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Twinrix Adult

Phase 3

Hepatitis B | Monoclonal antibody | Infectious Disease |GSK plc|Last Updated: Aug 20, 2018

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedACTIVE_CONTROLLED
Total Trials4
Total Enrollment749
FDA Designations
No designations recorded
Clinical Trials (4)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT00289718Long-Term Immune Persistence of GSK Biologicals' Combined Hepatitis A & B Vaccine Injected According to a 0,1,6 Month SchedulePHASE3 COMPLETED 51Nov 1, 2004Mar 2, 2005Feb 15, 20181 Belgium
NCT00197119Long-Term Follow-Up Studies at Year 6, 7, 8, 9, 10: 2 Formulations of Combined Hepatitis A/B Vaccine Compared in Subjects Aged 12-15 YearsPHASE3 COMPLETED 244May 1, 2004Jun 1, 2004Apr 20, 20172 Belgium, Czechia
NCT00289744Long-Term Immune Persistence of GSK Biologicals' Combined Hepatitis A & B Vaccine Injected According to a 0,6 Month SchedulePHASE3 COMPLETED 178Feb 16, 2004Apr 15, 2009Aug 20, 20181 Belgium
NCT00197184Long Term Follow-up Study at Years 2, 3, 4 and 5 Where 2 Dosing Schedules of the Combined Hepatitis A and B Vaccine Were ComparedPHASE3 COMPLETED 276Nov 1, 2003Mar 10, 2004Aug 20, 20187 Australia, Belgium +1
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Study Endpoints
Primary Endpoints
Anti-hepatitis A Virus (Anti-HAV) Antibody Concentration
At Years 11, 12, 13, 14, and 15 after the first vaccine dose of the 3-dose primary vaccination

Concentrations given as geometric mean concentration (GMC) expressed as milli-international unit per millilitre (mIU/mL).

Number of Subjects Reporting Any and Grade 3 Solicited Local Symptoms.
During the 4-day (Day 0-3) follow-up period after additional HBV vaccination

Solicited local symptoms assessed include pain, redness and swelling. Any was defined as occurrence of the specified solicited local symptom regardless of its intensity. Grade 3 pain was defined as pain that prevented normal everyday activities. Grade 3 swelling was greater than 100 millimeters (mm) i.e. \>100mm.

Number of Subjects Seropositive for Anti-HAV Antibodies
At Years 11, 12, 13, 14, and 15 after the first vaccine dose of the 3-dose primary vaccination

A seropositive subject was defined as a vaccinated subject who had a anti-HAV antibody titres ≥ 33 mIU/ml.

Anti-hepatitis B Surface Antigen (Anti-HBs) Antibody Concentration
At Years 11, 12, 13, 14, and 15 after the first vaccine dose of the 3-dose primary vaccination

Concentrations given as GMC expressed as mIU/mL. NOTE: There was a change of assay kit at Year 15 time-point, thus for the sake of bridging, blood samples corresponding to Year 14 were re-tested with ChemiLuminescence ImmunoAssay (CLIA). From Year 11 to Year 14, anti-HBs antibody concentrations were tested with ELISA with cut-off of 3.3 mIU/mL while, Year 14\* onwards, anti-HBs antibody concentrations were tested with the CLIA with cut-off of 6.2 mIU/mL.

Number of Subjects Seropositive for Anti-HB Antibodies
At Years 11, 12, 13, 14, and 15 after the first vaccine dose of the 3-dose primary vaccination

A seropositive subject was defined as a vaccinated subject who had anti-HB antibody titres ≥ 1 mIU/mL. NOTE: There was a change of assay kit at Year 15 time-point, thus for the sake of bridging, blood samples corresponding to Year 14 were re-tested with ChemiLuminescence ImmunoAssay (CLIA)

Number of Subjects Seroprotected for Anti-HBs Antibodies.
At Years 11, 12, 13, 14, and 15 after the first vaccine dose of the 3-dose primary vaccination

A seroprotected subject was defined as a subjects with the anti-HBs titres ≥ 10 mIU/mL. NOTE: There was a change of assay kit at Year 15 time-point, thus for the sake of bridging, blood samples corresponding to Year 14 were re-tested with ChemiLuminescence ImmunoAssay (CLIA)

Number of Subjects Reporting Serious Adverse Events (SAE)
During the follow-up period after additional vaccination (minimum 30 days)

A SAE was defined as any untoward medical occurrence that: resulted in death, was life threatening, required hospitalization or prolongation of hospitalization, resulted in disability/incapacity or was a congenital anomaly/birth defect in the offspring of a study subject. Any was defined as occurrence of any symptom regardless of intensity grade or relation to vaccination and related was an event assessed by the investigator as causally related to the study vaccination.

Number of Subjects Reporting Any Solicited General Symptoms.
During the 4-day (Day 0-3) follow-up period after additional HBV vaccination

Solicited general symptoms assessed included fatigue, headache, malaise, nausea, vomiting and fever. Any was defined as any solicited general symptom reported irrespective of intensity and relationship to vaccination.

Number of Subjects Reporting Unsolicited Adverse Events (AE)
During the 30-day follow-up period after additional vaccination

An AE is any untoward medical occurrence in a clinical investigation subject, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.

Number of Subjects Reporting Serious Adverse Events (SAEs)
At Years 11, 12, 13, 14, and 15 after the first vaccine dose of the 3-dose primary vaccination

A SAE was defined as any untoward medical occurrence that: resulted in death, was life threatening, required hospitalization or prolongation of hospitalization, resulted in disability/incapacity or was a congenital anomaly/birth defect in the offspring of a study subject. Any was defined as occurrence of any symptom regardless of intensity grade or relation to vaccination and related was an event assessed by the investigator as causally related to the study vaccination.

Number of Subjects With Anti-hepatitis A Virus (HAV) Antibody Concentrations Above the Cut-off Value
Year 6, 7, 8, 9 and 10 after the first vaccine dose of a two-dose or three-dose primary vaccination

Anti-HAV antibody concentration cut-off value assessed was ≥ 15 milli-International Units per milliliter (mIU/mL).

Number of Subjects With Anti-Hepatitis B Surface Antigen (HBs) Antibody Concentrations Above the Cut-Off Value
Year 6, 7, 8, 9 and 10 after the first vaccine dose of a two-dose or three-dose primary vaccination

Anti-HBs antibody concentration cut-off value assessed was ≥ 3.3 mIU/mL.

Serious Adverse Events (SAE) Causally Related to Primary Vaccination or Related to Hepatitis A or B Infection or Related to Study Participation (Blood Sampling)
From Year 6 through to Year 10

An SAE is any untoward medical occurrence that: results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/ incapacity, is a congenital anomaly/birth defect in the offspring of a study subject, or may evolve into one of the outcomes listed above.

Number of Subjects With Immune Response to the Additional Dose of Engerix™-B
One month after the additional dose administration

Immune response was defined as: * anti-hepatitis B surface antigen (anti-HBs) antibody concentration equal or above to 10 milli-international units per milliliter (mIU/mL) at 1 month post-challenge dose in subjects seronegative at the pre-challenge time-points * at least a 4-fold increase in anti-HBs antibody concentrations at 1 month post-challenge dose in subjects seropositive at the pre-challenge time-points.

Number of Subjects Reporting Serious Adverse Events (SAEs) Assessed by the Investigator as Causally Related to Primary Vaccination, Study Procedures or Lack of Vaccine Efficacy
At Year 6, 7, 8, 9 and 10

Serious adverse events (SAEs) assessed include medical occurrences that result in death, is life threatening, require hospitalization or prolongation of hospitalization, result in disability/incapacity or are a congenital anomaly/birth defect in the offspring of a study subject.

Number of Subjects Reporting Solicited Local and General Symptoms
During the 4-day follow-up period after additional dose

Solicited local symptoms assessed include pain, redness and swelling. Solicited general symptoms assessed include fatigue, fever, gastrointestinal symptoms and headache.

Number of Subjects Reporting Unsolicited Adverse Events
During the 30-day follow-up period after additional dose

Unsolicited adverse event (AE) covers any AE reported in addition to those solicited during the clinical study and any solicited symptom with onset outside the specified period of follow-up for solicited symptoms.

Anti-hepatitis A (HAV) Antibody Concentrations
Year 2 (Month 24), Year 3 (Month 36), Year 4 (Month 48) and Year 5 (Month 60)

Geometric mean concentration for anti-HAV antibodies expressed as Milli-International Units per milliliter (mIU/mL)

Anti-hepatitis B (HBs) Antibody Concentrations
Year 2 (Month 24), Year 3 (Month 36), Year 4 (Month 48) and Year 5 (Month 60)

Geometric mean concentration for anti-HBs antibodies expressed as Milli-International Units per milliliter (mIU/mL).

Anti-HAV Antibody Concentrations in Subjects Receiving the Additional Vaccine Dose.
Before and one month after additional vaccination

Any subjects becoming seronegative for anti-HAV antibodies (i.e. titres \< 15 mIU/ml) at any long term time point, were to receive an additional vaccine dose administered between 6 to 12 months after Year 5 time point.

Anti-HBs Antibody Concentrations in Subjects Receiving the Additional Vaccine Dose.
Before and One month after additional vaccination

Subjects losing seroprotective anti-HBs antibody titres (i.e. titres \< 10 mIU/ml) at any long term time point, received an Engerix challenge dose. The table presents the geometric mean concentrations for anti-HBs antibodies, expressed as Milli-International Units per milliliter (mIU/mL).

Secondary Endpoints
Number of Subjects Reporting Serious Adverse Events (SAEs) Determined by the Investigator to Have a Causal Relationship to Primary Vaccination or Due to Lack of Vaccine Efficacy.
From last study visit of the primary study up to Year 5 long term follow-up
Number of Subjects Receiving an Additional Vaccine Dose and Reporting Solicited Local Symptoms
during the 4-day follow-up period after additional vaccination
Number of Subjects Receiving an Additional Vaccine Dose and Reporting Solicited General Symptoms.
During the 4-day follow-up period after additional vaccination
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Study Design & Arms
AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposePREVENTION
Treatment Arms
ArmTypeDescription
Twinrix GroupEXPERIMENTALSubjects who received 2 doses of Twinrix™ (lot A, B or C) in the primary study. As lot to lot consistency was assessed during the primary study, the 3 groups (lot A, B or C) were pooled into the Twinrix Group for data analyses during the long term follow-up.
Group Twinrix AdultACTIVE_COMPARATORSubjects received Twinrix™ Adult (720/20) in a 0, 6 month schedule in the primary study.
Group Twinrix JuniorACTIVE_COMPARATORSubjects received Twinrix™ Junior (360/10) in a 0, 1, 6 month schedule in the primary study.
Engerix-B Additional Dose (Adult)EXPERIMENTALSubjects aged 16 years and above who received an additional dose of EngerixTM-B (adult dose).
Engerix-B Additional Dose (Pediatric)EXPERIMENTALSubjects under the age of 16 years who received an additional dose of EngerixTM-B (pediatric dose).
Twinrix JuniorEXPERIMENTALSubjects previously received 3 doses of combined hepatitis A / hepatitis B vaccine (junior formulation).
Twinrix AdultACTIVE_COMPARATORSubjects previously received 2 doses of combined hepatitis A / hepatitis B vaccine (adult formulation).
Interventions
NameTypeDescription
Twinrix™ adultBIOLOGICALIntramuscular administration
Twinrix™ JuniorBIOLOGICALIntramuscular administration in the deltoid region (3 doses).
Engerix TMBIOLOGICALIf a subject has become seronegative for anti-HAV antibodies or lost anti-HBs seroprotection concentrations at the long-term blood sampling time point (i.e. Years 6, 7, 8, 9 or 10), he/ she will be offered an additional vaccine dose.
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Eligibility Criteria
Age Range18 Years — N/A
SexALL
Healthy VolunteersYes
Study Sites1

Inclusion Criteria: * Subjects participating in this study should have received three-dose primary vaccination with combined hepatitis A/hepatitis B vaccine in the primary study. * Written informed consent will be obtained from each subject before the blood sampling visit of each year

Countries:BelgiumCzechiaAustraliaSpain
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