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Global HIV Vaccine Development: MOSAICO Trial Overview

Explore the latest updates on HIV vaccine efficacy studies, including insights on the MOSAICO clinical trial presented at the Sabrina Spinosa Guzman Janssen Protocol Chair event during the HVTN satellite on 21st July 2019. Gain comprehensive information on considerations for vaccine efficacy evaluation, clade diversity, transmission modes, and the clinical development plan for various studies such as APPROACH, TRAVERSE, IMBOKODO, ASCENT, and MOSAICO. Follow the progress of IMBOKODO and MOSAICO studies in Southern Africa, America, and Europe, focusing on Clade C and B, targeting heterosexual women, MSM, TG, and the impact of intra-vaginal and intra-rectal transmission along with PrEP use.

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Global HIV Vaccine Development: MOSAICO Trial Overview

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  1. Sabrina Spinosa GuzmanJanssen Protocol Chair • HVTN satellite • 21st July 2019 • HIV Vaccine efficacy studies and the MOSAICO clinical trial

  2. Disclosure • I have the following conflicts of interest to declare: • I am an employee of Janssen Vaccines & Prevention B.V., a pharmaceutical company of Johnson & Johnson • I hold equity shares in Johnson & Johnson

  3. Towards a globalHIV vaccine

  4. Considerations forefficacy evaluation Clade diversity Transmission mode Use of PrEP

  5. Clinical development plan NHP #13-19 Ph2a APPROACH N=393 FIH Ad26.Mos.HIV and heterologous regimens F. Tomaka: Tue, 23 Jul Casa Montejo 1 Session: 14:30-16:00 Ph2a TRAVERSE N=198 Ad26.Mos4.HIV vs Ad26.Mos.HIV Ph2b IMBOKODO N=2,637 Ph2a ASCENT N=150 Boost with Clade C+Mos gp140 vs Clade C alone D. Stieh: Tue, 23 Jul Palacio de Valparaíso 2 Session: 16:30-18:00 Ph3 MOSAICO N=3,800 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2014 2015 2016 2017 2018 2019 2020 2021 2022

  6. IMBOKODO Ph2b MOSAICO Ph3 Southern Africa Americas, Europe Predominantly Clade C Predominantly Clade B Heterosexual Women MSM + TG Intra-vaginal transmission Intra-rectal transmission Limited PrEP use Increased PrEP use

  7. IMBOKODO HPX2008/HVTN705 A phase 2b multicenter, randomized, parallel group, placebo-controlled, double-blind clinical trial.

  8. IMBOKODO - Study design N=2,600 women, 1:1 randomization, +/- 1.5 year recruitment Primary analysis Study completion Vacc 4Mo 12 Vacc 2 Mo 3 Group N Vacc 1 Mo 0 Vacc 3Mo 6 Follow up Month 24 Follow up Month 36

  9. Primary Objectives and Endpoints Primary ObjectivesTo evaluate the preventive vaccine efficacy (VE) for the prevention of HIV infection in HIV-seronegative women residing in sub-Saharan Africa from confirmed HIV-1 infections diagnosed between the Month 7 and Month 24 visits. To evaluate the safety and tolerability of a heterologous regimen for the prevention of HIV infection in HIV-seronegative women. Primary Endpoints Vaccine efficacy as derived from confirmed HIV-1 infections diagnosed between the Month 7 and Month 24 visits. Local and systemic reactogenicity after each vaccination. Serious adverse events, AESIs, and adverse events leading to discontinuation for the entire duration of the study.

  10. Clinical development plan NHP #13-19 Ph2a APPROACH N=393 FIH Ad26.Mos.HIV and heterologous regimens Ph2a TRAVERSE N=198 Ad26.Mos4.HIV vs Ad26.Mos.HIV Ph2b IMBOKODO N=2,600 Ph2a ASCENT N=150 Boost with Clade C+Mos gp140 vs Clade C alone Ph3 MOSAICO N=3,800 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2014 2015 2016 2017 2018 2019 2020 2021 2022

  11. MOSAICO HPX3002/HVTN706 A Multi-center, Randomized, Double-blind, Placebo-controlled Phase 3 Efficacy Study of a Heterologous Vaccine Regimen of Ad26.Mos4.HIV and Adjuvanted Clade C gp140 and Mosaic gp140 to Prevent HIV-1 Infection Among Cis-gender Men and Transgender Individuals who Have Sex with Cis-gender Men and/or Transgender Individuals.

  12. MOSAICO - Study design 3,800 participants; 1:1 randomization (stratified by site) Vacc 4Mo 12 Vacc 2 Mo 3 Group N Vacc 1 Mo 0 Vacc 3Mo 6 Follow up Month 24-30 Primary analysis Follow‑up HIV-1 negative: ≥24 m after 3rd vaccination HIV-1 positive: 6 m after diagnosis

  13. Primary Objective and Endpoint Primary ObjectiveTo evaluate the vaccine efficacy (VE) for the prevention of HIV-1 infection in HIV-1 seronegative cis-gender men and transgender individuals having sex with cis-gender men and/or transgender individuals. Primary Endpoint Confirmed HIV-1 infections diagnosed between Month 7 and Month x (with 24≤x≤30 months) visits in the per-protocol (PP) population.

  14. Secondary Objectives Secondary ObjectivesTo evaluate the safety and reactogenicity. To evaluate VE at other timepoints and in other analysis populations. To evaluate the immune responses elicited by the vaccine regimen. To evaluate VE by and adjusting for potential (baseline) confounders.

  15. Main inclusion criteria HIV-uninfected cis-gender men and transgender individuals having sex with cis-gender men and/or transgender individuals who are considered to be at increased risk for HIV infection.Participants must in the last 6 months have had: • Any condomless receptive anal or vaginal sex (not included is condomless anal sex within a mutually monogamous relationship ≥12 months if the partner is HIV negative or living with HIV and virally suppressed), OR • Rectal or urethral gonorrhea or chlamydia or incident syphilis, OR • Any stimulant use (eg, cocaine, amphetamine), OR • 5 or more sex partners  Potential participant is negative for HIV-1 and HIV-2 infection <28 days prior to first vaccination.

  16. Main exclusion criteria Potential participant shares needles during injection of drugs or any other substance. Potential participant choosing to use PrEP • Note: Once participants received the first vaccination, they can decide at any time to initiate PrEP, while remaining in the study. • The use of long acting PrEP is disallowed from 24 months prior to Day 1.

  17. HIV prevention in the study All participants will be offered comprehensive prevention methods: • Risk reduction counseling • Condom and lubricant provision • Pre-Exposure prophylaxis counseling, referral, and linkage • Post Exposure prophylaxis counseling referral, and linkage • STI screening, access to treatment and referral The trial will allow some comparison of the Vaccine + Standard Prevention package vs. Standard Prevention package alone

  18. Global site distribution Europe Americas USA: 24 Poland: 3 Mexico: 3 Spain: 6 Italy: 3 Peru: 5 Brazil: 9 Argentina: 4

  19. Overview of Study Evaluations

  20. Efficacy Evaluations An HIV test will be performed approximately every 3 months. Testing will be performed according to a sponsor-approved HIV testing algorithm that differentiates VISP from true HIV infection. Flexibility is given for additional HIV tests as unscheduled visits.Participants should refrain from performing any HIV testing outside of the study protocol. Participant with a confirmed positive HIV test during the study, will remain in the study but NO further vaccinations will be administered.A blinded endpoint adjudication process will be in place.

  21. Participant Reported Outcomes Sexual Activity QuestionnaireAssess determinants of HIV acquisition throughout the study as well as information on HIV testing outside the study. Questionnaire on the Use of Oral PrEPInformation on use of and adherence to PrEP. Social Impact Questionnaire Problems experienced with personal relationships, employment, education, health care, housing, health, disability or life insurance, travel, and immigration. Vaccine regimen acceptability

  22. Evaluation HIV infected individuals • Participants will remain in the study but NO further vaccinations will be administered. • The participant will be followed‑up until approximately 6 months after the diagnosis. • Referral to a local clinic for medical treatment and follow-up.

  23. IMBOKODO Ph2b MOSAICO Ph3 Southern Africa Americas, Europe Predominantly Clade C Predominantly Clade B Heterosexual Women MSM + TG Intra-vaginal transmission Intra-rectal transmission Fully enrolled Q2 2019 Start Q3 2019 Limited PrEP use Increased PrEP use

  24. HPX3002/HVTN 706 Protocol Team Acknowledgements Janssen Team Sabrina Spinosa Guzman, Protocol Leadership Chair Ludo Lavreys, Study Responsible Physician Vicky Cárdenas, Study Responsible Scientist Frank Tomaka, Franchise Clinical Leader Maria Grazia Pau, Compound Development Team Leader Carla Truyers, Study Statistician Steven Nijs, Clinical Team Statistical Lead Daniel Stieh, Biomarkers Lead Zelda Euler, Senior Scientist Wolf Ribbens, Senior Associate Scientist RaphaeleRoten, Medical Safety Officer Lorenz Scheppler, Global Regulatory Affairs Olive Yuan, Associate Director Data Management Caroline Hodin, Global Data Manager Specialist WouterVandermeiren, Senior Global Data Manager Chris McShane, GCDO Clinical Program Leader Karen Buleza, GCDO Clinical Trial Leader Johan De Decker, Senior Clinical Trial Manager Cornelia Linthicum, Senior Clinical Trial Manager Eveline Hoste, Associate Director Reg Medical Writing AnickVandingenen, Associate Dir. Reg Medical Writing Corina Ramers-Verhoeven, Global Communication Leader, Vaccines R&D

  25. HPX3002/HVTN 706 Protocol Team Acknowledgements HVTN Team Larry Corey, Principal Investigator Jim Kublin, Principal Staff Scientist Susan Buchbinder, HVTN Chair Philipp Mann, Protocol Team Leader Megan Jones, Clinical Safety Specialist Robert De La Grecca, Regional Medical Liaison India Tindale, Clinical Trials Manager Niles Eaton, Director of Site Operations Laurie Rinn, Regulatory Associate Mariel Franklin, Regulatory Project Manager Stephaun Wallace, Sen Community Engagement Project Manager Aziel Gangerdine, Director of Communication Steven Wakefield, Director of External Relations DAIDS Julia Hutter, Medical Officer Lab John Hural, Associate Director of Laboratory Operations Mike Stirewalt, Quality Assurance Program Manager Katheryn Dougherty, Quality Assurance Associate Jennifer Hanke, Protocol Operations Coordinator Lisa Sanders, Protocol Operations Coordinator SCHARP Jessica Andriesen, Associate Director of Data Operations Lisa Bunts, Data Operations Project Manager Lauren Young, Lab Data Manager Nada Aboulhosn, Research Project Manager Kate Ostbye, Sr. Manager, Programming Julie Stofel, Manager, Clinical Programming Craig Chin, Prin. Clinical Programmer Brad Fischer, Sr. Clinical Programmer Abby Isaacs, Statistical Research Associate Alex Luedtke, Study Statistician Marco Carone, Study Statistician

  26. HPX3002/HVTN 706 Acknowledgements National Institute of Allergy and Infectious Diseases U.S. Army Medical Research and Development Command

  27. Acknowledgements Janssen COMPOUND DEVELOPMENT TEAMIedo Beeksma Antoine El Khoury Ad Knaapen Steven Nijs Valerie Oriol-Mathieu Maria Grazia Pau Lorenz Scheppler Daniel Stieh Frank Tomaka John Trott Frank Wegmann Mo Weijtens ...and their teams DAIDS, NIAIDCarl Dieffenbach Julia Hutter Mary Marovich Tina Tong Senior management Jerry Sadoff Stefan Thoelen MacayaDouoguih Jenny Hendriks Hanneke Schuitemaker Johan van Hoof Mathai Mammen Paul Stoffels Communities and advocates for their valuable input All the investigators, their staffs and study participants, external consultants and funders of the clinical development program

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