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Safety and Immunogenicity Study of an Inactivated SARS-CoV-2 Vaccine for Preventing Against COVID-19

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04412538
Recruitment Status : Recruiting
First Posted : June 2, 2020
Last Update Posted : June 4, 2020
Sponsor:
Collaborators:
West China Second University Hospital
Yunnan Center for Disease Control and Prevention
Information provided by (Responsible Party):
Qihan Li, Chinese Academy of Medical Sciences

Brief Summary:
This study is a randomized, double-blinded, and placebo-controlled phase Ia/IIa clinical trial of the Inactivated SARS-CoV-2 Vaccine to evaluate the safety and immunogenicity of the vaccine in healthy people aged 18~59 Years.

Condition or disease Intervention/treatment Phase
COVID-19 Biological: Low dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 28-day schedule Biological: Low dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 14-day schedule Biological: Medium dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 28-day schedule Biological: Medium dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 14-day schedule Biological: High dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 28-day schedule Biological: High dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 14-day schedule Biological: Placebo on a 0- and 28-day schedule Biological: Placebo on a 0- and 14-day schedule Phase 1 Phase 2

Detailed Description:
This phase Ia/IIa trial is designed to evaluate the safety and immunogenicity of different doses of the Inactivated SARS-CoV-2 Vaccine inoculated with different immunization schedules based upon the randomized, double-blind and placebo-controlled principle. A total of 942 subjects aged 18 to 59 years old will be enrolled in the study, of which 192 and 750 will be enrolled for phase Ia and phase Ⅱa,respectively.The enrolled subjects in phase Ia receive two doses of low-, medium-, or high-dose of experimental vaccines or placebo at an interval of 14 or 28 days, while the enrolled subjects in Phase Ⅱa receive two doses of medium, high-dose experimental vaccines or placebo at an interval of 14 or 28 days.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 942 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: A Randomized, Double-blind, Placebo-controlled, Phase Ia/IIa Trial of an Inactivated SARS-CoV-2 Vaccine in Healthy People Aged 18 to 59 Years
Actual Study Start Date : May 15, 2020
Estimated Primary Completion Date : September 2020
Estimated Study Completion Date : September 2021

Arm Intervention/treatment
Experimental: Low dosage vaccine on a 0- and 28-day schedule
Two doses of low dosage Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0, 28
Biological: Low dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 28-day schedule
Two doses of low dosage(50U/0.5ml) Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0,28

Experimental: Low dosage vaccine on a 0- and 14-day schedule
Two doses of low dosage Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0, 14
Biological: Low dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 14-day schedule
Two doses of low dosage(50U/0.5ml) Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0,14

Experimental: Medium dosage vaccine on a 0- and 28-day schedule
Two doses of medium dosage Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0, 28
Biological: Medium dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 28-day schedule
Two doses of medium dosage(100U/0.5ml) Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0,28

Experimental: Medium dosage vaccine on a 0- and 14-day schedule
Two doses of medium dosage Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0, 14
Biological: Medium dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 14-day schedule
Two doses of medium dosage(100U/0.5ml) Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0,14

Experimental: High dosage vaccine on a 0- and 28-day schedule
Two doses of high dosage Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0, 28
Biological: High dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 28-day schedule
Two doses of high dosage(150U/0.5ml) Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0,28

Experimental: High dosage vaccine on a 0- and 14-day schedule
Two doses of high dosage Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0, 14
Biological: High dosage Inactivated SARS-CoV-2 Vaccine on a 0- and 14-day schedule
Two doses of high dosage(150U/0.5ml) Inactivated SARS-CoV-2 Vaccine at the vaccination schedule of day 0,14

Placebo Comparator: Placebo on a 0- and 28-day schedule
Two doses of placebo at the vaccination schedule of day 0, 28
Biological: Placebo on a 0- and 28-day schedule
Two doses of placebo at the vaccination schedule of day 0,28

Placebo Comparator: Placebo on a 0- and 14-day schedule
Two doses of placebo at the vaccination schedule of day 0, 14
Biological: Placebo on a 0- and 14-day schedule
Two doses of placebo at the vaccination schedule of day 0,14




Primary Outcome Measures :
  1. Adverse reactions/events rate [ Time Frame: 7 days after vaccination ]
    Occurence of adverse reactions/events after vaccination

  2. Adverse reactions/events rate [ Time Frame: 28 days after vaccination ]
    Occurence of adverse reactions/events after vaccination

  3. Seroconversion rate of Neutralizing antibodies against SARS-CoV-2 Phase IIa (Day 0, 14 schedule) [ Time Frame: 14 days after the second vaccination ]
    Seroconversion rate of neutralizing antibodies against SARS-CoV-2 in serum for the Phase IIa immunization schedule of day 0,14

  4. Seroconversion rate of Neutralizing antibodies against SARS-CoV-2 Phase IIa (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Seroconversion rate of neutralizing antibodies against SARS-CoV-2 in serum for the Phase IIa immunization schedule of day 0,28

  5. Seroconversion rate of IgG antibodies against SARS-CoV-2 Phase IIa (Day 0, 14 schedule) [ Time Frame: 14 days after the second vaccination ]
    Seroconversion rate of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase IIa immunization schedule of day 0,14

  6. Seroconversion rate of IgG antibodies against SARS-CoV-2 Phase IIa (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Seroconversion rate of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase IIa immunization schedule of day 0,28


Secondary Outcome Measures :
  1. Serious adverse events [ Time Frame: 12 months after the second vaccination ]
    Occurence of Serious adverse events after vaccination

  2. Level of Neutralizing antibodies against SARS-CoV-2 Phase Ia (Day 0, 14 schedule) [ Time Frame: 7, 14 and 28 days after the second vaccination ]
    Level of neutralizing antibodies against SARS-CoV-2 in serum for the Phase Ia immunization schedule of day 0,14

  3. Level of Neutralizing antibodies against SARS-CoV-2 Phase IIa (Day 0, 14 schedule) [ Time Frame: 14 and 28 days after the second vaccination ]
    Level of neutralizing antibodies against SARS-CoV-2 in serum for the Phase IIa immunization schedule of day 0,14

  4. Level of IgG antibodies against SARS-CoV-2 Phase Ia (Day 0, 14 schedule) [ Time Frame: 7, 14 and 28 days after the second vaccination ]
    Level of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase Ia immunization schedule of day 0,14

  5. Level of IgG antibodies against SARS-CoV-2 Phase IIa (Day 0, 14 schedule) [ Time Frame: 14 and 28 days after the second vaccination ]
    Level of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase IIa immunization schedule of day 0,14

  6. Level of Neutralizing antibodies against SARS-CoV-2 Phase Ia (Day 0, 28 schedule) [ Time Frame: 7 and 28 days after the second vaccination ]
    Level of neutralizing antibodies against SARS-CoV-2 in serum for the Phase Ia immunization schedule of day 0,28

  7. Level of Neutralizing antibodies against SARS-CoV-2 Phase IIa (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Level of neutralizing antibodies against SARS-CoV-2 in serum for the Phase IIa immunization schedule of day 0,28

  8. Level of IgG antibodies against SARS-CoV-2 Phase Ia (Day 0, 28 schedule) [ Time Frame: 7 and 28 days after the second vaccination ]
    Level of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase Ia immunization schedule of day 0,28

  9. Level of IgG antibodies against SARS-CoV-2 Phase IIa (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Level of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase IIa immunization schedule of day 0,28

  10. Seroconversion rate of Neutralizing antibodies against SARS-CoV-2 Phase Ia (Day 0, 14 schedule) [ Time Frame: 14 days after the second vaccination ]
    Seroconversion rate of neutralizing antibodies against SARS-CoV-2 in serum for the Phase Ia immunization schedule of day 0,14

  11. Seroconversion rate of IgG antibodies against SARS-CoV-2 Phase Ia (Day 0, 14 schedule) [ Time Frame: 14 days after the second vaccination ]
    Seroconversion rate of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase Ia immunization schedule of day 0,14

  12. Seroconversion rate of Neutralizing antibodies against SARS-CoV-2 Phase Ia (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Seroconversion rate of neutralizing antibodies against SARS-CoV-2 in serum for the Phase Ia immunization schedule of day 0,28

  13. Seroconversion rate of IgG antibodies against SARS-CoV-2 Phase Ia (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Seroconversion rate of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase Ia immunization schedule of day 0,28


Other Outcome Measures:
  1. Level of IgM antibodies against SARS-CoV-2 Phase Ia (Day 0, 14 schedule) [ Time Frame: 7, 14 and 28 days after the second vaccination ]
    Level of IgM antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase Ia immunization schedule of day 0,14

  2. Level of IgM antibodies against SARS-CoV-2 Phase IIa (Day 0, 14 schedule) [ Time Frame: 14 and 28 days after the second vaccination ]
    Level of IgM antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase IIa immunization schedule of day 0,14

  3. Level of anti-N protein antibodies Phase Ia (Day 0, 14 schedule) [ Time Frame: 7, 14 and 28 days after the second vaccination ]
    Level of anti-N protein antibodies for the Phase Ia immunization schedule of day 0,14

  4. Level of anti-N protein antibodies Phase IIa (Day 0, 14 schedule) [ Time Frame: 14 and 28 days after the second vaccination ]
    Level of anti-N protein antibodies for the Phase IIa immunization schedule of day 0,14

  5. Level of IgM antibodies against SARS-CoV-2 Phase Ia (Day 0, 28 schedule) [ Time Frame: 7 and 28 days after the second vaccination ]
    Level of IgM antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase Ia immunization schedule of day 0,28

  6. Level of IgM antibodies against SARS-CoV-2 Phase IIa (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Level of IgM antibodies against SARS-CoV-2 tested by ELISA in serum for the Phase IIa immunization schedule of day 0,28

  7. Level of anti-N protein antibodies Phase Ia (Day 0, 28 schedule) [ Time Frame: 7 and 28 days after the second vaccination ]
    Level of anti-N protein antibodies for the Phase Ia immunization schedule of day 0,28

  8. Level of anti-N protein antibodies Phase IIa (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Level of anti-N protein antibodies for the Phase IIa immunization schedule of day 0,28

  9. Level of Neutralizing antibodies against SARS-CoV-2 Phase Ia (both schedules) [ Time Frame: 3, 6, 9 and 12 months after the second vaccination ]
    Level of neutralizing antibodies against SARS-CoV-2 in serum for both the Phase Ia immunization schedules

  10. Level of Neutralizing antibodies against SARS-CoV-2 Phase IIa (both schedules) [ Time Frame: 6 and 12 months after the second vaccination ]
    Level of neutralizing antibodies against SARS-CoV-2 in serum for both the Phase IIa immunization schedules

  11. Level of IgG antibodies against SARS-CoV-2 Phase Ia (both schedules) [ Time Frame: 3, 6, 9 and 12 months after the second vaccination ]
    Level of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for both the Phase Ia immunization schedules

  12. Level of IgG antibodies against SARS-CoV-2 Phase IIa (both schedules) [ Time Frame: 6 and 12 months after the second vaccination ]
    Level of IgG antibodies against SARS-CoV-2 tested by ELISA in serum for both the Phase IIa immunization schedules

  13. Cellular immune responses Phase Ia (Day 0, 14 schedule) [ Time Frame: 7, 14 and 28 days after the second vaccination ]
    Cellular immune responses (CD4+, CD8+, Th1, Th2, IFN-γ, TNFα, IL-2, IL-6) will be measured for the Phase Ia immunization schedule of day 0,14

  14. Cellular immune responses Phase IIa (Day 0, 14 schedule) [ Time Frame: 14 and 28 days after the second vaccination ]
    Cellular immune responses (CD4+, CD8+, Th1, Th2, IFN-γ, TNFα, IL-2, IL-6) will be measured for the Phase IIa immunization schedule of day 0,14

  15. Cellular immune responses Phase Ia (Day 0, 28 schedule) [ Time Frame: 7 and 28 days after the second vaccination ]
    Cellular immune responses (CD4+, CD8+, Th1, Th2, IFN-γ, TNFα, IL-2, IL-6) will be measured for the Phase Ia immunization schedule of day 0,28

  16. Cellular immune responses Phase IIa (Day 0, 28 schedule) [ Time Frame: 28 days after the second vaccination ]
    Cellular immune responses (CD4+, CD8+, Th1, Th2, IFN-γ, TNFα, IL-2, IL-6) will be measured for the Phase IIa immunization schedule of day 0,28



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   18 Years to 59 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Phase Ia:

    1. Healthy adults aged 18 to 59 years (including boundary values), both men and women.
    2. Proven legal identity.
    3. Participants should understand the contents of the informed consent form, the vaccine in this trial, voluntarily sign the informed consent form, and be capable of using thermometers, scales, and filling in diary cards and contact cards as required.
    4. Participants should be able to communicate well with investigators, understand and comply with the requirements of this trial.
    5. Axillary temperature ≤37.0 ℃.
  • Phase IIa:

    1. Healthy adults aged 18 to 59 years (including boundary values), both men and women.
    2. Proven legal identity.
    3. Participants should understand the contents of the informed consent form, the vaccine in this trial, voluntarily sign the informed consent form, and be capable of using thermometers, scales, and filling in diary cards and contact cards as required.
    4. Participants should be able to communicate well with investigators, understand and comply with the requirements of this trial.
    5. Axillary temperature ≤37.0 ℃.

Exclusion Criteria:

  • Phase Ia:

    1. Contraindications for vaccination.
    2. History of allergy to vaccines or drugs.
    3. Immunization with any vaccine within 1 month.
    4. History of abnormal clinical manifestations and serious diseases to be excluded, including but not limited to nervous system, cardiovascular system, blood and lymphatic system, immune system, kidney, liver, gastrointestinal tract, respiratory system, metabolism, bones and other system diseases, and a history of malignant tumors.
    5. Those who developed acute disease within 2 weeks, or had symptoms of fever or upper respiratory tract infection within 7 days.
    6. Those who have a hereditary bleeding tendency or coagulation dysfunction, or a history of thrombosis or bleeding disorders.
    7. Those who cannot tolerate venipuncture, or have a history of halo needles or halo blood.
    8. Surgical removal of spleen or other important organs for any reason.
    9. Those who have undergone surgery within 3 months before signing the informed consent, or those who plan to perform surgery during the trial or within 3 months after the end of the trial (including cosmetic surgery, dental and oral surgery).
    10. Those who donated or lost blood (≥400 mL) in the past 3 months, who received blood transfusion or use of blood products, or who planned blood donation during the trial.
    11. Receipt of other investigational or unregistered products (drugs, vaccines, biological product or devices) in the past 3 months, or plan to use other investigational or unregistered products during the study.
    12. Receipt of immunosuppressive therapy within 6 months before signing the informed consent form, such as long-term systemic glucocorticoid therapy (with systemic glucocorticoid therapy for more than 2 weeks within 6 months, such as prednisone or similar drugs) ), but local administration (such as ointment, eye drops, inhalation, or nasal spray) is allowed. The local administration should not exceed the dosage recommended in the instructions or have any signs of systemic exposure.
    13. Those who have took soft drugs (such as marijuana) within 3 months before signing the informed consent form or took hard drugs (such as: cocaine, phencyclidine, etc.) within 1 year before the trial.
    14. Those who smoked more than 5 cigarettes per day within 3 months before signing the informed consent form.
    15. The weekly drinking volume is greater than 14 units within 3 months before signing the informed consent form (1 unit alcohol approximately equal to 360 mL beer or 45 mL spirits with 40% alcohol content or 150 mL wine).
    16. The comprehensive physical examination does not meet the health standards, mainly including: (1) Those with abnormal vital signs with clinical significance. (2) BMI<18 kg/m^2 or> 30 kg/m^2. (3) Abnormal laboratory examination with clinical significance. (4) Those who tested positive for human immunodeficiency virus (HIV) antibody, hepatitis B surface antigen, hepatitis B e antigen, hepatitis C virus antibody, or Treponema pallidum antibody (tp-trust).
    17. Participants who have a positive pregnancy test, or are breastfeeding, or plan to become pregnant, or plan to donate sperm or eggs from the screening to 12 months after the second vaccination.
    18. Positive in drug abuse screening during the screening period (Morphine, Methamphetamine, Ketamine, MDMA and Tetrahydrocannabinolic acid).
    19. Positive in alcohol breath test during the screening period.
    20. Positive in SARS-CoV-2 nucleic acid screening or antibodies (IgG or IgM) screening.
    21. History of severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS) or other coronavirus infection (HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1).
    22. History of contact with confirmed or suspected cases infected with SARS-CoV-2 within 1 month.
    23. Any other situations judged by investigators as not suitable for participating in this study.
  • Phase IIa:

    1. Contraindications for vaccination.
    2. History of allergy to vaccines or drugs.
    3. Immunization with any vaccine within 1 month.
    4. History of abnormal clinical manifestations and serious diseases to be excluded, including but not limited to nervous system, cardiovascular system, blood and lymphatic system, immune system, kidney, liver, gastrointestinal tract, respiratory system, metabolism, bones and other system diseases, and a history of malignant tumors.
    5. Those who developed acute disease within 2 weeks, or had symptoms of fever or upper respiratory tract infection within 7 days.
    6. Those who have a hereditary bleeding tendency or coagulation dysfunction, or a history of thrombosis or bleeding disorders.
    7. Surgical removal of spleen or other important organs for any reason.
    8. Those who have undergone surgery within 3 months before signing the informed consent, or those who plan to perform surgery during the trial or within 3 months after the end of the trial (including cosmetic surgery, dental and oral surgery).
    9. Those who donated or lost blood (≥400 mL) in the past 3 months, who received blood transfusion or use of blood products, or who planned blood donation during the trial.
    10. Receipt of other investigational or unregistered products (drugs, vaccines, biological product or devices) in the past 3 months, or plan to use other investigational or unregistered products during the study.
    11. Receipt of immunosuppressive therapy within 6 months before signing the informed consent form, such as long-term systemic glucocorticoid therapy (with systemic glucocorticoid therapy for more than 2 weeks within 6 months, such as prednisone or similar drugs) ), but local administration (such as ointment, eye drops, inhalation, or nasal spray) is allowed. The local administration should not exceed the dosage recommended in the instructions or have any signs of systemic exposure.
    12. The comprehensive physical examination does not meet the health standards, mainly including: (1) Those with abnormal vital signs (Pulse <55 beats per minute or> 100 beats per minute at rest, Systolic blood pressure ≥140mmHg or Diastolic blood pressure ≥90mmHg, breathing> 20 beats per minute or <12 beats per minute). (2) Those who tested positive for human immunodeficiency virus (HIV) antibody, hepatitis B surface antigen, hepatitis B e antigen, hepatitis C virus antibody, or Treponema pallidum antibody (tp-trust).
    13. Participants who have a positive pregnancy test, or are breastfeeding, or plan to become pregnant, or plan to donate sperm or eggs from the screening to 12 months after the second vaccination.
    14. Positive in SARS-CoV-2 nucleic acid screening or antibodies (IgG or IgM) screening.
    15. History of severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS) or other coronavirus infection (HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1).
    16. History of contact with confirmed or suspected cases infected with SARS-CoV-2 within 1 month.
    17. Any other situations judged by investigators as not suitable for participating in this study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04412538


Contacts
Layout table for location contacts
Contact: Qihan Li, PhD 86-0871-68335905 liqihan@imbcams.com
Contact: Yanchun Che, Researcher 86-0871-68335905 cheyanchun@imbcams.com

Locations
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China, Sichuan
West China Second University Hospital, Sichuan University / West China women's and children's Hospital Recruiting
Chengdu, Sichuan, China, 610041
Contact: Qin Yu    86-028-85501952    908929936@qq.com   
Sponsors and Collaborators
Chinese Academy of Medical Sciences
West China Second University Hospital
Yunnan Center for Disease Control and Prevention
Investigators
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Principal Investigator: Qin Yu West China Second University Hospital, Sichuan University
Principal Investigator: Xiaoqiang Liu Yunnan Center for Disease Control and Prevention
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Responsible Party: Qihan Li, Professor, Chinese Academy of Medical Sciences
ClinicalTrials.gov Identifier: NCT04412538    
Other Study ID Numbers: 20200401
First Posted: June 2, 2020    Key Record Dates
Last Update Posted: June 4, 2020
Last Verified: June 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Vaccines
Immunologic Factors
Physiological Effects of Drugs