A Phase 3, Randomized, Double-Blind, Comparator-Controlled Study to Evaluate Safety, Tolerability, and Immunogenicity of V114, a 15-Valent Pneumococcal Conjugate Vaccine, in Allogeneic Hematopoietic Cell Transplant Recipients (PNEU-STEM).

BACKGROUND: Individuals who receive allogeneic hematopoietic cell transplant (allo-HCT) are immunocompromised and at high risk of pneumococcal infections, especially in the months following transplant. This study evaluated the safety and immunogenicity of V114 (VAXNEUVANCE; Merck, Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA), a 15-valent pneumococcal conjugate vaccine (PCV), when given to allo-HCT recipients. METHODS: Participants received 3 doses of V114 or PCV13 (Prevnar 13; Wyeth LLC) in 1-month intervals starting 3-6 months after allo-HCT. Twelve months after HCT, participants received either PNEUMOVAX 23 or a fourth dose of PCV (if they experienced chronic graft vs host disease). Safety was evaluated as the proportion of participants with adverse events (AEs). Immunogenicity was evaluated by measuring serotype-specific immunoglobulin G (IgG) geometric mean concentrations (GMCs) and opsonophagocytic activity (OPA) geometric mean titers (GMTs) for all V114 serotypes in each vaccination group. RESULTS: A total of 274 participants were enrolled and vaccinated in the study. The proportions of participants with AEs and serious AEs were generally comparable between intervention groups, and the majority of AEs in both groups were of short duration and mild-to-moderate intensity. For both IgG GMCs and OPA GMTs, V114 was generally comparable to PCV13 for the 13 shared serotypes, and higher for serotypes 22F and 33F at day 90. CONCLUSIONS: V114 was well tolerated in allo-HCT recipients, with a generally comparable safety profile to PCV13. V114 induced comparable immune responses to PCV13 for the 13 shared serotypes, and was higher for V114 serotypes 22F and 33F. Study results support the use of V114 in allo-HCT recipients. Clinical Trials Registration. clinicaltrials.gov (NCT03565900) and European Union at EudraCT 2018-000066-11.

Challenges in developing antidrug antibody screening assays.

Robert Dodge is the Laboratory Director for Immunochemistry and Cell Biology at Taylor Technology, a Pharmanet company in Princeton, NJ, USA. Taylor Technology is a contract research laboratory specializing in assay development and sample testing in a good laboratory practice environment. Robert oversees a staff of scientists responsible for the development of assays for use in protein drug quantitation, antidrug antibody screening and biomarker detection. Protein drugs may elicit an immune response in the form of production of antidrug antibodies (ADAs) by a subject. This ADA response may have serious safety implications for subjects or, at a minimum, may affect drug efficacy. Bioanalytical testing for antidrug antibodies has therefore become a required part of safety testing for subjects receiving protein drugs. Regulatory guidance and scientific white papers recommend a tiered approach for bioanalytical ADA testing. The first assay in the tiered testing scheme is a screening assay, which tests all subjects in the study for the presence of ADAs. The screening assay is quasiquantitative, typically lacks a specific positive control and must be designed to detect numerous isotypes and subclasses of antibodies. These characteristics of an ADA screening assay differ from a those of a standard immunoassay designed to quantitate a specific protein in matrix and thus present unique challenges. This article reviews the unique challenges encountered during the development of an ADA assay.