Song Chin Vern, Ahmad Bustamam Ros Suzanna, Gin Gin Gan, Saad Marniza, Abdul Satar Nur Fadhlina, Ramasamy Alagu Manthiram, Sam I-Ching, Kong Yek-Ching, Alagir Rajah Harenthri Devy, Chan Yoke Fun, Fu Jolene Yin Ling, Tan Cheng Siang, Danaee Mahmoud, Yip Cheng Har, Van Gils Carla H, Bhoo-Pathy Nirmala
Julius Center, UMC (University Medical Center) Utrecht, Utrecht, NLD.
Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Kuala Lumpur, MYS.
Cureus. 2024 Nov 12;16(11):e73528. doi: 10.7759/cureus.73528. eCollection 2024 Nov.
There is a lack of real-world evidence on direct comparisons between COVID-19 vaccines in multiethnic low- and middle-income settings. Cancer patients have an impaired vaccine response due to the disease itself or the effects of treatment. Hence, identifying the best vaccine to use for cancer patients is important. We aimed to compare the antibody response between cancer patients and healthy individuals following COVID-19 vaccination and assess seroconversion rates, vaccine efficacy, and the impact of sex on antibody response, as well as document adverse events in cancer patients.
A prospective cohort study of cancer patients and healthy individuals receiving vaccines was conducted in Malaysia. All participants were aged 18 or above at recruitment and received at least two doses of vaccine. We excluded patients who had missing serum antibody data post-first dose and post-second dose. Sociodemographic and clinical data were collected at baseline, prior to vaccination. Data on self-reported breakthrough infection was collected at six months. Multivariable linear mixed-effects regression models were used to investigate the association between the type of vaccine and serum IgG titer.
A total of 389 patients with solid (n=276, 71.0%) or hematologic cancers (n=113, 29.0%) were included, along with 246 healthy individuals. Most cancer patients received BNT162b2 (n=358, 92.0%), followed by AZ1222 (n=19, 4.9%) and Coronavac (n=12, 3.1%). Most healthy individuals received BNT162b2 (n=151, 61.4%), followed by Coronavac (n=95, 38.6%). Vaccination, after adjustment for confounders (pre-vaccine infection, age, ethnicity, comorbidity, timepoint, income, cancer type, and booster), with Coronavac was associated with lower log IgG titer (-3.09 U/ml, 95% confidence interval=-4.37 to -1.80, p<0.01) than that of BNT162b2 in patients with cancer and also lower log IgG titer (-2.64 U/ml, 95% confidence interval=-2.97 to -2.30, p<0.01) than that of BNT162b2 in healthy individuals. No effect modification by sex was observed. Among the cancer cohort, 76 patients (19.5%) reported breakthrough infections after vaccination, while 33 (13.4%) participants in the healthy cohort reported breakthrough infections after vaccination. Coronavac was associated with greater odds of breakthrough infection among healthy individuals (odds ratio=7.34 compared to BNT162b2, confidence interval=1.40 to 33.49, p=0.02).
Vaccination with BNT162b2 yields higher IgG titer than Coronavac in all groups and fewer breakthrough infections in healthy subjects. The effect of vaccination is not modified by sex.
在多民族低收入和中等收入环境中，缺乏关于新冠病毒疫苗之间直接比较的真实世界证据。癌症患者由于疾病本身或治疗影响，疫苗反应受损。因此，确定最适合癌症患者使用的疫苗很重要。我们旨在比较癌症患者和健康个体在接种新冠病毒疫苗后的抗体反应，评估血清转化率、疫苗效力以及性别对抗体反应的影响，并记录癌症患者的不良事件。
在马来西亚对接受疫苗接种的癌症患者和健康个体进行了一项前瞻性队列研究。所有参与者在招募时年龄均在18岁及以上，并接受了至少两剂疫苗。我们排除了在第一剂和第二剂疫苗接种后血清抗体数据缺失的患者。在接种疫苗前的基线时收集社会人口统计学和临床数据。在六个月时收集自我报告的突破性感染数据。使用多变量线性混合效应回归模型研究疫苗类型与血清IgG滴度之间的关联。
共纳入389例实体癌（n = 276，71.0%）或血液系统癌症（n = 113，29.0%）患者以及246名健康个体。大多数癌症患者接种BNT162b2（n = 358，92.0%），其次是AZ1222（n = 19，4.9%）和科兴疫苗（Coronavac，n = 12，3.1%）。大多数健康个体接种BNT162b2（n = 151，61.4%），其次是科兴疫苗（n = 95，38.6%）。在对混杂因素（疫苗接种前感染、年龄、种族、合并症、时间点、收入、癌症类型和加强针）进行调整后，癌症患者中接种科兴疫苗与BNT162b2相比，log IgG滴度较低（-3.09 U/ml，95%置信区间=-4.37至-1.80，p<0.01），健康个体中接种科兴疫苗与BNT162b2相比，log IgG滴度也较低（-2.64 U/ml, 95%置信区间=-2.97至-2.30，p<0.01）。未观察到性别对结果的影响。在癌症队列中，76例患者（19.5%）报告接种疫苗后出现突破性感染，而健康队列中有33例（13.4%）参与者报告接种疫苗后出现突破性感染。在健康个体中，科兴疫苗与更高的突破性感染几率相关（与BNT162b2相比，优势比=7.34，置信区间=1.40至33.49，p = 0.02）。
在所有组中，接种BNT162b2产生的IgG滴度高于科兴疫苗，且在健康受试者中突破性感染较少。疫苗接种效果不受性别的影响。
