Comparative effectiveness of two- and three-dose COVID-19 vaccination schedules involving AZD1222 and BNT162b2 in people with kidney disease: a linked OpenSAFELY and UK Renal Registry cohort study.
Comparative effectiveness of two- and three-dose COVID-19 vaccination schedules involving AZD1222 and BNT162b2 in people with kidney disease: a linked OpenSAFELY and UK Renal Registry cohort study.
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DOI：
10.1016/j.lanepe.2023.100636
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发表时间：
2023-05-03
影响因子：
20.9
通讯作者：
Tomlinson, Laurie A
中科院分区：
文献类型：
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作者：
Parker, Edward P K;Horne, Elsie M F;Hulme, William J;Tazare, John;Zheng, Bang;Carr, Edward J;Loud, Fiona;Lyon, Susan;Mahalingasivam, Viyaasan;MacKenna, Brian;Mehrkar, Amir;Scanlon, Miranda;Santhakumaran, Shalini;Steenkamp, Retha;Goldacre, Ben;Sterne, Jonathan A C;Nitsch, Dorothea;Tomlinson, Laurie A
肾脏疾病是导致 COVID-19 相关死亡和疫苗反应欠佳的关键风险因素。优化疫苗接种策略对于减轻这一弱势群体的疾病负担至关重要。因此，我们比较了 AZD1222（AZ；ChAdOx1-S）和 BNT162b2（BNT）在英格兰肾病患者中的两剂和三剂方案的有效性。经英国 NHS 批准，我们对中重度肾脏疾病患者进行了一项回顾性队列研究。利用 OpenSAFELY-TPP 平台中关联的初级保健和英国肾脏登记记录，我们确定了患有 3-5 期慢性肾病的成年人、透析接受者和肾移植接受者。我们使用 Cox 比例风险模型来比较两剂（AZ-AZ 与 BNT-BNT）和三剂（AZ-AZ-BNT 与 BNT-BNT-BNT）方案后的 COVID-19 相关结果和非 COVID-19 死亡。两次接种后，AZ-AZ (n = 257,580) 中 Delta 波的发病率高于 BNT-BNT 接受者 (n = 169,205)；调整后的风险比 [95% CI] 1.43 [1.37–1.50]、1.59 [1.43–1.77]、1.44 [1.12–1.85] 和1.09 [1.02–1.17] 为 分别为 SARS-CoV-2 感染、COVID-19 相关住院、COVID-19 相关死亡和非 COVID-19 死亡）。不同疾病亚组（包括透析和移植受者）的研究结果是一致的。注射三剂后，在 Omicron 占主导地位期间，几乎没有证据表明 AZ-AZ-BNT (n = 220,330) 和 BNT-BNT-BNT 接受者 (n = 157,065) 之间的任何结果存在差异。在患有中重度肾病的个体中，两剂 BNT 比 AZ 能提供更强的针对 SARS-CoV-2 感染和严重疾病的保护作用。随后的 BNT 剂量创造了公平的竞争环境，强调了异源 RNA 剂量对弱势群体的价值。 ， ， ， 和 。
Kidney disease is a key risk factor for COVID-19-related mortality and suboptimal vaccine response. Optimising vaccination strategies is essential to reduce the disease burden in this vulnerable population. We therefore compared the effectiveness of two- and three-dose schedules involving AZD1222 (AZ; ChAdOx1-S) and BNT162b2 (BNT) among people with kidney disease in England. With the approval of NHS England, we performed a retrospective cohort study among people with moderate-to-severe kidney disease. Using linked primary care and UK Renal Registry records in the OpenSAFELY-TPP platform, we identified adults with stage 3–5 chronic kidney disease, dialysis recipients, and kidney transplant recipients. We used Cox proportional hazards models to compare COVID-19-related outcomes and non-COVID-19 death after two-dose (AZ–AZ vs BNT–BNT) and three-dose (AZ–AZ–BNT vs BNT–BNT–BNT) schedules. After two doses, incidence during the Delta wave was higher in AZ–AZ (n = 257,580) than BNT–BNT recipients (n = 169,205; adjusted hazard ratios [95% CIs] 1.43 [1.37–1.50], 1.59 [1.43–1.77], 1.44 [1.12–1.85], and 1.09 [1.02–1.17] for SARS-CoV-2 infection, COVID-19-related hospitalisation, COVID-19-related death, and non-COVID-19 death, respectively). Findings were consistent across disease subgroups, including dialysis and transplant recipients. After three doses, there was little evidence of differences between AZ–AZ–BNT (n = 220,330) and BNT–BNT–BNT recipients (n = 157,065) for any outcome during a period of Omicron dominance. Among individuals with moderate-to-severe kidney disease, two doses of BNT conferred stronger protection than AZ against SARS-CoV-2 infection and severe disease. A subsequent BNT dose levelled the playing field, emphasising the value of heterologous RNA doses in vulnerable populations. , , , and .