Final Analysis of a Trial of M72/AS01E Vaccine to Prevent Tuberculosis

New England Journal of Medicine
06 Nov, 2019 ,

Dereck R. Tait et al reported on the results of the 3-year final analysis of efficacy, safety, and immunogenicity of the M72/AS01E vaccine for tuberculosis prevention. The study sample included adults aged 18-50 years infected with Mycobacterium tuberculosis. Participants were randomized in a 1:1 ratio to receive two doses of either M72/AS01E or placebo, administered 1 month apart. Specifically, of the 3,575 participants who underwent randomization, 3,573 received at least one dose of M72/AS01E or placebo, and 3,330 received both planned doses. Among the 3,289 participants in the according-to-protocol efficacy cohort, 13 of the 1,626 participants in the M72/AS01E group—compared with 26 of the 1,663 participants in the placebo group—had cases of tuberculosis that met the first case definition. At month 36, vaccine efficacy was 49.7%. Among participants in the M72/AS01E group, the concentrations of M72-specific antibodies and the frequencies of M72-specific CD4+ T cells increased after the first dose, and were sustained throughout the follow-up period. The rate of serious adverse events, potential immune-mediated diseases, and deaths were similar between the two groups. Overall, in this study cohort infected with M. tuberculosis, M72/AS01E vaccination elicited an immune response, and provided protection against progression to pulmonary tuberculosis disease for ≥ 3 years.

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Abstract

BACKGROUND

Results of an earlier analysis of a trial of the M72/AS01E candidate vaccine against Mycobacterium tuberculosis showed that in infected adults, the vaccine provided 54.0% protection against active pulmonary tuberculosis disease, without evident safety concerns. We now report the results of the 3-year final analysis of efficacy, safety, and immunogenicity.

METHODS

From August 2014 through November 2015, we enrolled adults 18 to 50 years of age with M. tuberculosis infection (defined by positive results on interferon-γ release assay) without evidence of active tuberculosis disease at centers in Kenya, South Africa, and Zambia. Participants were randomly assigned in a 1:1 ratio to receive two doses of either M72/AS01E or placebo, administered 1 month apart. The primary objective was to evaluate the efficacy of M72/AS01E to prevent active pulmonary tuberculosis disease according to the first case definition (bacteriologically confirmed pulmonary tuberculosis not associated with human immunodeficiency virus infection). Participants were followed for 3 years after the second dose. Participants with clinical suspicion of tuberculosis provided sputum samples for polymerase-chain-reaction assay, mycobacterial culture, or both. Humoral and cell-mediated immune responses were evaluated until month 36 in a subgroup of 300 participants. Safety was assessed in all participants who received at least one dose of M72/AS01E or placebo.

RESULTS

A total of 3575 participants underwent randomization, of whom 3573 received at least one dose of M72/AS01E or placebo, and 3330 received both planned doses. Among the 3289 participants in the according-to-protocol efficacy cohort, 13 of the 1626 participants in the M72/AS01E group, as compared with 26 of the 1663 participants in the placebo group, had cases of tuberculosis that met the first case definition (incidence, 0.3 vs. 0.6 cases per 100 person-years). The vaccine efficacy at month 36 was 49.7% (90% confidence interval [CI], 12.1 to 71.2; 95% CI, 2.1 to 74.2). Among participants in the M72/AS01E group, the concentrations of M72-specific antibodies and the frequencies of M72-specific CD4+ T cells increased after the first dose and were sustained throughout the follow-up period. Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the two groups.

CONCLUSIONS

Among adults infected with M. tuberculosis, vaccination with M72/AS01E elicited an immune response and provided protection against progression to pulmonary tuberculosis disease for at least 3 years.