Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Adults with Underlying Medical Conditions: Systematic Literature Review and Pairwise Meta-Analysis Using GRADE

IF 3.4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Therapy Pub Date : 2025-03-10 DOI:10.1007/s12325-025-03117-7

Xuan Wang, Ankit Pahwa, Mary T. Bausch-Jurken, Anushri Chitkara, Pawana Sharma, Mia Malmenäs, Sonam Vats, Michael Gordon Whitfield, Kira Zhi Hua Lai, Priyadarsini Dasari, Ritu Gupta, Maria Nassim, Nicolas Van de Velde, Nathan Green, Ekkehard Beck

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Abstract

Introduction

This systematic literature review and pairwise meta-analysis evaluated the comparative effectiveness of mRNA-1273 versus BNT162b2 in patients with at least one underlying medical condition at high risk for severe COVID-19.

Methods

MEDLINE, Embase, and Cochrane databases were searched for relevant articles from January 1, 2019 to February 9, 2024. Studies reporting effectiveness data from at least two doses of mRNA-1273 and BNT162b2 vaccination in adults with medical conditions at high risk of developing severe COVID-19 according to the US Centers for Disease Control and Prevention were included. Outcomes of interest were SARS-CoV-2 infection (overall, symptomatic, and severe), hospitalization due to COVID-19, and death due to COVID-19. Risk ratios (RRs) were calculated with random effects models. Subgroup analyses by specific medical conditions, number of vaccinations, age, and SARS-CoV-2 variant were conducted. Heterogeneity between studies was estimated with chi-square testing. The certainty of evidence was assessed using the Grading of Recommendations, Assessments, Development, and Evaluations framework.

Results

Sixty-five observational studies capturing the original/ancestral-containing primary series to Omicron-containing bivalent original-BA4-5 vaccinations were included in the meta-analysis. mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR, 0.85 [95% CI, 0.79–0.92]; I² = 92.5%), symptomatic SARS-CoV-2 infection (RR, 0.75 [95% CI, 0.65–0.86]; I² = 62.3%), severe SARS-CoV-2 infection (RR, 0.83 [95% CI, 0.78–0.89]; I² = 38.0%), hospitalization due to COVID-19 (RR, 0.88 [95% CI, 0.82–0.94]; I² = 38.7%), and death due to COVID-19 (RR, 0.84 [95% CI, 0.76–0.93]; I² = 1.3%) than BNT162b2. Findings were generally consistent across subgroups. Evidence certainty was low or very low because sufficiently powered randomized controlled trials are impractical in this heterogeneous population.

Conclusion

Meta-analysis of 65 observational studies showed that vaccination with mRNA-1273 was associated with a significantly lower risk of SARS-CoV-2 infection and COVID-19-related hospitalization and death than BNT162b2 in patients with medical conditions at high risk of severe COVID-19.

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mRNA-1273和BNT162b2 COVID-19疫苗在有潜在疾病的成人中的比较效果：系统文献综述和使用GRADE的两两荟萃分析

本系统文献综述和两两荟萃分析评估了mRNA-1273与BNT162b2在至少有一种潜在疾病的严重COVID-19高风险患者中的比较疗效。方法：检索MEDLINE、Embase和Cochrane数据库2019年1月1日至2024年2月9日的相关文章。根据美国疾病控制和预防中心的数据，研究报告了至少两剂mRNA-1273和BNT162b2疫苗接种对患有严重COVID-19高风险医疗条件的成年人的有效性数据。关注的结局是SARS-CoV-2感染（总体、有症状和严重）、因COVID-19住院和因COVID-19死亡。采用随机效应模型计算风险比（rr）。按特定医疗条件、疫苗接种次数、年龄和SARS-CoV-2变体进行亚组分析。用卡方检验估计研究间的异质性。使用建议、评估、发展和评估框架的分级来评估证据的确定性。结果：荟萃分析纳入了65项观察性研究，这些研究捕获了原始/含有祖先的原始系列到含有omicron的二价原始ba4 -5疫苗。mRNA-1273与SARS-CoV-2感染风险显著降低相关(RR, 0.85 [95% CI, 0.79-0.92]；I2 = 92.5%)，有症状的SARS-CoV-2感染(RR, 0.75 [95% CI, 0.65 ~ 0.86]；I2 = 62.3%)，严重SARS-CoV-2感染(RR, 0.83 [95% CI, 0.78-0.89]；I2 = 38.0%)，因COVID-19住院(RR, 0.88 [95% CI, 0.82-0.94]；I2 = 38.7%)和COVID-19导致的死亡(RR, 0.84 [95% CI, 0.76-0.93]；I2 = 1.3%)比BNT162b2。各亚组的研究结果基本一致。证据确定性低或非常低，因为在这种异质人群中进行足够有力的随机对照试验是不切实际的。结论：65项观察性研究的荟萃分析显示，与BNT162b2相比，接种mRNA-1273与严重COVID-19高风险医疗条件患者的SARS-CoV-2感染和COVID-19相关住院和死亡风险显著降低相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.