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BNT162b2 versus mRNA-1273 Third Dose COVID-19 Vaccine in Patients with CKD and Maintenance Dialysis Patients

Kevin Yau1,2,3, Paul Tam4, Christopher T Chan2,3

  • 1Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Clinical Journal of the American Society of Nephrology : CJASN
|October 17, 2023
PubMed
Abstract

Insights

In patients with chronic kidney disease (CKD), a third dose of the Moderna (mRNA-1273) COVID-19 vaccine generated higher SARS-CoV-2 antibody levels compared to the Pfizer-BioNTech (BNT162b2) vaccine over six months.

Area of Science:

  • Immunology
  • Nephrology
  • Vaccinology

Background:

  • Limited randomized controlled trial data exists on the immunogenicity of different coronavirus disease 2019 (COVID-19) mRNA vaccine regimens in patients with chronic kidney disease (CKD).
  • CKD populations may exhibit altered immune responses to vaccination, necessitating specific research.

Purpose of the Study:

  • To compare the immunogenicity of third-dose mRNA-1273 (Moderna) versus BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines in patients with CKD.
  • To evaluate antibody responses and vaccine reactogenicity following a third mRNA COVID-19 vaccine dose in this vulnerable population.

Main Methods:

  • A randomized controlled trial involving 273 participants with CKD (dialysis or non-dialysis) was conducted.
  • Participants received either a 30-µg dose of BNT162b2 or a 100-µg dose of mRNA-1273 as their third COVID-19 vaccine dose.
  • The primary outcome was SARS-CoV-2 IgG-binding antibodies to the receptor-binding domain (anti-RBD), with secondary outcomes including antispike levels, neutralizing antibodies, and reactogenicity over six months.

Main Results:

  • Third-dose mRNA-1273 was associated with significantly higher mean anti-RBD levels compared to BNT162b2 over six months (1871 vs. 1332 BAU/ml).
  • No statistically significant differences were observed in antispike levels or neutralizing antibodies against wild-type, Delta, or Omicron BA.1 variants.
  • COVID-19 infection occurred in 10% of participants, with no significant difference in risk between the vaccine groups.

Conclusions:

  • In patients with CKD, a third dose of mRNA-1273 elicited superior SARS-CoV-2 anti-RBD antibody levels compared to BNT162b2 over a six-month period.
  • Both mRNA vaccines demonstrate potential for boosting immune response in CKD patients, though mRNA-1273 showed a stronger antibody response.

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