SIDE EFFECTS
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. It is possible that broad use of AUDENZ could reveal adverse reactions not observed in clinical trials.
In adults 18 through 64 years of age, the most common (≥ 10%) solicited local and systemic reactions reported in clinical trials were injection site pain (64%), fatigue (25%), headache (25%), malaise (22%), myalgia (14%), arthralgia (10%) and nausea (10%).
In adults 65 years of age and older, the most common (≥ 10%) solicited local and systemic reactions reported in clinical trials were injection site pain (36%), fatigue (20%), malaise (16%), headache (16%), and arthralgia (10%).
In infants and children, 6 months through 5 years of age, the most common (≥ 10%) solicited local and systemic reactions reported in clinical trials were tenderness (56%), irritability (30%), sleepiness (25%), change in eating habits (18%), and fever (16%).
In children 6 years through 17 years of age, the most common (≥ 10%) solicited local and systemic reactions reported in clinical trials were injection site pain (68%), myalgia (30%), fatigue (27%), malaise (25%), headache (22%), loss of appetite (14%), nausea (13%), and arthralgia (13%).
Adults 18 Years Of Age And Older
Clinical safety data for AUDENZ in adults (18 years of age and older) have been collected from three studies: Study 1 in adults 18 through 64 years of age (NCT01776541); Study 2 in adults 65 years of age and older (NCT01766921), and Study 3, a placebo-controlled trial in adults 18 years of age and older (NCT02839330). Subjects in all studies received 2 doses of AUDENZ, administered intramuscularly 21 days apart. In all three studies, solicited local and systemic adverse reactions were collected for 7 days and unsolicited adverse events were collected for 21 days following each vaccination. Serious adverse events (SAEs), adverse events of special interest (AESIs) (prospectively defined events representing potential immune-mediated conditions), new onset of chronic diseases (NOCDs) (adverse events leading to a new diagnosis of a chronic medical condition), and medically-attended adverse events (MAAEs) (leading to an unscheduled healthcare visit) were collected for one year following the final vaccination in each subject. The safety population includes 3,579 subjects who received at least one dose of AUDENZ. Of these, 1,683 were adults 18 through 64 years of age and 1,896 were adults 65 years of age and older.
Study 3 was a randomized, observer-blind, multicenter, controlled study conducted in the US, in adults 18 years of age and older. Subjects were randomized in a 3:1 ratio to receive two doses of either AUDENZ or saline placebo, 21 days apart. In total, 3,191 subjects (18 through 64 years: N=1,596; 65 years and older: N=1,595) in the safety population received at least one dose of AUDENZ (N=2,395) or placebo (N=796). The mean age of the subjects ≥ 18 years was 58 years, and included 45% male, 84% white, 13% black or African American, 1% Asian, fewer than 1% reported as other racial groups, and 92% non-Hispanic/non-Latinos.
Solicited Reactions
In Study 3, the most commonly reported (≥ 10%) solicited local and systemic reactions in adults 18 through 64 years within 7 days following administration of AUDENZ were injection site pain (64%), fatigue (25%), headache (25%), malaise (22%), myalgia (14%), arthralgia (10%), and nausea (10%). In adults 65 years of age and older, the most common (≥ 10%) solicited local and systemic reactions reported within 7 days following administration of AUDENZ were injection site pain (36%), fatigue (20%), malaise (16%), headache (16%), and arthralgia (10%).
Tables 1 and 2 present the reported frequencies of pre-specified solicited local and systemic adverse reactions in Study 3, actively collected on standardized diary cards during the seven days following any vaccination (i.e., on the day of vaccination and for six days thereafter). Adults 65 years and older generally reported fewer solicited local and systemic reactions as compared to younger persons. The majority of solicited local and systemic adverse reactions were mild or moderate in intensity. Severe reactions in subjects receiving AUDENZ were reported in 1% or fewer subjects for each reaction. Other than injection site pain which occurred more frequently in AUDENZ recipients as compared to placebo, rates and severity were similar between treatment groups. Frequencies of adverse reactions were higher after the first dose than after the second dose. Most local and systemic reactions occurred within two or three days of vaccination and were less than three days in duration.
Table 1: Percentages of Subjects 18 through 64 Years of Age and 65 Years of Age and Older Reporting Solicited Local Adverse Reactions within 7 Days after Any Vaccination with AUDENZ or Saline Placebo (Study 3a).
Solicited Local Adverse Reactionsb (%) | Adults 18 through 64 years of age AUDENZ (N=1163)c | Adults 18 through 64 years of age Placebo (N=387)c | Adults 65 years of age and older AUDENZ (N=1189)c | Adults 65 years of age and older Placebo (N=397)c |
Injection site pain | 64 | 20 | 36 | 10 |
Erythema ≥25 mm | 0.6 | 0 | 0.4 | 0 |
Induration ≥25 mm | 0.4 | 0 | 0.7 | 0 |
Ecchymosis ≥25 mm | 0.3 | 0 | 0.6 | 0.3 |
a NCT02839330 b Severe (Grade 3) reactions of each type were reported in 1% or fewer subjects receiving AUDENZ; severe (Grade 3) reactions of each type were also reported in the placebo group at similar percentages. Grade 3 local pain is that which prevents daily activity; Grade 3 injection site erythema, induration and ecchymosis include any ≥ 100 mm in diameter. c Number of subjects in the Solicited Safety Population (subjects who were vaccinated and provided any solicited safety data, excluding the 30-minute post-vaccination observation period) for each dose group. |
Table 2: Percentages of Subjects 18 through 64 Years of Age and 65 Years of Age and Older Reporting Solicited Systemic Adverse Reactions within 7 Days after Any Vaccination with AUDENZ or Saline Placebo (Study 3a).
Solicited Systemic Adverse Reactionsb (%) | Adults 18 through 64 years of age AUDENZ (N=1163)c | Adults 18 through 64 years of age Placebo (N=387)c | Adults 65 years of age and older AUDENZ (N=1189)c | Adults 65 years of age and older Placebo (N=397)c |
Fatigue | 25 | 21 | 20 | 19 |
Headache | 25 | 23 | 16 | 16 |
Malaise | 22 | 12 | 16 | 12 |
Myalgia | 14 | 11 | 9 | 8 |
Arthralgia | 10 | 9 | 10 | 9 |
Nausea | 10 | 11 | 7 | 6 |
Loss of appetite | 8 | 9 | 6 | 6 |
Chills | 4 | 4 | 4 | 3 |
Fever (≥100.4°F) | 0.6 | 2 | 0.7 | 0.3 |
a NCT02839330 b Severe (Grade 3) reactions of each type were reported in 1% or fewer subjects receiving AUDENZ; severe (Grade 3) reactions of each type were also reported in the placebo group at similar percentages. Grade 3 fever is any oral temperature ≥ 102.2°F; for other systemic reactions, Grade 3 is that which prevents daily activity or leads to decreased oral intake. c Number of subjects in the Solicited Safety Population (subjects who were vaccinated and provided any solicited safety data, excluding the 30-minute post-vaccination observation period) for each dose group. |
Unsolicited Adverse Events
In Study 3, the proportion of subjects 18 years of age and older who reported unsolicited AEs in the 21 days after each vaccination was similar between AUDENZ and placebo groups (23% vs. 22%). The frequencies and types of unsolicited adverse events were similar between treatment groups. Across both age and treatment groups, most events were mild to moderate in severity and considered unrelated to vaccinations.
Serious Adverse Events (SAEs)
In Study 3, fatal and non-fatal SAEs reported in the 12 months following vaccinations among adults 18 through 64 years of age occurred in 2.9% of subjects who received AUDENZ and 3.3% of subjects who received placebo. SAE rates among adults 65 years of age and older were 10.5% in subjects administered AUDENZ and 15.3% in subjects who received placebo. Fatal SAEs included 11 (0.5%) AUDENZ recipients and 1 (0.1%) placebo recipients. No SAEs were assessed as being related to AUDENZ.
Studies 1 and 2 did not have a placebo or active comparator control for comparison of safety. Four deaths occurred in Study 1 (subjects 18 through 64 years) and two in Study 2 (subjects ≥ 65 years), none assessed as related to AUDENZ. In the 12 months following vaccinations, SAEs (fatal and non-fatal) occurred in a total of n=28 (3%) of all subjects in Study 1. SAEs occurred in a total of n=96 (7%) subjects in Study 2. In both Studies 1 and 2, all SAEs appeared unrelated to study treatment.
Adverse Events of Special Interest (AESIs)
In Studies 1, 2, and 3 combined, AESIs, such as new onset neuroinflammatory and immune mediated diseases, were assessed in the studies using a predefined list. The percentages of subjects with an AESI at any time after vaccination was 0.2% among adults 18 through 64 years of age and 0.4% among adults 65 years of age and older who received AUDENZ. In the placebo group, 1.8% of adults 65 years and older reported AESIs while there were no AESIs reported for adults 18 through 64 years. No AESIs were assessed as related to AUDENZ.
New Onset of Chronic Diseases and Medically-Attended Adverse Events
In Studies 1, 2 and 3 combined, NOCDs (9.7% vs 9.2%) and MAAEs (47.1% vs 46.0%) occurred with similar frequencies between AUDENZ and placebo recipients, respectively, with larger proportions of these events occurring in subjects ≥ 65 years. No large imbalances in types of events were observed between treatment groups.
Children And Adolescents 6 Months Through 17 Years Of Age
Clinical safety data for AUDENZ in children 6 months through 17 years of age were collected in Study 4.
Study 4 was an observer-blind, multicenter study conducted in the U.S. and Thailand in children 6 months through 17 years of age (NCT 01776554). A total of 329 subjects in the safety population received two doses of AUDENZ administered intramuscularly 21 days apart. Solicited local (injection site) and systemic adverse reactions were collected for seven days (the day of vaccination and for six days thereafter) following each vaccination in all children, divided into two age cohorts (6 months through 5 years [N=160], and 6 years through 17 years of age [N=163]). Unsolicited adverse events were collected for 21 days following each vaccination for children 6 months through 17 years of age. SAEs, AESIs, NOCDs, and MAAEs were monitored for one year after the last vaccination.
The mean age of subjects in Study 4 was 79 months (6.5 years), 54% were male, 72% were Asian, 22% white, 4% black or African American, 2% other, <1% American Indian or Alaska native, and 96% were non-Hispanic/non-Latino. A total of 72% of the safety population was enrolled in Thailand and 28% in the U.S.
Solicited Reactions
The majority of solicited local and systemic adverse reactions reported in each age group of children 6 months through 5 years and 6 years through 17 years were mild or moderate in intensity, and resolved within a few days. The proportions of subjects who reported solicited local or systemic reactions were lower following the second vaccination as compared to the first.
The most common (≥10%) solicited local and systemic reactions within 7 days following administration of AUDENZ in children 6 months through 5 years of age were tenderness (56%), irritability (30%), sleepiness (25%), change in eating habits (18%) and fever (16%). The most common (≥10%) solicited local and systemic reactions within 7 days following administration of AUDENZ in children 6 years through 17 years of age were pain (68%), myalgia (30%), fatigue (27%), malaise (25%), headache (22%), loss of appetite (14%), nausea (13%), and arthralgia (13%).
The proportions of children 6 months through 5 years who reported solicited adverse reactions are presented in Tables 3 and 4.
Table 3: Percentage of Children 6 Months through 5 Years of Age with Solicited Adverse Local Reactions within 7 days after Any Vaccination with AUDENZ (Study 4a)
Solicited Local Adverse Reactionsb | AUDENZ (N=159)c % |
Tenderness (Any) | 56 |
Tenderness (Severe) | 1 |
Erythema (≥ 10 mm) | 3 |
Erythema (≥ 50 mm) | 0 |
Induration (≥ 10 mm) | 1 |
Induration (≥ 50 mm) | 0 |
Ecchymosis (≥ 10 mm) | 0 |
Ecchymosis (≥ 50 mm) | 0 |
a NCT01776554 b Any erythema, induration or ecchymosis were defined as a measured diameter ≥ 10 mm. Severe (Grade 3) reactions were defined as follows: Tenderness = cried when injected limb was moved; Erythema, Induration and Ecchymosis = diameter ≥ 50 mm. c N = number of subjects in the Solicited Safety Population who were vaccinated and provided solicited local adverse event safety data, excluding the 30-minute post-vaccination observation period). |
Table 4: Percentage of Children 6 Months through 5 Years of Age with Solicited Adverse Systemic Reactions within 7 days after Any Vaccination with AUDENZ (Study 4a)
Solicited Systemic Adverse Reactionsb | AUDENZ (N=159)c % |
Irritability (Any) | 30 |
Irritability (Severe) | 1 |
Sleepiness (Any) | 25 |
Sleepiness (Severe) | 0 |
Change in eating habits (Any) | 18 |
Change in eating habits (Severe) | 0 |
Fever (≥ 100.4° F) | 16 |
Fever (≥ 102.1° F) | 2 |
a NCT01776554 b Severe (Grade 3) reactions were defined as follows: Irritability = unable to console; Sleepiness = sleeps most of the time and it is hard to arouse him/her; Change in eating habits = missed more than 2 feeds; Fever = body temperature ≥102.1°F. c N = number of subjects in the Solicited Safety Population who were vaccinated and provided solicited systemic adverse event safety data, excluding the 30-minute post-vaccination observation period). |
The reported frequencies of solicited adverse reactions in children 6 years through 17 years of age are presented in Tables 5 and 6.
Table 5: Percentage of Children 6 through 17 Years of Age with Solicited Local Adverse Reactions within 7 days after Any Vaccination with AUDENZ (Study 4a)
Solicited Local Adverse Reactionsb | AUDENZ (N=163)c % |
Injection site pain (Any) | 68 |
Injection site pain (Severe) | 1 |
Erythema (≥ 25 mm) | 1 |
Erythema (≥ 100 mm) | 0 |
Induration (≥ 25 mm) | 2 |
Induration (≥ 100 mm) | 0 |
Ecchymosis (≥ 25 mm) | 0 |
Ecchymosis (≥ 100 mm) | 0 |
a NCT01776554 b Severe (Grade 3) reactions were defined as follows: Pain = prevented daily activity; Erythema, Induration and Ecchymosis = diameter > 100 mm; . c Number of subjects in the Solicited Safety Population who were vaccinated and provided solicited local adverse event safety data, excluding the 30-minute post-vaccination observation period). |
Table 6: Percentage of Children 6 through 17 Years of Age with Solicited Systemic Adverse Reactions within 7 days after Any Vaccination with AUDENZ (Study 4a)
Solicited Systemic Adverse Reactionsb | AUDENZ (N=162-163)c % |
Myalgia (Any) | 30 |
Myalgia (Severe) | 0 |
Fatigue (Any) | 27 |
Fatigue (Severe) | 1 |
Malaise (Any) | 25 |
Malaise (Severe) | 1 |
Headache (Any) | 22 |
Headache (Severe) | 0 |
Loss of appetite (Any) | 14 |
Loss of appetite (Severe) | 1 |
Nausea (Any) | 13 |
Nausea (Severe) | 1 |
Arthralgia (Any) | 13 |
Arthralgia (Severe) | 0 |
Fever (≥ 100.4°F) | 4 |
Fever (≥ 102.1°F) | 1 |
a NCT01776554 b Severe (Grade 3) reactions were defined as follows: Myalgia, Fatigue, Malaise, Headache, Nausea and Arthralgia = Prevents daily activity; Loss of appetite = Decreased oral intake with weight loss. c Number of subjects in the Solicited Safety Population who were vaccinated and provided solicited systemic adverse event safety data, excluding the 30-minute post-vaccination observation period). |
Unsolicited Adverse Events
In children 6 months through 17 years of age (N=329), 26% of subjects who received AUDENZ reported at least one unsolicited adverse event within 21 days after any vaccination. The most common unsolicited AEs (≥ 2%) among all subjects were upper respiratory infection (8%), pyrexia (5%), nasopharyngitis (4%) and vomiting (2%). Most AEs were mild or moderate in severity. One child was discontinued from the second vaccination due to a non-serious AE (pyrexia on Day 3) assessed as possibly related to study vaccine.
Serious Adverse Events
A total of 8 (2%) children 6 months through 17 years of age in the safety population (N=326) experienced SAEs during the study. SAEs consisted of events typical for a pediatric population and were assessed as unrelated to study vaccine. No deaths were reported during the study.
Adverse Events of Special Interest
No AESIs were reported during the study.
New Onset of Chronic Diseases and Medically-Attended Adverse Events
No AUDENZ recipients reported NOCDs during the study. MAAEs were reported by 34% of all subjects and were typical of events that occur in a pediatric population. The most common MAAEs were categorized as infections and infestations (reported by 26% of subjects).
Postmarketing Experience
There is no postmarketing experience following administration of AUDENZ.
The following adverse events have been reported during postmarketing use of influenza vaccines that contain the same MF59® adjuvant or share the same manufacturing platform as the influenza antigen in AUDENZ.
Because spontaneously reported events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their incidence or to establish a causal relationship to the vaccine.
Blood and lymphatic system disorders: Lymphadenopathy.
Immune system disorders: Hypersensitivity reactions including angioedema and anaphylaxis.
Nervous system disorders: Bell’s Palsy, convulsions, including febrile convulsion, demyelination, encephalitis, Guillain-Barré Syndrome, neuritis, paresthesia, syncope.
Skin and subcutaneous tissue disorders: Urticaria, pruritis, non-specific rash.
Musculoskeletal and connective tissue disorders: Muscular weakness.
DRUG INTERACTIONS
Concomitant Vaccine Administrations
No data are available to evaluate the concomitant administration of AUDENZ with other vaccines.
Concurrent Use With Immunosuppressive Therapies
Immunosuppressive or corticosteroid therapies may reduce the immune response to AUDENZ.