Infectious Disease

Moderna COVID-19 vaccine offers stronger protection in immunocompromised patients

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Disclosures:
Mitchell reports receiving grants from the American Society of Transplant Surgeons while this study was being conducted. Please see the study for all other authors’ relevant financial disclosures.

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The Moderna COVID-19 mRNA vaccine was more likely to elicit a stronger response in patients with varying degrees of immunosuppression than the Pfizer-BioNTech vaccine, according to data published in JAMA Network Open.

“Both mRNA-1273 and BNT162b2 SARS-CoV-2 vaccines elicit immune responses consistent with viral neutralization in most immunocompetent persons,” Jonathan Mitchell, MBBS, of Johns Hopkins University School of Medicine, and co-authors wrote. “Immunosuppressed individuals, such as persons with rheumatic and musculoskeletal diseases (RMDs) and solid organ transplant recipients (SOTRs), have decreased immune responses to these vaccines. Thus, differential vaccine immunogenicity is clinically relevant in ways not seen in immunocompetent persons.”

Graphic showing study findings from results section.

The Moderna COVID-19 mRNA vaccine was more likely to elicit a stronger response in patients with varying degrees of immunosuppression than the Pfizer-BioNTech vaccine, according to data derived from Mitchell J, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.11897.

To evaluate the impact of humoral immunogenicity provided by each vaccine, Mitchell and colleagues recruited patients with rheumatic and musculoskeletal diseases, as well as solid-organ transplant recipients, who did not have a previous positive SARS-CoV-2 test. Patients who received two doses of an mRNA-based COVID-19 vaccine between Dec. 16, 2020, and July 6, 2021, were included in the study. Antibody testing was performed between 15 and 45 days following the second vaccine dose.

Patients were grouped depending on the severity of their immunosuppression. The groups ranged from patients with rheumatic and musculoskeletal diseases who were not receiving immunosuppressive therapy, to solid-organ transplant recipients receiving mycophenolic acid or mycophenolate mofetil. Researchers compared vaccine response rates between the Moderna and Pfizer-BioNTech vaccines using a modified Poisson regression analysis.

In all, 1,158 patients with rheumatic and musculoskeletal diseases, as well as 697 transplant recipients, were included, the authors wrote. Of those, 647 patients with rheumatic diseases, and 220 transplant recipients, received the Pfizer-BioNTech vaccine.

Among patients with rheumatic diseases who were not receiving immunosuppression, hydroxychloroquine or intravenous immunoglobulin, anti-receptor binding domain (RBD) titer rates of 250 U/mL or greater were comparable between recipients of both vaccines, at 91.5% for Pfizer-BioNTech and 93.1 % for Moderna (IRR = 1.02; 95% CI, 0.94-1.1).

Patients receiving the Moderna vaccine demonstrated higher rates of anti-RBD titers, of 250 U/mL or greater, than Pfizer-BioNTech vaccine recipients among patients with rheumatic diseases receiving immunosuppression (IRR = 1.3; 95% CI, 1.2-1.43), transplant recipients not receiving mycophenolic acid or mycophenolate mofetil (IRR = 1.56; 95% CI, 1.24-1.96) and transplant recipients receiving those therapies (IRR = 2.62; 95% CI, 1.28-5.37).

“In conclusion, mRNA-1273 was more likely to induce stronger humoral immunogenicity compared with BNT162b2 in immunosuppressed patients; this effect was more pronounced with greater immunosuppression,” Mitchell and colleagues wrote. “These findings suggest that choice of mRNA vaccine platform is important in optimizing immune responses to SARS-CoV-2 vaccination and can help inform strategies for booster doses in high-risk, immunosuppressed populations.”

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COVID-19 and Rheumatology

COVID-19 and Rheumatology

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