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A comparison of four self-controlled study designs in an analysis of COVID-19 vaccines and myocarditis using five European databases.
Schultze, Anna; Martin, Ivonne; Messina, Davide; Bots, Sophie; Belitser, Svetlana; José Carreras-Martínez, Juan; Correcher-Martinez, Elisa; Urchueguía-Fornes, Arantxa; Martín-Pérez, Mar; García-Poza, Patricia; Villalobos, Felipe; Pallejà-Millán, Meritxell; Alberto Bissacco, Carlo; Segundo, Elena; Souverein, Patrick; Riefolo, Fabio; Durán, Carlos E; Gini, Rosa; Sturkenboom, Miriam; Klungel, Olaf; Douglas, Ian.
Afiliação
  • Schultze A; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: anna.schultze@lshtm.ac.uk.
  • Martin I; Department of Data Science and Biostatistics, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • Messina D; Agenzia Regionale di Sanità (ARS), Florence, Toscana, Italy.
  • Bots S; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
  • Belitser S; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
  • José Carreras-Martínez J; Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO - Public Health), Valencia, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
  • Correcher-Martinez E; Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO - Public Health), Valencia, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
  • Urchueguía-Fornes A; Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO - Public Health), Valencia, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
  • Martín-Pérez M; Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain.
  • García-Poza P; Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain.
  • Villalobos F; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
  • Pallejà-Millán M; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
  • Alberto Bissacco C; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
  • Segundo E; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
  • Souverein P; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
  • Riefolo F; Teamit Institute, Partnerships, Barcelona Health Hub, Barcelona, Spain.
  • Durán CE; Department of Data Science and Biostatistics, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • Gini R; Agenzia Regionale di Sanità (ARS), Florence, Toscana, Italy.
  • Sturkenboom M; Department of Data Science and Biostatistics, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • Klungel O; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
  • Douglas I; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Vaccine ; 42(12): 3039-3048, 2024 Apr 30.
Article em En | MEDLINE | ID: mdl-38580517
ABSTRACT

INTRODUCTION:

The aim of this study was to assess the possible extent of bias due to violation of a core assumption (event-dependent exposures) when using self-controlled designs to analyse the association between COVID-19 vaccines and myocarditis.

METHODS:

We used data from five European databases (Spain BIFAP, FISABIO VID, and SIDIAP; Italy ARS-Tuscany; England CPRD Aurum) converted to the ConcePTION Common Data Model. Individuals who experienced both myocarditis and were vaccinated against COVID-19 between 1 September 2020 and the end of data availability in each country were included. We compared a self-controlled risk interval study (SCRI) using a pre-vaccination control window, an SCRI using a post-vaccination control window, a standard SCCS and an extension of the SCCS designed to handle violations of the assumption of event-dependent exposures.

RESULTS:

We included 1,757 cases of myocarditis. For analyses of the first dose of the Pfizer vaccine, to which all databases contributed information, we found results consistent with a null effect in both of the SCRI and extended SCCS, but some indication of a harmful effect in a standard SCCS. For the second dose, we found evidence of a harmful association for all study designs, with relatively similar effect sizes (SCRI pre = 1.99, 1.40 - 2.82; SCRI post 2.13, 95 %CI - 1.43, 3.18; standard SCCS 1.79, 95 %CI 1.31 - 2.44, extended SCCS 1.52, 95 %CI = 1.08 - 2.15). Adjustment for calendar time did not change these conclusions. Findings using all designs were also consistent with a harmful effect following a second dose of the Moderna vaccine.

CONCLUSIONS:

In the context of the known association between COVID-19 vaccines and myocarditis, we have demonstrated that two forms of SCRI and two forms of SCCS led to largely comparable results, possibly because of limited violation of the assumption of event-dependent exposures.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Vacinas / COVID-19 / Miocardite Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Vacinas / COVID-19 / Miocardite Idioma: En Ano de publicação: 2024 Tipo de documento: Article