Randomized comparison of the safety of Flublok® versus licensed inactivated influenza vaccine in healthy, medically stable adults ≥50 years of age

Background: The safety and tolerability of Flublok (R), a purified recombinant hemagglutinin seasonal influenza vaccine, was compared to AFLURIA (R) in a randomized, blinded clinical trial in adults >= 50 years of age with attention to hypersensitivity reactions. Methods: This blinded, randomized trial of healthy adults >= 50 years of age compared safety of Flublok vs. AFLURIA with respect to pre-specified possible hypersensitivity: "rash," "urticaria," "swelling" and "non-dependent edema:" solicited reactogenicity and unsolicited adverse events. Subject-reported outcomes were collected for 30 days after vaccination. All adverse event terms were reviewed by physicians blinded to vaccine group, who added other terms possibly reflecting hypersensitivity. Case records of subjects with possible hypersensitivity were adjudicated by independent experts blinded to treatment assignment to identify likely hypersensitivity reactions. Non-inferiority of the incidence of hypersensitivity in the two vaccine groups was pre-defined as an absolute difference with an upper bound of 2-sided 95% confidence limits <= 0.015. Results: A total of 2640 subjects were enrolled, evenly split in age cohorts of 50-64 and >= 65 years. Fifty-two subjects reported at least one term possibly representing hypersensitivity, with a slight imbalance of 31 on Flublok and 21 on AFLURIA. The adjudicators determined that six and four subjects on Flublok and AFLURIA, respectively, likely met clinical criteria for hypersensitivity, yielding a difference in incidence between the two vaccine groups of 0.15% (upper bound of 2-sided 95% CI = 0.9%). Reactogenicity and overall adverse event profiles were similar across both vaccines. Conclusions: Flublok was non-inferior to AFLURIA in adults >= 50 years of age with respect to expert-adjudicated events of likely hypersensitivity during 30 days following vaccination. (C) 2015 Elsevier Ltd. All rights reserved.