Comparative effectiveness of adjuvanted versus high-dose seasonal influenza vaccines for older adults: a systematic review and meta-analysis

Domnich, Alexander; Waure, Chiara de

doi:10.1016/j.ijid.2022.07.048

Cited by 24 publications

(17 citation statements)

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“…This meta-analysis provides evidence for improved outcomes with the mRNA-1273 vaccine compared with the BNT162b2 vaccine in older adults. Similarly, high-dose and adjuvanted influenza vaccines have demonstrated improved outcomes over standard dose influenza vaccines in older adults [ 21 , 22 ]; as a result, these vaccines are preferentially recommended for the elderly population in many countries [ 68 , 69 ]. Immunology studies have also reported higher antibody production with the mRNA-1273 vaccine compared with the BNT162b2 vaccine [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Heterogeneity continued to be observed across these sub-analyses. Notably, high heterogeneity has also been noted in meta-analyses of influenza vaccine effectiveness in older adults [ 21 , 69 , 71 ]. Future studies and reviews examining which factors predict when, where, and for whom the vaccines show differential effectiveness would be beneficial to address possible disparities in protection.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Kavikondala,

Haeussler,

Wang

et al. 2024

Infect Dis Ther

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Introduction The mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in phase 3 clinical trials, including among older adults. To inform coronavirus disease 2019 (COVID-19) vaccine selection, this systematic literature review (SLR) and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 in older adults. Methods We systematically searched for relevant studies reporting COVID-19 outcomes with mRNA vaccines in older adults aged ≥ 50 years by first cross-checking relevant published SLRs. Based on the cutoff date from a previous similar SLR, we then searched the WHO COVID-19 Research Database for relevant articles published between April 9, 2022, and June 2, 2023. Outcomes of interest were SARS-CoV-2 infection, symptomatic SARS-CoV-2 infection, severe SARS-CoV-2 infection, COVID-19–related hospitalization, and COVID-19–related death following ≥ 2 vaccine doses. Random effects meta-analysis models were used to pool risk ratios (RRs) across studies. Heterogeneity was evaluated using chi-square testing. Evidence certainty was assessed per GRADE framework. Results Twenty-four non-randomized real-world studies reporting clinical outcomes with mRNA vaccines in individuals aged ≥ 50 years were included in the meta-analysis. Vaccination with mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR 0.72 [95% confidence interval (CI) 0.64‒0.80]), symptomatic SARS-CoV-2 infection (RR 0.72 [95% CI 0.62‒0.83]), severe SARS-CoV-2 infection (RR 0.67 [95% CI 0.57‒0.78]), and COVID-19–related hospitalization (RR 0.65 [95% CI 0.53‒0.79]) but not COVID-19–related death (RR 0.80 [95% CI 0.64‒1.00]) compared with BNT162b2. There was considerable heterogeneity between studies for all outcomes ( I 2 > 75%) except death ( I 2 = 0%). Multiple subgroup and sensitivity analyses excluding specific studies generally demonstrated consistent results. Certainty of evidence across outcomes was rated as low (type 3) or very low (type 4), reflecting the lack of randomized controlled trial data. Conclusion Meta-analysis of 24 observational studies demonstrated significantly lower risk of asymptomatic, symptomatic, and severe infections and hospitalizations with the mRNA-1273 versus BNT162b2 vaccine in older adults aged ≥ 50 years. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-024-00936-z.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Kavikondala,

Haeussler,

Wang

et al. 2024

Infect Dis Ther

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“…Heterogeneity continued to be observed across these sub-analyses. Notably, high heterogeneity has also been noted in meta-analyses of influenza vaccine effectiveness in older adults (21,64,66). Future studies and reviews examining which factors predict when, where, and for whom the vaccines show differential effectiveness Page 23 of 57 would be beneficial to address possible disparities in protection.…”

Section: Discussionmentioning

confidence: 99%

“…This meta-analysis provides evidence for improved outcomes with the mRNA-1273 vaccine compared with the BNT162b2 vaccine in older adults. Similarly, high-dose and adjuvanted influenza vaccines have demonstrated improved outcomes over standard dose influenza vaccines in older adults (21, 22), and, as a result, these vaccines are preferentially recommended for the elderly population in many countries (63, 64). Immunology studies have also reported higher antibody production with the mRNA-1273 vaccine compared with the BNT162b2 vaccine (19).…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Kavikondala,

Haeussler,

Wang

et al. 2023

Preprint

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BackgroundThe mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against SARS-CoV-2 infection in phase 3 clinical trials, including among older adults. To inform COVID-19 vaccine selection, this systematic literature review (SLR) and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 in older adults.MethodsWe systematically searched for relevant studies reporting COVID-19 outcomes with mRNA vaccines in older adults aged ≥50 years by first cross-checking relevant published SLRs. Based on the cutoff date from a previous similar SLR, we then searched the WHO COVID-19 Research Database for relevant articles published between April 9, 2022 and June 2, 2023. Outcomes of interest were SARS-CoV-2 infection, symptomatic SARS-CoV-2 infection, severe SARS-CoV-2 infection, COVID-19‒related hospitalization, and COVID-19‒related death following ≥2 vaccine doses. Random-effects meta-analysis models were used to pool risk ratios (RRs) across studies. Heterogeneity was evaluated using chi-squared testing. Evidence certainty was assessed per GRADE framework.Results24 non-randomized real-world studies reporting clinical outcomes with mRNA vaccines in individuals aged ≥50 years were included in the meta-analysis. Vaccination with mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR 0.72 [95% confidence interval (CI) 0.64‒0.80]), symptomatic SARS-CoV-2 infection (RR 0.72 [95% CI 0.62‒0.83]), severe SARS-CoV-2 infection (RR 0.67 [95% CI 0.57‒0.78]), COVID-19‒related hospitalization (RR 0.65 [95% CI 0.53‒0.79]) and COVID-19‒related death (RR 0.80 [95% CI 0.64‒0.99]) compared with BNT162b2. There was considerable heterogeneity between studies for all outcomes (I2>75%) except death (I2=0%). Multiple subgroup and sensitivity analyses excluding specific studies generally demonstrated consistent results. Certainty of evidence across outcomes was rated as low (type 3) or very low (type 4), reflecting the lack of randomized-controlled trial data.ConclusionMeta-analysis of 24 observational studies demonstrated significantly lower risk of asymptomatic, symptomatic, and severe infections; hospitalizations; and deaths with the mRNA-1273 versus BNT162b2 vaccine in older adults aged ≥50 years.SUMMARY POINTSThe COVID-19 pandemic has disproportionately affected older adults, as this population is generally more susceptible to infection and severe outcomes due to immune senescence and underlying comorbidities.The 2 available mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against SARS-CoV-2 infection in phase 3 clinical trials, including among older adults.To inform COVID-19 vaccine selection, this systematic literature review and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 among older adults in real-world settings.Vaccination with homologous primary or booster mRNA-1273 was associated with significantly lower risk of infection (including asymptomatic, symptomatic, and severe infections), hospitalization, and death due to COVID-19 than vaccination with BNT162b2 in older adults aged ≥50 years.

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“…Entrambi i vaccini hanno mostrato un significativo miglioramento dell'efficacia, rispetto al vaccino quadrivalente standard, sia in termini di riduzione del numero di casi di influenza confermata in laboratorio, sia in termini di riduzione delle ospedalizzazioni, delle visite mediche e degli accessi in pronto soccorso [20][21][22], mentre non sembrerebbero esserci differenze significative di efficacia sul campo (effectiveness) tra i due vaccini, come mostrato nella recente revisione sistematica e meta-analisi di Domnich e colleghi in cui sono stati inclusi e analizzati solo studi di confronto diretto tra QIV-HD e aQIV [23]. Il Piano Nazionale Prevenzione Vaccinale (2017-2019) italiano non fa riferimento a specifiche caratteristiche di ciascun vaccino e si limita a raccomandare il raggiungimento della massima protezione possibile [24].…”

Section: Introduzioneunclassified

[Budget Impact Analysis of the Adjuvanted Quadrivalent Influenza Vaccine in the Elderly in Italy]

Baldo¹,

Bellone²

2022

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BACKGROUND: Vaccination is the most effective way to prevent influenza and its complications. The MF59-adjuvanted quadrivalent (aQIV) and the high-dose quadrivalent (QIV-HD) influenza vaccines have been specifically developed to protect subjects aged ≥65 years. The aim of this study was to evaluate the economic consequences associated with the use of aQIV in the elderly population in Italy.METHODS: An Excel-based budget impact model was developed to estimate the costs of aQIV for the prevention of influenza and its complications in elderly subjects, from the perspective of the Italian National Health Service. In the base-case analysis a current scenario (with aQIV) was compared with a past scenario (without aQIV), in which only the standard quadrivalent influenza vaccine (QIV-STD) was available. In the scenario analysis, a current scenario was compared with a future (hypothetical) scenario, in which the market share of aQIV grows. Efficacy (or effectiveness) data of vaccines, in terms of reduction of influenza-related deaths and hospitalizations for influenza/pneumonia, respiratory, and cardiac complications, were obtained from the scientific literature. Relative effectiveness of aQIV and QIV-HD vs. QIV-STD in preventing laboratory-confirmed influenza cases came from two meta-analysis of real-world studies. Epidemiological data and unit costs are collected from Italian published sources.RESULTS: In the base-case analysis the introduction of aQIV e QIV-STD was associated with a reduction of influenza and influenza-like illness – ILI (-93,171) cases, hospitalization for influenza, respiratory and cardiovascular complications (-6,823), and deaths (-1,841) and a consequent saving of € 1.9 million and € 24 million related to events and hospital admissions avoided, respectively. In the scenario analysis, the growth of the market shares of aQIV was associated with 13,602 fewer cases of influenza and ILI, 996 fewer hospitalizations, and an overall saving equal to € 3.8 million.CONCLUSIONS: aQIV reduces the number of cases of influenza and ILI, hospitalizations for influenza and respiratory or cardiac complications, and deaths in the Italian population aged ≥65 years.

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Comparative effectiveness of adjuvanted versus high-dose seasonal influenza vaccines for older adults: a systematic review and meta-analysis

Cited by 24 publications

References 40 publications

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

[Budget Impact Analysis of the Adjuvanted Quadrivalent Influenza Vaccine in the Elderly in Italy]

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