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Efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate in ten countries in Europe and Latin America (HERALD): a randomised, observer-blinded, placebo-controlled, phase 2b/3 trial

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dc.contributor.author Kremsner, Peter G.
dc.contributor.author Ahuad Guerrero, Rodolfo Andrés
dc.contributor.author Arana-Arri, Eunate
dc.contributor.author Aroca Martinez, Gustavo Jose
dc.contributor.author Bonten, Marc
dc.contributor.author Chandler, Reynaldo
dc.contributor.author Corral, Gonzalo
dc.contributor.author De Block, Eddie Jan Louis
dc.contributor.author Ecker, Lucie
dc.contributor.author Gabor, Julian Justin
dc.contributor.author Garcia Lopez, Carlos Alberto
dc.contributor.author Gonzales, Lucy
dc.contributor.author Granados González, María Angélica
dc.contributor.author Gorini, Nestor
dc.contributor.author Grobusch, Martin P.
dc.contributor.author Hrabar, Adrian D.
dc.contributor.author Junker, Helga
dc.contributor.author Kimura, Alan
dc.contributor.author Lanata, Claudio F.
dc.contributor.author Lehmann, Clara
dc.contributor.author Leroux-Roels, Isabel
dc.contributor.author Mann, Philipp
dc.contributor.author Martinez-Reséndez, Michel Fernando
dc.contributor.author Ochoa Woodell, Theresa Jean
dc.contributor.author Poy, Carlos Alberto
dc.contributor.author Reyes Fentanes, Maria Jose
dc.contributor.author Rivera Mejia, Luis Maria
dc.contributor.author Ruiz Herrera, Vida Veronica
dc.contributor.author Sáez-Llorens, Xavier
dc.contributor.author Schönborn-Kellenberger, Oliver
dc.contributor.author Schunk, Mirjam
dc.contributor.author Sierra Garcia, Alexandra
dc.contributor.author Vergara, Itziar
dc.contributor.author Verstraeten, Thomas
dc.contributor.author Vico, Marisa
dc.contributor.author Oostvogels, Lidia
dc.date.accessioned 2021-12-12T20:24:54Z
dc.date.available 2021-12-12T20:24:54Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/10200
dc.description.abstract BACKGROUND: Additional safe and efficacious vaccines are needed to control the COVID-19 pandemic. We aimed to analyse the efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate. METHODS: HERALD is a randomised, observer-blinded, placebo-controlled, phase 2b/3 clinical trial conducted in 47 centres in ten countries in Europe and Latin America. By use of an interactive web response system and stratification by country and age group (18-60 years and ≥61 years), adults with no history of virologically confirmed COVID-19 were randomly assigned (1:1) to receive intramuscularly either two 0·6 mL doses of CVnCoV containing 12 μg of mRNA or two 0·6 mL doses of 0·9% NaCl (placebo) on days 1 and 29. The primary efficacy endpoint was the occurrence of a first episode of virologically confirmed symptomatic COVID-19 of any severity and caused by any strain from 15 days after the second dose. For the primary endpoint, the trial was considered successful if the lower limit of the CI was greater than 30%. Key secondary endpoints were the occurrence of a first episode of virologically confirmed moderate-to-severe COVID-19, severe COVID-19, and COVID-19 of any severity by age group. Primary safety outcomes were solicited local and systemic adverse events within 7 days after each dose and unsolicited adverse events within 28 days after each dose in phase 2b participants, and serious adverse events and adverse events of special interest up to 1 year after the second dose in phase 2b and phase 3 participants. Here, we report data up to June 18, 2021. The study is registered at ClinicalTrials.gov, NCT04652102, and EudraCT, 2020-003998-22, and is ongoing. FINDINGS: Between Dec 11, 2020, and April 12, 2021, 39 680 participants were enrolled and randomly assigned to receive either CVnCoV (n=19 846) or placebo (n=19 834), of whom 19 783 received at least one dose of CVnCoV and 19 746 received at least one dose of placebo. After a mean observation period of 48·2 days (SE 0·2), 83 cases of COVID-19 occurred in the CVnCoV group (n=12 851) in 1735·29 person-years and 145 cases occurred in the placebo group (n=12 211) in 1569·87 person-years, resulting in an overall vaccine efficacy against symptomatic COVID-19 of 48·2% (95·826% CI 31·0-61·4; p=0·016). Vaccine efficacy against moderate-to-severe COVID-19 was 70·7% (95% CI 42·5-86·1; CVnCoV 12 cases in 1735·29 person-years, placebo 37 cases in 1569·87 person-years). In participants aged 18-60 years, vaccine efficacy against symptomatic disease was 52·5% (95% CI 36·2-64·8; CVnCoV 71 cases in 1591·47 person-years, placebo, 136 cases in 1449·23 person-years). Too few cases occurred in participants aged 61 years or older (CVnCoV 12, placebo nine) to allow meaningful assessment of vaccine efficacy. Solicited adverse events, which were mostly systemic, were more common in CVnCoV recipients (1933 [96·5%] of 2003) than in placebo recipients (1344 [67·9%] of 1978), with 542 (27·1%) CVnCoV recipients and 61 (3·1%) placebo recipients reporting grade 3 solicited adverse events. The most frequently reported local reaction after any dose in the CVnCoV group was injection-site pain (1678 [83·6%] of 2007), with 22 grade 3 reactions, and the most frequently reported systematic reactions were fatigue (1603 [80·0%] of 2003) and headache (1541 [76·9%] of 2003). 82 (0·4%) of 19 783 CVnCoV recipients reported 100 serious adverse events and 66 (0·3%) of 19 746 placebo recipients reported 76 serious adverse events. Eight serious adverse events in five CVnCoV recipients and two serious adverse events in two placebo recipients were considered vaccination-related. None of the fatal serious adverse events reported (eight in the CVnCoV group and six in the placebo group) were considered to be related to study vaccination. Adverse events of special interest were reported for 38 (0·2%) participants in the CVnCoV group and 31 (0·2%) participants in the placebo group. These events were considered to be related to the trial vaccine for 14 (<0·1%) participants in the CVnCoV group and for five (<0·1%) participants in the placebo group. INTERPRETATION: CVnCoV was efficacious in the prevention of COVID-19 of any severity and had an acceptable safety profile. Taking into account the changing environment, including the emergence of SARS-CoV-2 variants, and timelines for further development, the decision has been made to cease activities on the CVnCoV candidate and to focus efforts on the development of next-generation vaccine candidates en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet. Infectious Diseases
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject CVnCoV SARS-CoV-2 mRNA en_US
dc.subject vaccine en_US
dc.subject HERALD en_US
dc.title Efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate in ten countries in Europe and Latin America (HERALD): a randomised, observer-blinded, placebo-controlled, phase 2b/3 trial en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S1473-3099(21)00677-0
dc.relation.issn 1474-4457


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