Food and Drug Administration
Center for Biologics Evaluation and Research
VACCINES AND RELATED BIOLOGICAL PRODUCTS ADVISORY COMMITTEE
Meeting # 91: May 21, 2002
Dr. Robert Daum, Chair
Dr. Pamela Diaz
Dr. Walter Faggett
*Ms. Barbara Loe Fisher
Dr. Judith Goldberg
Dr. Diane Griffin
Dr. Sam Katz
Dr. David Markovitz
Dr. Gary Overturf
Dr. Julie Parsonnet
Dr. David Stephens
Dr. Rich Whitley
Dr. Mimi Glode
Dr. Richard Schwartz
Dr. Dixie Snider
Dr. Holli Hamiliton
Dr. Steven Black
Dr. George Siber
Dr. Terhi Kilpi
Dr. Susan Ellenberg
Dr. Norman Baylor
Dr. Karen Goldenthal
Dr. Patricia Rohan
Dr. Jingyee Kou
Dr. Estuardo Aguilar-Cordova
Dr. Audrey Manley
Dr. Peter Palese
Dr. Jody Sachs
These summary minutes for the May 21, 2002 meeting of the Vaccines and Related Biological Products Advisory Committee were approved on ______________________ .
I certify that I participated in the May 21, 2002 Meeting of the Vaccines and Related Biological Products Advisory Committee and that these minutes accurately reflect what transpired.
Jody Sachs, D.P.M. Robert S. Daum, M.D.
Executive Secretary Chair
The 91th meeting of the Vaccines and Related Biological Products Advisory Committee was called to order at 8:30 a.m. EST on May 21, 2002 by the Chair, Dr. Robert Daum. The meeting addressed in Session #1: Prevnarâ for indication in acute ottitis media, and
Session #2: Update on GSK Lyme Disease Vaccine (LYMErixä). Both Session 1 and 2 were open sessions.
Following is a summary of the discussion. Additional information and specific details may be obtained from the transcript of the meeting. The transcript may be viewed on the world wide web at: http://www.fda.gov/ohrms/dockets/ac/02acsdocs.htm. A copy of the agenda is attached.
Prevnar® for Acute Otitis Media (AOM) Indication
The committee discussed an additional proposed indication for PrevnarÒ “for active immunization of infants and toddlers against otitis media caused by Streptococcus pneumoniae due to capsular serotypes included in the vaccine (4, 6B, 9V, 14, 18C, 19F and 23F).”
Data supporting this indication were provided from two controlled clinical trials:
1) Finnish Acute Otitis Media Trial (FinAOM)
2) Northern California Kaiser Permanente Efficacy Trial (NCKP)
Efficacy Against Otitis Media
FinAOM (%) NCKP (%)
Vaccine Serotype AOM 57 (44,67) 69* (0.4,93)
Vaccine Related Serotype AOM 51 (27,67)
Non Vaccine Serotype AOM -33 (-81,1)
All Pnc AOM 34 (21,45)
Recurrent AOM 16 (-6,35) 12 (7,16)
All AOM 6 (-4,16) 7 (4,9)
Tube Placement 44 (19,62) 24 (12,35)
* Spontaneous TM rupture
In the Finnish study, vaccine efficacy was 57% (95%CI: 44%, 67%) for AOM episodes due to vaccine serotypes, and 34% (95%CI: 21%, 45%) for all AOM episodes caused by pneumococci, regardless of serotype. The Finnish study included myringotomy and cultures of the middle ear, this was not true of the Kaiser study. Vaccine efficacy for all causes of AOM, regardless of etiology, was 7% (95%CI: 4.1%, 9.7%), based on evidence from the Kaiser study, and 6% based on evidence from the Finnish Study.
In summary, the Committee concluded that data derived from two efficacy trials are adequate to demonstrate efficacy of Prevnar® against AOM caused by vaccine serotype. However, the committee expressed concern about the low efficacy (7%) of the vaccine against AOM regardless of etiology and concluded that substantial clinical benefit of Prevnar in reducing AOM regardless of etiology had not been demonstrated. The Committee cautioned against including an indication statement as proposed by the sponsor into the label and suggested using qualifying language if an indication for AOM regardless of etiology were to be added. Committee members cautioned against promoting prevention of AOM as a benefit of PrevnarÒ in direct-to-consumer advertising because of concerns about unrealistic public expectations. The Committee was concerned that promoting PrevnarÒ as an “AOM vaccine” could potentially compromise confidence in the existing recommendations for the vaccine and trust in the labeling that FDA puts on a vaccine. It was noted that an AOM indication for Prevnar® could set precedence for licensure of additional pneumococcal conjugate vaccines for prevention of AOM.
Discussion points included:
Recommendations were as follows:
FDA Update on the GSK-Lyme Disease Vaccine (LYMErixä)
The FDA informed the committee members that GSK voluntary withdrew LYMErixä from sale in February of 2002 and distribution was discontinued. GSK cited poor sales as the reason for withdrawal. No further vaccinations are recommended, clinical trial vaccination ended, Dear Doctor/Investigator letters were sent, and refunds were given for returned vaccine. Complete safety follow-up will be completed for all clinical studies and the Phase 4 post-marketing study is to be completed in 2006.
Two Open Public Hearing sessions were announced. No one requested time to speak in Session #1. For Session #2 there were eight requests for speaking.
Session #2-Open Public Hearing
Public Speakers on Lyme Disease:
1. Karen Vanderhoof-Forschner (Lyme Disease Foundation)
2. Dr. Norman Latov
3. Dr. Mark Geier
4. David Geier
5. Stephen Sheller, Esq.
6. Kathy Shepanski
7. Pat Smith (Lyme Disease Assoc.)
8. Jenny Marra
Proceedings were adjourned at approximately 3:30 p.m. EST on May 21, 2002.
 Fin AOM follow up