Comparative Effectiveness of mRNA-based BNT162b2 Vaccine versus Adenovirus Vector–Based Ad26.COV2.S Vaccine for the Prevention of COVID-19 among Dialysis Patients

Abstract

Background Studies have demonstrated that mRNA-based SARS-CoV-2 vaccines are highly effective among dialysis patients. Because individual vaccines may be differentially available or acceptable to patients, it is important to understand comparative effectiveness relative to other vaccines, such those based on adenovirus technologies. Methods In this retrospective study, we compared the clinical effectiveness of adenovirus vector-based Ad26.COV2.S (Janssen/Johnson & Johnson) to mRNA-based BNT162b2 (Pfizer/BioNTech) in a contemporary cohort of dialysis patients. Patients who received a first BNT162b2 dose were matched 1:1 to Ad26.COV2.S recipients based on date of first vaccine receipt, US state of residence, site of dialysis care (in-center versus home), prior history of COVID-19, and propensity score. The primary outcome was the comparative rate of COVID-19 diagnoses starting in the seventh week postvaccination. In a subset of consented Ad26.COV2.S patients, blood samples were collected ≥28 days after vaccination and anti-SARS-Cov-2 immunoglobulin G antibodies were measured Results A total of 2572 matched pairs of patients qualified for analysis. Cumulative incidence rates of COVID-19 did not differ for BNT162b2 versus Ad26.COV2.S. No differences were observed in peri-COVID-19 hospitalizations and deaths among patients receiving BNT162b2 versus Ad26.COV2.S who were diagnosed with COVID-19 during follow-up. Results were similar when excluding patients with prior history of COVID-19, in subgroup analyses restricted to patients who completed the two-dose BNT162b2 regimen, and in patients receiving in-center hemodialysis. SARS-CoV-2 antibodies were detected in 59.4% of 244 patients who received Ad26.COV2.S. Conclusions In a large real-world cohort of dialysis patients, no difference was detected in clinical effectiveness of BNT162b2 and Ad26.COV2.S over the first 6 months postvaccination, despite an inconsistent antibody response to the latter.

Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions

“…Data from a large not-for-profit dialysis centre indicated efficacy against hospitalization or death of 81%, only slightly lower than contemporaneous data for the general population, noting vaccine effectiveness of around 86–87% 49 . Vaccine immunogenicity by vaccine type has been studied closely, and concerns have been raised regarding the lack of immunogenicity of Ad26.COV2.S, although clinical effectiveness of this vaccine may be similar to the mRNA platform vaccines 50 . Furthermore, there was no difference in vaccine response by vaccine type among home dialysis versus in-centre patients 51 .…”

Risk factors for severe Covid-19 breakthrough infections: an observational longitudinal study

“…Stouten and colleagues [ 22 ] found that adenoviral-vector-based vaccines were associated with a higher risk of breakthrough infections, compared to mRNA-based vaccines. In a large real-world cohort of patients on dialysis, Brunelli and colleagues [ 23 ] highlighted an inconsistent antibody response in Ad26.COV2.S comparing with BNT162b2, however, no difference was detected in clinical effectiveness over generali the first 6 months postvaccination. However, these findings should be interpreted with caution since the different vaccine types were introduced in different times through the COVID-19 epidemic.…”

COVID-19 vaccine effectiveness in patients with non–dialysis-dependent chronic kidney diseases: findings from a population-based observational study from British Columbia, Canada

“…Patients with chronic kidney disease (CKD) are considered to be a high-risk group for contracting SARS-CoV-2 (COVID-19) infection and post-infection complications. Recent research investigating the COVID-19 vaccine effectiveness (VE) in CKD population mostly involve patients receiving renal replacement therapy including kidney dialysis or transplantation( 1 , 2 , 3 , 4 , 5 ). Little is known about the VE in non-dialysis dependent CKD patients.…”