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Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Adults with Underlying Medical
Xuan Wang1, Ankit Pahwa2, Mary T Bausch-Jurken3
1ICON plc, Stockholm, Sweden.
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.
Insights
mRNA-1273 vaccination demonstrated a lower risk of SARS-CoV-2 infection, hospitalization, and death compared to BNT162b2 in high-risk individuals. This finding is crucial for vulnerable populations during the COVID-19 pandemic.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- High-risk individuals with underlying medical conditions face increased risk of severe COVID-19.
- Comparative effectiveness of mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech) vaccines is critical for this population.
- Systematic review and meta-analysis provide robust evidence for vaccine efficacy.
Purpose of the Study:
- To compare the effectiveness of mRNA-1273 and BNT162b2 vaccines.
- To evaluate outcomes including SARS-CoV-2 infection, hospitalization, and death.
- To focus on adult patients with high-risk medical conditions for severe COVID-19.
Main Methods:
- Systematic literature review and pairwise meta-analysis of observational studies.
- Searched MEDLINE, Embase, and Cochrane databases (Jan 2019-Feb 2024).
- Included studies with at least two vaccine doses in high-risk adults; analyzed SARS-CoV-2 infection, hospitalization, and death rates.
Main Results:
- mRNA-1273 showed significantly lower risks of overall, symptomatic, and severe SARS-CoV-2 infection compared to BNT162b2.
- Vaccination with mRNA-1273 was associated with reduced risk of COVID-19 hospitalization and death.
- Findings were consistent across subgroups, though evidence certainty was low to very low.
Conclusions:
- mRNA-1273 vaccination offers superior protection against SARS-CoV-2 infection, hospitalization, and death in high-risk individuals compared to BNT162b2.
- The study highlights the importance of vaccine choice for vulnerable populations.
- Further research with randomized controlled trials is needed to confirm findings due to limitations in observational data.
