This study was designed to test whether the immune responses induced by the concomitant administration of PCV13 + TIV to antigens A/HIN1, A/H3N2 Selumetinib and B are noninferior to those induced by TIV alone (TIV + Placebo), and that the immune responses to the PCV13 serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F) induced by PCV13 + TIV are noninferior to those induced by PCV13 administered 1 month after TIV. The safety profile of PCV13 + TIV compared with that

of each agent alone was also assessed. The immune responses induced by PCV13 + TIV were compared with those of TIV alone (Placebo + TIV), as measured by the standard hemagglutination inhibition (HAIs) assays for the TIV strains (A/H1N1, A/H3N2, and B) 1 month after TIV vaccination, and with PCV13 alone in a subset of 605 participants, as measured by a standardized enzyme-linked immunosorbent assay for serotype-specific immunoglobulin G (IgG) 1 month after PCV13 vaccination [13]. For TIV antigens (A/H1N1, A/H3N2, and B), a responder was defined as a participant achieving a ≥4-fold increase in HAI titres from prevaccination to 1 month postvaccination. A comparison between the two treatment groups (PCV13 + TIV Libraries relative to Placebo + TIV) was based on the difference in proportions of responders. Noninferiority was declared if the lower limit of the

2-sided 95% confidence interval (CI) for the difference in the proportion of responders between groups ([PCV13 + TIV] − [Placebo + TIV]) was greater than −0.10 consistent with existing literature [14]. Serotype-specific anticapsular polysaccharide IgG geometric mean concentrations (GMCs) were

calculated for each of the JAK inhibition 13 pneumococcal serotypes. A comparison between the two treatment groups (PCV13 + TIV relative to PCV13) was based on the ratio of GMCs for each of the pneumococcal serotypes. Noninferiority was declared if the lower limit of the 2-sided 95% CI for the GMC ratio ([PCV13 + TIV]:PCV13) was >0.5 (2-fold criterion) calculated 1-month after PCV13 vaccination. PCV13 efficacy data in the adult populations are not yet available. For the purpose of comparing groups administered PCV13 with and without TIV, a 0.5 margin was applied. This definition Bumetanide was considered to be reasonable on the basis of GMC ratios of 2- to 3-fold seen among serotypes, and across several of the infant PCV7 or PCV9 efficacy trials [15]. These differences are not manifested as differences in efficacy among the serotypes. Therefore, geometric mean immune response values that are within a 2–3-fold range are unlikely to manifest as a clinically significant change in the effectiveness of the vaccine. This noninferiority margin was consistent with relevant publications at the time of study design [14]. Additionally, the immune response of PCV13 + TIV was assessed based on the European Medicines Agency (EMA) “Note for Guidance on Harmonisation of Requirements for Influenza Vaccines” [16].