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Influenza Phase 2 Binary Endpoint NCT00992719

Novartis H1N1 Vaccine in Pregnant Women: Complete Statistical Analysis

This phase II trial record concerns an unadjuvanted inactivated H1N1 vaccine at two dose levels in pregnant women, with a non-pregnant comparison group. The registry reports maternal complications as the primary outcome but does not provide a primary-outcome result or analysis.

Trial start: 2009-11  ·  Enrollment: 84  ·  Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
Scope of this record

This page provides an independent statistical analysis and educational interpretation of publicly reported results. ClinicalTrials.gov provides the official trial registry record. Numerical trial results on this page are restricted to the results posted in the ClinicalTrials.gov record; calculations added by Clinical Biostats are labelled as such.

1. Trial at a Glance

This page covers the registry results for Novartis H1N1 Vaccine in Pregnant Women (NCT00992719), a randomized phase 2 study. The primary outcome is Number of Participants Reporting Maternal Complications of Pregnancy, Labor and Delivery.

84
Enrollment
Phase 2
n/a
Arms
In the primary outcome
n/a
Effect
No re-analysis shown
n/a
95% CI
See limitations
FeatureRegistry value
ClinicalTrials.gov identifierNCT00992719
PhasePhase 2
ConditionInfluenza
AllocationRandomized
Design modelParallel
MaskingNone (open label)
Enrollment84
Arms in the primary outcomen/a
Lead sponsorNational Institute of Allergy and Infectious Diseases (NIAID)
Results postedYes

2. Clinical Question

Population

Pregnant women were studied alongside a non-pregnant comparison group. The brief summary describes participants ages 18-39 and states that the study includes 200 pregnant women and 100 non-pregnant women. The enrollment field lists 84; these registry figures do not agree, and the actual analyzed population for the primary outcome is not reported in the registry record.

Intervention

The intervention was an unadjuvanted inactivated H1N1 vaccine. The pregnant groups were assigned to 15 mcg or 30 mcg, and the non-pregnant comparison group was assigned to 15 mcg.

Comparator

The record describes comparisons between pregnant groups receiving different dose levels and a non-pregnant group receiving 15 mcg. It does not report a placebo or untreated group. Details of the allocation process and the planned statistical comparisons are not reported in the registry record.

Primary question

The registered primary outcome counts participants reporting maternal complications of pregnancy, labor and delivery at the time of delivery. The record also describes safety and immune response as study aims. It does not report the primary-outcome group counts, an effect estimate, a confidence interval, or a statistical test.

The registry identifies the study as randomized, with a parallel design and no masking. The listed intervention and groups frame questions about safety across dose levels in pregnant participants, as well as differences between pregnant and non-pregnant participants receiving 15 mcg. Those comparisons are not interchangeable: pregnancy status differs between the latter groups, while dose differs between the pregnant groups.

Secondary outcomes include counts of participants with a serum HAI antibody titer greater than or equal to 40 against the novel influenza H1N1 2009 virus, measured in maternal blood at delivery and in cord blood. The posted results do not give those outcome counts or analyses. Consequently, the record describes the questions the study was designed to address, but does not provide enough outcome results to quantify answers.

3. Trial Design

The record describes a phase II, randomized, parallel study with no masking. Its registered intervention is an inactivated H1N1 vaccine. Pregnant participants are described in two groups, receiving 15 mcg or 30 mcg, and a non-pregnant comparison group is described as receiving 15 mcg. The official title characterizes the vaccine as unadjuvanted.

The enrollment field lists 84. Separately, the brief summary describes 200 pregnant women and 100 non-pregnant women, and the arm descriptions specify 100 participants in each of the three groups. These enrollment descriptions are inconsistent. The registry record does not explain the discrepancy, and the listed safety denominators are 28 for each group. Those denominators should not be treated as a reconciliation of the conflicting enrollment figures.

The study start is listed as 2009-11, primary completion as 2011-02, and status as completed. The brief summary describes physical examinations, blood samples, and a daily memory aid for temperature and side effects for 8 days after vaccination, with study-related procedures lasting about 6 months. These are descriptions of planned procedures, not outcome results.

The primary outcome is the number of participants reporting maternal complications of pregnancy, labor and delivery, with collection at the time of delivery. The registry says participants were contacted after delivery and medical records reviewed, using a prospectively defined list of complications. It identifies the relevant population as participants from whom outcome data were collected in the ITT safety population. The number in that population and the group-specific primary-outcome results are not reported in the registry record.

Details such as the randomization method, allocation concealment, protocol deviations, and planned statistical model are not reported in the registry record. The record also does not explain how the planned group sizes relate to the enrollment field or the safety denominators.

4. Participant Flow and Accounting

The registry reports how participants moved through each stage of the study. All counts below are exactly as posted; missing counts are not inferred from other stages.

Overall Study

StageGroup 1: Pregnant Women: 15 Mcg H1N1 VaccineGroup 2: Pregnant Women: 30 Mcg H1N1 VaccineGroup 3: Non-pregnant Women: 15 Mcg H1N1 Vaccine
STARTED282828
COMPLETED272728
NOT COMPLETED110

Analysis population for the primary outcome, as defined in the registry: All participants from whom outcome data were collected are included in the ITT safety population for this outcome measure.

5. Baseline Characteristics

The table reproduces the baseline characteristics posted in the registry, which describe the participants analysed at baseline and help show whether the randomized groups were comparable.

CharacteristicUnitGroup 1: Pregnant Women: 15 Mcg H1N1 VaccineGroup 2: Pregnant Women: 30 Mcg H1N1 VaccineGroup 3: Non-pregnant Women: 15 Mcg H1N1 VaccineTotal
Participants analysed28282884
Age, Categorical: <=18 yearsParticipants0000
Age, Categorical: Between 18 and 65 yearsParticipants28282884
Age, Categorical: >=65 yearsParticipants0000
Age Continuousyears30 (SD 6.0)28.8 (SD 4.9)30.8 (SD 5.6)29.9 (SD 5.5)
Sex: Female, Male: FemaleParticipants28282884
Sex: Female, Male: MaleParticipants0000
Region of Enrollment: United Statesparticipants28282884

6. Primary Endpoint

The registry lists the primary outcome as Number of Participants Reporting Maternal Complications of Pregnancy, Labor and Delivery, measured over At time of delivery.

ElementRegistry entry
Result typeNumber
Measure of spreadnot applicable
Unitparticipants
Endpoint classificationBinary Endpoint

The primary endpoint is the number of participants reporting maternal complications of pregnancy, labor and delivery at the time of delivery. The registry description says information was collected after delivery through participant contact and medical-record review. Collection followed a prospectively defined list of complications. The record notes that some complications may also have been reported as serious adverse events when they met the applicable requirements.

A count of participants with an event is a binary-outcome summary at the participant level: each participant either has at least one qualifying event or does not, according to the endpoint definition. This differs from a count of all event occurrences, because a participant may experience more than one complication. The registry names the measure as a number of participants, but does not report the group-specific counts or clarify how multiple complications in a participant contribute to any separate event totals.

General statistical context: an endpoint of this kind can summarize clinically relevant events over a defined period and can be compared across groups. Interpretation depends on a clear event definition, consistent ascertainment, and complete follow-up. Medical-record review and participant contact are the described collection methods, but the record does not report completeness of ascertainment or how missing outcome information was handled.

The primary endpoint is useful for organizing the safety question around pregnancy, labor and delivery complications. It does not, by itself, provide evidence about immune response; the registered HAI antibody outcomes address that separate question. No primary endpoint result or statistical analysis is reported in the registry record.

7. Why No Re-analysis Is Shown

Reported as posted, not recalculated. Primary outcome has several categories or time points; not reduced to one comparison. A result is recalculated only when the posted data support a clean two-arm comparison, so no result is shown beyond what the sponsor posted.

8. Statistical Interpretation

Clinical Biostats interpretation

The posted record identifies a completed randomized phase II study and gives the primary outcome definition, but it does not provide primary-outcome results. There are no group-specific complication counts, comparative estimates, confidence intervals, or p-values in the record. The field indicating the number of analyses is 0. Therefore, the registry record does not support a quantitative interpretation of differences in maternal complications between the groups.

The safety figures available concern serious and other adverse events, not the registered primary endpoint as described. For the pregnant 15 mcg group, the record lists 8 serious events among 28 at risk and 19 other events among 28 at risk. For the pregnant 30 mcg group, it lists 6 serious events among 28 at risk and 24 other events among 28 at risk. For the non-pregnant 15 mcg group, it lists 1 serious event among 28 at risk and 19 other events among 28 at risk. These are registry event summaries and should not be substituted for the unavailable primary-outcome counts. The record does not explain the relationship between these safety denominators and the conflicting enrollment descriptions.

General statistical context: an estimate describes the observed contrast between groups, while a confidence interval indicates the range of values reasonably compatible with the data under the analysis assumptions. Without an estimate and interval, readers cannot assess either the direction or precision of a comparative result. A lack of a reported test is not evidence that groups were equivalent; equivalence requires a suitable design and analysis, which are not reported in the registry record.

The study has three groups that differ in dose and pregnancy status. Comparisons between the two pregnant groups address a dose contrast within the described pregnant population. A comparison of pregnant and non-pregnant participants at 15 mcg also reflects a difference in pregnancy status, not only a treatment contrast. The record does not report adjusted comparisons or a plan for interpreting these contrasts.

For immune response, the record lists maternal and cord-blood HAI outcomes, defined using a titer threshold of greater than or equal to 40. It does not provide results for either outcome. The posted information therefore allows readers to identify the registered safety and immunogenicity questions, but not to estimate the magnitude or precision of answers to them.

9. Statistical Methods Explained

Statistical methods can help distinguish what an observed result says from what remains uncertain. In this record, however, the analysis methods and primary-outcome results are not reported in the registry record. General explanations below describe how common methods would be interpreted; they do not claim that those methods were used in this study.

What does a participant count represent?

The primary outcome is a number of participants reporting complications. For a binary participant-level endpoint, each participant is classified according to whether the defined event occurred. A group count can be made more interpretable by reporting the number with the event alongside the number assessed. Comparative analysis can then estimate a difference or another contrast between groups. No such primary-outcome counts or estimates are reported in the registry record.

Participant counts and event counts are not necessarily the same. A participant may have multiple complications, while a participant-level endpoint may count that person only once. The record defines the primary measure as a number of participants and describes a list of complications, but does not report separate counts of events or further operational detail about handling multiple complications.

What would a confidence interval add?

General statistical context: a confidence interval communicates uncertainty around an estimated effect. A narrow interval indicates greater precision under the model and assumptions used; a wide interval indicates less precision. It does not guarantee that the estimate is unbiased or that the study design and measurement were free of problems. Because the record has no primary-outcome estimate or interval, the precision of any group comparison cannot be assessed from the posted results.

How should a p-value be read?

General statistical context: a p-value describes how unusual data at least as incompatible with a specified null model would be, assuming that model and the analysis assumptions. It is not the probability that the null hypothesis is true, and it does not measure the size or importance of an effect. The registry record reports no primary-outcome p-value or analysis, so no significance conclusion can be drawn from it.

Why do group definitions matter?

The groups differ in ways that shape the meaning of any contrast. The two pregnant groups receive different dose levels. The non-pregnant group receives the same listed dose as the pregnant 15 mcg group, but differs in pregnancy status. General statistical context: a randomized allocation can support causal comparisons of assigned interventions when implementation, follow-up, and analysis are appropriate. The record says allocation was randomized, but the method, allocation concealment, and analysis details are not reported. The comparison involving pregnancy status should not be described as if pregnancy status itself had been randomized.

General statistical context: adjustment can account for measured covariates, but it cannot automatically remove bias from unmeasured differences or flawed measurement. The record does not report adjusted estimates, covariates, or a statistical model. It is therefore not possible to determine whether the posted safety summaries are adjusted or whether any group comparisons account for other factors.

What does over-dispersion mean?

General statistical context: over-dispersion occurs when the variability in count data exceeds what a chosen model expects. If ignored, uncertainty estimates can be too small. It is relevant when analyzing counts of events, particularly when participants can experience multiple events. The primary measure is described as participants reporting complications, not a total event count, and no count model or dispersion information is reported. It would be inappropriate to assert that over-dispersion was present or that a particular model was used.

What can planning calculations show?

The registry record describes a sample-size illustration based on a fraction of an observed effect, a two-sided significance level of 0.05, equal allocation between two arms, and a normal approximation. It specifies that such illustrations are planning calculations, not observed power. No calculated sample-size values are reported in the registry record for this explanation. The registry record does not report that this illustration was the trial's original design justification or that the trial was planned around the observed effect. Its own design justification is not reported in the registry record.

General statistical context: sample-size calculations depend on assumptions about the target effect, variability or event frequency, analysis, and allocation. A planning illustration can show how required enrollment changes under different assumed effects, but it does not establish whether a completed study was adequately powered. Observed power is not a substitute for interpreting an effect estimate and its confidence interval. Here, primary-outcome estimates and intervals are not reported, so the illustration cannot fill that gap.

What is available for safety interpretation?

The registry lists event counts and denominators for serious and other adverse events, along with selected serious-event terms and percentages. These summaries can describe what the registry recorded, but the record does not provide a comparative statistical analysis, definitions for every listed category, or a complete account of event ascertainment. General statistical context: safety interpretation benefits from clear definitions, exposure time, participant-level and event-level summaries, and uncertainty estimates. Those details are not reported in the registry record.

10. Multiplicity, Missing Data and Analysis Populations

The trial has multiple registered outcomes, including the primary maternal-complication outcome and secondary maternal-blood and cord-blood HAI antibody outcomes. The registry lists 11 outcome measures, but no analyses. It does not report a multiplicity strategy, such as whether outcomes or comparisons were ordered in advance, whether the primary outcome had a single planned contrast, or whether any adjustment for multiple testing was used. Without those details, the risk of selectively emphasizing results across outcomes cannot be assessed from the registry record.

The primary outcome description says that participants from whom outcome data were collected are included in the ITT safety population for this measure. This identifies the stated population definition, but does not give the number assessed in each group or explain how participants without outcome data were handled. Missing-data counts, reasons for missingness, and sensitivity analyses are not reported in the registry record.

The record also does not describe protocol deviations, withdrawals, exclusions after allocation, or whether all randomized participants were included in each analysis. The brief summary describes follow-up procedures, but does not establish how complete follow-up was or how incomplete records affected the outcome results.

General statistical context: missing data can affect both the precision and validity of an estimate, particularly if the chance of missingness is related to outcome status or group assignment. Different handling methods rely on different assumptions. A clear analysis population and sensitivity checks help readers understand how dependent conclusions are on those assumptions. No missing-data method or sensitivity analysis is reported.

Because the record provides no outcome analyses, it is not possible to evaluate whether the reported safety figures use the ITT safety population or another population, or whether multiplicity affected any inferential claims.

11. Safety Results

The registry reports serious adverse events as affected participants divided by participants at risk.

ArmParticipants with serious adverse eventsParticipants at riskPercentage
Group 1: Pregnant Women: 15 Mcg H1N1 Vaccine82828.6%
Group 2: Pregnant Women: 30 Mcg H1N1 Vaccine62821.4%
Group 3: Non-pregnant Women: 15 Mcg H1N1 Vaccine1283.6%
Participants with at least one serious adverse event
Serious adverse events by armGroup 1: Pregnant Women: 15 M…28.6%Group 2: Pregnant Women: 30 M…21.4%Group 3: Non-pregnant Women: …3.6%% of participants with at least one serious adverse event

Other (non-serious) adverse events

Participants with at least one non-serious event at or above the registry's 5% reporting threshold.

ArmParticipants affected of at risk
Group 1: Pregnant Women: 15 Mcg H1N1 Vaccine19 of 28
Group 2: Pregnant Women: 30 Mcg H1N1 Vaccine24 of 28
Group 3: Non-pregnant Women: 15 Mcg H1N1 Vaccine19 of 28

Most frequent serious adverse event terms

Event termOrgan systemGroup 1: Pregnant Women: 15 Mcg H1N1 VaccineGroup 2: Pregnant Women: 30 Mcg H1N1 VaccineGroup 3: Non-pregnant Women: 15 Mcg H1N1 Vaccine
Pre-eclampsiaPregnancy, puerperium and perinatal conditions1 of 283 of 280 of 28
Respiratory distressRespiratory, thoracic and mediastinal disorders2 of 281 of 280 of 28
Premature babyPregnancy, puerperium and perinatal conditions0 of 282 of 280 of 28
Premature labourPregnancy, puerperium and perinatal conditions1 of 280 of 280 of 28
AmniorrhoeaPregnancy, puerperium and perinatal conditions1 of 280 of 280 of 28
Vaginal haemorrhageReproductive system and breast disorders1 of 280 of 280 of 28
Postpartum haemorrhagePregnancy, puerperium and perinatal conditions1 of 280 of 280 of 28
Premature separation of placentaPregnancy, puerperium and perinatal conditions0 of 281 of 280 of 28
Renal colicRenal and urinary disorders0 of 281 of 280 of 28
Thyroid cancerNeoplasms benign, malignant and unspecified (incl cysts and polyps)0 of 280 of 281 of 28

Most frequent non-serious adverse event terms

Event termOrgan systemGroup 1: Pregnant Women: 15 Mcg H1N1 VaccineGroup 2: Pregnant Women: 30 Mcg H1N1 VaccineGroup 3: Non-pregnant Women: 15 Mcg H1N1 Vaccine
TendernessGeneral disorders13 of 2815 of 2814 of 28
MalaiseGeneral disorders7 of 2814 of 284 of 28
HeadacheNervous system disorders8 of 289 of 287 of 28
Injection site painGeneral disorders4 of 288 of 286 of 28
NauseaGastrointestinal disorders3 of 288 of 283 of 28
MyalgiaMusculoskeletal and connective tissue disorders1 of 286 of 284 of 28
Upper respiratory tract infectionInfections and infestations4 of 280 of 286 of 28
Injection site erythemaGeneral disorders2 of 282 of 282 of 28
Feeling hotGeneral disorders0 of 282 of 283 of 28
Injection site swelling (functional grading)General disorders1 of 282 of 282 of 28

Serious events with the highest arm-level rate: pre-eclampsia (10.7%), respiratory distress (7.1%), premature baby (7.1%), premature labour (3.6%), amniorrhoea (3.6%).

Do not overextend the safety comparison. Serious-adverse-event counts are safety observations, not efficacy outcomes, and should not be combined with the primary result into a single benefit-risk number.

The registry lists serious and other adverse-event figures for each group. In the pregnant 15 mcg group, the serious-event summary is 8 among 28 at risk, and the other-event summary is 19 among 28 at risk. In the pregnant 30 mcg group, the corresponding summaries are 6 among 28 at risk and 24 among 28 at risk. In the non-pregnant 15 mcg group, they are 1 among 28 at risk and 19 among 28 at risk. The record does not report deaths.

Selected serious-event terms are listed with percentages: Pre-eclampsia, 10.7%; Respiratory distress, 7.1%; Premature baby, 7.1%; Premature labour, 3.6%; Amniorrhoea, 3.6%; and Vaginal haemorrhage, 3.6%. The registry record does not explain in this summary whether these percentages refer to participants, events, or another denominator, so they should be read as the recorded term-and-percentage entries rather than converted into counts.

These safety summaries do not provide a complete comparative analysis. The record does not report confidence intervals, hypothesis tests, exposure-adjusted rates, or details sufficient to determine how multiple events in one participant are represented. The safety denominators also differ from the planned group sizes described in the arm descriptions, and the registry does not explain that discrepancy. The figures should not be treated as results for the primary maternal-complications endpoint.

12. What the Result Does, and Does Not, Mean

The registry record documents a randomized phase II study of an inactivated H1N1 vaccine with two dose levels in pregnant women and a non-pregnant comparison group. It describes a primary safety outcome based on maternal complications at delivery and secondary HAI antibody outcomes in maternal and cord blood. These details establish the questions and group structure recorded for the study.

The posted results do not include primary-outcome counts, immune-response results, comparative estimates, confidence intervals, or p-values. As a result, they do not show the magnitude or precision of any difference between groups on the registered primary endpoint or the secondary antibody outcomes. The adverse-event summaries provide some recorded safety counts, but cannot replace the missing endpoint results or establish a comparative effect.

General statistical context: a result that is not reported is not equivalent to a finding of no effect, no difference, or no risk. Likewise, the absence of a statistical test does not establish that groups are equivalent. Equivalence or non-inferiority claims require appropriate prespecified criteria and analysis, which are not reported in the registry record.

The study's randomized designation is relevant to how assigned-dose comparisons might be interpreted, but the registry does not give enough detail to assess implementation or analysis. The pregnant and non-pregnant groups also differ by pregnancy status, so their comparison cannot isolate dose as the only difference. The record does not provide an analysis that addresses this distinction.

The enrollment field lists 84, while the brief summary and arm descriptions state larger planned group sizes. The registry does not explain the discrepancy. The safety denominators are 28 per group, but those figures do not resolve the conflicting enrollment descriptions or reveal the number included in the primary-outcome analysis.

13. Why This Trial Matters Statistically

This study is statistically notable for the way its groups separate two questions. Within pregnant participants, the listed dose levels are 15 mcg and 30 mcg. The comparison group is non-pregnant and receives 15 mcg. A dose comparison among pregnant participants is conceptually distinct from a comparison by pregnancy status at the same listed dose. Keeping those contrasts separate is essential for interpreting any reported effect.

The registered primary endpoint is a count of participants reporting maternal complications through pregnancy, labor and delivery. The endpoint description includes participant contact and medical-record review and notes that a prospectively defined list was used. This makes the outcome definition and ascertainment process central to interpretation. Yet the registry record does not provide the actual primary counts or comparative analysis, leaving the central statistical question unanswered in the posted results.

The record also illustrates why consistency across registration fields matters. The enrollment field lists 84, whereas the brief summary and arm descriptions state 200 pregnant women and 100 non-pregnant women, with 100 in each group. Safety denominators are 28 for each group. Because the record does not explain these differing figures, readers cannot use one description to infer the analyzed population or explain the others.

General statistical context: transparent reporting of analysis populations, missingness, effect estimates, uncertainty, and multiplicity helps readers judge how much confidence to place in findings. These details are not reported for the primary endpoint. The record therefore supports an understanding of the design and registered questions, while demonstrating the limits of interpreting an outcome record without its analysis results.

14. Limitations

The registry record contains an internal discrepancy in participant numbers. The enrollment field lists 84, while the brief summary describes 200 pregnant women and 100 non-pregnant women, and each arm description states 100 participants. The safety summaries list 28 at risk per group. The record does not explain how these figures relate to one another, so they should not be combined or treated as interchangeable descriptions of the analyzed population.

The primary endpoint is defined, but its results are absent. No group-specific primary counts, effect estimates, confidence intervals, or tests are reported. The record also reports no analyses, despite listing 11 outcome measures. Secondary HAI outcomes are named but their results are not reported.

Important design and analysis details are not reported in the registry record, including the randomization method, allocation concealment, analysis model, missing-data handling, protocol deviations, and multiplicity strategy. The ITT safety population is mentioned for the primary outcome, but its group sizes and the treatment of participants without collected outcome data are not described.

The safety summary is limited by missing detail about event definitions and the meaning of the percentages attached to selected serious-event terms. The record does not report deaths. It also does not provide uncertainty estimates or a comparative analysis for the adverse-event figures.

Finally, the groups differ by dose and pregnancy status. The non-pregnant comparison group cannot by itself isolate the effect of pregnancy status from other group differences, and the record does not report an adjusted analysis. These limitations restrict quantitative interpretation of the posted record.

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18. Record Summary

The registry describes NCT00992719, a completed phase II randomized, parallel study with no masking, evaluating an unadjuvanted inactivated H1N1 vaccine. Pregnant participants are described as receiving 15 mcg or 30 mcg, with a non-pregnant comparison group receiving 15 mcg. The primary outcome is the number of participants reporting maternal complications of pregnancy, labor and delivery at the time of delivery.

The record lists maternal and cord-blood HAI antibody outcomes as secondary measures. It reports selected serious and other adverse-event summaries, but no primary-outcome or antibody-outcome results, and no analyses. The enrollment field, arm descriptions, and safety denominators are inconsistent; the registry does not explain the discrepancy. The record does not report the statistical analysis plan, missing-data methods, or multiplicity handling. Consequently, the posted information describes the trial design and questions but does not permit a quantitative conclusion about the primary endpoint.

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