Comparative Risks of Potential Adverse Events Following COVID-19 mRNA Vaccination Among Older US Adults.

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  • Additional Information
    • Source:
      Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
    • Publication Information:
      Original Publication: Chicago, IL : American Medical Association, [2018]-
    • Subject Terms:
      Frailty*/epidemiology ; Frailty*/etiology ; COVID-19*/epidemiology ; COVID-19*/prevention & control ; Thrombocytopenia* ; Purpura*; United States/epidemiology ; Humans ; Aged ; Female ; Adult ; Middle Aged ; Male ; COVID-19 Vaccines/adverse effects ; 2019-nCoV Vaccine mRNA-1273 ; BNT162 Vaccine ; Cohort Studies ; Retrospective Studies ; Medicare ; SARS-CoV-2 ; Vaccination/adverse effects ; mRNA Vaccines ; RNA, Messenger
    • Abstract:
      Importance: Head-to-head safety comparisons of the mRNA vaccines for SARS-CoV-2 are needed for decision making; however, current evidence generalizes poorly to older adults, lacks sufficient adjustment, and inadequately captures events shortly after vaccination. Additionally, no studies to date have explored potential variation in comparative vaccine safety across subgroups with frailty or an increased risk of adverse events, information that would be useful for tailoring clinical decisions.
      Objective: To compare the risk of adverse events between mRNA vaccines for COVID-19 (mRNA-1273 and BNT162b2) overall, by frailty level, and by prior history of the adverse events of interest.
      Design, Setting, and Participants: This retrospective cohort study was conducted between December 11, 2020, and July 11, 2021, with 28 days of follow-up following the week of vaccination. A novel linked database of community pharmacy and Medicare claims data was used, representing more than 50% of the US Medicare population. Community-dwelling, fee-for-service beneficiaries aged 66 years or older who received mRNA-1273 vs BNT162b2 as their first COVID-19 vaccine were identified. Data analysis began on October 18, 2022.
      Exposure: Dose 1 of mRNA-1273 vs BNT162b2 vaccine.
      Main Outcomes and Measures: Twelve potential adverse events (eg, pulmonary embolism, thrombocytopenia purpura, and myocarditis) were assessed individually. Frailty was measured using a claims-based frailty index, with beneficiaries being categorized as nonfrail, prefrail, and frail. The risk of diagnosed COVID-19 was assessed as a secondary outcome. Generalized linear models estimated covariate-adjusted risk ratios (RRs) and risk differences (RDs) with 95% CIs.
      Results: This study included 6 388 196 eligible individuals who received the mRNA-1273 or BNT162b2 vaccine. Their mean (SD) age was 76.3 (7.5) years, 59.4% were women, and 86.5% were White. A total of 38.1% of individuals were categorized as prefrail and 6.0% as frail. The risk of all outcomes was low in both vaccine groups. In adjusted models, the mRNA-1273 vaccine was associated with a lower risk of pulmonary embolism (RR, 0.96 [95% CI, 0.93-1.00]; RD, 9 [95% CI, 1-16] events per 100 000 persons) and other adverse events in subgroup analyses (eg, 11.0% lower risk of thrombocytopenia purpura among individuals categorized as nonfrail). The mRNA-1273 vaccine was also associated with a lower risk of diagnosed COVID-19 (RR, 0.86 [95% CI, 0.83-0.87]), a benefit that was attenuated by frailty level (frail: RR, 0.94 [95% CI, 0.89-0.99]).
      Conclusions and Relevance: In this cohort study of older US adults, the mRNA-1273 vaccine was associated with a slightly lower risk of several adverse events compared with BNT162b2, possibly due to greater protection against COVID-19. Future research should seek to formally disentangle differences in vaccine safety and effectiveness and consider the role of frailty in assessments of COVID-19 vaccine performance.
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    • Grant Information:
      U54 AG063546 United States AG NIA NIH HHS
    • Accession Number:
      0 (COVID-19 Vaccines)
      EPK39PL4R4 (2019-nCoV Vaccine mRNA-1273)
      0 (BNT162 Vaccine)
      0 (mRNA Vaccines)
      0 (RNA, Messenger)
    • Publication Date:
      Date Created: 20230802 Date Completed: 20230803 Latest Revision: 20230908
    • Publication Date:
      20240628
    • Accession Number:
      PMC10398407
    • Accession Number:
      10.1001/jamanetworkopen.2023.26852
    • Accession Number:
      37531110