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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04230213
Other study ID # B5381012
Secondary ID 2019-000284-24B5
Status Completed
Phase Phase 3
First received
Last updated
Start date January 13, 2020
Est. completion date June 22, 2021

Study information

Verified date January 2024
Source Pfizer
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The study will assess the impact of pharmacokinetics (PK), safety and immunogenicity after switches between PF-06410293 and adalimumab and with continuous dosing with adalimumab in combination with methotrexate in subjects with moderately to severely active rheumatoid arthritis.


Recruitment information / eligibility

Status Completed
Enrollment 455
Est. completion date June 22, 2021
Est. primary completion date June 22, 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years to 70 Years
Eligibility Inclusion Criteria: - Diagnosis of RA based on 2010 ACR/EULAR for RA for at least a 4 month duration. - Moderately to severely active RA based on local standard of care. Exclusion Criteria: -Evidence of untreated or inadequately treated latent or active TB.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
PF-06410293
SC injection
adalimumab
SC injection

Locations

Country Name City State
Bosnia and Herzegovina University Clinical Center of the Republic of Srpska Banja Luka
Bosnia and Herzegovina Health Center Gradiska Gradiska
Bosnia and Herzegovina Clinical Center University of Sarajevo Sarajevo
Bosnia and Herzegovina General Hospital Prim. Dr.Abdulah Nakas Sarajevo
Bulgaria UMHAT "Dr Georgi Stranski" EAD Pleven
Bulgaria DCC Sveti Georgi Plovdiv
Bulgaria Unimed Medical Centre Plovdiv
Czechia IMEDICA s.r.o. Brno
Czechia Lekarna Biovita Brno
Czechia Lekarna Na Lidicke Brno
Czechia Revmacentrum MUDr. Mostera, s.r.o. Brno
Czechia X-Medica, s.r.o. Brno
Czechia L.K.N. Arthrocentrum, s.r.o. Hlucin
Czechia Plicni ambulance Hlucin
Czechia Chirurgie Sibenik Olomouc
Czechia CTCenter MaVe s.r.o Olomouc
Czechia Lekarna u Pottingea Olomouc
Czechia Lekarna Vesalion Ostrava
Czechia CCR Czech a.s. Pardubice
Czechia Lekarna BENU Pardubice
Czechia CCR Prague s.r.o. Praha
Czechia Diagnostické centrum OlÅ¡anská s.r.o. Praha
Czechia Lekarna Pod Platany Praha
Czechia Revmatologicky ustav Praha 2
Czechia Fakultni Nemocnice v Motole Praha 5
Czechia Lekarna Hradebni s.r.o. Uherske Hradiste
Czechia MEDICAL PLUS s.r.o. Uherske Hradiste
Czechia Radiodiagnosticka ordinace a pracoviste Uherske Hradiste
Lithuania Hospital of Lithuanian University of Health Sciences, Kauno klinikos Kaunas
Lithuania Klaipeda University Hospital Klaipeda
Poland Gabinet Internistyczno-Reumatologiczny Piotr Adrian Klimiuk Bialystok
Poland NZOZ Osteo-Medic s.c. A.Racewicz, J. Supronik Bialystok
Poland Malopolskie Badania Kliniczne Sp. z o. o. Sp. k. Krakow
Poland Pratia MCM Krakow Krakow
Poland Zespol Poradni Specjalistycznych REUMED Lublin
Poland NZOZ Lecznica MAK-MED s.c. Nadarzyn
Poland Twoja Przychodnia Centrum Medyczne Nowa Sol Nowa Sol
Poland Prywatna Praktyka Lekarska Prof. UM dr hab. med. Pawel Hrycaj Poznan
Poland Nasz Lekarz Przychodnie Medyczne Torun
Poland Rheuma Medicus Zaklad Opieki Zdrowotnej Warszawa
Russian Federation Limited Liability Company "Clinic on Maroseyka" Moscow
Russian Federation Limited Liability Company Consultative and Diagnostic Rheumatological Center "Healthy Joints" Novosibirsk
Russian Federation FGBOU VO "Orenburg State Medical University" of the Ministry of Health of the Russian Federation Orenburg
Russian Federation GBUZ "Orenburg Regional Clinical Hospital" Orenburg
Russian Federation SBHI of the Republic of Karelia "Republican Hospital n. a. V.A. Baranov" Petrozavodsk
Russian Federation FSBEI of HE "Ryazan State Medical University n. a academician I.P.Pavlov" Ryazan
Russian Federation SBI of Ryazan Region "Regional Clinical Hospital" Ryazan
Russian Federation SBI of the Ryazan Region "Regional Clinical Cardiology dispensary" Ryazan
Russian Federation FSBEI of HE "Smolensk State Medical University" of the Ministry of Health of the RF Smolensk
Russian Federation Smolensk Regional Clinical Hospital Smolensk
Russian Federation LLC "BioMed" Vladimir
Russian Federation LLC "Center for Medical Advice and Research-PRACTICE" Yaroslavl
Serbia Institute of Rheumatology Belgrade
Serbia Institute for Treatment and Rehabilitation Niska Banja Niska Banja
Serbia Special Hospital for Rheumatic Diseases Novi Sad Novi Sad
South Africa Arthritis Clinical Research Trials Cape Town Western CAPE
South Africa Panorama Medical Centre Cape Town Western CAPE
South Africa Emmed Research Pretoria Gauteng
South Africa Jakaranda Hospital Pretoria Gauteng
South Africa Winelands Medical Research Centre Stellenbosch Western CAPE
Ukraine Komunalne nekomertsiine pidpryiemstvo Kharkivskoi oblasnoi rady Oblasna klinichna likarnia Kharkiv
Ukraine Derzhavna ustanova Natsionalnyi naukovyi tsentr Instytut kardiolohii imeni akademika M.D. Strazheska Kyiv
Ukraine Medychnyi tsentr tovarystva z obmezhenoiu vidpovidalnistiu " Instytut revmatolohii " Kyiv
Ukraine Komunalne Nekomertsiine Pidpryiemstvo "Tsentralna Miska Klinichna Likarnia M. Ivano-Frankivsk
Ukraine Bahatoprofilnyi medychnyi tsentr Odeskoho natsionalnoho medychnoho universytetu Odesa
Ukraine Komunalne nekomertsiine pidpryiemstvo "Odeska oblasna klinichna likarnia" Odesa
Ukraine Komunalne nekomertsiine pidpryiemstvo "Vinnytska oblasna klinichna likarnia im. M.I. Pyrohova Vinnytsia
Ukraine Komunalne pidpryiemstvo "Likarnia No 1" Zhytomyrskoi miskoi rady Zhytomyr
United States Rheumatology and Pulmonary Clinic Beckley West Virginia
United States Graves Gilbert Clinic Bowling Green Kentucky
United States Metroplex Clinical Research Center Dallas Texas
United States Altoona Center for Clinical Research Duncansville Pennsylvania

Sponsors (1)

Lead Sponsor Collaborator
Pfizer

Countries where clinical trial is conducted

United States,  Bosnia and Herzegovina,  Bulgaria,  Czechia,  Lithuania,  Poland,  Russian Federation,  Serbia,  South Africa,  Ukraine, 

Outcome

Type Measure Description Time frame Safety issue
Primary Maximum Observed Serum Concentration (Cmax) of Adalimumab Cmax refers to maximum observed serum concentration of drug. The geometric coefficient of variation is expressed in percentage. Pre-dose, 48, 72, 96, 144, 240 and 336 hours post dose on Day 211 (Week 30)
Primary Area Under the Serum Concentration-Time Curve Over the Dosing Interval (AUCtau) of Adalimumab Area under the serum concentration curve from time 0 to end of dosing interval (tau), where dosing interval was once every two weeks. The geometric coefficient of variation is expressed in percentage. Pre-dose, 48, 72, 96, 144, 240 and 336 hours post dose on Day 211 (Week 30)
Secondary Time to Reach Cmax (Tmax) of Adalimumab Tmax is the time taken (in hours) to reach the maximum serum drug concentration. Pre-dose, 48, 72, 96, 144, 240 and 336 hours post dose on Day 211 (Week 30)
Secondary Average Serum Concentration (Cav) of Adalimumab Cav was defined as average serum concentration over the dosing interval. The geometric coefficient of variation is expressed in percentage. Pre-dose, 48, 72, 96, 144, 240 and 336 hours post dose on Day 211 (Week 30)
Secondary Apparent Clearance (CL/F) of Serum Adalimumab Clearance of a drug is a measure of the rate at which a drug is metabolized or eliminated by normal biological processes. CL/F was calculated as dose administered divided by area under the concentration curve from time 0 extrapolated to infinite time (AUCinf). The geometric coefficient of variation is expressed in percentage. Pre-dose, 48, 72, 96, 144, 240 and 336 hours post dose on Day 211 (Week 30)
Secondary Pre-dose Serum Concentration During Multiple Dosing (Ctrough) of Adalimumab Ctrough was defined as pre-dose serum concentration during multiple dosing and observed directly from data. Pre-dose on Day 1, 71,113, 155, 169, 183, 197 and 211
Secondary Number of Participants With Treatment-Emergent Adverse Events (TEAEs), Serious TEAEs and Treatment Related TEAEs: TP1 An adverse event (AE) was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. An SAE was any untoward medical occurrence that, at any dose: resulted in death; required inpatient hospitalization or prolongation of existing hospitalization; was life-threatening; resulted in persistent or significant disability/ incapacity; congenital anomaly/birth defect and other important medical events. Treatment-related AE was any untoward medical occurrence attributed to study drug in a participant who received study drug. TEAE for TP1 was defined as any AE that occurred after the beginning of study treatment in TP1 and before the first dose of study treatment administration after randomization in TP2. AEs included both serious and all non-serious AEs. Day 1 up to maximum of 10 Weeks
Secondary Number of Participants With TEAEs, Serious TEAEs and Treatment Related TEAEs: TP2 and Beyond An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. An SAE was any untoward medical occurrence that, at any dose: resulted in death; required inpatient hospitalization or prolongation of existing hospitalization; was life-threatening; resulted in persistent or significant disability/ incapacity; congenital anomaly/birth defect and other important medical events. Treatment-related AE was any untoward medical occurrence attributed to study drug in a participant who received study drug. TEAE for TP2 and beyond was defined as any AE that occurred after administering the first dose of study treatment after randomization in TP2 and up to 4 weeks after last dose. AEs included both serious and all non-serious AEs. Post randomization up to maximum of 4 weeks after last dose (maximum of 26 weeks)
Secondary Number of Participants With Grade 3 or Higher TEAEs: TP1 An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. TEAE for TP1 was defined as any AE that occurred after the beginning of study treatment in TP1 and before the first dose of study treatment administration after randomization in TP2. AEs were graded using the Common Terminology Criteria for Adverse Events where, grade 1=mild AE; grade 2=moderate AE; grade 3=severe AE; grade 4= life-threatening consequences; urgent intervention indicated; and grade 5= death related to AE. Number of participants with grade 3 or higher TEAEs were presented. Day 1 up to maximum of 10 Weeks
Secondary Number of Participants With Grade 3 or Higher TEAEs: TP2 and Beyond An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. TEAE for TP2 and beyond was defined as any AE that occurred after the first dose of study treatment administration after randomization in TP2 and up to 4 weeks after last dose. AEs were graded using the Common Terminology Criteria for Adverse Events where, grade 1=mild AE; grade 2=moderate AE; grade 3=severe AE; grade 4= life-threatening consequences; urgent intervention indicated; and grade 5= death related to AE. Number of participants with grade 3 or higher TEAEs were presented. Post randomization up to maximum of 4 weeks after last dose (maximum of 26 weeks)
Secondary Number of Participants Who Discontinued Treatment and Study Due to TEAEs: TP1 An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. TEAE for TP1 was defined as any AE that occurred after the beginning of study treatment in TP1 and before the first dose of study treatment administration after randomization in TP2. Participants who discontinued treatment due to TEAEs were those who had an AE record indicating that action taken with study treatment was drug withdrawn but AE did not cause the participant to be discontinued from study. Participants who discontinued from study due to TEAE were those who had an TEAE in TP1 indicating that the AE caused the participant to be discontinued from the study. Day 1 up to maximum of 10 Weeks
Secondary Number of Participants Who Discontinued Treatment and Study Due to TEAEs: TP2 and Beyond An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. TEAE for TP2 and beyond was defined as any AE that occurred after the first dose of study treatment administration after randomization in TP2 and up to 4 weeks after last dose. AEs included both serious and all non-serious AEs. Participants who discontinued treatment due to TEAEs were those who had an AE record indicating that action taken with study treatment was drug withdrawn but AE did not cause the participant to be discontinued from study. Participants who discontinued from study due to TEAE were those who had an AE record indicating that the AE caused the participant to be discontinued from the study. Post randomization up to maximum of 4 weeks after last dose (maximum of 26 weeks)
Secondary Number of Participants With TEAEs of Special Interest: TP2 and Beyond AEs of special interest (AESI) included: hypersensitivity events (anaphylactic reaction, hypersensitivity, angioedema, delayed immune responses and injection site reactions [ISRs]); blood and lymphatic system events (white blood cell disorders and anemias nonhemolytic and marrow depression); cardiovascular events (cardiac failure, hypertension and myocardial infarction); demyelinating conditions, gastric/hepatic events (gastrointestinal perforation, ulceration, hemorrhage or obstruction and hepatic disorders); infections and infestations (including TB and other opportunistic infections); malignancies (neoplasms benign, malignant and unspecified [including cysts and polyps]) and lupus like syndrome. TEAE was defined as any AE that occurred after the first dose of study treatment administered after randomization in TP2. Number of participants with any AESI were presented in this outcome measure. Post randomization up to maximum of 4 weeks after last dose (maximum of 26 weeks)
Secondary Number of Participants With Potential Immunogenic AEs to Study Treatment: TP2 and Beyond Among Anti-drug Antibody (ADA) Positive Participants During TP1 In this outcome, participants who were antidrug antibody (ADA) positive during TP1 were assessed in TP2 and beyond per visit for their ADA status at the time of start of their potential immunogenic AEs including ISRs, medically evaluated board standard MedDRA query (SMQ) of potential hypersensitivity (anaphylactic reactions, hypersensitivity and angioedema), medically evaluated AEs meeting Sampson criteria, cytokine storm and delayed immune responses (DIR). ADA positive was defined as ADA titer >=1.88. TP2 and Beyond: Week 16, 22, 24, 26, 28, 30, 32
Secondary Number of Participants With Potential Immunogenic AEs to Study Treatment: TP2 and Beyond Among ADA Negative Participants During TP1 In this outcome, participants who were ADA negative during TP1 were assessed in TP2 and beyond per visit for their ADA status at the time of start of their potential immunogenic AEs including ISRs, medically evaluated board SMQ of potential hypersensitivity (anaphylactic reactions, hypersensitivity and angioedema), medically evaluated AEs meeting Sampson criteria, cytokine storm and DIR. ADA negative was defined as ADA titer <1.88. TP2 and Beyond: Week 16, 22, 24, 26, 28, 30, 32
Secondary Number of Participants With TEAEs and Serious TEAEs Related to COVID-19: TP1 An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. An SAE was any untoward medical occurrence that, at any dose: resulted in death; required inpatient hospitalization or prolongation of existing hospitalization; was life-threatening; resulted in persistent or significant disability/ incapacity; congenital anomaly/birth defect and other important medical events. TEAE for TP1 was defined as any AE that occurred after the beginning of study treatment in TP1 and before the first dose of study treatment administration after randomization in TP2. AEs included both serious and all non-serious AEs. TEAEs and serious TEAEs related to Covid-19 as per investigator's assessment were presented. Day 1 up to maximum of 10 Weeks
Secondary Number of Participants With TEAEs and Serious TEAEs Related to COVID-19: TP2 and Beyond An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. An SAE was any untoward medical occurrence that, at any dose: resulted in death; required inpatient hospitalization or prolongation of existing hospitalization; was life-threatening; resulted in persistent or significant disability/ incapacity; congenital anomaly/birth defect and other important medical events. TEAE for TP2 and beyond was defined as any AE that occurred after the first dose of study treatment administration after randomization in TP2 and up to 4 weeks after last dose. AEs included both serious and all non-serious AEs. TEAEs and serious TEAEs related to Covid-19 as per investigator's assessment were presented. Post randomization up to maximum of 4 weeks after last dose (maximum of 26 weeks)
Secondary Number of Participants Who Discontinued Treatment and Study Due to TEAEs Related to COVID-19: TP1 An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. TEAE for TP1 was defined as any AE that occurred after the beginning of study treatment in TP1 and before the first dose of study treatment administration after randomization in TP2. Participants who discontinued treatment due to TEAEs were those who had an AE record indicating that action taken with study treatment was drug withdrawn but AE did not cause the participant to be discontinued from study. Participants who discontinued from study due to TEAE were those who had an AE record indicating that the AE caused the participant to be discontinued from the study. TEAEs were related to Covid-19. Day 1 up to maximum of 10 Weeks
Secondary Number of Participants Who Discontinued Treatment and Study Due to TEAEs Related to COVID-19: TP2 and Beyond An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. TEAE for TP2 and beyond was defined as any AE that occurred after the first dose of study treatment administration after randomization in TP2 and up to 4 weeks after last dose. AEs included both serious and all non-serious AEs. Participants who discontinued treatment due to TEAEs were those who had an AE record indicating that action taken with study treatment was drug withdrawn but AE did not cause the participant to be discontinued from study. Participants who discontinued from study due to TEAE were those who had an AE record indicating that the AE caused the participant to be discontinued from the study. TEAEs were related to Covid-19. Post randomization up to maximum of 4 weeks after last dose (maximum of 26 weeks)
Secondary Number of Participants With Laboratory Abnormalities: TP1 Blood samples were collected for the analysis of following laboratory parameters: hematology parameters (hemoglobin, erythrocyte mean corpuscular volume, erythrocyte mean corpuscular hemoglobin, erythrocyte mean corpuscular hemoglobin concentration platelet count, leukocytes, lymphocytes, neutrophils, eosinophils, monocytes); clinical chemistry parameters (bilirubin, alanine aminotransferase [ALT], blood urea nitrogen [BUN], creatinine, potassium, bicarbonate); urine parameters: urine protein, urine hemoglobin, nitrite, leukocyte esterase and bacteria. Number of participants with any laboratory abnormalities is presented. Day 1 up to maximum of 10 Weeks
Secondary Number of Participants With Laboratory Abnormalities: TP2 and Beyond Blood samples were collected for the analysis of following laboratory parameters: hematology parameters (hemoglobin, erythrocyte mean corpuscular volume, erythrocyte mean corpuscular hemoglobin, erythrocyte mean corpuscular hemoglobin concentration platelet count, leukocytes, lymphocytes, neutrophils, eosinophils, monocytes); clinical chemistry parameters (bilirubin, ALT, BUN, creatinine, potassium, bicarbonate); urine parameters: urine protein, urine hemoglobin, nitrite, leukocyte esterase and bacteria. Number of participants with any laboratory abnormalities is presented. Post randomization up to end of study treatment (maximum of 22 weeks)
Secondary Number of Participants With Hematology Results by Maximum Common Toxicity Criteria (CTC) Grade: TP2 and Beyond Blood samples were collected for the analysis of following hematology parameters: anemia, hemoglobin increased, leukocytosis, lymphocyte count decreased, lymphocyte count increased, neutrophil count decreased, platelet count decreased, white blood cell decreased. Laboratory parameters were graded according to National Cancer Institute-CTC version 4.03 where, Grade 0= within normal limits; Grade1: mild; Grade 2: moderate; Grade 3: severe or medically significant; Grade 4: life-threatening consequences and Grade 5: death. Categories with at least 1 non-zero value were reported in this outcome measure. Post randomization up to end of study treatment (maximum of 22 weeks)
Secondary Number of Participants With Chemistry Results by Maximum CTC Grade: TP2 and Beyond Blood samples were collected for analysis of clinical chemistry parameters: ALT increased, alkaline phosphatase increased (ALP), aspartate aminotransferase increased (AST), blood bilirubin increased, creatinine increased, hypercalcemia, hyperkalemia, hypernatremia, hypoalbuminemia, hypocalcemia, hypokalemia, hyponatremia. Laboratory parameters were graded according to NCI-CTC version 4.03 where, grade 0= within normal limits; Grade1: mild; Grade 2: moderate; Grade 3: severe or medically significant; Grade 4: life-threatening consequences and Grade 5: death. Categories with at least 1 non-zero value were reported. Post randomization up to end of study treatment (maximum of 22 weeks)
Secondary Number of Participants With Laboratory Results Based on Evaluation of Drug-Induced Serious Hepatotoxicity (eDISH) Analysis: TP2 and Beyond In this outcome measure, liver function laboratory parameters, which included: normal bilirubin and AST/ALT, Temple's Corollary (AST/ALT [more than or equal to] >=3*upper limit normal [ULN] and normal bilirubin), Gilbert's Syndrome or cholestasis (normal AST/ALT and bilirubin >=2*ULN) and Potential Hy's Law Cases (AST/ALT >=3*ULN and Bilirubin>=2*ULN) according to eDISH criteria, were reported. Post randomization up to end of study treatment (maximum of 22 weeks)
Secondary Baseline, Absolute Week 32 Values for Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Change From Baseline in SBP, DBP at Week 32 (EOT/ ET) SBP and DBP were measured in a supine position using an automated device preceded by at least 5 minutes of rest for the participant in a quiet setting without any distractions. Baseline value was defined as the most recent measurement prior to the first dose of study treatment after randomization in TP2. Baseline and Week 32 (end of treatment [EOT]/early termination [ET])
Secondary Baseline, Absolute Week 32 Values for Pulse Rate and Change From Baseline in Pulse Rate at Week 32 (EOT/ET) Pulse rate was measured in a supine position using an automated device preceded by at least 5 minutes of rest for the participant in a quiet setting without any distractions. Baseline value was defined as the most recent measurement prior to the first dose of study treatment after randomization in TP2. Baseline and Week 32 (EOT/ET)
Secondary Baseline, Absolute Week 32 Values for Temperature and Change From Baseline in Temperature at Week 32 (EOT/ET) Baseline value was defined as the most recent measurement prior to the first dose of study treatment after randomization in TP2. Baseline and Week 32 (EOT/ET)
Secondary Baseline, Absolute Week 32 Values for Respiratory Rate and Change From Baseline in Respiratory Rate at Week 32 (EOT/ET) Baseline value was defined as the most recent measurement prior to the first dose of study treatment after randomization in TP2. Baseline and Week 32 (EOT/ET)
Secondary Number of Participants Who Were Anti-Drug Antibodies (ADA) Positive and Neutralizing Antibodies (NAb) Positive Serum samples were analyzed using a validated electrochemoluminescent (ECL) immunoassay for ADA assessment. Samples positive for ADA were further tested for neutralizing activity using a validated cell based NAb assay. ADA positive was defined as ADA titer >=1.88 while NAb positive was defined as NAb titer >=0.70. Week 10, 16, 22, 24, 26, 28, 32
Secondary Mean ADA Titers Serum samples were analyzed using a validated ECL immunoassay for ADA assessment. Endpoint titer was defined as log10 of the reciprocal of the ADA serum dilution at which the sample response was equal to the cut-point of the assay. Week 10, 16, 22, 24, 26, 28, 30, 32
Secondary Mean NAb Titers Serum samples were analyzed using a validated ECL immunoassay for ADA assessment. Endpoint titer was defined as log10 of the reciprocal of the NAb serum dilution at which the sample response was equal to the cut-point of the assay. Week 10, 16, 22, 24, 26, 28, 30, 32
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