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Covid19Phase 4NCT04952402

SARS-CoV-2 Immune Responses After COVID-19 Therapy and Subsequent Vaccine

A Phase 4 study testing Study-provided Moderna mRNA-1273 COVID-19 vaccine, Community-provided Moderna mRNA-1273 COVID-19 Vaccine and Community-Provided Pfizer-BioNTech BNT162b2 COVID-19 Vaccine in people with Covid19 and SARS-CoV2 Infection, run by National Institute of Allergy and Infectious Diseases (NIAID) at 6 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to evaluate the safety and efficacy of mRNA COVID-19 vaccines in: People with prior COVID-19 (SARS-CoV-2 infection) who were in the ACTIV-2/A5401 study. And People who have never had COVID-19 (SARS-CoV-2 infection). Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Covid19, SARS-CoV2 Infection
What is being tested?
Study-provided Moderna mRNA-1273 COVID-19 vaccine, Community-provided Moderna mRNA-1273 COVID-19 Vaccine and Community-Provided Pfizer-BioNTech BNT162b2 COVID-19 Vaccine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
43 participants
Where
6 sitesUnited States
Study dates
9 Jul 2021to 10 Jan 2023
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • For all participants: Ability and willingness of participant (or legally authorized representative) to provide informed consent prior to initiation of any study procedures.
  • For participants who are in, or who have completed, the ACTIV-2/A5401 trial: Receipt of all selected investigational therapy or active comparator/placebo for that therapy at selected sites.
  • For participants who are in, or who have completed, the ACTIV-2/A5401 trial and receive study-provided Moderna mRNA-1273 COVID-19 vaccine: Receipt of the last dose of investigational therapy or active comparator/placebo for that therapy ≥30 days and ≤240 days prior to study entry.
  • For participants who are in, or who have completed, the ACTIV-2/A5401 trial and have received or will be receiving community-provided mRNA-based COVID-19 vaccine: Receipt of the last dose of investigational therapy or active comparator/placebo for that therapy ≥30 and ≤240 days prior to receipt or planned receipt of the first dose of community-provided vaccine.

Who cannot join

  • For participants who are in, or who have completed, the ACTIV-2/A5401 trial: Self-report of prior receipt of a non-mRNA-based COVID-19 vaccine.
  • For participants who are in, or who have completed, the ACTIV-2/A5401 trial: Self-report of receipt of the first dose of an mRNA-based COVID-19 vaccine 140 days or more before A5404 enrollment.
  • For participants who are in, or who have completed, the ACTIV-2/A5401 trial: Self-report of a second SARS-CoV-2 infection after the infection that qualified the participant for ACTIV-2/A5401.
  • For non-A5401/ACTIV-2 participants: Self-report of receipt of any prior COVID-19 vaccine.
  • For non-A5401/ACTIV-2 participants: Known prior history of any SARS-CoV-2-positive test (e.g., PCR test, Nucleic Acid Amplification Test (NAAT), antigen test, serology test).
  • For participants who receive study-provided Moderna mRNA-1273 COVID-19 vaccine: Known allergy to any component of the Moderna COVID-19 vaccine.

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

United States6 sites
  • Brigham and Women's Hospital Therapeutics Clinical Research Site (BWH TCRS) CRS

    Boston, Massachusetts, 02115

  • Chapel Hill CRS (Site ID: 3201)

    Chapel Hill, North Carolina, 27599

  • Rush University CRS (Site ID: 2702)

    Chicago, Illinois, 60612

  • UCLA CARE Center CRS

    Los Angeles, California, 90035-4709

  • UCSD Antiviral Research Center CRS

    San Diego, California, 92103

  • University of Washington AIDS CRS

    Seattle, Washington, 98104-9929

Other trials in United States

About this study

The purpose of this study is to evaluate the safety and efficacy of mRNA COVID-19 vaccines in:

  • People with prior COVID-19 (SARS-CoV-2 infection) who were in the ACTIV-2/A5401 study.

And

  • People who have never had COVID-19 (SARS-CoV-2 infection).
Read the detailed description

A5404 is a phase IV, open-label study. The objective of A5404 is to evaluate how prior investigational therapy for COVID-19 versus comparator (placebo or active comparator) affects vaccine response. The safety of mRNA COVID-19 vaccines is also explored.

Eligible A5404 participants include: Participants of ACTIV-2/A5401 at selected sites who received an investigational therapy or its comparator; and persons without known history of prior SARS-CoV-2 infection defined as no known history of any SARS-CoV-2 positive test (non-A5401 participants). In line with our protocol, for outcome measures related to neutralizing antibodies and adverse events, we further break down the ACTIV-2/A5401 participants into two exposure groups: those who received an active therapy (AZD7442 IM or IV, BRII-196 + BRII 198 IV, SAB 185 (3,840 or 10,240 units/kg) IV, BMS 096414+BMS 986413 subcutaneous) and those who received Camostat Oral or Placebo.

Participants of ACTIV-2/A5401 received study-provided standard dosing of the Moderna mRNA-1273 vaccine, or a community-provided mRNA-based COVID-19 vaccine (e.g., Moderna or Pfizer). Participants in ACTIV-2/A5401 received their mRNA-based COVID-19 vaccine 60-240 days after receiving their last dose of a select ACTIV-2/A5401 investigational therapy, or its comparator. Participants without prior COVID-19 received study-provided standard dosing of the Moderna mRNA-1273 vaccine.

The study closed early to accrual on February 25, 2022 due to slow enrollment. Clarification Memo #1 (dated January 11, 2023) reflects decisions to discontinue follow up at study Day 365 instead of following participants to Day 730 after the first dose of vaccine and to reallocate some secondary outcome measures to exploratory outcome measures.

Being tested
Study-provided Moderna mRNA-1273 COVID-19 vaccine, Community-provided Moderna mRNA-1273 COVID-19 Vaccine, Community-Provided Pfizer-BioNTech BNT162b2 COVID-19 Vaccine
Medical subject headings
COVID-19

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Study-provided Moderna mRNA-1273 COVID-19 vaccineBiological

    Participants received a two-dose series (100 µg (0.5 mL) was administered intramuscularly (IM) at Day 0 and Day 28).

  • Community-provided Moderna mRNA-1273 COVID-19 VaccineBiological

    Participants received a two-dose series.

  • Community-Provided Pfizer-BioNTech BNT162b2 COVID-19 VaccineBiological

    Participants received a two-dose series.

Study groups in NCT04952402
Study groupRoleWhat they receive
Cohort: ACTIV-2/A5401ExperimentalParticipants of the ACTIV-2/A5401 randomized trial who received a select investigational (active) therapy (AZD7442 IM or IV, BRII-196 + BRII 198 IV, SAB 185 (3,840 or 10,240 units/kg) IV, BMS 096414+BMS 986413 subcutaneous, Camostat Oral) or its corresponding comparator (Placebo).
Receives: Biological: Study-provided Moderna mRNA-1273 COVID-19 vaccine; Biological: Community-provided Moderna mRNA-1273 COVID-19 Vaccine; Biological: Community-Provided Pfizer-BioNTech BNT162b2 COVID-19 Vaccine
Cohort: COVID-19 NaïveExperimentalParticipants without known history of prior SARS-CoV-2 infection defined as no known history of any SARS-CoV-2 positive test (non-ACTIV-2/A5401 participants).
Receives: Biological: Study-provided Moderna mRNA-1273 COVID-19 vaccine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Neutralizing Antibody (NAb) Level

    NAb level was measured by using both 50% neutralizing dilution titers (ND50) and 80% neutralizing titers (ND80). A higher NAb level corresponds to a stronger immune response. For ND50 values less than lower limit of quantification (LLQ), we impute with 10 (which is ½ LLQ of 20). For ND50 values exceeding the upper limit of quantification (ULQ), we impute with 20,000 (a value suggested by the immunology lab, which is 2 times the ULQ of 10,000). For ND80, we impute similarly with 10 and 20,000. We carry forward the Day 56 NAb measurement if the Day 140 measurement is not reported.

    Measured: Measured 140 days after the first dose of the vaccine

Secondary outcomes (5)
  1. Geometric Mean of Relative Change in Neutralizing Antibody Levels From Pre-vaccine to Post-vaccine

    Relative change is defined as the ratio of post-vaccine NAb level/pre-vaccine NAb level. A ratio greater than one indicates an increase of NAb response. For ND50 values less than lower limit of quantification (LLQ), we impute with 10 (which is ½ LLQ of 20). For ND50 values exceeding the upper limit of quantification (ULQ), we impute with 20,000 (a value suggested by the immunology lab, which is 2 times the ULQ of 10,000). For ND80, we impute similarly with 10 and 20,000.

    Measured: Measured before the first dose of the vaccine, and 56 days after the first dose of the vaccine

  2. Proportion of Participants With New Grade 3 or Higher AE, or SAE, or AE Leading to Change or Discontinuation in Vaccine Receipt

    An adverse event (AE) is any unfavorable and unintended sign, symptom, or diagnosis that occurs in a study participant during the conduct of the study REGARDLESS of the attribution. A serious adverse event (SAE) is defined as any untoward medical occurrence that results in death; is life-threatening; requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect; is an important medical event that may not be immediately life-threatening or result in death or hospitalization but may jeopardize the patient or may require intervention to prevent one of the other outcomes listed in the definition above.

    Adverse events are graded on a scale from 1-5: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death. AE grading was per Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE Grading Table V2.1).

    Measured: From first dose of the vaccine through 140 days after the first dose of the vaccine

  3. Number of Participants With Grade 1 or Higher Allergic Reaction

    Adverse events are graded on a scale from 1-5: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death. AE grading was per Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE Grading Table V2.1).

    Measured: From first dose of the vaccine through 56 days after the first dose of the vaccine

  4. Proportion of Participants With Grade 2 or Higher Injection Site Reaction

    Adverse events are graded on a scale from 1-5: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death. AE grading was per Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE Grading Table V2.1).

    Measured: From first dose of the vaccine through 56 days after the first dose of the vaccine

  5. Geometric Mean of Relative Change in Neutralizing Antibody Levels From Pre-vaccine to Post-vaccine by Received Vaccine

    Relative change is defined as the ratio of post-vaccine NAb level/pre-vaccine NAb level by received vaccine, i.e., Moderna mRNA-1273 versus Pfizer-BioNTech BNT162b2. A ratio greater than one indicates an increase of NAb response for those on Moderna mRNA-1273 versus Pfizer-BioNTech BNT162b2. For ND50 values less than lower limit of quantification (LLQ), we impute with 10 (which is ½ LLQ of 20). For ND50 values exceeding the upper limit of quantification (ULQ), we impute with 20,000 (a value suggested by the immunology lab, which is 2 times the ULQ of 10,000). For ND80, we impute similarly with 10 and 20,000.

    Measured: Measured before the first dose of the vaccine, and 56 days after the first dose of the vaccine

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Jul 2021
  2. Study start9 Jul 2021
  3. Primary completion28 Feb 2022
  4. Study completion10 Jan 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
43 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04952402
Sponsor's protocol ID
A5404
Status last verified
May 2023
First submitted
28 Jun 2021
Last updated
24 May 2023
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: Individual participant data that underlie results in the publication, after deidentification.

Publications

  • Smith DM, Weir IR, Ramirez S, Coelho CH, Manne-Goehler J, Aziz M, Benson CA, Wu X, Hyer R, Dhillon PK, Faraji F, Bloom N, Myers A, Ramezani-Rad P, Lopez PG, Parikh UM, Heaps AL, Javan AC, Bender Ignacio RA, Li JZ, Greninger AL, Daar ES, Wohl DA, Crotty S, Sieg SF, Chew KW. Impact of COVID-19 Monoclonal Antibody Therapy on Subsequent Vaccine-Elicited SARS-CoV-2 Immune Responses. J Infect Dis. 2026 Aug 3;234(1):e18-e28. doi: 10.1093/infdis/jiag091.

    PubMed 41700320

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Study-provided Moderna mRNA-1273 COVID-19 vaccine, Community-provided Moderna mRNA-1273 COVID-19 Vaccine and Community-Provided Pfizer-BioNTech BNT162b2 COVID-19 Vaccine in people with Covid19 and SARS-CoV2 Infection, run by National Institute of Allergy and Infectious Diseases (NIAID) at 6 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 24 May 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 19 May 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Neutralizing Antibody (NAb) Level (time frame: Measured 140 days after the first dose of the vaccine). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04952402, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 May 2023.

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