Phase I Trial of ZOSTAVAX® Prior to Renal Transplantation
Infection with varicella-zoster virus (VZV) produces a life-long latent infection in sensory
ganglia. Reactivation of viral replication from latency results in a number of clinical
syndromes, most commonly herpes zoster, or shingles. Herpes zoster is typically a unilateral
vesicular rash in a dermatomal distribution accompanied by radicular pain that may be
severe. Immunocompromised persons are at higher risk for herpes zoster than immunocompetent
adults. The markedly increased risk of herpes zoster in organ transplant recipients suggests
that this population would benefit substantially if a similar strategy could be adopted. The
currently licensed zoster vaccine, ZOSTAVAX® (Zoster Vaccine Live), is not licensed for use
in immunosuppressed persons and in the United States for those less than 50 years of age. A
small Phase I study is important to address immunogenicity in patients with Chronic Kidney
Disease (CKD) prior to transplantation as well as safety and persistence of immune responses
following transplantation. This study is a multi-center, double blind, randomized,
placebo-controlled trial of ZOSTAVAX® immunization in subjects who will undergo renal
transplantation from a living donor or are wait-listed for a deceased donor no less than 4
weeks after vaccination. The primary objective of this study is to assess the safety of
ZOSTAVAX® when administered to subjects with CKD a minimum of 4 weeks prior to live donor
renal transplantation. This will be accomplished by comparing the rates of specific local
and systemic reactogenicity events and adverse events (AEs) between the vaccine and placebo
groups. Subjects likely to be suitable for renal transplant and who have an identified
living donor will be consented for screening serology for antibodies to VZV if such serology
is not standard of care or serostatus is not known. Subjects with positive VZV serology, an
identified living donor, and meeting inclusion and exclusion criteria will provide signed
informed consent for study enrollment. Subjects will be randomized to receive either active
vaccine (ZOSTAVAX®) [30 subjects] or placebo vaccine [10 subjects]. Blood will be drawn on
day 0 (day of vaccine) prior to vaccine administration for assessment of baseline humoral
and cellular immunity to VZV. Subjects will receive ZOSTAVAX® or placebo vaccination. At
approximately 5 weeks post-vaccination, subjects will have blood drawn for measurement of
humoral and cellular immune response. Subjects will undergo living donor renal transplant
with immunosuppression according to standard of care at each institution. All transplanted
subjects will receive anti-viral prophylaxis for 3 months post-transplant, consisting of
either valganciclovir (or ganciclovir) or acyclovir (or valacyclovir or famciclovir)
depending on risk of cytomegalovirus (CMV) disease. Subjects will be followed and treated by
the renal transplant team at each center according to local standard of care with
concomitant monitoring by the vaccine study teams. Subjects will have blood drawn for
humoral and cell-mediated immune assays at day 0, and week 5 post vaccination, and 6 months
and 12 months post-transplantation if they undergo transplantation.
Interventional
Allocation: Randomized, Endpoint Classification: Safety Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Prevention
Safety: incidence of grade 3 or higher vaccine related adverse events (AEs) and vaccine related serious adverse events (SAEs).
During the 4 weeks post-immunization.
Yes
United States: Institutional Review Board
09-0016
NCT01137669
September 2010
April 2013
Name | Location |
---|---|
Stanford University - Stanford Hospital and Clinics - Pediatrics - Infectious Diseases | Stanford, California 94305-5208 |
University of Iowa - Infectious Disease Clinic | Iowa City, Iowa 52242 |
University of Maryland Baltimore - School of Medicine - Medicine | Baltimore, Maryland 21201 |
Vanderbilt University - Medicine - Infectious Diseases | Nashville, Tennessee 37232-2035 |