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Cited by 747Cervical Cancer and HPV ResearchGenital Health and DiseaseReproductive tract infections research

A review of clinical trials of human papillomavirus prophylactic vaccines

Open access
Schiller, John T., Castellsagué, Xavier, Garland, Suzanne M.·2012·Vaccine
DOI 10.1016/j.vaccine.2012.04.108PMC PMC4636904
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Abstract

End of study analyses of the phase III trials of prophylactic human papillomavirus (HPV) virus-like particle (VLP) vaccines in young women are now largely completed. Two distinct vaccines were evaluated, Gardasil(®) (Merck & Co., Whitehouse Station, NJ USA) a quadrivalent vaccine containing VLPs of types 6, 11, 16 and 18 and Cervarix(®) (GlaxoSmithKline Biologicals, Rixensart, Belgium), a bivalent vaccine containing VLPs of types 16 and 18. Both vaccines exhibited excellent safety and immunogenicity profiles. The vaccines also demonstrated remarkably high and similar efficacy against the vaccine-targeted types for a range of cervical endpoints from persistent infection to cervical intraepithelial neoplasia grade 3 (CIN3) in women naïve to the corresponding type at the time of vaccination. However, protection from incident infection or disease from non-vaccine types was restricted, and the vaccines had no effect on prevalent infection or disease. Gardasil(®) also demonstrated strong protection against genital warts and vulvar/vaginal neoplasia associated with the vaccine types. In other trials, Gardasil(®) protected mid-adult women from incident infection and CIN caused by the vaccine types and protected men for incident infection, genital warts and anal intraepithelial neoplasia by the vaccine types. Cervarix(®) protected against vaccine-targeted anal infections in women in an end of study evaluation. For practical reasons, efficacy studies have not been conducted in the primary target populations of current vaccination programs, adolescent girls and boys. However, immunogenicity bridging studies demonstrating excellent safety and strong immune responses in adolescence, coupled with the documentation of durable antibody responses and protection in young adults, leads to an optimistic projection of the effectiveness of the vaccines in adolescent vaccination programs. Taken together, the excellent clinical trial results strongly support the potential of the vaccines as high value public health interventions and justify their widespread implementation to prevent anogenital HPV infections and their associated neoplasia. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.

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  • The incidence rate of HPV infection among unvaccinated 20-25-year-old women was computed as 11.6%.

    “Using the reported annual incidence rate of 0.8% for the HPV infection (HPV 16 and 18) among 20–25 year old immunized women with 2 doses of HPV vaccine [28] and vaccine efficacy of 93%, [29] we computed the incidence rate of HPV infection as 11.6% among unvaccinated cohort of the same age group.”

    From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [29]

    The citation is attached to the 93% vaccine-efficacy figure, not to the citing authors’ calculation of 11.6%. Section 4.3 reports 92.4% efficacy against persistent HPV16/18 infection in a vaccine-type-naïve cohort, but does not establish 93% efficacy for the stated 20–25-year-old group; section 4.2 reports 93.2% for a different endpoint, CIN3. The review does not report the calculated 11.6% incidence. (LLM, conf=0.83)

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  • Sensitivity and specificity of each screening strategy and colposcopy, and efficacy of HPV vaccine, were based on published meta-analysis studies.

    “Sensitivity and specificity of each of the screening strategy and colposcopy and efficacy of HPV vaccine was based on the published meta-analysis studies (Table 1). [29, 33, 34]”

    From Cost effectiveness of strategies for cervical cancer prevention in India (2020) · cites this paper as [29]

    Section 4.1 reports HPV vaccine efficacy estimates from clinical trials, supporting the vaccine-efficacy part of the sentence. The paper does not provide sensitivity or specificity estimates for screening strategies or colposcopy, and its vaccine efficacy estimates are presented as trial findings rather than as results of a meta-analysis. Page numbers are unavailable in our copy. (LLM, conf=0.86)

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Authors
Schiller, J. T., Castellsagué, X., & Garland, S. M.
Affiliations
  • National Institutes of Health (US)
  • Institut Català d'Oncologia (ES)
  • Royal Children's Hospital (AU)
Corresponding author
Schiller, John T.
ORCID
Venue
Vaccine
Publisher
Elsevier BV
Published
2012-11
Volume
30
Pages
F123-F138
ISSN
0264-410X (ISSN-L)
DOI
10.1016/j.vaccine.2012.04.108
PMC
PMC4636904
OpenAlex
W1963888311
Cited by
747
References
1
Citations by year
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FWCI
9.18
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Vaccine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Cancer Institute (ZIABC009052)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Surgery › Genital Health and Disease
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
human papillomavirus, prophylactic HPV vaccines, Gardasil, Cervarix, virus-like particle vaccine, vaccine efficacy, cervical intraepithelial neoplasia, genital warts, anal intraepithelial neoplasia, persistent HPV infection, immunogenicity, adolescent vaccination, vaccine safety
MeSH terms
Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18, Anus Neoplasms, Uterine Cervical Neoplasms, Condylomata Acuminata, Female, Humans, Male, Vaginal Neoplasms, Vulvar Neoplasms, Clinical Trials, Phase III as Topic, Papillomavirus Infections, Papillomavirus Vaccines, Vaccines, Virus-Like Particle

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