Baltimore, MD—The Moderna COVID-19 vaccine appears to be somewhat more effective in protecting specific immunocompromised patients from the SARS-CoV-2 virus.
Both mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccines elicit immune responses consistent with viral neutralization in most immunocompetent persons, according to Johns Hopkins University School of Medicine–led authors, who explained, "Immunosuppressed individuals, such as persons with rheumatic and musculoskeletal diseases (RMDs) and solid organ transplant recipients (SOTRs), have decreased immune responses to these vaccines. Thus, differential vaccine immunogenicity is clinically relevant in ways not seen in immunocompetent persons."
As a result, they conducted a study comparing antispike antibody titers after the two-dose mRNA-1273 and BNT162b2 vaccines in incrementally immunosuppressed patients. Results were published in the Journal of the American Medical Association Network Open.
The focus was on participants receiving two SARS-CoV-2 mRNA doses between December 16, 2020, and July 6, 2021, with the cohort including 1,158 participants with RMDs and 697 with SOTRs. Of those, 647 patients with RMDs (55.8%) and 367 SOTRs (52.7%) received BNT162b2, while the remainder received mRNA-1273.
Results indicated that among the 220 participants with RMDs not receiving immunosuppression, hydroxychloroquine, or IV immunoglobulin, the rate of anti-RBD titers of 250 U/mL or greater was comparable among BNT162b2 (108/118 [91.5%]) and mRNA-1273 (95/102 [93.1%]) recipients (incidence rate ratio [IRR], 1.02; 95% CI, 0.94-1.10; P = .69).
"However, mRNA-1,273 recipients had higher rates of anti-RBD titers of 250 U/mL or greater than BNT162b2 recipients among the 938 patients with RMDs receiving immunosuppression (324/409 [79.2%] vs. 320/529 [60.5%]; IRR, 1.30; 95% CI, 1.20-1.43; P <.001), 260 SOTRs not receiving mycophenolic acid or mycophenolate mofetil (85/128 [66.4%] vs. 59/132 [44.7%]; IRR, 1.56; 95% CI, 1.24-1.96; P <.001), and 437 SOTRs receiving mycophenolic acid or mycophenolate mofetil (23/202 [11.4%] vs. 10/235 [4.3%]; IRR, 2.62; 95% CI, 1.28-5.37; P = .01). Similar trends were observed with the other cutoffs."
The authors pointed out that they observed similar seroresponses to mRNA-1273 and BNT162b2 vaccines in patients not receiving immunosuppression, but those who were receiving immunosuppression "had higher mRNA-1273 vs. BNT162b2 vaccination seroresponses. Differential immunogenicity was highest in the most immunosuppressed participants (SOTRs receiving mycophenolic acid or mycophenolate mofetil), with a 2.6-fold higher rate of achieving anti-RBD titers of 250 U/mL or greater."
"In conclusion, mRNA-1273 was more likely to induce stronger humoral immunogenicity compared with BNT162b2 in immunosuppressed patients; this effect was more pronounced with greater immunosuppression," researchers concluded. "These findings suggest that choice of mRNA vaccine platform is important in optimizing immune responses to SARS-CoV-2 vaccination and can help inform strategies for booster doses in high-risk, immunosuppressed populations."
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