期刊论文详细信息
Frontiers in Immunology
Comparative effectiveness of mRNA-1273 and BNT162b2 COVID-19 vaccines in immunocompromised individuals: a systematic review and meta-analysis using the GRADE framework
Immunology
Anne Spellman1  Leslie E. Phillips2  Allison Ramiller2  Sonam Vats3  Pawana Sharma4  Anna Krivelyova4  Katrin Haeussler5  Xuan Wang6  Mary T. Bausch-Jurken7  Nicolas Van de Velde7 
[1] Data Health Ltd, London, United Kingdom;Data-Driven LLC, Seattle, WA, United States;ICON plc, Bengaluru, India;ICON plc, London, United Kingdom;ICON plc, Munich, Germany;ICON plc, Stockholm, Sweden;Moderna, Inc., Cambridge, MA, United States;
关键词: severe acute respiratory syndrome coronavirus 2;    SARS-CoV-2;    COVID-19;    mRNA vaccine;    mRNA-1273;    BNT162b2;    immunocompromised;    effectiveness;   
DOI  :  10.3389/fimmu.2023.1204831
 received in 2023-04-12, accepted in 2023-08-16,  发布年份 2023
来源: Frontiers
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【 摘 要 】

IntroductionDespite representing only 3% of the US population, immunocompromised (IC) individuals account for nearly half of the COVID-19 breakthrough hospitalizations. IC individuals generate a lower immune response after vaccination in general, and the US CDC recommended a third dose of either mRNA-1273 or BNT162b2 COVID-19 vaccines as part of their primary series. Influenza vaccine trials have shown that increasing dosage could improve effectiveness in IC populations. The objective of this systematic literature review and pairwise meta-analysis was to evaluate the clinical effectiveness of mRNA-1273 (50 or 100 mcg/dose) vs BNT162b2 (30 mcg/dose) in IC populations using the GRADE framework.MethodsThe systematic literature search was conducted in the World Health Organization COVID-19 Research Database. Studies were included in the pairwise meta-analysis if they reported comparisons of mRNA-1273 and BNT162b2 in IC individuals ≥18 years of age; outcomes of interest were symptomatic, laboratory-confirmed SARS-CoV-2 infection, SARS-CoV-2 infection, severe SARS-CoV-2 infection, hospitalization due to COVID-19, and mortality due to COVID-19. Risk ratios (RR) were pooled across studies using random-effects meta-analysis models. Outcomes were also analyzed in subgroups of patients with cancer, autoimmune disease, and solid organ transplant. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies. Evidence was evaluated using the GRADE framework.ResultsOverall, 17 studies were included in the pairwise meta-analysis. Compared with BNT162b2, mRNA-1273 was associated with significantly reduced risk of SARS-CoV-2 infection (RR, 0.85 [95% CI, 0.75–0.97]; P=0.0151; I2 = 67.7%), severe SARS-CoV-2 infection (RR, 0.85 [95% CI, 0.77–0.93]; P=0.0009; I2 = 0%), COVID-19–associated hospitalization (RR, 0.88 [95% CI, 0.79–0.97]; P<0.0001; I2 = 0%), and COVID-19–associated mortality (RR, 0.63 [95% CI, 0.44–0.90]; P=0.0119; I2 = 0%) in IC populations. Results were consistent across subgroups. Because of sample size limitations, relative effectiveness of COVID-19 mRNA vaccines in IC populations cannot be studied in randomized trials. Based on nonrandomized studies, evidence certainty among comparisons was type 3 (low) and 4 (very low), reflecting potential biases in observational studies.ConclusionThis GRADE meta-analysis based on a large number of consistent observational studies showed that the mRNA-1273 COVID-19 vaccine is associated with improved clinical effectiveness in IC populations compared with BNT162b2.

【 授权许可】

Unknown   
Copyright © 2023 Wang, Haeussler, Spellman, Phillips, Ramiller, Bausch-Jurken, Sharma, Krivelyova, Vats and Van de Velde

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