Persistence of Protection by Shingrix

University of Colorado Denver (CU Denver)

Status and phase: Completed; Phase 4

Conditions: Herpes Zoster

Treatments: Biological: Shingrix; Biological: Zostavax

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04169009

1U01AI141919-01 (U.S. NIH Grant/Contract)

18-0580

Details and patient eligibility

About

The study plans to learn more about how the shingles vaccine, Shingrix (SRX), successfully prevents shingles in older people. Two vaccines are currently approved by the Food and Drug Administration (FDA) to prevent shingles. Zostavax is a live virus vaccine which has been available since 2006 and prevents shingles about 50% of the time, though it is less effective the older a person is when they receive it. Shingrix, which was approved by the FDA in 2017, is not a live virus, but has an additive in the vaccine to boost immune response. It is about 97% effective at preventing shingles regardless of a person's age and so far has been effective for at least 4 years after vaccination. Because Zostavax has live virus in it, giving a "challenge" dose of Zostavax - vOka varicella zoster virus - to people who have received both vaccines (Zostavax or Shingrix) in the past, will allow researchers to learn more about how the body works to prevent shingles and how any shingles vaccination helps protect against shingles.

Full description

The primary endpoint of this study was the area under the concentration/time curve of quantitative VZV DNA in plasma. However, all the VZV DNA measurements were below the lower limit of quantitation of the assay. Due to this unexpected outcome, we performed a qualitative analysis of presence or absence of VZV DNA in plasma at Day ≥3 after the vOka challenge.

Enrollment: 105 patients

Sex: All

Ages: 50 to 85 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Age 50-85
• General good health
• Women of non-childbearing potential must be postmenopausal or have undergone hysterectomy or bilateral oophorectomy
• ARM 1 ONLY: Documented evidence of immunization with ZVL or SRX at least 5 years previously
• ARM 2 ONLY; Documented evidence of immunization with ZVL 6-12 months prior to enrollment
• ARM 3 ONLY: Have never received any shingles vaccination

Exclusion criteria

• Prior history of herpes zoster (HZ)
• Blood products received in the 3 months prior to study enrollment or planned for the subsequent week for Arm 1; Arm 2 requires same exclusion; Arm 3 extends the exclusion to the week after the vOka challenge, which is 6 months after completing SRX administration.
• Significant immune suppressive illness or therapy
• Concomitant vaccine received within 2 (inactive) or 4 (live) weeks prior to the study or during the first week of the study.
• Women of childbearing potential.
• Pregnancy or breastfeeding.
• Participation in a concurrent clinical study in which the subject will be exposed to and investigational product during the period starting 7 days before the first dose of study vaccine through the completion of the study.

Trial design

Primary purpose: Basic Science

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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105 participants in 4 patient groups

ZVL >5 years previously

Active Comparator group

Description:

Participants have received Zostavax (ZVL) at least 5 years previously. Will be administered intradermal vOka varicella zoster virus (ZVL) in non-dominant deltoid. A skin biopsy will be performed at the injection site on 20 subjects.

Treatment:

Biological: Zostavax

ZVL 6-12 months previously

Active Comparator group

Description:

Participants who received ZVL 6-12 months previously will be administered an intradermal dose of vOka varicella zoster virus (ZVL) in non-dominant deltoid.

Treatment:

Biological: Zostavax

No previous ZVL

Active Comparator group

Description:

Participants who've never received a shingles vaccine will be given the 2 standard doses of RZV. Six months later they will be given the intradermal dose of vOka varicella zoster virus (ZVL) in the non-dominant deltoid.

Treatment:

Biological: Zostavax

Biological: Shingrix

SRX >5 years previously

Active Comparator group

Description:

Participants have received Shingrix at least 5 years previously. Will be administered intradermal vOka varicella zoster virus (ZVL) in non-dominant deltoid. A skin biopsy will be performed at the injection site on 20 subjects.

Treatment:

Biological: Zostavax