Comparative effectiveness of BNT162b2 versus mRNA-1273 covid-19 vaccine boosting in England: matched cohort study in OpenSAFELY-TPP

William J Hulme¹, Elsie M F Horne^{2

3}, Edward P K Parker⁴, Ruth H Keogh⁴, Elizabeth J Williamson⁴, Venexia Walker^{2

5}, Tom M Palmer^{2

5}, Helen J Curtis⁶, Alex J Walker⁶, Colm D Andrews⁶, Amir Mehrkar⁶, Jessica Morley⁶, Brian MacKenna⁶, Sebastian C J Bacon⁶, Ben Goldacre⁶, Miguel A Hernán^{7

8}, Jonathan A C Sterne^{2

3

9}

Affiliations

¹ The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK william.hulme@phc.ox.ac.uk.
² Population Health Sciences, University of Bristol, Bristol, UK.
³ NIHR Bristol Biomedical Research Centre, Bristol, UK.
⁴ London School of Hygiene and Tropical Medicine, London, UK.
⁵ MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK.
⁶ The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁷ CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁸ Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ Health Data Research UK South West, Bristol, UK.

PMID: 36921925
PMCID: PMC10014664
DOI: 10.1136/bmj-2022-072808

Observational Study

Comparative effectiveness of BNT162b2 versus mRNA-1273 covid-19 vaccine boosting in England: matched cohort study in OpenSAFELY-TPP

William J Hulme et al. BMJ. 2023.

. 2023 Mar 15:380:e072808.

doi: 10.1136/bmj-2022-072808.

Authors

Affiliations

¹ The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK william.hulme@phc.ox.ac.uk.
² Population Health Sciences, University of Bristol, Bristol, UK.
³ NIHR Bristol Biomedical Research Centre, Bristol, UK.
⁴ London School of Hygiene and Tropical Medicine, London, UK.
⁵ MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK.
⁶ The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁷ CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁸ Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ Health Data Research UK South West, Bristol, UK.

PMID: 36921925
PMCID: PMC10014664
DOI: 10.1136/bmj-2022-072808

Abstract

Objective: To compare the effectiveness of the BNT162b2 mRNA (Pfizer-BioNTech) and mRNA-1273 (Moderna) covid-19 vaccines during the booster programme in England.

Design: Matched cohort study, emulating a comparative effectiveness trial.

Setting: Linked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 delta and omicron variants were dominant.

Participants: 3 237 918 adults who received a booster dose of either vaccine between 29 October 2021 and 25 February 2022 as part of the national booster programme in England and who received a primary course of BNT162b2 or ChAdOx1.

Intervention: Vaccination with either BNT162b2 or mRNA-1273 as a booster vaccine dose.

Main outcome measures: Recorded SARS-CoV-2 positive test, covid-19 related hospital admission, covid-19 related death, and non-covid-19 related death at 20 weeks after receipt of the booster dose.

Results: 1 618 959 people were matched in each vaccine group, contributing a total 64 546 391 person weeks of follow-up. The 20 week risks per 1000 for a positive SARS-CoV-2 test were 164.2 (95% confidence interval 163.3 to 165.1) for BNT162b2 and 159.9 (159.0 to 160.8) for mRNA-1273; the hazard ratio comparing mRNA-1273 with BNT162b2 was 0.95 (95% confidence interval 0.95 to 0.96). The 20 week risks per 1000 for hospital admission with covid-19 were 0.75 (0.71 to 0.79) for BNT162b2 and 0.65 (0.61 to 0.69) for mRNA-1273; the hazard ratio was 0.89 (0.82 to 0.95). Covid-19 related deaths were rare: the 20 week risks per 1000 were 0.028 (0.021 to 0.037) for BNT162b2 and 0.024 (0.018 to 0.033) for mRNA-1273; hazard ratio 0.83 (0.58 to 1.19). Comparative effectiveness was generally similar within subgroups defined by the primary course vaccine brand, age, previous SARS-CoV-2 infection, and clinical vulnerability. Relative benefit was similar when vaccines were compared separately in the delta and omicron variant eras.

Conclusions: This matched observational study of adults estimated a modest benefit of booster vaccination with mRNA-1273 compared with BNT162b2 in preventing positive SARS-CoV-2 tests and hospital admission with covid-19 20 weeks after vaccination, during a period of delta followed by omicron variant dominance.