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Meta-Analysis
. 2022 May 13;11(1):53.
doi: 10.1186/s40249-022-00977-x.

Immunogenicity and safety of heterologous versus homologous prime-boost schedules with an adenoviral vectored and mRNA COVID-19 vaccine: a systematic review

Jingjing Lv #  1 , Hui Wu #  2 , Junjie Xu  3 , Jiaye Liu  4
Affiliations
Meta-Analysis

Immunogenicity and safety of heterologous versus homologous prime-boost schedules with an adenoviral vectored and mRNA COVID-19 vaccine: a systematic review

Jingjing Lv et al. Infect Dis Poverty. .

Abstract

Background: Heterologous prime-boost with ChAdOx1 nCoV-19 vector vaccine (ChAd) and a messenger RNA vaccine (BNT or mRNA-1273) has been widely facilitating mass coronavirus disease 2019 (COVID-19) immunisation. This review aimed to synthesize immunogenicity and reactogenicity of heterologous immunisations with ChAd and BNT (mRNA-1273) vaccine compared with homologous ChAd or BNT (mRNA-1273) immunisation.

Methods: PubMed, Web of Science, and Embase databases were searched from inception to March 7, 2022. Immunogenicity involving serum antibodies against different SAS-CoV-2 fragments, neutralizing antibody, or spike-specific T cells response were compared. Any, local and systemic reactions were pooled by meta-analysis for comparison.

Results: Of 14,571 records identified, 13 studies (3024 participants) were included for analysis. Compared with homologous BNT/BNT vaccination, heterologous ChAd/BNT schedule probably induced noninferior anti-spike protein while higher neutralizing antibody and better T cells response. Heterologous ChAd/BNT (mRNA-1273) immunisation induced superior anti-spike protein and higher neutralizing antibody and better T cells response compared with homologous ChAd/ChAd vaccination. Heterologous ChAd/BNT (mRNA-1273) had similar risk of any reaction (RR = 1.30, 95% CI: 0.86-1.96) while higher risk of local reactions (RR = 1.65, 95% CI: 1.27-2.15) and systemic reactions (RR = 1.49, 95% CI: 1.17-1.90) compared with homologous ChAd/ChAd vaccination. There was a higher risk of local reactions (RR = 1.16, 95% CI: 1.03-1.31) in heterologous ChAd/BNT (mRNA-1273) vaccination compare with homologous BNT/BNT but a similar risk of any reaction (RR = 1.03, 95% CI: 0.79-1.34) and systemic reactions (RR = 0.89, 95% CI: 0.60-1.30).

Conclusions: Heterologous ChAd/BNT schedule induced at least comparable immunogenicity compared with homologous BNT/BNT and better immunogenicity compared with homologous ChAd/ChAd vaccination. The synthetical evidence supported the general application of heterologous prime-boost vaccination using ChAd and BNT COVID-19 vaccines.

Keywords: COVID-19; Heterologous vaccination; Homologous vaccination; Immunogenicity; Safety.

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Conflict of interest statement

Jingjing Lv, Hu Wu, Junjie Xu, and Jiaye Liu declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study selection
Fig. 2
Fig. 2
Estimates of risk ratio of reactions stratified by any, local, and systematic reactions. Figure shows the risk ratio of any, local, and systemic events in participants who received heterologous ChAd/BNT schedule compared with those in homologous ChAd/ChAd (A) and the risk ratio of any, local, and systemic events in participants who received heterologous ChAd/BNT schedule compared with those in homologous BNT/BNT (B). BNT BNT162b2 vaccine, Pfizer–BioNTech, ChAd ChAdOx1 nCoV-19 vaccine, AstraZeneca, CI confidence intervals, RR risk ratio
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