E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
COVID-19 is associated with severely increased morbidity and mortality in kidney transplant patients. Available data show that the immune response after a standard regimen of two mRNA vaccinations is severely attenuated in kidney transplant patients compared to controls, especially when their immunosuppressive regimen contains mycophenolate mofetil (MMF) / mycophenolic acid (MPA). |
COVID-19 is geassocieerd met ernstig vergroot risico op ziekte en mortaliteit in niertransplantatie patiënten. Beschikbare data laat zien dat de immuunrespons na een standaard programma van 2 mRNA vaccinaties ernstig lager is in niertransplantatie patienten dan in een controle groep, zeker wanneer hun immuunsuppressie therapie MMF/MPA bevat. |
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E.1.1.1 | Medical condition in easily understood language |
Many kidneytransplant patients are none responsive to the current Covid-19 vaccination regime. Therefore it is important to know whether a booster vaccine will increase the efficacy of vaccination. |
Veel niertransplantatie patienten hebben geen respons op het huidige Covid-19 vaccinatie beleid. Het is daarom van belang om te weten of een booster vaccin de effectiviteit van vaccinatie vergroot. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Respiratory Tract Diseases [C08] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084401 |
E.1.2 | Term | COVID-19 respiratory infection |
E.1.2 | System Organ Class | 100000004862 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084464 |
E.1.2 | Term | COVID-19 immunization |
E.1.2 | System Organ Class | 100000004865 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084465 |
E.1.2 | Term | COVID-19 vaccination |
E.1.2 | System Organ Class | 100000004865 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084508 |
E.1.2 | Term | COVID-19 antibody test |
E.1.2 | System Organ Class | 10022891 - Investigations |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10023439 |
E.1.2 | Term | Kidney transplant rejection |
E.1.2 | System Organ Class | 10021428 - Immune system disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10023438 |
E.1.2 | Term | Kidney transplant |
E.1.2 | System Organ Class | 100000004865 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084270 |
E.1.2 | Term | SARS-CoV-2 acute respiratory disease |
E.1.2 | System Organ Class | 100000004862 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084272 |
E.1.2 | Term | SARS-CoV-2 infection |
E.1.2 | System Organ Class | 100000004862 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084462 |
E.1.2 | Term | SARS-CoV-2 vaccination |
E.1.2 | System Organ Class | 100000004865 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084463 |
E.1.2 | Term | SARS-CoV-2 immunisation |
E.1.2 | System Organ Class | 100000004865 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10084466 |
E.1.2 | Term | SARS-CoV-2 immunization |
E.1.2 | System Organ Class | 100000004865 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10084501 |
E.1.2 | Term | SARS-CoV-2 antibody test |
E.1.2 | System Organ Class | 10022891 - Investigations |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the immunogenicity (expressed as percentage of responders) of various COVID-19 booster vaccination strategies in kidney transplant patients that failed to mount a sufficient antibody response after two primary doses of the mRNA-1273 vaccine. |
Om de immunogeniciteit (uitgedrukt als percentage van de responders) te beoordelen van verschillende COVID-19-boostervaccinatiestrategieën bij niertransplantatiepatiënten die geen voldoende antilichaamrespons opriepen na twee primaire doses van het mRNA-1273-vaccin. |
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E.2.2 | Secondary objectives of the trial |
- To measure the concentration of SARS-CoV-2 spike S1-specific IgG antibodies in serum at 28 days after the 3rd vaccine administration - To assess the durability of the SARS-CoV-2 spike S1-specific IgG antibody response at 6 and 12 months after the 3rd vaccine administration - To measure the presence and titer of neutralizing anti-SARS-CoV-2 antibodies after booster vaccination - To evaluate SARS-CoV-2 specific T cell responses - To measure anti-S1 antibody (IgG and IgA) responses and neutralizing capacity of these antibodies in nasal mucosal fluid - To evaluate vaccine safety in terms of incidence of solicited local and systemic adverse events (AEs) graded according to severity, including the incidence of acute rejections within 6 months after the third vaccination . |
- Om de concentratie van SARS-CoV-2 spike S1-specifieke IgG-antilichamen in serum te meten 28 dagen na de 3e vaccintoediening - Om de duurzaamheid van de SARS-CoV-2 spike S1-specifieke IgG-antilichaamrespons te beoordelen op 6 en 12 maanden na de 3e vaccintoediening - Om de aanwezigheid en titer van neutraliserende anti-SARS-CoV-2-antilichamen te meten na boostervaccinatie - Om SARS-CoV-2-specifieke T-celreacties te evalueren - Om anti-S1 antilichaam (IgG en IgA) responsen en neutraliserend vermogen van deze antilichamen in neusslijmvliesvloeistof te meten - Om de veiligheid van het vaccin te evalueren in termen van incidentie van gevraagde lokale en systemische bijwerkingen (AE's) gerangschikt naar ernst, inclusief de incidentie van acute afstoting binnen 6 maanden na de derde vaccinatie. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Age 18 years or older 2. Received 2 doses of mRNA-1273 according to the recommended vaccination schedule, with the last administration within the last nine months 3. Insufficient response to vaccination, defined as anti-spike IgG in serum < 10 BAU/mL measured between 25 and 56 days after the second dose of the mRNA-1273 vaccine with a validated test 4. Eligible for COVID-19 vaccination as described by the instructions of the manufacturers of the vaccine (Moderna and Janssen) 5. Capable of understanding the purpose and risks of the study, fully informed and given written informed consent (signed informed consent form has been obtained) 6. Willing to adhere to the protocol and be available during the study period
Additional inclusion criteria to be eligible for stratum A: 7. Maintenance immunosuppressive therapy consisting of a calcineurin inhibitor (tacrolimus or cyclosporine), MMF/MPA, and prednisone 8. In case of tacrolimus treatment: last tacrolimus pre-dose level while on current dosage above 4 μg/l 9. In case of cyclosporine treatment: last cyclosporine pre-dose level while on current dosage above 75 μg/l 10. Prednisone dose at least 5 mg/day 11. First or second transplantation 12. Calculated level of panel reactive antibodies prior to last transplantation below 85% 13. No signs of acute rejection during the preceding year |
1. Leeftijd 18 jaar of ouder 2. 2 Doses mRNA-1273 vaccin volgens het aanbevolen vaccinatie schema hebben ontvangen, met de laatste registratie binnen de afgelopen negen maanden 3. Onvoldoende respons op de vaccinatie, gedefinieerd als anti-spike IgG in serum < 10 BAU/mL, gemeten tussen 25 en 56 dagen na de tweede dosis mRNA-1273 vaccin met een gevalideerde test. 4. In aanmerking komend voor Covid-19 vaccinatie zoals beschreven in de instructies van de fabrikant (Moderna en Janssen) 5. In staat om het doel en de risico's van de studie te begrijpen, volledig geïnformeerd en schriftelijke geïnformeerde toestemming te geven (ondertekend formulier voor geïnformeerde toestemming is verkregen) 6. Bereid zijn het protocol te volgen en gedurende de periode van de studie beschikbaar te zijn
Bijkomende inclusie criteria om in aanmerking te komen voor arm A: 7. Onderhouds immuunsuppressie therapie bestaande uit een calcineurine remmer (tacrolimus of cyclosporine), MMF/MPA en Prednison 8. In het geval van tacrolimus gebruik: laatste tacrolimus dalspiegel tijdens de huidige dosering boven de 4 μg/l 9. In het geval van cyclosporine gebruik: laatste cyclosporine dalspiegel tijdens de huidige dosering boven de 75 μg/l 10. Prednison dosering minimaal 5mg/dag 11. Eerste of tweede transplantatie 12. Berekende hoeveelheid panel reactieve antilichamen voorafgaand aan de laatste transplantatie lager dan 85% 13. Geen tekenen van acute afstoting in het voorafgaande jaar. |
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E.4 | Principal exclusion criteria |
1. Multi-organ transplant recipient 2. History of severe adverse reaction associated with a vaccine and/or severe allergic reaction (e.g. anaphylaxis) to any component of the study intervention(s). 3. Previous or active COVID-19 disease 4. Active malignancy, except non-melanoma skin cancer 5. Inherited immune deficiency 6. Infection with Human Immunodeficiency Virus (HIV) 7. Administration of T cell, B cell, or plasma cell depleting antibodies during the last 6 months 8. Any vaccination within a month before enrolment 9. Bleeding diathesis or condition associated with prolonged bleeding that would, in the opinion of the investigator, contraindicate intramuscular injection. |
1. Multi orgaan transplantatie ontvanger 2. Geschiedenis van ernstige bijwerkingen na vaccinatie en/of een ernstige allergische reactie (bv anafylactie) op een onderdeel van de studie interventies. 3. Eerdere of actieve Covid-19 besmetting 4. Actieve maligne aandoening, behalve non-melanoom huidkanker 5. Aangeboren immuun deficiëntie 6. HIV infectie 7. Toediening van T cellen, B cellen of plasma cellen gedurende de afgelopen 6 maanden 8. geen enkele vaccinatie gehad in de maand voor deelname 9. verhoogde bloedingsneiging of een aandoening met een verlengde bloedingstijd die, naar inzicht van de onderzoeker, een contra-indicatie is voor een intramusculaire injectie |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is the percentage of subjects with a serum anti-S1 IgG concentration ≥10 BAU/mL at 28 days after the third vaccine administration. |
Het primaire eindpunt is het percentage deelnemers met een serum anti-S1 IgG concentratie ≥10 BAU/mL op dag 28 na de derde vaccinatie. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
28 days after the third (and possibly a fourth) vaccination |
28 dagen na de derde (en eventueel de vierde) vaccinatie |
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E.5.2 | Secondary end point(s) |
o SARS-CoV-2 specific antibody concentrations in serum at 28 days after the 3rd vaccine administration o SARS-CoV-2 specific antibody concentrations in serum at 6 and 12 months after the 3rd vaccine administration o The titer of neutralizing anti-SARS-CoV-2 antibodies at 28 days after the 3rd vaccine administration o SARS-CoV-2 specific antibody concentrations in nasal mucosal fluid at 28 days and 6 months after the 3rd vaccine administration o SARS-CoV-2 specific T cell responses at 28 days after the third vaccine administration by: Measuring interferon-gamma concentration in whole blood after ex vivo stimulation with SARS-CoV-2 specific peptides Measuring ex vivo production of T cell related cytokines by peripheral blood mononuclear cells (PBMC) in ELISpot assays o Incidence of acute rejection within 6 months after the third vaccine administration o Safety in terms of incidence of solicited local and systemic adverse events (AEs) within one week after vaccine administration graded according to severity. The following items will be specifically addressed: Percentage of participants reporting local reactions (pain at the injection site, redness and swelling) within 7 days after vaccine administration Percentage of participants reporting systemic events (fever, fatigue, headache, chills, vomiting, diarrhea, new of worsened muscle pain, and new or worsened joint pain) within 7 days after vaccine administration Percentage of participants with serious adverse events within 6 months after the third vaccine administration |
- SARS-CoV-2 specifieke antilichamen concentraties in serum op 28 dagen na de derde vaccinatie - SARS-CoV-2 specifieke antilichamen concentraties in serum op 6 en 12 maanden na de derde vaccinatie - De titer van neutraliserende antilichamen op 28 dagen na de derde vaccinatie - SARS-CoV-2 specifieke antilichamen concentraties in neusslijm op 28 dagen en 6 maanden na de derde vaccinatie - SARS-CoV-2 specifieke T cel respons op- 28 dagen na de derde vaccinatie door: *het meten van de interferon gamma concentratie in volbloed na ex vivo stimulatie met SARS-CoV-2 specifieke peptiden * het meten van de ex-vivo productie van T cel gerelateerde cytokines door perifeer bloed mononucleaire cellen (PBMC) in ELIspot assays - Het voorkomen van acute afstoting binnen 6 maanden na de derde vaccinatie - Veiligheid in termen van het voorkomen van lokale en systemische bijwerkingen (AE's) binnen ene week na de vaccinatie, ingedeeld naar ernst. De volgende items worden specifiek benoemd: * percentage deelnemers dat lokale reacties benoemd (pijn op de injectieplek, roodheid, zwelling) binnen 7 dagen na vaccinatie * percentage deelnemers dat systemische reacties benoemd (koorts, moeheid, hoofdpijn, koude rillingen, braken, diarree, spierpijn (nieuw of verergerd), en gewrichtspijn (nieuw of verergerd) binnen 7 dagen na vaccinatie. * percentage deelnemers met ernstige bijwerkingen binnen 6 maanden na de derde vaccinatie
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
6 and 12 months after the third vaccination |
6 en 12 maanden na de derde vaccinatie |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 5 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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End of study will be 12 months after the last subjecthas had his/her third vaccination |
12 maanden nadat de laatste deelnemer zijn derde vaccinatie heeft gehad |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |