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

OpenSAFELY Collaborative; The LH&W NCS  (or CONVALESCENCE) Collaborative

doi:10.1016/j.lanepe.2023.100636

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

OpenSAFELY Collaborative, The LH&W NCS (or CONVALESCENCE) Collaborative

Research output: Contribution to journal › Article (Academic Journal) › peer-review

12 Citations (Scopus)

Abstract

BACKGROUND: 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.

METHODS: 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.

FINDINGS: 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.

INTERPRETATION: 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.

FUNDING: National Core Studies, Wellcome Trust, MRC, and Health Data Research UK.

Original language	English
Article number	100636
Journal	The Lancet Regional Health - Europe
Volume	30
Early online date	3 May 2023
DOIs	https://doi.org/10.1016/j.lanepe.2023.100636
Publication status	Published - 1 Jul 2023

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Publisher Copyright:
© 2023 The Authors

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OpenSAFELY Collaborative, & (or CONVALESCENCE) Collaborative, T. LHW. NCS. (2023). 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. The Lancet Regional Health - Europe, 30, Article 100636. https://doi.org/10.1016/j.lanepe.2023.100636

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title = "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",

abstract = "BACKGROUND: 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.METHODS: 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.FINDINGS: 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.INTERPRETATION: 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.FUNDING: National Core Studies, Wellcome Trust, MRC, and Health Data Research UK.",

author = "\{OpenSAFELY Collaborative\} and Parker, \{Edward P K\} and Horne, \{Elsie M F\} and Hulme, \{William J\} and John Tazare and Bang Zheng and Carr, \{Edward J\} and Fiona Loud and Susan Lyon and Viyaasan Mahalingasivam and Brian MacKenna and Amir Mehrkar and Miranda Scanlon and Shalini Santhakumaran and Retha Steenkamp and Ben Goldacre and Sterne, \{Jonathan A C\} and Dorothea Nitsch and Tomlinson, \{Laurie A\} and \{(or CONVALESCENCE) Collaborative\}, \{The LH\&W NCS\}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = jul,

day = "1",

doi = "10.1016/j.lanepe.2023.100636",

language = "English",

volume = "30",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

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OpenSAFELY Collaborative & (or CONVALESCENCE) Collaborative, TLHWNCS 2023, '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', The Lancet Regional Health - Europe, vol. 30, 100636. https://doi.org/10.1016/j.lanepe.2023.100636

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. / OpenSAFELY Collaborative; (or CONVALESCENCE) Collaborative, The LH&W NCS .
In: The Lancet Regional Health - Europe, Vol. 30, 100636, 01.07.2023.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Comparative effectiveness of two- and three-dose COVID-19 vaccination schedules involving AZD1222 and BNT162b2 in people with kidney disease

T2 - a linked OpenSAFELY and UK Renal Registry cohort study

AU - OpenSAFELY Collaborative

AU - Parker, Edward P K

AU - Horne, Elsie M F

AU - Hulme, William J

AU - Tazare, John

AU - Zheng, Bang

AU - Carr, Edward J

AU - Loud, Fiona

AU - Lyon, Susan

AU - Mahalingasivam, Viyaasan

AU - MacKenna, Brian

AU - Mehrkar, Amir

AU - Scanlon, Miranda

AU - Santhakumaran, Shalini

AU - Steenkamp, Retha

AU - Goldacre, Ben

AU - Sterne, Jonathan A C

AU - Nitsch, Dorothea

AU - Tomlinson, Laurie A

AU - (or CONVALESCENCE) Collaborative, The LH&W NCS

PY - 2023/7/1

Y1 - 2023/7/1

N2 - BACKGROUND: 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.METHODS: 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.FINDINGS: 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.INTERPRETATION: 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.FUNDING: National Core Studies, Wellcome Trust, MRC, and Health Data Research UK.

AB - BACKGROUND: 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.METHODS: 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.FINDINGS: 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.INTERPRETATION: 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.FUNDING: National Core Studies, Wellcome Trust, MRC, and Health Data Research UK.

U2 - 10.1016/j.lanepe.2023.100636

DO - 10.1016/j.lanepe.2023.100636

M3 - Article (Academic Journal)

C2 - 37363796

SN - 2666-7762

VL - 30

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100636

ER -

OpenSAFELY Collaborative, (or CONVALESCENCE) Collaborative TLHWNCS. 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. The Lancet Regional Health - Europe. 2023 Jul 1;30:100636. Epub 2023 May 3. doi: 10.1016/j.lanepe.2023.100636

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

Abstract

Bibliographical note

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