Immunogenicity of mRNA-1273 and BNT162b2 in Immunocompromised Patients: Systematic Review and Meta-Analysis Using GRADE

Abstract

Aim: Immunocompromised (IC) patients mount poor immune responses to vaccination. Higher-dose COVID-19 vaccines may offer increased immunogenicity. Materials & methods: A pairwise meta-analysis of 98 studies reporting comparisons of mRNA-1273 (50 or 100 mcg/dose) and BNT162b2 (30 mcg/dose) in IC adults was performed. Outcomes were seroconversion, total and neutralizing antibody titers, and cellular immune responses. Results: mRNA-1273 was associated with a significantly higher seroconversion likelihood (relative risk, 1.11 [95% CI, 1.08, 1.14]; P<0.0001; I2=66.8%) and higher total antibody titers (relative increase, 50.45% [95% CI, 34.63%, 66.28%]; P<0.0001; I2=89.5%) versus BNT162b2. mRNA-1273 elicited higher but statistically nonsignificant relative increases in neutralizing antibody titers and cellular immune responses versus BNT162b2. Conclusion: Higher-dose mRNA-1273 had increased immunogenicity versus BNT162b2 in IC patients.