1区 · 医学
Article
作者: Schwartz, Michael M ; Hennessey, John P ; Lizakowski, Mary ; Nyirjesy, Paul ; Hoover, Keila ; Edwards, John E ; Edwards, Lance ; Augenbraun, Michael ; Schmidt, Clint S ; Hoeg, Jesse ; Filler, Scott G ; Marchus, Erica ; DeMontigny, Elizabeth A ; Drusano, Michael ; Yeaman, Michael R ; Holmberg, Tuomas ; Ibrahim, Ashraf S ; Schodel, Florian ; Sussman, Steven ; Cooke, M Timothy ; Jacobs, Mark ; Sobel, Jack D
Background:Recurrent vulvovaginal candidiasis (RVVC) is a problematic form of mucosal Candida infection, characterized by repeated episodes per year. Candida albicans is the most common cause of RVVC. Currently, there are no immunotherapeutic treatments for RVVC.
Methods:This exploratory randomized, double-blind, placebo-controlled trial evaluated an immunotherapeutic vaccine (NDV-3A) containing a recombinant C. albicans adhesin/invasin protein for prevention of RVVC.
Results:The study in 188 women with RVVC (n = 178 evaluable) showed that 1 intramuscular dose of NDV-3A was safe and generated rapid and robust B- and T-cell immune responses. Post hoc exploratory analyses revealed a statistically significant increase in the percentage of symptom-free patients at 12 months after vaccination (42% vaccinated vs 22% placebo; P = .03) and a doubling in median time to first symptomatic episode (210 days vaccinated vs 105 days placebo) for the subset of patients aged <40 years (n = 137). The analysis of evaluable patients, which combined patients aged <40 years (77%) and ≥40 years (23%), trended toward a positive impact of NDV-3A versus placebo (P = .099).
Conclusions:In this unprecedented study of the effectiveness of a fungal vaccine in humans, NDV-3A administered to women with RVVC was safe and highly immunogenic and reduced the frequency of symptomatic episodes of vulvovaginal candidiasis for up to 12 months in women aged <40 years. These results support further development of NDV-3A vaccine and provide guidance for meaningful clinical endpoints for immunotherapeutic management of RVVC.
Clinical Trials Registration:NCT01926028.