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dc.titleEfficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis
dc.contributor.authorBin Lee, Ainsley Ryan Yan
dc.contributor.authorWong, Shi Yin
dc.contributor.authorChai, Louis Yi Ann
dc.contributor.authorLee, Soo Chin
dc.contributor.authorLee, Matilda Xinwei
dc.contributor.authorMuthiah, Mark Dhinesh
dc.contributor.authorTay, Sen Hee
dc.contributor.authorTeo, Chong Boon
dc.contributor.authorTan, Benjamin Kye Jyn
dc.contributor.authorChan, Yiong Huak
dc.contributor.authorSundar, Raghav
dc.contributor.authorSoon, Yu Yang
dc.identifier.citationBin Lee, Ainsley Ryan Yan, Wong, Shi Yin, Chai, Louis Yi Ann, Lee, Soo Chin, Lee, Matilda Xinwei, Muthiah, Mark Dhinesh, Tay, Sen Hee, Teo, Chong Boon, Tan, Benjamin Kye Jyn, Chan, Yiong Huak, Sundar, Raghav, Soon, Yu Yang (2022-03-02). Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis. BMJ-BRITISH MEDICAL JOURNAL 376. ScholarBank@NUS Repository.
dc.description.abstractOBJECTIVE: To compare the efficacy of covid-19 vaccines between immunocompromised and immunocompetent people. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase, Central Register of Controlled Trials, COVID-19 Open Research Dataset Challenge (CORD-19), and WHO covid-19 databases for studies published between 1 December 2020 and 5 November 2021. and the WHO International Clinical Trials Registry Platform were searched in November 2021 to identify registered but as yet unpublished or ongoing studies. STUDY SELECTION: Prospective observational studies comparing the efficacy of covid-19 vaccination in immunocompromised and immunocompetent participants. METHODS: A frequentist random effects meta-analysis was used to separately pool relative and absolute risks of seroconversion after the first and second doses of a covid-19 vaccine. Systematic review without meta-analysis of SARS-CoV-2 antibody titre levels was performed after first, second, and third vaccine doses and the seroconversion rate after a third dose. Risk of bias and certainty of evidence were assessed. RESULTS: 82 studies were included in the meta-analysis. Of these studies, 77 (94%) used mRNA vaccines, 16 (20%) viral vector vaccines, and 4 (5%) inactivated whole virus vaccines. 63 studies were assessed to be at low risk of bias and 19 at moderate risk of bias. After one vaccine dose, seroconversion was about half as likely in patients with haematological cancers (risk ratio 0.40, 95% confidence interval 0.32 to 0.50, I2=80%; absolute risk 0.29, 95% confidence interval 0.20 to 0.40, I2=89%), immune mediated inflammatory disorders (0.53, 0.39 to 0.71, I2=89%; 0.29, 0.11 to 0.58, I2=97%), and solid cancers (0.55, 0.46 to 0.65, I2=78%; 0.44, 0.36 to 0.53, I2=84%) compared with immunocompetent controls, whereas organ transplant recipients were 16 times less likely to seroconvert (0.06, 0.04 to 0.09, I2=0%; 0.06, 0.04 to 0.08, I2=0%). After a second dose, seroconversion remained least likely in transplant recipients (0.39, 0.32 to 0.46, I2=92%; 0.35, 0.26 to 0.46), with only a third achieving seroconversion. Seroconversion was increasingly likely in patients with haematological cancers (0.63, 0.57 to 0.69, I2=88%; 0.62, 0.54 to 0.70, I2=90%), immune mediated inflammatory disorders (0.75, 0.69 to 0.82, I2=92%; 0.77, 0.66 to 0.85, I2=93%), and solid cancers (0.90, 0.88 to 0.93, I2=51%; 0.89, 0.86 to 0.91, I2=49%). Seroconversion was similar between people with HIV and immunocompetent controls (1.00, 0.98 to 1.01, I2=0%; 0.97, 0.83 to 1.00, I2=89%). Systematic review of 11 studies showed that a third dose of a covid-19 mRNA vaccine was associated with seroconversion among vaccine non-responders with solid cancers, haematological cancers, and immune mediated inflammatory disorders, although response was variable in transplant recipients and inadequately studied in people with HIV and those receiving non-mRNA vaccines. CONCLUSION: Seroconversion rates after covid-19 vaccination were significantly lower in immunocompromised patients, especially organ transplant recipients. A second dose was associated with consistently improved seroconversion across all patient groups, albeit at a lower magnitude for organ transplant recipients. Targeted interventions for immunocompromised patients, including a third (booster) dose, should be performed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021272088.
dc.subjectScience & Technology
dc.subjectLife Sciences & Biomedicine
dc.subjectMedicine, General & Internal
dc.subjectGeneral & Internal Medicine
dc.subjectBNT162B2 VACCINATION
dc.contributor.departmentDEAN'S OFFICE (MEDICINE)
dc.description.sourcetitleBMJ-BRITISH MEDICAL JOURNAL
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