Seroconversion rate after primary vaccination with two doses of BNT162b2 versus mRNA-1273 in solid organ transplant recipients: a systematic review and meta-analysis

  1. Arno Verleye
  2. Veerle Wijtvliet
  3. Steven Abrams
  4. Rachel Hellemans
  5. Rania Bougrea
  6. Annick Massart
  7. Lissa Pipeleers
  8. Karl Martin Wissing
  9. Kevin K Ariën
  10. Benedicte Y De Winter
  11. Pierre Van Damme
  12. Daniel Abramowicz
  13. Kristien J Ledeganck

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

In the general population, the seroconversion rate after primary vaccination with two doses of an anti-severe acute respiratory syndrome coronavirus 2 messenger RNA (mRNA) vaccine reaches nearly 100%, with significantly higher antibody titers after mRNA-1273 vaccination compared to BNT162b2 vaccination. Here we performed a systematic review and meta-analysis to compare the antibody response after two-dose mRNA-1273 versus BNT162b2 vaccination in solid organ transplant (SOT) recipients.

Methods

A systematic literature review was performed using PubMed, Web of Science and the Cochrane Library and original research papers were included for a meta-analysis to calculate vaccine-specific seroconversion rates for each of the mRNA vaccines. Next, the pooled relative seroconversion rate was estimated.

Results

Eight studies that described the development of antibodies against receptor-binding domain (RBD) and/or spike protein were eligible for meta-analysis. Two of these studies also reported antibody titers. The meta-analysis revealed lower seroconversion rates in SOT recipients vaccinated with two doses of BNT162b2 {44.3% [95% confidence interval (CI) 34.1–54.7]} as compared with patients vaccinated with two doses of mRNA-1273 [58.4% (95% CI 47.2–69.2)]. The relative seroconversion rate was 0.795 (95% CI 0.732–0.864).

Conclusions

This systematic review and meta-analysis indicates that in SOT recipients, higher seroconversion rates were observed after vaccination with mRNA-1273 compared with BNT162b2.

Article activity feed

  1. Version published to 10.1093/ndt/gfac174
  2. ScreenIT

    SciScore for 10.1101/2021.12.23.21268314: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationIndeed, we could not retrieve any randomized controlled trial on this topic.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    A clinical research question was formulated according to the following PICO (Population, Intervention, Comparison, Outcome) (11): in SOT patients (P), do two doses of mRNA-1273 vaccination (I), compared to two doses of BNT162b2 vaccination (C), result in a higher seroconversion rate (O1) and/or higher anti-SARS-CoV-2 antibody titers (O2)?
    anti-SARS-CoV-2
    suggested: None
    O2
    suggested: None
    Software and Algorithms
    SentencesResources
    A systematic search of three databases was conducted (PubMed, Web of Science and Cochrane library) using the following search terms: transplant* AND vaccin* AND (mRNA OR Moderna OR Pfizer BioNTech OR mRNA-1273 OR BNT162b2 OR Comirnaty OR Spikevax).
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Cochrane library
    suggested: (Cochrane Library, RRID:SCR_013000)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This meta-analysis makes clear that the current research on immunity after SARS-CoV-2 vaccination in vulnerable patients has several limitations. First, given the fact that the response after vaccination against SARS-CoV-2 has only been investigated since less than a year, only 6 studies, reporting on 1586 patients could be included into this systematic review and meta-analysis. However, even with this restrictive number of papers, the results were consistent across all studies making this meta-analysis sound. Second, the included studies were all observational in nature; none of them was a randomized controlled trial. Third, the number of studies reporting on vaccine specific antibody titers was too small to allow for a meta-analysis, and only two studies reported on T-cell response. Finally, there was a considerable amount of heterogeneity across the different studies, which could be explained by the different transplant types analyzed. However, this heterogeneity disappeared when looking at the relative differences across patient groups (cfr. I^2 value: 2% of total variability due to between-study variability). Larger studies with stratification by age, gender, transplant type and immunosuppressive drugs could help overcome this problem. In conclusion, the seroconversion rate appeared to be higher after mRNA-1273 vaccination vs. BNT162b2 vaccination in SOT recipients. Future studies are needed to assess whether these differences are also associated with a better clinical p...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.12.23.21268314v1 on medRxiv