 1 laboratory abnormality is defined as the value which is ≤ Grade 1 upon repeated testing on a second sample from this individual during the screening period (prior to Visit 1). Individuals with abnormal but not clinically significant parameters not included in the toxicity guidance may be considered eligible at discretion of investigator.
• Abnormal total bilirubin at Visit 0. Note: inclusion of volunteers with bilirubin ≤1.25 upper limit of normal (ULN) if due to Gilbert's syndrome is allowed.
• Any abnormal troponin I value at Visit 0.
• A 12-lead ECG at Visit 0 which is consistent with probable or possible myocarditis/pericarditis or which demonstrates clinically relevant abnormalities that may affect participant safety or are otherwise clinically significant findings (e.g., complete left bundle branch block, AV block, average corrected QT interval by Fridericia (QTcF interval) >450 msec, signs of myocardial infarction, ST elevation consistent with myocardial ischemia, or serious brady- or tachyarrhythmias).
• Febrile illness (body temperature ≥38.0°C) or other acute illness within 48 hours prior to Dose 1 and/or current (if presented at Visit 1, temporary deferral is allowed).
• Participation or planned participation in strenuous or endurance exercise within 7 days before or after each IMP administration.
• SSA only: Vaccination with any Orthopoxvirus-based vaccine including vaccines for prevention of smallpox, disease caused by vaccinia virus or mpox, or vector Orthopoxvirus-based vaccines.
• SSB only: Vaccination for prevention of mpox or disease caused by vaccinia virus, or with vector Orthopoxvirus-based vaccine. Vaccination for prevention of smallpox done in or after 1980.
• Any vaccination within 28 days before Dose 1. Seasonal inactivated influenza vaccine is allowed, however, it should be administered at least 14 days before IMP administration.
• Any non-trial IMP within 28 days or five half-lives (whichever is longer) before Dose 1.
• Blood/plasma products and/or immunoglobulins within 120 days before Dose 1.
• Allergy treatment with antigen injections within 14 days before Dose 1.
• Immunosuppressive therapy, including corticosteroids, or radiotherapy within 6 months or five half-lives (whichever is longer) before Dose 1. If systemic corticosteroids have been administered short term (≤14 days, at a dose of ≤20 mg/day of prednisone or equivalent) for treatment of an acute illness, individuals should be enrolled in the trial only after corticosteroid therapy has been discontinued for at least 28 days before Dose 1. Intraarticular, intrabursal, or topical (skin or eyes) corticosteroids are permitted.
• Have a history of alcohol abuse within 1 year before Visit 0 or have a history of substance abuse within the past 5 years before Visit 0.
• Are vulnerable individuals as per ICH E6 definition, i.e., are individuals whose willingness to volunteer in a clinical trial may be unduly influenced by the expectation, whether justified or not, of benefits associated with participation, or of a retaliatory response from senior members of a hierarchy in case of refusal to participate.

Contacts and Locations

Contacts

Contact: BioNTech clinical trials patient information; +49 6131 9084 ext 0; patients@biontech.de

Locations

United States, California

California Research Foundation; Recruiting

San Diego, California, United States, 92123

United States, Missouri

Alliance for Multispecialty Research, LLC; Recruiting

Kansas City, Missouri, United States, 64114

United States, Tennessee

Alliance for Multispecialty Research, LLC; Recruiting

Knoxville, Tennessee, United States, 37909

United States, Washington

University of Washington Virology Research Clinic; Recruiting

Seattle, Washington, United States, 98104

United Kingdom

Addenbrooke's Hospital - Cambridge University Hospitals NHS Foundation Trust; Recruiting

Cambridge, United Kingdom, CB2 0QQ

Royal Surrey County Hospital Foundation Trust, NIHR Royal Surrey Clinical Research Facility; Recruiting

Guildford, United Kingdom, GU2 7XP

Guy's and St Thomas' NHS Foundation Trust of St Thomas' Hospital; Recruiting

London, United Kingdom, SE1 7EH

Medicine Evaluation Unit Ltd, The Langley Building, Wythenshawe Hospital; Recruiting

Manchester, United Kingdom, M239QZ

University Hospital Southampton; Recruiting

Southampton, United Kingdom, SO16 6YD

Sponsors and Collaborators

BioNTech SE

Investigators

• Study Director: BioNTech Responsible Person; BioNTech SE

More Information

• Responsible Party: BioNTech SE
• ClinicalTrials.gov Identifier: NCT05988203
• Other Study ID Numbers: BNT166-01; 1006947 ( Other Identifier: Integrated Research Application System (IRAS) )
• First Posted: August 14, 2023
• Last Update Posted: March 13, 2024
• Last Verified: March 2024

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by BioNTech SE:

Prevention of mpox; Monkeypox virus; RNA vaccine; Vaccine; mpox; MPXV; Monkeypox

Additional relevant MeSH terms:

Mpox (monkeypox); Poxviridae Infections; DNA Virus Infections; Virus Diseases; Infections