Low-dose intravenous and subcutaneous CIS43LS monoclonal antibody for protection against malaria (VRC 612 Part C): a phase 1, adaptive trial

• Published in: The Lancet infectious diseases 2023-05, Vol.23 (5), p.578-588
• Main Authors: Lyke, Kirsten E, Berry, Andrea A, Mason, Kaitlin, Idris, Azza H, O'Callahan, Mark, Happe, Myra, Strom, Larisa, Berkowitz, Nina M, Guech, Mercy, Hu, Zonghui, Castro, Mike, Basappa, Manjula, Wang, Lu, Low, Kwang, Holman, LaSonji A, Mendoza, Floreliz, Gordon, Ingelise J, Plummer, Sarah H, Trofymenko, Olga, Strauss, Kathleen S, Joshi, Sudhaunshu, Shrestha, Biraj, Adams, Matthew, Chagas, Andrezza Campos, Murphy, Jittawadee R, Stein, Judy, Hickman, Somia, McDougal, Andrew, Lin, Bob, Narpala, Sandeep R, Vazquez, Sandra, Serebryannyy, Leonid, McDermott, Adrian, Gaudinski, Martin R, Capparelli, Edmund V, Coates, Emily E, Wu, Richard L, Ledgerwood, Julie E, Dropulic, Lesia K, Seder, Robert A, Young, Cheryl, Boyce, Colleen, Winkler, Jennifer, Holian, Susan, Greenberg, Nancy, George, Shirley, Kwon, Alyson, Dorsey, Brenda, Da Costa, Ana Raquel, Witt, William, Grays, Daryl, Gapasin, Arren, Bernal, Paula, Floyd, Jeffrey, Goldstein, Eric, Howe, Leslie, Lee, Myounghee, Marron, Jennifer, Brooks, Kelly, Turek, Lisa, Farley, Patricia, Frels, Shantel, Booth, Delores, Gall, Jason, Carlton, Kevin, Albright, Gabriela, Amharref, Nadia, Atallah, Kandace, Banappagari, Sashikanth, Bastani, Niutish, Blackstock, Daniel, Boonyaratanakornkit, Bobby, Carey, Elizabeth, Charlton, Adam, Chaudhuri, Rajoshi, Caringal, Alegria M., Chen, Mingzhong, Chen, Peifeng, Cheng, Wei, Gowetski, Daniel, Gulla, Krishana, Hastings, Erica, Horwitz, Joe, Ivleva, Vera, Kordella, Dan, Kueltzo, Lisa A., Lagler, Sara, Le, Matt, Lee, James, Lei, Paula, Li, Yile, Nagy, Attila, Patel, Aakash, Runsewe, Peyi, Shadrick, Will, Shetty, Shamitha, Wang, Hairong, Webber, Calvin, Vejzagic, Farah, Yang, Yoo-Jung
• Format: Article
• Language: English
• Subjects: Adult; Allergies; Animals; Antibodies, Monoclonal - therapeutic use; Antimalarials; Atovaquone; Clinical trials; Coronaviruses; COVID-19 vaccines; Disease transmission; Dosage; Global health; Human performance; Humans; Infections; Infectious diseases; Inoculation; Liver; Malaria; Malaria Vaccines - therapeutic use; Malaria, Falciparum - drug therapy; Malaria, Falciparum - prevention & control; Monoclonal antibodies; Morbidity; Motility; Mutation; Optimization; Pandemics; Plasmodium falciparum; Proguanil; Proteins; Public health; Research centers; Review boards; Safety; Vaccine development; Vector-borne diseases
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(22)00793-9

Human monoclonal antibodies might offer an important new approach to reduce malaria morbidity and mortality. In the first two parts of a three-part clinical trial, the antimalarial monoclonal antibody CIS43LS conferred high protection against parasitaemia at doses of 20 mg/kg or 40 mg/kg administered intravenously followed by controlled human malaria infection. The ability of CIS43LS to confer protection at lower doses or by the subcutaneous route is unknown. We aimed to provide data on the safety and optimisation of dose and route for the human antimalaria monoclonal antibody CIS43LS. VRC 612 Part C was the third part of a three-part, first-in-human, phase 1, adaptive trial, conducted at the University of Maryland, Baltimore Center for Vaccine Development and Global Health, Baltimore, MD, USA. We enrolled adults aged 18–50 years with no previous malaria vaccinations or infections, in a sequential, dose-escalating manner. Eligible participants received the monoclonal antibody CIS43LS in a single, open-label dose of 1 mg/kg, 5 mg/kg, or 10 mg/kg intravenously, or 5 mg/kg or 10 mg/kg subcutaneously. Participants underwent controlled human malaria infection by the bites of five mosquitoes infected with Plasmodium falciparum 3D7 strain approximately 8 weeks after their monoclonal antibody inoculation. Six additional control participants who did not receive CIS43LS underwent controlled human malaria infection simultaneously. Participants were followed-up daily on days 7–18 and day 21, with qualitative PCR used for P falciparum detection. Participants who tested positive for P falciparum were treated with atovaquone-proguanil and those who remained negative were treated at day 21. Participants were followed-up until 24 weeks after dosing. The primary outcome was safety and tolerability of CIS43LS at each dose level, assessed in the as-treated population. Secondary outcomes included protective efficacy of CIS43LS after controlled human malaria infection. This trial is now complete and is registered with ClinicalTrials.gov, NCT04206332. Between Sept 1, 2021, and Oct 29, 2021, 47 people were assessed for eligibility and 31 were enrolled (one subsequently withdrew and was replaced) and assigned to receive doses of 1 mg/kg (n=7), 5 mg/kg (n=4), and 10 mg/kg (n=3) intravenously and 5 mg/kg (n=4) and 10 mg/kg (n=4) subcutaneously, or to the control group (n=8). CIS43LS administration was safe and well tolerated; no serious adverse events occurred. CIS43LS protected 18