Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines in U.S. Veterans

作者：Barbra A. Dickerman, Hanna Gerlovin, Arin L. Madenci, Katherine E. Kurgansky, Brian R. Ferolito, Michael J. Figueroa Muñiz, DAVID R. GAGNON, J. Michael Gaziano, Kelly Cho, Juan Pablo Casas, Miguel Ángel Hernán · 发表于：New England Journal of Medicine · 年份：2021 · DOI：10.1056/nejmoa2115463 · 被引用次数：274 · 研究领域：SARS-CoV-2 and COVID-19 Research、Immune responses and vaccinations、Animal Virus Infections Studies

BACKGROUND: The messenger RNA (mRNA)-based vaccines BNT162b2 and mRNA-1273 are more than 90% effective against coronavirus disease 2019 (Covid-19). However, their comparative effectiveness for a range of outcomes across diverse populations is unknown. METHODS: We emulated a target trial using the electronic health records of U.S. veterans who received a first dose of the BNT162b2 or mRNA-1273 vaccine between January 4 and May 14, 2021, during a period marked by predominance of the SARS-CoV-2 B.1.1.7 (alpha) variant. We matched recipients of each vaccine in a 1:1 ratio according to their risk factors. Outcomes included documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, symptomatic Covid-19, hospitalization for Covid-19, admission to an intensive care unit (ICU) for Covid-19, and death from Covid-19. We estimated risks using the Kaplan-Meier estimator. To assess the influence of the B.1.617.2 (delta) variant, we emulated a second target trial that involved veterans vaccinated between July 1 and September 20, 2021. RESULTS: Each vaccine group included 219,842 persons. Over 24 weeks of follow-up in a period marked by alpha-variant predominance, the estimated risk of documented infection was 5.75 events per 1000 persons (95% confidence interval [CI], 5.39 to 6.23) in the BNT162b2 group and 4.52 events per 1000 persons (95% CI, 4.17 to 4.84) in the mRNA-1273 group. The excess number of events per 1000 persons for BNT162b2 as compared with mRNA-1273 w...