Humoral and Cellular Immune Response to Covid-19 Vaccination in Patients with Chronic Graft-versus-Host Disease on Immunosuppression

Immunogenicity of mRNA-1273 and BNT162b2 in Immunocompromised Patients: Systematic Review and Meta-analysis Using GRADE

“…k Wide 95% CI due to wide IQR and range for mean antibody levels per arm in Andreica et al [ 83 ] and Manjappa et al [ 85 ]…”

“…Expressed as absolute differences, we found that mRNA-1273 vaccination Relative effect is shown as risk ratio for the seroconversion outcome and relative increase in total and neutralizing antibody titers or cellular immune response for the remaining outcomes a I 2 = 66.8%, Χ 2 = 235.2, p(Q) = 0; substantial heterogeneity b Outcome definitions were heterogeneous (various antibody types tested through many assays) c Wider 95% CI due to only 1 event in the mRNA-1273 arm in Gallais et al [79] and Werbel et al [78] and the overall small sample size of Werbel et al [78] d Lower grading due to imprecision and indirectness because of varying outcome definitions (various antibody types tested through many assays) e I 2 = 0%, Χ 2 = 0, p(Q) = 1; no issues of heterogeneity or inconsistency f Lower grading due limited evidence and higher grading due to RCT evidence g I 2 = 89.5%, Χ 2 = 417.88, p(Q) = 0; considerable heterogeneity h Wide 95% CI for mean antibody levels per arm in Helfgott et al [92] and Narasimhan et al [93] i Lower grading due to imprecision and higher grading due to strong association in relative increase. Type 3 due to nonrandomized studies j I 2 = 53.2%, Χ 2 = 12.81, p(Q) = 0.05; moderate heterogeneity k Wide 95% CI due to wide IQR and range for mean antibody levels per arm in Andreica et al [83] and Manjappa et al [85] l Lower grading due to imprecision and nonrandomized studies. No strong association identified, therefore type 4 m I 2 = 76.2%, Χ 2 = 54.56, p(Q) = 0; considerable heterogeneity n Wide 95% CI due to wide IQR for mean antibody levels per arm in Stumpf et al [75] GRADE analysis found that the certainty of evidence of the seroconversion outcome overall and in the solid organ transplant and autoimmunity subgroups was downgraded to type 4 (very low) due to imprecision and indirectness because different assays and antibody thresholds were used to assess and define seroconversion across the studies analyzed.…”

“…The SARS-CoV-2 variant against which the neutralization assays were performed was not reported in 5 studies [80,[82][83][84][85]; neutralization was evaluated against delta, omicron, and early WA1/2020 variants in 1 study [86] and against delta, omicron, and D614G/ancestral variants in another study [87]. When assessed in IC patients overall from 7 nonrandomized studies, neutralizing anti-spike titers were not statistically significantly different in patients who received mRNA-1273 compared with BNT162b2 (Table 1).…”