Pharmacoepidemiology Research Unit, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O.B. 12272, 9112102, Jerusalem, Israel.
Jerusalem Distric, Clalith Health Services Community Division, Jerusalem, Israel.
Sci Rep. 2021 Nov 23;11(1):22777. doi: 10.1038/s41598-021-02321-z.
New Coronavirus Disease 2019 (COVID-19) vaccines are available to prevent the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We compared the efficacy of new COVID-19 vaccines to prevent symptomatic and severe disease in the adult population and to prevent symptomatic COVID-19 among the elderly. Leading medical databases were searched until August 30, 2021. Published phase 3 randomized controlled trials (RCTs) evaluated efficacy of the vaccine to prevent symptomatic and sever COVID-19 in adults were included. Two reviewers independently evaluated the literature search results and independently extracted summary data. The risk of bias was evaluated using the Cochrane Risk of Bias Assessment Tool. We performed a network meta-analysis (NMA) according to PRISMA-NMA 2015 to pool indirect comparisons between different vaccines regarding their relative efficacy. The primary outcomes were the efficacy of the vaccine against symptomatic COVID-19 in adults (PROSPERO registration number: CRD42021235364). Above 200,000 adult participants from eight phase 3 RCTs were included in NMA, of whom 52% received the intervention (active COVID-19 vaccine). While each of nine vaccines was tested in the unique clinical trial as compared to control, based on indirect comparison, BNT162b2 and mRNA-1273 vaccines were ranked with the highest probability of efficacy against symptomatic COVID-19 (P-scores 0.952 and 0.843, respectively), followed by Gam-COVID-Vac (P-score 0.782), NVX-CoV23730 (P-score 0.700), CoronaVac (P-score 0.570), BN02 (P-score 0.428), WIV04 (P-score 0.327), and Ad26.COV2.S (P-score 0.198). No statistically significant difference was seen in the ability of the vaccines to prevent symptomatic disease in the elderly population. No vaccine was statistically significantly associated with a decreased risk for severe COVID-19 than other vaccines, although mRNA-1273 and Gam-COVID-Vac have the highest P-scores (0.899 and 0.816, respectively), indicating greater protection against severe disease than other vaccines. In our indirect comparison, the BNT162b2 and mRNA-1273 vaccines, which use mRNA technology, were associated with the highest efficacy to prevent symptomatic COVID-19 compared to other vaccines. This finding may have importance when deciding which vaccine to use, together with other important factors as availability of the vaccines, costs, logistics, side effects, and patient acceptability.
新型冠状病毒病 2019（COVID-19）疫苗可用于预防持续的严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）大流行。我们比较了新型 COVID-19 疫苗在成年人群中预防有症状和严重疾病以及预防老年人出现有症状 COVID-19 的功效。截至 2021 年 8 月 30 日，我们检索了主要的医学数据库。纳入了评估疫苗预防成年人有症状和严重 COVID-19 的疗效的已发表的 3 期随机对照试验（RCT）。两名审查员独立评估文献检索结果，并独立提取汇总数据。使用 Cochrane 偏倚风险评估工具评估偏倚风险。我们根据 PRISMA-NMA 2015 进行了网络荟萃分析（NMA），以汇总不同疫苗之间关于相对疗效的间接比较。主要结局是疫苗对成年人有症状 COVID-19 的疗效（PROSPERO 注册号：CRD42021235364）。8 项 3 期 RCT 中的 20 多万名成年参与者纳入了 NMA，其中 52%接受了干预（活性 COVID-19 疫苗）。虽然与对照相比，每种疫苗都在独特的临床试验中进行了测试，但基于间接比较，BNT162b2 和 mRNA-1273 疫苗被认为是预防有症状 COVID-19 的疗效最高的疫苗（P 评分分别为 0.952 和 0.843），其次是 Gam-COVID-Vac（P 评分 0.782）、NVX-CoV23730（P 评分 0.700）、CoronaVac（P 评分 0.570）、BN02（P 评分 0.428）、WIV04（P 评分 0.327）和 Ad26.COV2.S（P 评分 0.198）。疫苗在预防老年人群有症状疾病方面的能力没有统计学上的显著差异。虽然 mRNA-1273 和 Gam-COVID-Vac 的 P 评分最高（分别为 0.899 和 0.816），但与其他疫苗相比，没有一种疫苗在预防严重 COVID-19 方面具有统计学意义的优势，表明它们对严重疾病的保护作用优于其他疫苗。在我们的间接比较中，使用 mRNA 技术的 BNT162b2 和 mRNA-1273 疫苗与其他疫苗相比，预防有症状 COVID-19 的疗效最高。当决定使用哪种疫苗时，这一发现可能与其他重要因素一起具有重要意义，如疫苗的可获得性、成本、后勤、副作用和患者可接受性。
