In a recent publication in Frontiers in Immunology, researchers sought to assess the clinical effectiveness of both available mRNA COVID-19 vaccines in immunocompromised (IC) populations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.
The authors wrote, “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.”
The authors indicated that for this present analysis, which adhered to the GRADE framework, their goal was to address the following healthcare question: “Is the mRNA-1273 COVID-19 vaccine (50 or 100 mcg/dose) more clinically effective in IC populations compared with the BNT162b2 COVID-19 vaccine (30 mcg/dose)?”
The researchers performed a systematic literature review and pairwise meta-analysis in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 framework. Studies were incorporated in the pairwise meta-analysis based on the following criteria: if they described comparisons of mRNA-1273 and BNT162b2 in IC individuals who were aged 18 years and older; outcomes of interest were symptomatic; had laboratory-established SARS-CoV-2 infection; SARS-CoV-2 infection; severe SARS-CoV-2 infection; hospitalization due to COVID-19; and mortality as a result of a COVID-19 infection.
This systematic review and pairwise meta-analysis included 17 studies that met established criteria.
The results revealed that compared with BNT162b2, mRNA-1273 was linked with meaningfully decreased risk of SARS-CoV-2 infection (relative risk [RR], 0.85; 95% CI, 0.75-0.97; P = .0151; I2 = 67.7%); severe SARS-CoV-2 infection (RR, 0.85; 95% CI, 0.77-0.93; P = .0009; I2 = 0%); COVID-19-associated hospitalization (RR, 0.88; 95% CI, 0.79-0.97]; P <.0001; I2 = 0%); and COVID-19-associated mortality (RR, 0.63; 95% CI, 0.44-0.90; P = .0119; I2 = 0%) among patients who were IC. The results were consistent across subgroups.
Based on their findings, the authors wrote, “We found that mRNA-1273 was associated with a significantly lower risk of SARS-CoV-2 infection, severe SARS-CoV-2 infection, hospitalization due to COVID-19, and COVID-19–associated mortality compared with BNT162b2 in adults with a broad spectrum of severe IC conditions.”
The authors also indicated that mRNA-1273 was also correlated with a considerably diminished risk of SARS-CoV-2 infection in patients with autoimmune diseases and COVID-19-associated mortality among solid organ–transplant recipients.
The authors also noted that since all included studies were pairwise comparisons between mRNA-1273 and BNT162b2, the research question was not biased by variations in the period evaluated, population, or viral variants within each study.
The authors concluded, “Based on these findings, vaccinating IC individuals in the United States with mRNA-1273 instead of BNT162b2 would prevent an additional 14 and 15 hospitalizations and deaths per 100,000 individuals, respectively. Although the numerical differences in estimated prevented COVID–19–associated hospitalizations and deaths are small, the implications for care are considerable in IC patients, who are at increased risk of severe COVID-19.”
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