Relative Effectiveness of BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines and Homologous Boosting in Preventing COVID-19 in Adults in the US
Văn Hùng Nguyễn, Cathérine Boileau, Alina Bogdanov, Meg Sredl, Mac Bonafede, Thiérry Ducruet, Scott Chavers, Andrew Rosen, David Martin, Philip O. Buck, Daina B. Esposito, Nicolas Van de Velde, James A. Mansi
Abstract
Abstract Background Few head-to-head comparisons have been performed on the real-world effectiveness of coronavirus disease 2019 (COVID-19) booster vaccines. We evaluated the relative effectiveness (rVE) of a primary series of mRNA-1273 vs BNT162b2 and Ad26.COV2.S and a homologous mRNA booster against any medically attended, outpatient, and hospitalized COVID-19. Methods A data set linking primary care electronic medical records with medical claims data was used for this retrospective cohort study of US patients age ≥18 years vaccinated with a primary series between February and October 2021 (Part 1) and a homologous mRNA booster between October 2021 and January 2022 (Part 2). Adjusted hazard ratios (HRs) were derived from 1:1 matching adjusted across potential covariates. rVE was (1 – HRadjusted) × 100. Additional analysis was performed across regions and age groups. Results Following adjustment, Part 1 rVE for mRNA-1273 vs BNT162b2 was 23% (95% CI, 22%–25%), 23% (95% CI, 22%–25%), and 19% (95% CI, 14%–24%), while the rVE for mRNA-1273 vs Ad26.COV2.S was 50% (95% CI, 48%–51%), 50% (95% CI, 48%–52%), and 57% (95% CI, 53%–61%) against any medically attended, outpatient, and hospitalized COVID-19, respectively. The adjusted rVE in Part 2 for mRNA-1273 vs BNT162b2 was 14% (95% CI, 10%–18%), 13% (95% CI, 8%–17%), and 19% (95% CI, 1%–34%) against any medically attended, outpatient, and hospitalized COVID-19, respectively. rVE against medically attended COVID-19 was higher in adults age ≥65 years (35%; 95% CI, 24%–47%) than in those age 18–64 years (13%; 95% CI, 9%–17%) after the booster. Conclusions In this study, mRNA-1273 was more effective than BNT162b2 or Ad26.COV2.S following a primary series during the Delta-dominant period and more effective than BNT162b2 as a booster during the Omicron-dominant period.