Real-world effectiveness of COVID-19 vaccines and anti-SARS-CoV-2 monoclonal antibodies against postacute sequelae of SARS-CoV-2: analysis of a COVID-19 observational registry for a diverse US metropolitan population

Apr 5, 2023BMJ open

COVID-19 vaccines and antibody treatments may reduce long-term symptoms after infection in a diverse US city population

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Abstract

Among 53,239 subjects, 11.1% experienced (PASC).

Vaccinated individuals had a 42% lower likelihood of developing PASC compared to unvaccinated individuals.
Monoclonal antibody-treated patients had a 23% lower likelihood of developing PASC compared to those who were untreated.
Vaccination was linked to decreased odds of all constitutional and systemic symptoms associated with PASC, except for changes in taste and smell.
In a replication analysis, the frequency of PASC was consistent at 11.2%, showing similar protective effects for both vaccination and monoclonal antibodies.

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OBJECTIVES: We evaluated the effectiveness of COVID-19 vaccines and monoclonal antibodies (mAbs) against (PASC).

DESIGN AND SETTING: A retrospective cohort study using a COVID-19 specific, electronic medical record-based surveillance and outcomes registry from an eight-hospital tertiary hospital system in the Houston metropolitan area. Analyses were replicated across a global research network database.

PARTICIPANTS: We identified adult (≥18) patients with PASC. PASC was defined as experiencing constitutional (palpitations, malaise/fatigue, headache) or systemic (sleep disorder, shortness of breath, mood/anxiety disorders, cough and cognitive impairment) symptoms beyond the 28-day postinfection period.

STATISTICAL ANALYSIS: We fit multivariable logistic regression models and report estimated likelihood of PASC associated with vaccination or mAb treatment as adjusted ORs with 95% CIs.

RESULTS: Primary analyses included 53 239 subjects (54.9% female), of whom 5929, 11.1% (95% CI 10.9% to 11.4%), experienced PASC. Both vaccinated breakthrough cases (vs unvaccinated) and mAb-treated patients (vs untreated) had lower likelihoods for developing PASC, aOR (95% CI): 0.58 (0.52-0.66), and 0.77 (0.69-0.86), respectively. Vaccination was associated with decreased odds of developing all constitutional and systemic symptoms except for taste and smell changes. For all symptoms, vaccination was associated with lower likelihood of experiencing PASC compared with mAb treatment. Replication analysis found identical frequency of PASC (11.2%, 95% CI 11.1 to 11.3) and similar protective effects against PASC for the COVID-19 vaccine: 0.25 (0.21-0.30) and mAb treatment: 0.62 (0.59-0.66).

CONCLUSION: Although both COVID-19 vaccines and mAbs decreased the likelihood of PASC, vaccination remains the most effective tool for the prevention of long-term consequences of COVID-19.

Key numbers

0.58

Likelihood Reduction of with Vaccination

Adjusted odds ratio for vaccinated breakthrough cases vs. unvaccinated

5929 of 53239

Prevalence

Number of patients with out of total cohort

0.77

Likelihood Reduction of with mAb Treatment

Adjusted odds ratio for mAb-treated patients vs. untreated

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Real-world effectiveness of COVID-19 vaccines and anti-SARS-CoV-2 monoclonal antibodies against postacute sequelae of SARS-CoV-2: analysis of a COVID-19 observational registry for a diverse US metropolitan population

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