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Comparative effectiveness of BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19.
BMC Med. 2023 02 28; 21(1):78.BM

Abstract

BACKGROUND

Both BNT162b2 (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines have shown high efficacy against COVID-19 in randomized controlled trials. However, their comparative effectiveness against COVID-19 is unclear in the real world. We evaluated the comparative effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19 in the UK general population.

METHODS

We emulated a target trial using IQVIA Medical Research Database (IMRD), an electronic primary care database from the UK (2021). We included 1,311,075 participants, consisting of 637,549 men and 673,526 women age≥18 years, who received vaccination with BNT162b2 or ChAdOx1 nCoV-19 between January 1 and August 31, 2021. The outcomes consisted of confirmed diagnosis of SARS-CoV-2 infection, hospitalisation for COVID-19 and death from COVID-19 in the IMRD. We performed a cox-proportional hazard model to compare the risk of each outcome variable between the two vaccines adjusting for potential confounders with time-stratified overlap weighting of propensity score (PS).

RESULTS

During a mean of 6.7 months of follow-up, 20,070 confirmed SARS-CoV-2 infection occurred in individuals who received BNT162b2 vaccine (PS weighted incidence rate: 3.65 per 1000 person-months), and 31,611 SARS-CoV-2 infection occurred in those who received ChAdOx1 nCoV-19 vaccine (PS weighted incidence rate: 5.25 per 1000 person-months). The time-stratified PS weighted rate difference of SARS-CoV-2 infection for BNT162b2 group vs. ChAdOx1 nCoV-19 group was -1.60 per 1000 person-months (95% confidence interval [CI]: -1.76 to -1.43 per 1000 person-months), and the hazard ratio was 0.69 (95% CI: 0.68 to 0.71). The results were similar across the stratum of sex, age (<65 and ≥65 years), and study periods (i.e., alpha-variant predominance period and delta-variant predominance period). The PS weighted incidence of hospitalisation for COVID-19 was also lower in the BNT162b2 vaccine group than that in the ChAdOx1 vaccine group (RD: -0.09, 95%CI: -0.13 to -0.05 per 1000 person-months; HR: 0.65, 95%CI: 0.57 to 0.74). No significant difference in the risk of death from COVID-19 was observed between the two comparison groups.

CONCLUSIONS

In this population-based study, the BNT162b2 vaccine appears to be more efficacious than the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2 infection and hospitalisation for COVID-19 but not death from COVID-19.

Links

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Authors+Show Affiliations

Wei J
Health Management Center, Xiangya Hospital, Central South University, Changsha, China.
Zhang W
Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK. Arthritis Research UK Pain Centre, Nottingham, UK.
Doherty M
Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK. Arthritis Research UK Pain Centre, Nottingham, UK.
Wallace ZS
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA. The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA. Department of Medicine, Harvard Medical School, Boston, USA.
Sparks JA
Department of Medicine, Harvard Medical School, Boston, USA. Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, USA.
Lu N
Arthritis Research Canada, Richmond, Canada.
Li X
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
Zeng C
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. zengchao@csu.edu.cn. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China. zengchao@csu.edu.cn.
Lei G
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. lei_guanghua@csu.edu.cn. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China. lei_guanghua@csu.edu.cn.
Zhang Y
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA. yzhang108@mgh.harvard.edu. The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA. yzhang108@mgh.harvard.edu.

MeSH

AdolescentAgedFemaleHumansMaleBNT162 VaccineChAdOx1 nCoV-19COVID-19COVID-19 VaccinesSARS-CoV-2

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

36855108

Citation

Wei, Jie, et al. "Comparative Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 Vaccines Against COVID-19." BMC Medicine, vol. 21, no. 1, 2023, p. 78.
Wei J, Zhang W, Doherty M, et al. Comparative effectiveness of BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19. BMC Med. 2023;21(1):78.
Wei, J., Zhang, W., Doherty, M., Wallace, Z. S., Sparks, J. A., Lu, N., Li, X., Zeng, C., Lei, G., & Zhang, Y. (2023). Comparative effectiveness of BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19. BMC Medicine, 21(1), 78. https://doi.org/10.1186/s12916-023-02795-w
Wei J, et al. Comparative Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 Vaccines Against COVID-19. BMC Med. 2023 02 28;21(1):78. PubMed PMID: 36855108.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative effectiveness of BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19. AU - Wei,Jie, AU - Zhang,Weiya, AU - Doherty,Michael, AU - Wallace,Zachary S, AU - Sparks,Jeffrey A, AU - Lu,Na, AU - Li,Xiaoxiao, AU - Zeng,Chao, AU - Lei,Guanghua, AU - Zhang,Yuqing, Y1 - 2023/02/28/ PY - 2022/04/09/received PY - 2023/02/20/accepted PY - 2023/3/1/entrez PY - 2023/3/2/pubmed PY - 2023/3/3/medline KW - BNT162b2 KW - COVID-19 KW - ChAdOx1 nCoV-19 KW - Vaccine SP - 78 EP - 78 JF - BMC medicine JO - BMC Med VL - 21 IS - 1 N2 - BACKGROUND: Both BNT162b2 (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines have shown high efficacy against COVID-19 in randomized controlled trials. However, their comparative effectiveness against COVID-19 is unclear in the real world. We evaluated the comparative effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19 in the UK general population. METHODS: We emulated a target trial using IQVIA Medical Research Database (IMRD), an electronic primary care database from the UK (2021). We included 1,311,075 participants, consisting of 637,549 men and 673,526 women age≥18 years, who received vaccination with BNT162b2 or ChAdOx1 nCoV-19 between January 1 and August 31, 2021. The outcomes consisted of confirmed diagnosis of SARS-CoV-2 infection, hospitalisation for COVID-19 and death from COVID-19 in the IMRD. We performed a cox-proportional hazard model to compare the risk of each outcome variable between the two vaccines adjusting for potential confounders with time-stratified overlap weighting of propensity score (PS). RESULTS: During a mean of 6.7 months of follow-up, 20,070 confirmed SARS-CoV-2 infection occurred in individuals who received BNT162b2 vaccine (PS weighted incidence rate: 3.65 per 1000 person-months), and 31,611 SARS-CoV-2 infection occurred in those who received ChAdOx1 nCoV-19 vaccine (PS weighted incidence rate: 5.25 per 1000 person-months). The time-stratified PS weighted rate difference of SARS-CoV-2 infection for BNT162b2 group vs. ChAdOx1 nCoV-19 group was -1.60 per 1000 person-months (95% confidence interval [CI]: -1.76 to -1.43 per 1000 person-months), and the hazard ratio was 0.69 (95% CI: 0.68 to 0.71). The results were similar across the stratum of sex, age (<65 and ≥65 years), and study periods (i.e., alpha-variant predominance period and delta-variant predominance period). The PS weighted incidence of hospitalisation for COVID-19 was also lower in the BNT162b2 vaccine group than that in the ChAdOx1 vaccine group (RD: -0.09, 95%CI: -0.13 to -0.05 per 1000 person-months; HR: 0.65, 95%CI: 0.57 to 0.74). No significant difference in the risk of death from COVID-19 was observed between the two comparison groups. CONCLUSIONS: In this population-based study, the BNT162b2 vaccine appears to be more efficacious than the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2 infection and hospitalisation for COVID-19 but not death from COVID-19. SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/36855108/Comparative_effectiveness_of_BNT162b2_and_ChAdOx1_nCoV_19_vaccines_against_COVID_19_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↑31]

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