Efficacy of the HPV-16/18 AS04-adjuvanted vaccine against low-risk HPV types (PATRICIA randomized trial): an unexpected observation

J Infect Dis. 2013 Nov 1;208(9):1391-6. doi: 10.1093/infdis/jit360.

Abstract

Background: Public Health England has reported a decrease of up to 20.8% in new diagnoses of external genital warts (GWs) among women aged <19 years since the national vaccination program with the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine began in 2008. A post hoc analysis of the phase III PATRICIA (PApilloma TRIal against Cancer In young Adults) trial (NCT00122681) was performed to ascertain whether protection against low-risk HPV types was apparent.

Methods: Vaccine efficacy (VE) at 48 months was assessed against 6-month persistent infection (6MPI) with low-risk HPV types in the total vaccinated cohort (TVC) and in the TVC naive (for 25 HPV types tested) populations.

Results: In the TVC naive cohort, VE against 6MPI (95% confidence interval) was 34.5% (11.3 to 51.8) for HPV-6/11, 34.9% (9.1 to 53.7) for HPV-6, 30.3% (-45.0 to 67.5) for HPV-11, and 49.5% (21.0 to 68.3) for HPV-74.

Conclusions: The HPV-16/18 AS04-adjuvanted vaccine appears to have moderate efficacy against persistent infections with a number of low-risk HPV types (HPV-6/11/74), which are responsible for the majority of external GWs, and recently, antibody and cell-mediated immune response to HPV-6/11 have been observed. These findings may help to explain the decrease in external GW diagnoses seen in England.

Keywords: HPV; HPV vaccine; genital warts; human papillomavirus.

MeSH terms

  • Adjuvants, Immunologic / administration & dosage*
  • Aluminum Hydroxide / administration & dosage*
  • Clinical Trials, Phase III as Topic
  • Condylomata Acuminata / epidemiology
  • Condylomata Acuminata / immunology
  • Condylomata Acuminata / prevention & control*
  • Double-Blind Method
  • Female
  • Human papillomavirus 16 / immunology*
  • Human papillomavirus 18 / immunology*
  • Human papillomavirus 6 / immunology
  • Humans
  • Incidence
  • Incidental Findings
  • Lipid A / administration & dosage
  • Lipid A / analogs & derivatives*
  • Multicenter Studies as Topic
  • Papillomavirus Vaccines
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • Vaccination*

Substances

  • ASO4 mixture
  • Adjuvants, Immunologic
  • Lipid A
  • Papillomavirus Vaccines
  • Aluminum Hydroxide

Associated data

  • ClinicalTrials.gov/NCT00122681