Safety, tolerability and immunogenicity of PRV-101, a multivalent vaccine targeting coxsackie B viruses (CVBs) associated with type 1 diabetes: a double-blind randomised placebo-controlled Phase I trial

Abstract

Aims/hypothesis Infection with coxsackie B viruses (CVBs) can cause diseases ranging from mild common cold-type symptoms to severe life-threatening conditions. CVB infections are considered to be prime candidates for environmental triggers of type 1 diabetes. This, together with the significant disease burden of acute CVB infections and their association with chronic diseases other than diabetes, has prompted the development of human CVB vaccines. The current study evaluated the safety and immunogenicity of the first human vaccine designed against CVBs associated with type 1 diabetes in a double-blind randomised placebo-controlled Phase I trial. Methods The main eligibility criteria for participants were good general health, age between 18 and 45 years, provision of written informed consent and willingness to comply with all trial procedures. Treatment allocation (PRV-101 or placebo) was based on a computer-generated randomisation schedule and people assessing the outcomes were masked to group assignment. In total, 32 participants (17 men, 15 women) aged 18–44 years were randomised to receive a low (n=12) or high (n=12) dose of a multivalent, formalin-inactivated vaccine including CVB serotypes 1–5 (PRV-101), or placebo (n=8), given by intramuscular injections at weeks 0, 4 and 8 at a single study site in Finland. The participants were followed for another 24 weeks. Safety and tolerability were the primary endpoints. Anti-CVB IgG and virus-neutralising titres were analysed using an ELISA and neutralising plaque reduction assays, respectively. Results Among the 32 participants (low dose, n=12; high dose, n=12; placebo, n=8) no serious adverse events or adverse events leading to study treatment discontinuation were observed. Treatment-emergent adverse events considered to be related to the study drug occurred in 37.5% of the participants in the placebo group and 62.5% in the PRV-101 group (injection site pain, headache, injection site discomfort and injection site pruritus being most common). PRV-101 induced dose-dependent neutralising antibody responses against all five CVB serotypes included in the vaccine in both the high- and low-dose groups. Protective titres ≥8 against all five serotypes were seen in >90% of participants over the entire follow-up period. Conclusions/interpretation The results indicate that the tested multivalent CVB vaccine is well tolerated and immunogenic, supporting its further clinical development. Trial registration ClinicalTrials.gov NCT04690426. Funding This trial was funded by Provention Bio, a Sanofi company. Graphical Abstract

Enteroviruses: epidemic potential, challenges and opportunities with vaccines

“…This vaccine, based on our vaccine platform and promising preclinical studies [ 155 – 160 ], targets several strains of CVBs associated with islet autoimmunity and type 1 diabetes (T1D). The phase 1 study suggested that the vaccine is well tolerated and elicits virus-neutralizing antibodies in vaccinated individuals [ 161 ].

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“…We have developed inactivated virus vaccines for the six CVBs and demonstrated their safety and efficacy as monovalent [ 155 – 160 ] and multivalent [ 158 ] vaccines in animal models. Based on these studies, a double-blind randomised placebo-controlled Phase I trial for multivalent CVB vaccine targeting serotypes associated with type 1 diabetes has been completed [ 161 ]. Inactivated virus vaccines have been developed also for CVB3 (reviewed in [ 169 ]), CVA5 [ 185 ], CVA6, CVA10 [ 184 , 186 ], CVA16 [ 187 ], CVA2 [ 188 ] and EV-D68 [ 189 ].…”