Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
Department of Rheumatology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA.
Ann Rheum Dis. 2022 Jun;81(6):875-880. doi: 10.1136/annrheumdis-2021-222045. Epub 2022 Feb 23.
We intended to assess the effectiveness of all three US Food and Drug Administration approved COVID-19 vaccines at preventing SARS-CoV-2 infection and COVID-19 hospitalisation in a large cohort of individuals on immunosuppressants for a diverse range of conditions.
We studied the effectiveness of BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna) and Ad26.COV2.S (Johnson & Johnson-Janssen) vaccines among individuals who take immunosuppressants (including disease-modifying antirheumatic drugs and glucocorticoids) by comparing vaccinated (n=97688) and unvaccinated (n=42094) individuals in the Michigan Medicine healthcare system from 1 January to 7 December 2021, using Cox proportional hazards modelling with time-varying covariates.
Among vaccinated and unvaccinated individuals, taking immunosuppressants increased the risk of SARS-CoV-2 infection (adjusted HR (aHR)=2.17, 95% CI 1.69 to 2.79 for fully vaccinated and aHR=1.40, 95% CI 1.07 to 1.83 for unvaccinated). Among individuals taking immunosuppressants, we found: (1) vaccination reduced the risk of SARS-CoV-2 infection (aHR=0.55, 95% CI 0.39 to 0.78); (2) the BNT162b2 and mRNA-1273 vaccines were highly effective at reducing the risk of SARS-CoV-2 infection (n=2046, aHR=0.59, 95% CI 0.38 to 0.91 for BNT162b2; n=2064, aHR=0.52, 95% CI 0.33 to 0.82 for mRNA-1273); (3) with a smaller sample size (n=173), Ad26.COV2.S vaccine protection did not reach statistical significance (aHR=0.34, 95% CI 0.09 to 1.30, p=0.17); and (4) receiving a booster dose reduced the risk of SARS-CoV-2 infection (aHR=0.42, 95% CI 0.24 to 0.76).
The mRNA-1273 and BNT162b2 vaccines are effective in individuals who take immunosuppressants. However, individuals who are vaccinated but on immunosuppressants are still at higher risk of SARS-CoV-2 infection and COVID-19 hospitalisation than the broader vaccinated population. Booster doses are effective and crucially important for individuals on immunosuppressants.
我们旨在评估所有三种经美国食品和药物管理局批准的 COVID-19 疫苗在预防 SARS-CoV-2 感染和 COVID-19 住院方面的有效性，这些疫苗适用于接受各种不同疾病条件下免疫抑制剂治疗的大量人群。
我们通过比较密歇根医疗系统中接种疫苗（n=97688）和未接种疫苗（n=42094）的个体，评估了 BNT162b2（辉瑞-生物技术公司）、mRNA-1273（莫德纳）和 Ad26.COV2.S（强生-杨森）疫苗在接受免疫抑制剂（包括疾病修正抗风湿药物和糖皮质激素）治疗的个体中的有效性。我们从 2021 年 1 月 1 日至 12 月 7 日，采用时间变化协变量的 Cox 比例风险模型，对接受免疫抑制剂治疗的个体进行了研究。
在接种疫苗和未接种疫苗的个体中，接受免疫抑制剂治疗会增加 SARS-CoV-2 感染的风险（完全接种疫苗的调整后的 HR（aHR）=2.17，95%CI 1.69 至 2.79；未接种疫苗的 aHR=1.40，95%CI 1.07 至 1.83）。在接受免疫抑制剂治疗的个体中，我们发现：（1）疫苗接种降低了 SARS-CoV-2 感染的风险（aHR=0.55，95%CI 0.39 至 0.78）；（2）BNT162b2 和 mRNA-1273 疫苗在降低 SARS-CoV-2 感染风险方面非常有效（n=2046，aHR=0.59，95%CI 0.38 至 0.91 用于 BNT162b2；n=2064，aHR=0.52，95%CI 0.33 至 0.82 用于 mRNA-1273）；（3）Ad26.COV2.S 疫苗的保护作用样本量较小（n=173），未达到统计学意义（aHR=0.34，95%CI 0.09 至 1.30，p=0.17）；（4）接受加强剂量可降低 SARS-CoV-2 感染的风险（aHR=0.42，95%CI 0.24 至 0.76）。
mRNA-1273 和 BNT162b2 疫苗在接受免疫抑制剂治疗的个体中有效。然而，与更广泛的接种人群相比，接受疫苗接种但仍接受免疫抑制剂治疗的个体感染 SARS-CoV-2 和 COVID-19 住院的风险仍然较高。加强剂量对接受免疫抑制剂治疗的个体有效且至关重要。
