Immunogenicity and reactogenicity of heterologous immunization schedules with COVID-19 vaccines: a systematic review and network meta-analysis.
10.1097/CM9.0000000000002567
- VernacularTitle:Immunogenicity and reactogenicity of heterologous immunization schedules with COVID-19 vaccines: a systematic review and network meta-analysis
- Author:
Pei LI
1
;
Weiwei WANG
1
;
Yiming TAO
1
;
Xiaoyu TAN
1
;
Yujing LI
2
;
Yinjun MAO
3
;
Le GAO
4
;
Lei FENG
5
;
Siyan ZHAN
1
;
Feng SUN
1
Author Information
1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
2. Peking University Aerospace School of Clinical Medicine, Beijing 100049, China.
3. Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China.
4. Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
5. National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
- Publication Type:Journal Article
- MeSH:
Adult;
Humans;
BNT162 Vaccine;
2019-nCoV Vaccine mRNA-1273;
Network Meta-Analysis;
Immunization Schedule;
COVID-19/prevention & control*;
COVID-19 Vaccines/adverse effects*;
Viral Vaccines;
mRNA Vaccines;
Antibodies, Neutralizing;
Antibodies, Viral
- From:
Chinese Medical Journal
2023;136(1):24-33
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Data on the immunogenicity and safety of heterologous immunization schedules are inconsistent. This study aimed to evaluate the immunogenicity and safety of homologous and heterologous immunization schedules.
METHODS:Multiple databases with relevant studies were searched with an end date of October 31, 2021, and a website including a series of Coronavirus disease 2019 studies was examined for studies before March 31, 2022. Randomized controlled trials (RCTs) that compared different heterologous and homologous regimens among adults that reported immunogenicity and safety outcomes were reviewed. Primary outcomes included neutralizing antibodies against the original strain and serious adverse events (SAEs). A network meta-analysis (NMA) was conducted using a random-effects model.
RESULTS:In all, 11 RCTs were included in the systematic review, and nine were ultimately included in the NMA. Among participants who received two doses of CoronaVac, another dose of mRNA or a non-replicating viral vector vaccine resulted in a significantly higher level of neutralizing antibody than a third CoronaVac 600 sino unit (SU); a dose of BNT162b2 induced the highest geometric mean ratio (GMR) of 15.24, 95% confidence interval [CI]: 9.53-24.39. Following one dose of BNT162b2 vaccination, a dose of mRNA-1273 generated a significantly higher level of neutralizing antibody than BNT162b2 alone (GMR = 1.32; 95% CI: 1.06-1.64), NVX-CoV2373 (GMR = 1.60; 95% CI: 1.16-2.21), or ChAdOx1 (GMR = 1.80; 95% CI: 1.25-2.59). Following one dose of ChAdOx1, a dose of mRNA-1273 was also more effective for improving antibody levels than ChAdOx1 (GMR = 11.09; 95% CI: 8.36-14.71) or NVX-CoV2373 (GMR = 2.87; 95% CI: 1.08-3.91). No significant difference in the risk for SAEs was found in any comparisons.
CONCLUSIONS:Relative to vaccination with two doses of CoronaVac, a dose of BNT162b2 as a booster substantially enhances immunogenicity reactions and has a relatively acceptable risk for SAEs relative to other vaccines. For primary vaccination, schedules including mRNA vaccines induce a greater immune response. However, the comparatively higher risk for local and systemic adverse events introduced by mRNA vaccines should be noted.
REGISTRATION:PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; No. CRD42021278149.
