Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.


Journal

Lancet (London, England)
ISSN: 1474-547X
Titre abrégé: Lancet
Pays: England
ID NLM: 2985213R

Informations de publication

Date de publication:
09 01 2021
Historique:
received: 24 11 2020
revised: 01 12 2020
accepted: 03 12 2020
pubmed: 12 12 2020
medline: 2 2 2021
entrez: 11 12 2020
Statut: ppublish

Résumé

A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 10 Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; p ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.

Sections du résumé

BACKGROUND
A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials.
METHODS
This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 10
FINDINGS
Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; p
INTERPRETATION
ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials.
FUNDING
UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.

Identifiants

pubmed: 33306989
pii: S0140-6736(20)32661-1
doi: 10.1016/S0140-6736(20)32661-1
pmc: PMC7723445
pii:
doi:

Substances chimiques

COVID-19 Vaccines 0
ChAdOx1 nCoV-19 B5S3K2V0G8

Banques de données

ClinicalTrials.gov
['NCT04324606', 'NCT04444674', 'NCT04400838']

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

99-111

Subventions

Organisme : Medical Research Council
ID : MR/L006588/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_18058
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_12023/22
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_19058
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 211153/Z/18/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_12014/8
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_19055
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 109965/Z/15/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_00008/11
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_19026
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/L018942/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0600520
Pays : United Kingdom
Organisme : Medical Research Council
ID : G1001046
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/T001151/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/N008219/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/T031891/1
Pays : United Kingdom

Investigateurs

Marites Aban (M)
Fatola Abayomi (F)
Kushala Abeyskera (K)
Jeremy Aboagye (J)
Matthew Adam (M)
Kirsty Adams (K)
James Adamson (J)
Yemi A Adelaja (YA)
Gbadebo Adewetan (G)
Syed Adlou (S)
Khatija Ahmed (K)
Yasmeen Akhalwaya (Y)
Saajida Akhalwaya (S)
Andrew Alcock (A)
Aabidah Ali (A)
Elizabeth R Allen (ER)
Lauren Allen (L)
Thamires C D S C Almeida (TCDSC)
Mariana P S Alves (MPS)
Fabio Amorim (F)
Foteini Andritsou (F)
Rachel Anslow (R)
Matthew Appleby (M)
Edward H Arbe-Barnes (EH)
Mark P Ariaans (MP)
Beatriz Arns (B)
Laiana Arruda (L)
Paula Azi (P)
Lorena Azi (L)
Gavin Babbage (G)
Catherine Bailey (C)
Kenneth F Baker (KF)
Megan Baker (M)
Natalie Baker (N)
Philip Baker (P)
Lisa Baldwin (L)
Ioana Baleanu (I)
Danieli Bandeira (D)
Anna Bara (A)
Marcella A S Barbosa (MAS)
Debbie Barker (D)
Gavin D Barlow (GD)
Eleanor Barnes (E)
Andrew S Barr (AS)
Jordan R Barrett (JR)
Jessica Barrett (J)
Louise Bates (L)
Alexander Batten (A)
Kirsten Beadon (K)
Emily Beales (E)
Rebecca Beckley (R)
Sandra Belij-Rammerstorfer (S)
Jonathan Bell (J)
Duncan Bellamy (D)
Nancy Bellei (N)
Sue Belton (S)
Adam Berg (A)
Laura Bermejo (L)
Eleanor Berrie (E)
Lisa Berry (L)
Daniella Berzenyi (D)
Amy Beveridge (A)
Kevin R Bewley (KR)
Helen Bexhell (H)
Sutika Bhikha (S)
Asad E Bhorat (AE)
Zaheda E Bhorat (ZE)
Else Bijker (E)
Geeta Birch (G)
Sarah Birch (S)
Adam Bird (A)
Olivia Bird (O)
Karen Bisnauthsing (K)
Mustapha Bittaye (M)
Katherine Blackstone (K)
Luke Blackwell (L)
Heather Bletchly (H)
Caitlin L Blundell (CL)
Susannah R Blundell (SR)
Pritesh Bodalia (P)
Bruno C Boettger (BC)
Emma Bolam (E)
Elena Boland (E)
Daan Bormans (D)
Nicola Borthwick (N)
Francesca Bowring (F)
Amy Boyd (A)
Penny Bradley (P)
Tanja Brenner (T)
Phillip Brown (P)
Claire Brown (C)
Charlie Brown-O'Sullivan (C)
Scott Bruce (S)
Emily Brunt (E)
Ruaridh Buchan (R)
William Budd (W)
Yusuf A Bulbulia (YA)
Melanie Bull (M)
Jamie Burbage (J)
Hassan Burhan (H)
Aileen Burn (A)
Karen R Buttigieg (KR)
Nicholas Byard (N)
Ingrid Cabera Puig (I)
Gloria Calderon (G)
Anna Calvert (A)
Susana Camara (S)
Michelangelo Cao (M)
Federica Cappuccini (F)
João R Cardoso (JR)
Melanie Carr (M)
Miles W Carroll (MW)
Andrew Carson-Stevens (A)
Yasmin de M Carvalho (YM)
José A M Carvalho (JAM)
Helen R Casey (HR)
Paul Cashen (P)
Thais Castro (T)
Lucia Carratala Castro (LC)
Katrina Cathie (K)
Ana Cavey (A)
José Cerbino-Neto (J)
Jim Chadwick (J)
David Chapman (D)
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Jee-Sun Cho (JS)
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Deborah Warbick (D)
Theresa Wardell (T)
George Warimwe (G)
Sarah C Warren (SC)
Bridget Watkins (B)
Ekaterina Watson (E)
Stewart Webb (S)
Alice Webb-Bridges (A)
Angela Webster (A)
Jessica Welch (J)
Jeanette Wells (J)
Alison West (A)
Caroline White (C)
Rachel White (R)
Paul Williams (P)
Rachel L Williams (RL)
Rebecca Winslow (R)
Mark Woodyer (M)
Andrew T Worth (AT)
Danny Wright (D)
Marzena Wroblewska (M)
Andy Yao (A)
Rafael Zimmer (R)
Dalila Zizi (D)
Peter Zuidewind (P)

Commentaires et corrections

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Type : ErratumIn
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Informations de copyright

Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Auteurs

Merryn Voysey (M)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Sue Ann Costa Clemens (SAC)

Institute of Global Health, University of Siena, Siena, Brazil; Department of Paediatrics, University of Oxford, Oxford, UK.

Shabir A Madhi (SA)

MRC Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa.

Lily Y Weckx (LY)

Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil.

Pedro M Folegatti (PM)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Parvinder K Aley (PK)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Brian Angus (B)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Vicky L Baillie (VL)

Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.

Shaun L Barnabas (SL)

Family Centre for Research with Ubuntu, Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa.

Qasim E Bhorat (QE)

Soweto Clinical Trials Centre, Soweto, South Africa.

Sagida Bibi (S)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Carmen Briner (C)

Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Paola Cicconi (P)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Andrea M Collins (AM)

Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.

Rachel Colin-Jones (R)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Clare L Cutland (CL)

Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.

Thomas C Darton (TC)

Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Keertan Dheda (K)

Division of Pulmonology, Groote Schuur Hospital and the University of Cape Town, South Africa; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.

Christopher J A Duncan (CJA)

Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, Newcastle upon Tyne, UK.

Katherine R W Emary (KRW)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Katie J Ewer (KJ)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Lee Fairlie (L)

Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Saul N Faust (SN)

NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.

Shuo Feng (S)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Daniela M Ferreira (DM)

Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.

Adam Finn (A)

School of Population Health Sciences, University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.

Anna L Goodman (AL)

Department of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; MRC Clinical Trials Unit, University College London, London, UK.

Catherine M Green (CM)

Clinical BioManufacturing Facility, University of Oxford, Oxford, UK.

Christopher A Green (CA)

NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Paul T Heath (PT)

St George's Vaccine Institute, St George's, University of London, London, UK.

Catherine Hill (C)

Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Helen Hill (H)

Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.

Ian Hirsch (I)

AstraZeneca BioPharmaceuticals, Cambridge, UK.

Susanne H C Hodgson (SHC)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Alane Izu (A)

VIDA-Vaccines and Infectious Diseases Analytical Research Unit, Johannesburg, South Africa.

Susan Jackson (S)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Daniel Jenkin (D)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Carina C D Joe (CCD)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Simon Kerridge (S)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Anthonet Koen (A)

VIDA-Vaccines and Infectious Diseases Analytical Research Unit, Johannesburg, South Africa.

Gaurav Kwatra (G)

Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Rajeka Lazarus (R)

Severn Pathology, North Bristol NHS Trust, Bristol, UK.

Alison M Lawrie (AM)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Alice Lelliott (A)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Vincenzo Libri (V)

NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK.

Patrick J Lillie (PJ)

Department of Infection, Hull University Teaching Hospitals NHS Trust, UK.

Raburn Mallory (R)

AstraZeneca BioPharmaceuticals, Cambridge, UK.

Ana V A Mendes (AVA)

Escola Bahiana de Medicina e Saúde Pública, Salvador, Braziland Hospital São Rafael, Salvador, Brazil; Instituto D'Or, Salvador, Brazil.

Eveline P Milan (EP)

Department of Infectious Diseases, Universidade Federal do Rio Grande do Norte, Natal, Brazil.

Angela M Minassian (AM)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Alastair McGregor (A)

London Northwest University Healthcare, Harrow, UK.

Hazel Morrison (H)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Yama F Mujadidi (YF)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Anusha Nana (A)

Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Peter J O'Reilly (PJ)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Sherman D Padayachee (SD)

Setshaba Research Centre, Pretoria, South Africa.

Ana Pittella (A)

Department of Internal Medicine, Hospital Quinta D'Or, Rio de Janeiro, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil; Department of Internal Medicine, Universidade UNIGRANRIO, Rio de Janeiro, Brazil.

Emma Plested (E)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Katrina M Pollock (KM)

NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK.

Maheshi N Ramasamy (MN)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Sarah Rhead (S)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Alexandre V Schwarzbold (AV)

Clinical Research Unit, Department of Clinical Medicine, Universidade Federal de Santa Maria, Santa Maria, Brazil.

Nisha Singh (N)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Andrew Smith (A)

College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK.

Rinn Song (R)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA.

Matthew D Snape (MD)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.

Eduardo Sprinz (E)

Infectious Diseases Service, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Rebecca K Sutherland (RK)

Clinical Infection Research Group, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK.

Richard Tarrant (R)

Clinical BioManufacturing Facility, University of Oxford, Oxford, UK.

Emma C Thomson (EC)

MRC-University of Glasgow Centre for Virus Research & Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK.

M Estée Török (ME)

Department of Medicine, University of Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Mark Toshner (M)

Heart Lung Research Institute, Department of Medicine, University of Cambridge and Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.

David P J Turner (DPJ)

University of Nottingham and Nottingham University Hospitals NHS Trust, UK.

Johan Vekemans (J)

AstraZeneca BioPharmaceuticals, Cambridge, UK.

Tonya L Villafana (TL)

AstraZeneca BioPharmaceuticals, Cambridge, UK.

Marion E E Watson (MEE)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Christopher J Williams (CJ)

Public Health Wales, Cardiff, Wales; Aneurin Bevan University Health Board, Newport, UK.

Alexander D Douglas (AD)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Adrian V S Hill (AVS)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Teresa Lambe (T)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Sarah C Gilbert (SC)

Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK.

Andrew J Pollard (AJ)

Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. Electronic address: andrew.pollard@paediatrics.ox.ac.uk.

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