Cited by 627SARS-CoV-2 and COVID-19 ResearchCOVID-19 Clinical Research StudiesVaccine Coverage and Hesitancy

A Bivalent Omicron-Containing Booster Vaccine against Covid-19

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Chalkias, Spyros, Harper, Charles, Vrbicky, Keith, Walsh, Stephen R., Essink, Brandon, Brosz, Adam, McGhee, Nichole, Tomassini, Joanne E. +11 more·2022·New England Journal of Medicine

Published version of a preprint

Abstract

BACKGROUND: The safety and immunogenicity of the bivalent omicron-containing mRNA-1273.214 booster vaccine are not known. METHODS: In this ongoing, phase 2-3 study, we compared the 50-μg bivalent vaccine mRNA-1273.214 (25 μg each of ancestral Wuhan-Hu-1 and omicron B.1.1.529 [BA.1] spike messenger RNAs) with the previously authorized 50-μg mRNA-1273 booster. We administered mRNA-1273.214 or mRNA-1273 as a second booster in adults who had previously received a two-dose (100-μg) primary series and first booster (50-μg) dose of mRNA-1273 (≥3 months earlier). The primary objectives were to assess the safety, reactogenicity, and immunogenicity of mRNA-1273.214 at 28 days after the booster dose. RESULTS: Interim results are presented. Sequential groups of participants received 50 μg of mRNA-1273.214 (437 participants) or mRNA-1273 (377 participants) as a second booster dose. The median time between the first and second boosters was similar for mRNA-1273.214 (136 days) and mRNA-1273 (134 days). In participants with no previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the geometric mean titers of neutralizing antibodies against the omicron BA.1 variant were 2372.4 (95% confidence interval [CI], 2070.6 to 2718.2) after receipt of the mRNA-1273.214 booster and 1473.5 (95% CI, 1270.8 to 1708.4) after receipt of the mRNA-1273 booster. In addition, 50-μg mRNA-1273.214 and 50-μg mRNA-1273 elicited geometric mean titers of 727.4 (95% CI, 632.8 to 836.1) and 492.1 (95% CI, 431.1 to 561.9), respectively, against omicron BA.4 and BA.5 (BA.4/5), and the mRNA-1273.214 booster also elicited higher binding antibody responses against multiple other variants (alpha, beta, gamma, and delta) than the mRNA-1273 booster. Safety and reactogenicity were similar with the two booster vaccines. Vaccine effectiveness was not assessed in this study; in an exploratory analysis, SARS-CoV-2 infection occurred in 11 participants after the mRNA-1273.214 booster and in 9 participants after the mRNA-1273 booster. CONCLUSIONS: The bivalent omicron-containing vaccine mRNA-1273.214 elicited neutralizing antibody responses against omicron that were superior to those with mRNA-1273, without evident safety concerns. (Funded by Moderna; ClinicalTrials.gov number, NCT04927065.).

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  • Modified bivalent mRNA SARS-CoV-2 vaccines elicited significantly higher nAb responses against recent SARS-CoV-2 variants and non-inferior titres against ancestral virus compared with monovalent vaccines in humans and preclinical animal models.

    “In addition, modified bivalent mRNA SARS-CoV-2 vaccines elicited significantly higher nAb responses against recent SARS-CoV-2 variants and non-inferior titres against ancestral virus compared with monovalent vaccines in humans and preclinical animal models9,24.”

    From Efficacy of an unmodified bivalent mRNA vaccine against SARS-CoV-2 variants in female small animal models (2023) · cites this paper as [24]

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  • These results are similar to the neutralizing antibody titer ratios observed with other approved BA.1-adapted mRNA vaccines when compared with their prototype vaccines.

    “These results are similar to the neutralizing antibody titer ratios observed with the other approved BA.1-adapted mRNA vaccines when compared with their prototype vaccines.”

    From An Omicron-specific, self-amplifying mRNA booster vaccine for COVID-19: a phase 2/3 randomized trial (2024) · cites this paper as [20]

    The Methods (Study Vaccines; page not available) identify mRNA-1273.214 as a BA.1-containing vaccine, and the Results (Immunogenicity; page not available) report a neutralizing-antibody titer ratio of 1.75 versus the prototype mRNA-1273 booster. The copy does not establish that the BA.1-adapted vaccine was approved; it describes the prototype booster as previously authorized. (LLM, conf=0.82)

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  • Neutralizing antibody response is considered a surrogate for efficacy against severe disease and has been used in immunobridging studies.

    “Neutralizing antibody response is considered to be a surrogate for efficacy against severe disease24 and has been used in immunobridging studies, especially for variant-updated COVID-19 vaccines20.”

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Authors
Chalkias, S., Harper, C., Vrbicky, K., Walsh, S. R., Essink, B., Brosz, A., McGhee, N., Tomassini, J. E., Chen, X., Chang, Y., Sutherland, A., Montefiori, D. C., Girard, B., Edwards, D. K., Feng, J., Zhou, H., Baden, L. R., Miller, J. M., & Das, R.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Chalkias, Spyros
Venue
New England Journal of Medicine
Published
2022-10-06
Volume
387
Issue
14
Pages
1279-1291
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W4296026861
Cited by
627
References
24
Citations by year
2026: 29 · 2025: 74 · 2024: 163 · 2023: 276 · 2022: 83 · 2013: 1
FWCI
72.71
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • medRxiv (acceptedVersion, cc-by-nc)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Moderna
Topics
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
Keywords
Omicron variant, BA.1, neutralizing antibodies, vaccine immunogenicity, vaccine safety, reactogenicity, SARS-CoV-2 infection history
MeSH terms
Immunogenicity, Vaccine, COVID-19, SARS-CoV-2, COVID-19 Vaccines, mRNA Vaccines, 2019-nCoV Vaccine mRNA-1273, Adult, Antibodies, Viral, Humans, Immunization, Secondary, Vaccines, Combined, Antibodies, Neutralizing

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