Dengue 02 Biswal 508

CDC ACIP — Vaccine Advisory Committee

Acip

Slides

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Document text

TAK-003 (Tetravalent Dengue Vaccine Candidate) 
23 February 2023 
Shibadas Biswal, MD 
Senior Medical Director – Clinical Development Dengue 
Takeda Vaccines 
9 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 
VV-MEDMAT-82307 
                  
 
                  
        
             
           
    
         Disclaimers 
• TAK-003 is an investigational compound that has not been approved for use by the US Food and Drug 
Administration 
• There is no guarantee TAK-003 will be approved in any country or countries for use in indications under investigation in the trials or studies discussed herein 
• Regulatory approval and use of TAK-003 is dependent on review by relevant local authorities 
– Currently, TAK-003 is approved for use in Indonesia, the EU, and UK 
ACIP, Advisory Committee on Immunization Practices. 
10 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

   
  
    
      
        
         
         Topics to be covered 
• Construct of the vaccine 
• Immune response profile 
• Overview of the clinical development 
• Efficacy profile from the pivotal efficacy trial 
• Safety profile from an integrated analysis of placebo-controlled trials 
• Immunogenicity data from the pivotal efficacy trial 
• Summary 
11 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

TAK-003 is based on a live, attenuated DENV-2 virus backbone 
expressing E and prM proteins of all four DENV serotypes 
Genetic structure and design of TAK-0031–3 
Thre  e attenuatin  g mutations2 
          
        
     
         
Attenuated  TDV-  2 
Substitutio  n with  prM  and  E  gene  s 
fro  m DENV-1,  -3,  and  -4 
TDV-1 
TDV-3 
TDV-4 
C , capsid;  DENV  , dengue  virus;  E , envelope;  NS , non-structural;  pr  M, pre-membrane;  TDV  , tetravalent  dengue  vaccine.  
1.  Osorio  JE , et  al.  Expert  Rev  Vaccine  s 2016;15:497–508;  2.  Osorio  JE , et  al.  Vaccine 2015;33:7112–7120;  3.  Pate  l SS , et  al.  Clin  Infect  Dis 2022.  doi:10.1093/cid/ciac41  8 [Epub ahead  of  print]. 
12 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

 
       
           
           
 
       
 
            
        
                
                              
               
         In clinical trials, TAK-003 activated multiple facets of immunity 
Humoral-mediated immunity • TAK-003 elicited neutralizing antibodies against each of DENV-1,-2,-3,-4
1,2 
• TAK-003 elicited cross-reactive antibodies that blocked the activity of DENV NS1 protein3 
• TAK-003 elicited type-specific memory B cells that target DENV-1, -2, -3, -4*4 
Cell-mediated immunity • TAK-003 stimulated cross-reactive CD4+ and CD8+ T-cell responses
5 
Innate immunity • TAK-003 stimulated production of T cells capable of producing IFNγ, TNFα, and IL-2
5 
A broad  spectrum  of immune  responses  may  contribute  to protection  against  infection, 
virus  clearance,  and prevention  of severe  disease1–5 
*These data were gathered from non-human primates and humans. 
CD, cluster of differentiation; DENV, dengue virus; IFN, interferon; IL, interleukin; NS, non-structural; TNF, tumor necrosis factor. 1. Biswal S, et al. Lancet 2020;395:1423–1433; 2. Tricou V, et al. Lancet 2020;395:1434–1443; 3. Sharma M, et al. J Infect Dis 2020;221:867–877; 4. Michlmayr D, et al. J Infect Dis 2021;233:247–257; 
5. Tricou V, et al. Vaccine 2022;40:1143–1151. 
13 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

                 
                  
                   
                        
                   
                        
                   
                        
                 
                   
           
          
        Overview of the clinical development program 
• 19 clinical trials conducted in 13 dengue endemic and non-endemic countries 
• Over 28,000 children/adults (aged 1.5–60 years) participated in Phase I–III clinical studies 
• Clinical development included both baseline seronegative and seropositive participants 
• ~20,000 participants received at least one dose of TAK-003 
Ab, antibody; CMI, cell-mediated immunity; HepA, hepatitis A; HPV9, human papillomavirus 9 vaccine; S&I, safety and immunogenicity. 
1. ClinicalTrials.gov NCT01110551. Available at: https://www.clinicaltrials.gov/ct2/show/NCT01110551 (accessed January 2023); 2. ClinicalTrials.gov NCT01224639. Available at: https://www.clinicaltrials.gov/ct2/show/NCT01224639 (accessed January 2023); 3. ClinicalTrials.gov NCT01765426. Available at: 
https://www.clinicaltrials.gov/ct2/show/NCT01765426 (accessed January 2023); 4. ClinicalTrials.gov NCT01542632. Available at: https://www.clinicaltrials.gov/ct2/show/NCT01542632 (accessed January 2023); 5. ClinicalTrials.gov NCT01728792. Available at: https://www.clinicaltrials.gov/ct2/show/NCT01728792 (accessed 
January 2023); 6. ClinicalTrials.gov NCT02193087. Available at: https://www.clinicaltrials.gov/ct2/show/NCT02193087 (accessed January 2023); 7. ClinicalTrials.gov NCT01511250. Available at: https://www.clinicaltrials.gov/ct2/show/NCT01511250 (accessed January 2023); 8. ClinicalTrials.gov NCT02302066. Available at: 
https://www.clinicaltrials.gov/ct2/show/NCT02302066 (accessed January 2023); 9. ClinicalTrials.gov NCT02425098. Available at: https://www.clinicaltrials.gov/ct2/show/NCT02425098 (accessed January 2023); 10. ClinicalTrials.gov NCT02747927. Available at: https://www.clinicaltrials.gov/ct2/show/NCT02747927 (accessed 
January 2023); 11. ClinicalTrials.gov NCT02948829. Available at: https://www.clinicaltrials.gov/ct2/show/NCT02948829 (accessed January 2023); 12. ClinicalTrials.gov NCT03999996. Available at: https://www.clinicaltrials.gov/ct2/show/NCT03999996 (accessed January 2023); 13. ClinicalTrials.gov NCT03423173. Available at: 
https://www.clinicaltrials.gov/ct2/show/NCT03423173 (accessed January 2023); 14. ClinicalTrials.gov NCT03341637. Available at: https://www.clinicaltrials.gov/ct2/show/NCT03341637 (accessed January 2023); 15. ClinicalTrials.gov NCT03771963. Available at: https://www.clinicaltrials.gov/ct2/show/NCT03771963 (accessed 
January 2023); 16. ClinicalTrials.gov NCT03746015. Available at: https://www.clinicaltrials.gov/ct2/show/NCT03746015 (accessed January 2023); 17. ClinicalTrials.gov NCT03342898. Available at: https://www.clinicaltrials.gov/ct2/show/NCT03342898 (accessed January 2023); 18. ClinicalTrials.gov NCT03525119. Available at: 
https://www.clinicaltrials.gov/ct2/show/NCT03525119 (accessed January 2023); 19. ClinicalTrials.gov NCT04313244. Available at: https://www.clinicaltrials.gov/ct2/show/NCT04313244 (accessed January 2023). 
14 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

         
                       
                      TIDES (DEN-301): Pivotal Phase III trial design 
20,071 children (aged 4–16 years) received either TAK-003 or placebo in a 2:1 ratio1,2 
RT-PCR, reverse transcriptase polymerase chain reaction; SAE, serious adverse event. 
1. ClinicalTrials.gov NCT02747927. Available at: https://clinicaltrials.gov/ct2/show/NCT02747927 (accessed January 2023); 2. Biswal S, et al. N Engl J Med 2019;281:2009–2019. 
15 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

                   
           
                      
     
         
           
    
     
     
     
     
    
     =-
=Demographic and baseline characteristics: Safety set 
Characteristic Placebo 
n 6687 TAK 003 
n 13,380 
Seronegative, n (%) 1832 (27.4) 3714 (27.8) 
Mean age, years (SD) 9.6 (3.34) 9.6 (3.36) 
4–5 years, n (%) 846 (12.7) 1702 (12.7) 
6–11 years, n (%) 3697 (55.3) 7387 (55.2) 
12–16 years, n (%) 2144 (32.1) 4291 (32.1) 
Asia, n (%) 2993 (44.8) 5996 (44.8) 
Latin America, n (%) 3694 (55.2) 7384 (55.2) 
Baseline serostatus data were available for 6684 and 13,375 safety set participants in the placebo and TAK-003 groups, respectively. 
n refers to number of participants in the safety analysis set. Seronegative at baseline: seronegative to all four DENV serotypes. Seropositive at baseline: reciprocal neutralizing titer ≥10 for one or more DENV serotypes. DENV, dengue virus; SD, standard deviation. 
Takeda. Data on file. 
16 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

           
                                           
              
   
    
Dominican 
Nicaragua Republic LATAM2 APAC2 
Philippines 
Colombia 
Panama Cases of VCD, nThailand Sri Lanka 
Brazil 
Cases of VCD, n 
Serotype of infection Serotype of infection        
Trial sites and background dengue cases in the placebo group 
Up to 57 months post 1st dose: Safety set1 
APAC, Asia-Pacific; DENV, dengue virus; LATAM, Latin America; VCD, virologically confirmed dengue. 
1. 1. Tricou V, et al. Efficacy and safety of Takeda’s tetravalent dengue vaccine candidate (TAK-003) after 4.5 years of follow-up. Presented at NECTM, Rotterdam, Netherlands, 8–10 June 2022; 2. Takeda. Data on File. 
17 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 
     
                             
    Primary and secondary efficacy endpoint analysis 
Vaccine efficacy = 1 – hazard ratio (TAK-003 vs. placebo). Hazard ratio estimated from Cox proportional hazards model with adjustment for 
age and stratified by region. 
18 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

   
                     
                     
                     
                         
                     
 DEN-301: Primary and secondary endpoints 
Primary and secondary endpoints per protocol set data; placebo to TAK-003 1:2 randomization1–3 
VCD (per 100 person-years) 
-80 -60 -40 -20 0 20 40 60 80 100 
VE (%) 
VE against VCD by any serotype in the 30 days to 18 months post 2nd dose time frame was an exploratory endpoint; 
Seronegative at baseline: seronegative to all four DENV serotypes; seropositive at baseline: reciprocal neutralizing titer ≥10 for one or more DENV serotypes. 
CI, confidence interval; DCAC, Dengue Case Adjudication Committee; DENV, dengue virus; DHF, dengue hemorrhagic fever; VCD, virologically confirmed dengue; VE, vaccine efficacy. 
1. Biswal S, et al. Lancet 2020;395:1423–1433; 2. Biswal S, et al. N Engl J Med 2019;381:2009–2019; 3. Takeda. Data on File. 
19 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 
Placebo TAK-003 
Endpoint n=6317 n=12,704 VE  95% CI 
  30 days  to  12  months post 2nd   dose  (primary endpoint) 
   VCD by any serotype  149 (2.6)  61 (0.5) 80.2  (73.3, 85.3) 
  30 days  to  18  months post 2nd   dose  (secondary endpoint) 
      VCD leading to hospitalization (key secondary endpoint)  66 (0.8)  13 (<0.1) 90.4  (82.6, 94.7) 
   VCD by any serotype  206 (2.4)  114 (0.6) 73.3  (66.5, 78.8) 
 Baseline seropositive  150 (2.4)  75 (0.6) 76.1  (68.5, 81.9) 
 Baseline seronegative  56 (2.4)  39 (0.8) 66.2  (49.1, 77.5) 
  VCD by DENV-1  62 (0.7)  38 (0.2) 69.8  (54.8, 79.9) 
  VCD by DENV-2  80 (0.9)  8 (<0.1) 95.1  (89.9, 97.6) 
  VCD by DENV-3  60 (0.7)  63 (0.4) 48.9  (27.2, 64.1) 
  VCD by DENV-4  5 (<0.1)  5 (<0.1)  51.0 (−69.4, 85.8) 
  DCAC-defined severe VCD  1 (<0.1)  2 (<0.1)  2.3 (−997.5, 91.1) 
DHF  7 (<0.1)  2 (<0.1) 85.9  (31.9, 97.1) 
      
  
                             
    Cumulative efficacy results over ~57 months 
(safety set data) 
Vaccine efficacy = 1 – hazard ratio (TAK-003 vs. placebo). Hazard ratio estimated from Cox proportional hazards model with adjustment for 
age and stratified by region. 
20 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

TAK-003 was efficacious against VCD over 57 months regardless of 
baseline serostatus 
Cumulative incidence of participants 
with VCD (%) 10 
8 
6 4 2 
0 
Placebo 
TAK-003 
Placebo 
TAK-003 Seropositive 
Seronegative 
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 
Time since 1st dose (months)     
  
   Cumulative safety data set1 
VE (95% CI) 
                               
         
                                     
 
            
  
  
  
  Overall 61.2 (56.0, 65.8) 
Seronegative 53.5 (41.6, 62.9) 
Seropositive 64.2 (58.4, 69.2) 
Safety set data truncated at 57 months post 1st dose. Seronegative at baseline: seronegative to all four DENV serotypes; seropositive at baseline: reciprocal neutralizing titer ≥10 for one or more DENV serotypes. 
CI, confidence interval; DENV, dengue virus; VCD, virologically confirmed dengue. 
1. Tricou V, et al. Efficacy and safety of Takeda’s tetravalent dengue vaccine candidate (TAK-003) after 4.5 years of follow-up. Presented at NECTM, Rotterdam, Netherlands, 8–10 June 2022. 
21 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

    
   
   
2.5 
2.0 participants
CD (%) of 
d V1.5 nce 
izeincide1.0 lative 
with hospital0.5 Cumu0.0 
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 
Time since 1st dose (months) Placebo 
TAK-003 
Placebo 
TAK-003 Seropositive 
Seronegative 
                              
         
                                    
   
            
  
  
  
TAK-003 was efficacious against hospitalized VCD over 57 months 
regardless of baseline serostatus 
Cumulative safety data set1 
VE  (95%  CI) 
Overall 84. 1(77.8, 88.6) 
Seronegative 79. 3(63.5, 88.2) 
Seropositive 85. 9(78.7, 90.7) 
Safety set data truncated at 57 months post 1st dose. Seronegative at baseline: seronegative to all four DENV serotypes; seropositive at baseline: reciprocal neutralizing titer ≥10 for one or more DENV serotypes. 
CI, confidence interval; DENV, dengue virus; VCD, virologically confirmed dengue. 
1. Tricou V, et al. Efficacy and safety of Takeda’s tetravalent dengue vaccine candidate (TAK-003) after 4.5 years of follow-up. Presented at NECTM, Rotterdam, Netherlands, 8–10 June 2022. 
22 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 
                        
               
                     
            
                                       
           
     
 
 
 
  
  
  
  
   
   
  
 
 
   
  
          
=-
=Efficacy against VCD: By baseline serostatus and serotype 
1st dose to end of Part 3: Safety set (~57 months)1,2 
Placebo 
n 6687 TAK 003 
n 13,380 VE (95% CI) 
VCD, n (per 100 person-years) 
Seropositive 
DENV-1 DENV-2 DENV-3 DENV-4 151 (0.7) 135 (0.6) 
97 (0.4) 
20 (<0.1) 133 (0.3) 
54 (0.1) 96 (0.2) 
12 (<0.1) 56.1 (44.6, 65.2) 
80.4 (73.1, 85.7) 
52.3 (36.7, 64.0) 
70.6 (39.9, 85.6) 
Seronegative 
DENV-1 DENV-2 DENV-3 DENV-4 79 (1.0) 58 (0.7) 16 (0.2) 
3 (<0.1) 89 (0.5) 
14 (<0.1) 
36 (0.2) 
12 (<0.1) 45.4 (26.1, 59.7) 
88.1 (78.6, 93.3) 
−15.5 (−108.2, 35.9) 
−105.6 (−628.7, 42.0) 
n refers to number of participants in the safety set. Numbers of VCD (per 100 person-years) are based on the number of participants evaluated. 
Repeat episodes of VCD were excluded from efficacy analysis at VCD or serotype level as applicable. Seronegative at baseline: seronegative to all four DENV serotypes. Seropositive at baseline: reciprocal neutralizing titer ≥10 for one or more DENV serotypes. 
CI, confidence interval; DENV, dengue virus; VCD, virologically confirmed dengue; VE, vaccine efficacy. 
1. Tricou V, et al. Efficacy and safety of Takeda’s tetravalent dengue vaccine candidate (TAK-003) after 4.5 years of follow-up. Presented at NECTM, Rotterdam, Netherlands, 8–10 June 2022; 2. Takeda. Data on File. 
23 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

  
      
 
 
 
  
  
   
     
  
  
   
 
 
  
 
  
 
                         
         
                        
                      
              
                                       
 
                  
=-
=Efficacy against hospitalized VCD: By baseline serostatus 
and serotype 
1st dose to end of Part 3: Safety set (~57 months)1,2 
Placebo 
n 6687 TAK 003 
n 13,380 VE (95% CI) 
Hospitalized VCD, n (per 100 person-years) 
Seropositive 
DENV-1 
DENV-2 DENV-3 DENV-4 24 (0.1) 59 (0.3) 
15 (<0.1) 
3 (<0.1) 16 (<0.1) 
5 (<0.1) 8 (<0.1) 
0 (0.0) 66.8 (37.4, 82.3) 
95.8 (89.6, 98.3) 
74.0 (38.6, 89.0) 
100 (NE, NE) 
Seronegative 
DENV-1 DENV-2 DENV-3 DENV-4 14 (0.2) 23 (0.3) 3 (<0.1) 1 (<0.1) 6 (<0.1) 
0 (0.0) 
11 (<0.1) 
0 (0.0) 78.4 (43.9, 91.7) 
100 (NE, NE) 
−87.9 (−573.4, 47.6) 
100 (NE, NE) 
Rate of hospitalization among VCD cases in placebo group : The Philippines, 17/191 ( 8.9% ); Sri Lanka, 70/103 ( 68.0% ); Thailand, 25/64 ( 39.1% ); Brazil, 2/24 ( 8.3% ); Colombia, 14/87 ( 16.1% ); 
Dominican Republic, 4/22 ( 18.2% ); Nicaragua, 8/24 ( 33.3% ); Panama, 2/45 ( 4.4% ). 
n refers to number of participants in the safety set. Numbers of hospitalized VCD (per 100 person-years) are based on the number of participants evaluated. 
Seronegative at baseline: seronegative to all four DENV serotypes. Seropositive at baseline: reciprocal neutralizing titer ≥10 for one or more DENV serotypes. 
CI, confidence interval; DENV, dengue virus; NE, non-estimable; VCD, virologically confirmed dengue; VE, vaccine efficacy. 
1. Tricou V, et al. Efficacy and safety of Takeda’s tetravalent dengue vaccine candidate (TAK-003) after 4.5 years of follow-up. Presented at NECTM, Rotterdam, Netherlands, 8–10 June 2022; 2. Takeda. Data on File. 
24 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

   
                                       
         
      
               Rate of hospitalization among VCD cases by country 
Placebo group analysis 1st dose to end of Part 3 safety set (~57 months)1,2 
0 10 20 30 40 50 60 70 80 Rate of hospitalization among VCD cases 
in placebo group (%) 8.9 68.0 
39.1 
8.3 16.1 18.2 33.3 
4.4 
1 2 3 4 5 6 7 8 
VCD, virologically confirmed dengue. 
1. Tricou V, et al. Efficacy and safety of Takeda’s tetravalent dengue vaccine candidate (TAK-003) after 4.5 years of follow-up. Presented at NECTM, Rotterdam, Netherlands, 8–10 June 2022; 2. Takeda. Data on File. 
25 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

                            
      
                        
                      
              
           
 
           
      
Seropositive 
DENV-1  22 (0.1)  11 (<0.1)  75.1 (48.7, 87.9) 
DENV-2  18 (<0.1)  2 (<0.1)  94.4 (76.0, 98.7) 
DENV-3  11 (<0.1)  5 (<0.1)   78.3 (37.4, 92.4) 
DENV-4  2 (<0.1)  0 (0.0)   100 (NE, NE) 
Seronegative 
DENV-1  12 (0.2)  5 (<0.1)  78.9 (40.1, 92.6) 
DENV-2  3 (<0.1)  0 (0.0)  100 (NE, NE) 
DENV-3  3 (<0.1)  5 (<0.1)   15.3 (−254.4, 79.8) 
DENV-4  1 (<0.1)  0 (0.0)  100 (NE, NE)          
=-
=Efficacy against hospitalized VCD: by baseline serostatus 
and serotype 
1st dose to end of Part 3: Safety set (~57 months)1 
Sensitivity  analysis  excluding  data  from  Sri Lanka 
Placebo 
n 5987 TAK 003 
n 11,986 VE (95% CI) 
Hospitalized VCD, n (per 100 person-years) 
Rate of hospitalization among VCD cases in placebo group : The Philippines, 17/191 ( 8.9% ); Sri Lanka, 70/103 ( 68.0% ); Thailand, 25/64 ( 39.1% ); Brazil, 2/24 ( 8.3% ); Colombia, 14/87 ( 16.1% ); Dominican Republic, 4/22 
(18.2% ); Nicaragua, 8/24 ( 33.3% ); Panama, 2/45 ( 4.4% ). 
n refers to number of participants in the safety set. Numbers of hospitalized VCD (per 100 person-years) are based on the number of participants evaluated. 
Seronegative at baseline: seronegative to all four DENV serotypes. Seropositive at baseline: reciprocal neutralizing titer ≥10 for one or more DENV serotypes. 
CI, confidence interval; DENV, dengue virus; NE, non-estimable; VCD, virologically confirmed dengue; VE, vaccine efficacy. 
1. Takeda. Data on File. 
26 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

      
         Safety: Integrated analysis of placebo-controlled trials 
27 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

        
          
            
                             
  
              
                            
         
                   
     Integrated safety analysis 
Solicited local (within 7 days), systemic (within 14 days), and unsolicited (within 28 days) AEs 
in participants aged 4–60 years old1,2 
• Solicited reactions occurred more frequently in the TAK-003 arm 
• Similar reporting of unsolicited AEs in the TAK-003 and placebo arms 
• Most frequent TAK-003-related unsolicited AEs: injection-site pruritus (0.7%), bruising (0.6%), and pyrexia (0.2%) 
43.4 46.1 
21.3 
3.0 25.7 40.1 
22.8 
1.7 
0 10 20 30 40 50 60 70 80 90 100 Participants (%) AEs after any dose 
1 2 3 4 
Series1 Series2 
*Injection-site pain, erythema, and swelling; †For adults and children ≥6 years old: headache, myalgia, malaise, asthenia, and fever; for children <6 years old: irritability/fussiness, drowsiness, loss of appetite, and fever. 
AE, adverse event. 
Solicited AEs: n=3783 (TAK-003) and n=1703 (placebo); Unsolicited AEs: n=3830 (TAK-003) and n=1725 (placebo). 
1. Patel S. Presented at ASTMH 2021, National Harbor, MD, US, 17–21 November 2021; 2. Takeda. Data on File: Integrated safety analysis of placebo-controlled trials, Takeda. 
28 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

                             
                         
      
           
                       
             -TAK 003 
=n 14,627 Placebo 
=n 7167 
 Any SAE  1169 (7.99)  691 (9.64) 
 Any  related SAE  1 (<0.01)  4 (0.06) 
 SAEs   (by preferred  term)   experienced by >0.2%  of participants 
Appendicitis 
†  Dengue fever 104 (0.71) 
 77 (0.53)  48 (0.67) 
 144 (2.01) 
Gastroenteritis  52 (0.36)  21 (0.29) 
 Viral infection 
 Asymptomatic COVID-19‡  41 (0.28) 
 37 (0.25)  40 (0.56) 
 13 (0.18) 
Pneumonia  36 (0.25)  24 (0.33) 
  Urinary tract infection 
COVID-19‡  34 (0.23) 
 32 (0.22)  21 (0.29) 
 11 (0.15) 
Influenza DHF
†  31 (0.21) 
 14 (0.10)  20 (0.28) 
 37 (0.52)       
   
      
      
     
     
  
     Integrated safety analysis: SAEs 
Participants with event, n (%)* 
One SAE was considered related to 
TAK-003, compared with 
five related SAEs in four placebo 
recipients 
Deaths** 
• 16 (0.09%) in the TAK-003 group 
•
 9 (0.11%) in the placebo group 
•
 None were considered related to 
t
he investigational product 
• No fatal cases of dengue occurred 
*Placebo-controlled trials pool; includes SAEs up to 54 months post 2nd dose in DEN-301; †As reported by investigators: not necessarily virologically confirmed dengue fever or meeting WHO 97 DHF criteria; 
‡As per local practice in Sri Lanka and Thailand, symptomatic and asymptomatic COVID-19-positive participants were isolated in designated centers/hospitals, and therefore, cases met SAE criteria; 
**All trials pool: n=16,919 (TAK-003), n=8381 (placebo). 
DHF, dengue hemorrhagic fever; SAE, serious adverse event; WHO, World Health Organization. Takeda. Data on File: Integrated safety analysis of placebo-controlled trials including data from DEN-301 up to end of Part 3. 
29 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

     
         Immunogenicity in baseline seronegative participants 
30 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

                   
    
          
      
                                  Seropositivity rate across serotypes at Month 1 and Month 4 in the TAK-003 group 
(n=702) 
100 99.5 98.6 100.0 96.1 100.0 99.8 99.5 
80 
60 40 20 
0 
1 2 3 4 5 6 7 8 9 10 94.1 90.5 85.3 Seropositivity rate (%) Immunogenicity data: Seropositivity rate 
PPSI – participants seronegative at baseline in pivotal efficacy trial (TIDES) 
PPSI: number of participants evaluated at each time point may vary. Percentages are based on the number of participants evaluated. 
Seropositive: reciprocal neutralizing titer ≥10. DENV, dengue virus; M, month; PPSI, per protocol set of immunogenicity. 
Takeda. Data on File. 
31 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

                   
                          
            
   
             
  
 
 
-Baseline seronegative 10,000 
1000 
100 TAK-003 group 
Placebo group 10 
1 
0 1 3 4 9 15 27 39 51 PPSI analysis set TAK 003 Placebo 
Baseline seronegatives n=702 n=345 
Months after 1st vaccination 
        Immunogenicity  data:  GMT  * 
PPSI  – participants  seronegative  a t baseline  in  pivotal  efficac  y trial  (TIDES) GMT 
DENV-1 placebo DENV-1 TAK-003 DENV-2 placebo DENV-2 TAK-003 DENV-3 placebo DENV-3 TAK-003 DENV-4 placebo DENV-4 TAK-003 
PPSI: number of participants evaluated at each time point may vary. Percentages are based on the number of participants evaluated. 
*Titers expressed as the reciprocal of the highest dilution of test serum that shows a 50% reduction in plaque counts compared with that of virus controls. DENV, dengue virus; GMT, geometric mean titer; PPSI, per protocol set of immunogenicity. 
Takeda. Data on File. 
32 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

      
          
         
          
        
        
   
      
         
                  
    
      
        
     
      
         Summary 
• Data from the TIDES pivotal trial showed: 
– Long-term efficacy of TAK-003 in both baseline seronegative and seropositive participants 
– TAK-003 is immunogenic against each of DENV-1, -2,-3, -4 serotypes 
• Data from pivotal trial suggested varying TAK-003 efficacy profiles by serotype 
– Efficacious against all four serotypes in baseline seropositive participants 
– Efficacious against DENV-1 and DENV-2 in baseline seronegative participants 
– Among baseline seronegative participants: 
o 
o 
o 
o D ata suggested lack of efficacy against DENV-3 
T
he trial did not allow assessment of DENV-4 due to low incidence 
Long-term follow-up did not conclude a higher risk of hospitalized or severe forms of dengue associated with TAK-003 
and DENV-3 or -4 serotype 
Totality of data did not indicate harm 
• Safety data from integrated analysis of placebo-controlled trials showed: 
– TAK-003 had an acceptable safety profile 
DENV, dengue virus. Takeda. Data on File. 
33 Efficacy and safety of a tetravalent dengue vaccine (TAK-003) 

 
         Thank you 
34 Efficacy and safety of a tetravalent dengue vaccine (TAK-003)