Bringing Optimised COVID-19 Vaccine Schedules To ImmunoCompromised Populations (BOOST-IC): an Adaptive Randomised Controlled Clinical Trial

Multiple Myeloma Clinical Trial

Official title:

Bringing Optimised COVID-19 Vaccine Schedules To ImmunoCompromised Populations (BOOST-IC): an Adaptive Randomised Controlled Clinical Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05556720
• Other study ID #: 122.22
• Status: Recruiting
• Phase: Phase 3
• Start date: December 1, 2022
• Est. completion date: December 31, 2025

Study information

• Verified date: January 2023
• Source: Bayside Health
• Contact: Michelle Hagenauer
• Phone: +61 3 9076 3189
• Email: m.hagenauer[@]alfred.org.au
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Despite the greater risk of adverse COVID-19 outcomes, antibody and cell-mediated immune responses to COVID-19 vaccines vary amongst immunocompromised (IC) people and are poorly defined. IC hosts were largely excluded from the COVID-19 vaccine registration trials, though many countries recommend additional and booster doses of vaccination in this group.

BOOST-IC is an adaptive randomised clinical trial (RCT) to assess the immunogenicity and safety of additional COVID-19 vaccine doses in immunocompromised (IC) people, including people with HIV, solid organ transplants (SOT) recipients or those with haematological malignancies. Briefly, the study aims to generate high-quality evidence on the immunogenicity and safety of alternative COVID-19 booster strategies against SARS-CoV-2 for IC people in Australia.

Description:

Despite the greater risk of adverse COVID-19 outcomes, antibody and cell-mediated immune responses to COVID-19 vaccines vary amongst immunocompromised (IC) people and are poorly defined. IC hosts were largely excluded from the COVID-19 vaccine registration trials, though many countries recommend additional and booster doses of vaccination in this group. However, data are heterogeneous, in part due the variable nature of immunodeficiencies in IC groups and non-standardised outcome measures used in studies.

BOOST-IC is an adaptive randomised clinical trial (RCT) to assess the immunogenicity and safety of additional bivalent COVID-19 vaccine doses in immunocompromised (IC) people, including people with HIV, solid organ transplants (SOT) recipients or those with haematological malignancies. Briefly, the study aims to generate high-quality evidence on the immunogenicity and safety of alternative COVID-19 booster strategies against SARS-CoV-2 for IC people in Australia.

To do this, participants who have previously completed 3- to 6-doses of Australian TGA approved COVID-19 vaccines (BA.4/5 Moderna and Pfizer vaccines) will be randomised 1:1 to receive either one or two doses of a bivalent COVID-19 vaccine, as these become available in Australia. And additional arm can be added if an additional suitable vaccine becomes available. Namely, patients will be randomised to receive either one or two doses of bivalent Moderna or Pfizer COVID-19 vaccine. As additional bivalent vaccines become available in Australia, these will be included in the trial, as additional arms. The trial can incorporate up to three arms at one time.

Patients will be followed up for 455 days post randomisation. Specific study questions pertain to:

• examining how additional doses of COVID-19 vaccine/s affect correlates of protective immunity

• examining the safety of additional doses of COVID-19 vaccine/s

• characterising the humoral and cellular immune responses to COVID-19 vaccination receiving 1 or 2 booster doses of COVID-19 vaccine/s

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 960
• Est. completion date: December 31, 2025
• Est. primary completion date: February 28, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 16 Years and older

Eligibility

Inclusion Criteria:

• Able to give informed consent and undertake study procedures

• Age =16 years old

• Have completed at least 3 months prior, 3- to 6-doses of an Australian TGA approved SARS-CoV-2 vaccine (including mRNA [Pfizer or Moderna], ChAdOx1 [Oxford/Astra Zeneca] or protein [Novavax])

• Fit the criteria to be included in one of the following 3 populations: Infected with HIV; Current recipient of a solid organ transplant including: kidney, pancreas, liver, malignancy episodes of severe rejection requiring T- or B-cell depleting agents in the prior 3 months; Undergoing chemotherapy, immunotherapy and/or targeted therapy, or completed in the last 2 years for: chronic lymphocytic leukemia, multiple myeloma or non-Hodgkin lymphoma.

Exclusion Criteria:

• Are contraindicated to receive a COVID-19 booster vaccination, e.g. history of anaphylaxis to a vaccine component or myocarditis attributed to previous receipt of an mRNA vaccine.

• Has had led less than 3 or more than 6 doses of COVID-19 vaccine

• Is on another clinical trial investigating alternate COVID-19 vaccination schedules or investigational drugs to prevent or treat COVID-19

• Life expectancy < 12 months, or enrolment deemed not in the best interest of the patient

• Unable to provide informed consent

• Receipt of SARS-CoV-2 specific monoclonal antibodies in the 3 months prior to receiving the first dose of study vaccine

• Acute respiratory tract infection and/or temperature > 38 degrees centigrade on day of receiving first dose of study vaccine

• History of autologous stem cell transplant in the prior 6 months or history of ever having an allogeneic stem cell transplant or CAR T-cell therapy

Related Conditions & MeSH terms

• Chronic Lymphocytic Leukemia
• COVID-19
• COVID-19 Vaccines
• HIV
• Leukemia, Lymphocytic, Chronic, B-Cell
• Lymphoma, Non-Hodgkin
• Multiple Myeloma
• Organ Transplantation

Intervention

Biological:
• Pfizer Bivalent COVID-19 Vaccine
One or Two doses three months apart, per manufacturer's recommendations.
• Moderna Bivalent mRNA vaccine
One or Two doses three months apart, per manufacturer's recommendations.

Locations

Country	Name	City	State
Australia	Alfred Health	Melbourne	Victoria

Sponsors (2)

Lead Sponsor	Collaborator
Bayside Health	Monash University

Country where clinical trial is conducted

Australia, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The geometric mean concentration (GMC) of anti-spike SARS-CoV-2 IgG antibody against SARS-CoV-2	geometric mean concentration (GMC) of anti-spike SARS-CoV-2 IgG (AU/ml)	28 days after completion of trial vaccine/s
Secondary	anti-Spike IgG antibody geometric mean concentration	The geometric mean concentration (GMC) (AU/ml) of anti-spike SARS-CoV-2 IgG antibody against SARS-CoV-2 6- and 12-months after completion of trial vaccine/s	Up to 12 months post completion of trial vaccine/s
Secondary	Seroconversion	The proportion of participants seronegative to SARS-CoV-2 IgG becoming seropositive 1-, 6- and 12-months after completion of trial vaccine/s	1-, 6- and 12-months after completion of trial vaccine/s
Secondary	Neutralisation responses	Proportion of participants with SARS-CoV-2 neutralising antibody response in each group after 1-, 6- and 12-months post completion of trial vaccine/s, with response defined as either 4-fold rise in the neutralising antibody titre for those with detectable neutralising antibodies at baseline, OR Detectable neutralisation in those with no detectable neutralising antibodies at baseline	Up to 12 months post completion of trial vaccine/s
Secondary	T cell polyfunctionality	Subset analysis and polyfunctionality (number, and concentration of effector cytokines) of SARS-CoV-2 specific T-cell responses at 1-, 6- and 12-months post completion of trial vaccine/s in a subset of participants.	Up to 12 months post completion of trial vaccine/s
Secondary	T lymphocyte responses	Magnitude of SARS-CoV-2 specific T-cell responses at 1-, 6- and 12-months post completion of trial vaccine/s in a subset of participants	Up to 12 months post completion of trial vaccine/s
Secondary	Early local and systemic reactions	Local and systemic reactions assessed by questionnaire on Day 1,2,3,4,5,6 and 7 after randomisation.; Solicited and unsolicited adverse events following immunisation (AEFI) up to Day 28.; Hospitalisation resulting from adverse events following immunisation (AEFI) up to Day 28.	Up to 7 days post completion of trial vaccine/s
Secondary	Adverse Events Following Immunisation	Proportion with solicited and unsolicited adverse events following immunisation (AEFI) up to Day 28.	Up to 28 days post completion of trial vaccine/s
Secondary	Hospitalisation due to Immunisation	Proportion of participants with hospitalisation resulting from adverse events following immunisation (AEFI) up to Day 28.	Up to 28 days post completion of trial vaccine/s
Secondary	Clinical outcomes - COVID-19 infection	Proportion of patients with PCR-confirmed OR rapid antigen test (RAT) positive SARS-CoV-2 infection in participants up to 12-months post completion of trial vaccine/s	Up to 12 months post completion of trial vaccine/s
Secondary	Clinical outcomes - Healthcare Attendance Due to COVID-19 infection	Proportion of participants with PCR-confirmed OR rapid antigen test (RAT) positive SARS-CoV-2 infection requiring attendance at a medical facility for assessment and/or hospital admission up to 12-months post completion of trial vaccine/s	Up to 12 months post completion of trial vaccine/s
Secondary	Clinical outcomes - All Cause and SARS-CoV-2 Related Mortality	Proportion of participants experiencing mortality due to i) any cause and ii) SARS-CoV-2 infection up to 12-months post completion of trial vaccine/s	Up to 12 months post completion of trial vaccine/s
Secondary	Clinical outcomes - Severity	Proportion of participants needing oxygen therapy and/or ventilatory support due to SARS-CoV-2 infection up to 12-months post completion of trial vaccine/s Need for ICU care due to SARS-CoV-2 infection up to 12-months post completion of trial vaccine/s	Up to 12 months post completion of trial vaccine/s
Secondary	Clinical outcomes - Severe COVID-19	Proportion of Participants with need for ICU care due to SARS-CoV-2 infection up to 12-months post completion of trial vaccine/s	Up to 12 months post completion of trial vaccine/s
Secondary	Clinical outcomes - Quality of Life	Quality of life estimates (using EQ-5D-5L survey) at 1-, 6- and 12-months post completion of trial vaccine/s	Up to 12 months post completion of trial vaccine/s
Secondary	Clinical outcomes - Healthcare utilisation	Proportion of participants with healthcare utilisation including outpatient pharmaceutical and medical service use and inpatient hospital admissions related to COVID-19 or study vaccines up to 12-months post completion of trial vaccine/s	Up to 12 months post completion of trial vaccine/s
Secondary	Clinical outcomes - All cause healthcare utilisation	Proportion of participants with healthcare utilisation including outpatient pharmaceutical and medical service use and inpatient hospital admissions	Up to 12 months post completion of trial vaccine/s