Moderna Bivalent COVID-19 Vaccine More Effective at Preventing Hospitalization in High-Risk Patients Compared With Pfizer-BioNTech Vaccine

According to a real-world analysis, Moderna’s mRNA-1273.222 bivalent vaccine targeting SARS-CoV-2, the virus that causes COVID-19, was significantly more effective than the BNT162b2 vaccine developed by Pfizer-BioNTech at preventing COVID-19-related hospitalization and outpatient encounters in adults with 1 or more underlying medical conditions.¹

COVID-19 vaccination is important for those with underlying medical conditions that put them at higher risk for severe disease. | Image Credit: © Seventyfour | stock.adobe.com

Bivalent mRNA vaccines, including mRNA from the original SARS-CoV-2 strain together with an Omicron subvariant (BA.4/BA.5), were developed in response to the emergence of Omicron and its subvariants as the original virus continued to evolve. Pfizer-BioNTech and Moderna led the development of these new vaccines, as they did for the development of the original COVID-19 vaccines.¹

In 2022, these bivalent vaccines were granted authorization by the FDA for use as booster doses, with the CDC backing up this approval with a strong recommendation from the Advisory Committee on Immunization Practices for the public to receive these vaccines, especially older adults with underlying medical conditions who are at high risk of developing severe COVID-19.^2-4

Given the different vaccine options available, it is worthwhile to analyze whether one bivalent vaccine outperforms the other, especially as most of the US population deals with a chronic condition that can put them at higher risk of severe disease. Accordingly, a previously conducted analysis showed that mRNA-1273.222 outperformed BNT162b2 in adults 18 years and older.⁵

In the current analysis, the investigators used the same methodology to evaluate the relative vaccine effectiveness (rVE) of each vaccine in the prevention of COVID-19-related hospitalization and outpatient encounters in adult patients with 1 or more underlying medical condition typically associated with severe outcomes from the virus. In total, the investigators identified 1,962,547 adults 18 years and older for inclusion in the trial, with 38.6% having received the mRNA-1273.222 vaccine and 61.4% having received the BNT162b2 vaccine.¹

Results from the overall study cohort showed that 2360 (0.31%) individuals who received mRNA-1273.222 and 4198 (0.35%) who received BNT162b2 were hospitalized for COVID-19 during the follow-up period, respectively. Furthermore, 26,185 (3.5%) individuals who received mRNA-1273.222 and 42,866 (3.6%) who received BNT162b2 had a COVID-19 related outpatient encounter in the follow-up period.¹

These results demonstrate that mRNA-1273.222 was significantly more effective at preventing the outcomes of interest compared with BNT162b2. Notably, the rVE against COVID-19 related hospitalization was 10.9% (95% CI, 6.2%-16.2%; p < .001), while the rVE against outpatient COVID-19 was 3.2% (95% CI, 1.7%-4.7%, p < .001).¹

Increased effectiveness for mRNA-1273.222 was observed across all subgroups, including in patients with diabetes, cerebro- and cardiovascular disease, chronic lung disease, and immunocompromised patients. Sensitivity analysis results were consistent with those of the main analysis, according to the study authors.¹

An alignment with the previously conducted analysis of mRNA-1273.222 and BNT162b2 was observed in this trial. These results highlight the increased attention that should be focused on immunocompromised individuals, older individuals, and patients with chronic conditions in terms of COVID-19 vaccination, and discussions should be held with pharmacists to determine which vaccine is the best option for a patient. Both vaccines remain effective at preventing severe COVID-19 overall, as indicated by the extremely small portion of patients from either cohort who were hospitalized.^1,5

“Maximizing protection against preventive diseases, especially among patients with underlying medical conditions who require comprehensive clinical management, can reduce the burden of COVID-19 on individuals and the health care system,” the investigators concluded.¹

REFERENCES

1. Kopel H, Nguyen VH, Bogdanov A, et al. Comparative effectiveness of the bivalent (original/Omicron BA.4/BA.5) mRNA COVID-19 vaccines mRNA-1273.222 and BNT162b2 bivalent in adults with underlying medical conditions in the United States. Vaccines. 2024;12(10):1107. doi:10.3390/vaccines12101107

2. Antrim A. FDA authorizes updated COVID-19 boosters from Moderna, Pfizer-BioNTech. Pharmacy Times. Published August 31, 2022. Accessed November 6, 2024. https://www.pharmacytimes.com/view/fda-authorizes-updated-covid-19-boosters-from-moderna-pfizer-biontech

3. Rosenblum HG, Wallace M, Godfrey M, et al. Interim recommendations from the Advisory Committee on Immunization Practices for the use of bivalent booster doses of COVID-19 vaccines—United States, October 2022. Weekly. 2022;71(45):1436-1441. doi:10.15585/mmwr.mm7145a2

4. Ferruggia K. Older adults remain at high risk for hospitalization or death if infected with COVID-19. Pharmacy Times. Published November 3, 2023. Accessed November 6, 2024. https://www.pharmacytimes.com/view/older-adults-remain-at-high-risk-for-hospitalization-or-death-if-infected-with-covid-19

5. Kopel H, Nguyen VH, Boileau C, et al. Comparative effectiveness of bivalent (original/Omicron BA.4/BA.5) COVID-19 vaccines in adults. Vaccines. 2023;11(11):1711. doi:10.3390/vaccines11111711