Mathematical modelling for the selection of optimal vaccine dose - PhDData

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Mathematical modelling for the selection of optimal vaccine dose

The thesis was published by Benest, JH, in November 2022, London School of Hygiene and Tropical Medicine.

Abstract:

Background: Vaccines are an important tool in global disease burden reduction, with vaccine dose amount (hereafter ‘dose’) being a key decision during vaccine development. Vaccine dose selection is often conducted through empirical comparison of a small number of potential doses, which is likely to fail to find the optimal dose if none of the doses are optimal. Mathematical modelling has been suggested as a method for identifying optimal vaccine dose and has been historically important in determining optimal dose of, and informing clinical trials for, drug development. Mathematical modelling is however not commonly used in either the design of vaccine dose ranging trials nor in the selection of optimal vaccine dose based on the resulting clinical trial data. To address this gap, recently ‘Immunostimulation/lmmunodynamic’ (IS/ID) modelling has been proposed to encompass quantitative modelling for vaccine dose optimisation. Initial IS/ID work has been used to find the maximally immunogenic dose for tuberculosis and influenza vaccines, and has shown that, contrary to widespread belief, vaccine dose-efficacy response may be peaking rather than saturating. However, as the field is new, there are many gaps including: uncertainty in the prevalence of such peaking dose-response curve shape, primarily only efficacy-maximisation has been considered, the impact of incorrectly assuming a peaking/saturating dose response has not been assessed, and mathematical modelling has been performed retrospectively of clinical trials rather than informing them during the trial itself (e.g. in an adaptive trial design). Further, there has also been little research into multi-dimensional vaccine dose-optimisation, where there is a need to choose prime doses, boost doses, adjuvant doses, and/or time between doses, which may complicate the dose-response relationship through potential for synergism/antagonism. My aim for this thesis was to explore and expand the field of IS/ID and mathematical modelling for vaccine dose optimisation, addressing the gaps described above. My objectives were: (1.) To gather dose-response data through a systematic review of dose-ranging studies for a specific class of vaccine (adenoviral vector), and to find the distribution of the number of doses typically investigated in these studies. (2.) Using dose-response data from objective one and mathematical models, determine the prevalence of predicted saturating versus peaking dose- response curves. (3.) To extend IS/ID beyond efficacy-maximisation into multi-factor dose optimisation by proposing alternative utility functions and investigate the impact of the choice of utility function on the selection of ‘optimal’ dose. (4.) To evaluate the potential impact of correctly or incorrectly assuming a peaking/saturating dose-efficacy response, along with the impact of adaptive trial design, on optimal vaccine dose selection. (5.) To evaluate the use of a non-parametric dose-response model for the purpose of optimal vaccine dose selection in the adaptive trial design setting, with emphasis on multi-dimensional vaccine dose-optimisation. Methods: For objective one, a class of vaccine (adenoviral vector) was selected, and dose- response data were extracted from a systematic review of single-dose dose-ranging studies. I conducted a descriptive analysis of these studies to investigate the number of doses that were typically investigated. For objective two, representative peaking and saturating dose-response models were calibrated to the data from objective one. I assessed which of the two mathematical models best described the data through the use of Akaike Information Criterion. I determined the prevalence of dose-response data which was peaking or saturating and investigated potential covariates that may impact dose-response shape. For objective three, I calibrated dose-response models to efficacy and toxicity data from a phase I dose-ranging study of a recombinant adenovirus type-5 COVID-19 single-dose vaccine (Ad5-nCoV). Using these mathematical models, I predicted optimal dose for three potential dose selection criteria, namely i) achieving herd immunity, ii) balancing efficacy and toxicity, and iii) balancing efficacy, toxicity, and cost. For objective four, I used a simulation-based study to assess the impacts of different assumed efficacy models and trial dose selection methods on optimal dose selection and ethical trial design. Comparison was done using simulated clinical trials, using a utility function that involved both efficacy and ordinal toxicity and both peaking and saturating dose-efficacy curves across 14 dose-optimisation scenarios. For objective five, I conducted a second simulation-based study to assess a novel non-parametric dose-response model, the ‘Continuously Correlated Beta Process’ model, in identifying optimal dose. This was compared to other mathematical model- based and mathematical model-free methods of vaccine dose optimisation. The simulation study included both single-dose and multi-dimensional dose-optimisation scenarios. Results: For objective one, data from 35 studies were extracted and I found that adenoviral vector vaccine dose ranging trials were designed around selecting between a small number of doses (94% of studies investigated



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