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Nuvaxovid: which risks did reviewers probe?

COVID-19 vaccine, recombinant spike protein nanoparticle, Matrix-M-adjuvanted · SARS-CoV-2 spike (nanoparticle)
Immune & cytokine safety
Matrix-M1: injection-site inflammation, reversible draining lymph node enlargement, raised CRP, fibrinogen and globulin (immune stimulation)
“The findings were considered consistent with immune system stimulation consequent to administration of an active adjuvant, and comprised: local injection site inflammation, reversible enlargement of the lymph nodes draining the injection sites (but not elsewhere), and chemical markers of inflammation (i.e., CRP, fibrinogen, and globulin).”
✓ VerifiedEMA assessment report, p. 51Source ↗
Biodistribution & persistence
No biodistribution data at approval; mouse biodistribution study of Matrix-M1 adjuvant planned
“As the Matrix-M1 adjuvant is not currently marketed in a human vaccine in the EU market, Novavax is planning to conduct a biodistribution study in mice to evaluate the Matrix-M1 adjuvant, which may be of value in further understanding the mode of action of the adjuvant.”
✓ VerifiedEMA assessment report, p. 53Source ↗
Modality-specific risk
Vaccine-induced enhanced disease: none seen after SARS-CoV-2 challenge in animals given low (0.01-1 µg) antigen doses
“In animals vaccinated with low doses (i.e., 0.01 µg, 0.1 µg or 1 µg) of Wuhan rS prior to challenge with SARS-CoV-2, no evidence of exacerbation of disease was found in necropsy and histopathology, thus alleviating earlier concerns about potential occurrence of vaccine-induced enhanced disease in vaccine recipients after a subsequent exposure to SARS-CoV-2.”
✓ VerifiedFDA summary basis for approval, p. 17Source ↗
Anti-drug antibodies: animals
High anti-S IgG titers in rabbits, enhanced by Matrix-M1, confirming exposure
“SARS-CoV-2 rS vaccine was administered on day 1, 8, 15, and 36 and induced high anti-S IgG titers. Addition of Matrix-M1 adjuvant significantly enhanced anti-S IgG responses.”
✓ VerifiedEMA assessment report, p. 51Source ↗
Anti-drug antibodies: patients
Two-dose schedule produced seroconversion in almost all participants
“Clinical phase 3 data confirm that the vaccine is immunogenic and the studied two dose schedule resulted in seroconversion in almost all participants.”
✓ VerifiedEMA assessment report, p. 69Source ↗

Same question, other vaccines

Arexvy

respiratory syncytial virus vaccine, adjuvanted (AS01E) · RSV preF3; TLR4 (AS01E adjuvant)
In mice, AS01-adjuvanted RSVPreF3 induced CD4+/CD8+ T cells, neutralising antibodies and proinflammatory cytokines

Cervarix

human papillomavirus bivalent (types 16, 18) vaccine, recombinant, AS04-adjuvanted · HPV 16/18 L1 VLPs; TLR4 (AS04 adjuvant)
No neurological, immunological or autoimmune adverse reactions in MPL-containing preclinical studies (FDA concurred)

Cyfendus

anthrax vaccine adsorbed, adjuvanted · B. anthracis PA; TLR9 (CpG 7909 adjuvant)
Transient neutrophil, monocyte, basophil and inflammatory-marker increases; spleen weight increase and lymphoid hyperplasia

Fendrix

hepatitis B vaccine (rDNA), AS04C-adjuvanted · HBsAg VLPs; TLR4 (AS04C adjuvant)
Anti-HBs seroconversion in rabbits; rat dams and offspring exposed to high anti-HBs titres

Gardasil

human papillomavirus quadrivalent (types 6, 11, 16, 18) vaccine, recombinant · HPV 6/11/16/18 L1 VLPs
Theoretical autoimmunity from cross-reactive antibodies, not readily studied in animals; left to clinical assessment

Gardasil 9

human papillomavirus 9-valent vaccine, recombinant · HPV 9-valent L1 VLPs
Transient spleen weight increase from immune stimulation; theoretical autoimmunity risk left to post-marketing

HBVaxPro

hepatitis B vaccine (rDNA) · HBsAg VLPs
No autoimmune reactions, kidney or vascular lesions, or immune complex deposition in the rat repeat-dose study

Heplisav-B

hepatitis B vaccine (recombinant), adjuvanted · HBsAg; TLR9 (CpG 1018 adjuvant)
Serum IL-12p40 rose only 2-fold at ~20x the human CpG 1018 dose; no IL-12p40 or IFN-gamma increase at the 1x human dose

Mosquirix

RTS,S/AS01 malaria vaccine · P. falciparum CSP-HBsAg (RTS,S) VLPs; TLR4 (AS01 adjuvant)
Transient neutrophil and fibrinogen increases after dosing, back to pre-dose levels within three days

PreHevbrio

hepatitis B vaccine (recombinant), 3-antigen · HBsAg S/pre-S1/pre-S2 VLPs
Slight lymphoid hyperplasia in spleen and lymph nodes, an expected immunostimulatory effect

Shingrix

zoster vaccine recombinant, AS01B-adjuvanted · VZV glycoprotein E; TLR4 (AS01B adjuvant)
Acute-phase response (CRP rise) indicating systemic inflammation, possibly linked to malaise, fatigue and nausea

Flublok

influenza vaccine, recombinant hemagglutinin · Influenza HA
Not stated in public reviews

Summary across all 13 vaccines →