A clinical evaluation of a new, purified, heat-treated equine rabies immunoglobulin
(PHT-Erig), F(ab')2 preparation, was carried out in Thailand and in the Philippines-two
countries where rabies is endemic. An initial prospective, randomised, controlled
trial (Study 1), compared the safety and pharmacokinetics (serum concentrations of
rabies antibodies) after administration either of PHT-Erig or of a commercially-available,
equine rabies immune globulin (Erig PMC). A second trial (Study 2) simulated post-exposure
rabies prophylaxis by using a reference cell culture vaccine, the purified Vero-cell
rabies vaccine (PVRV), administered in association with either Erig PMC or PHT-Erig.
In Study 1, 27 healthy, Thai adults received a 40 IU kg(-1) dose of either Erig PMC
(n = 12) or PHT-Erig (n = 15) via the intramuscular (i.m.) route; half of the dose
was injected into the deltoid area and the other half into the buttocks. Serum for
rabies antibody determination and F(ab')2 concentration was collected at hours (H)
0, 6 and 12, and on day (D) 2, 3, 4, 6, 8, 10, 12 and 15. Both products were safe,
with no serious adverse events, and in particular, no anaphylactic reactions or serum
sickness was reported. A statistical comparison of the pharmacokinetic parameters
did not demonstrate bioequivalence of the two products. Nonetheless, the relative
bioavailability of 93% and the similar absorption rates suggest the pharmacokinetic
profiles of Erig and PHT-Erig are similar. The antibody level in either group were
low throughout the 15-day study period. The geometric mean titer (GMT) values ranged
from group 0.027-0.117 IU ml(-1) in the Erig group and from 0.029 to 0.072 IU ml(-1)
in the PHT-Erig. There was no significant difference between the evolution of GMT
values for the two groups. In Study 2, 71 healthy volunteers received 40 IU kg(-1)
via the intramuscular route of either Erig PMC (n = 36) or PHT-Erig (n = 35) on D0,
in association with five doses of PVRV on D0, D3, D7, D14 and D28. The safety evaluation
was performed during the 28-day follow-up and serum samples for anti-rabies antibody
titration were collected on D0 (before injection) D3, D7, D14 and D28. No serious
reactions were reported in either group. In particular, no immediate (anaphylactic
type) or delayed (serum sickness) allergic reactions were observed. Over the 28-day
follow-up period, GMT profiles of the two groups were statistically equivalent. On
D14, 100% of the subjects had protective antibody titers (anti-rabies antibodies >
or = 0.5 IU ml(-1), which is the WHO-recommended level of seroconversion), and Erig
PMC and PHT-Erig were indistinguishable according to the clinical definition chosen.
On D28, the GMT values were 33.2 IU ml(-1) (95% CI, 23.8-46.1 IU ml(-1)) in the Erig
PMC/PVRV group and 31.4 IU ml(-1) (95% confidence interval, CI, 23.4-42.2 IU ml(-1))
in the PHT-Erig/PVRV group, showing evidence of adequate vaccine-induced antibody
responses in both groups. The increased purity, the heat-treatment step introduced
in the manufacturing process of PHT-Erig, and the good clinical results substantiate
the use of this new generation, purified equine F(ab')2 preparation in the post-exposure
prophylaxis of rabies.