Guideline Development Tool

Author(s): K. Probyn, H. Bergman, N. Henschke

Question: ChAdOx1 compared to MenACWY for vaccination against COVID-19 ^a

Setting: Worldwide

Bibliography: https://covid-nma.com

Certainty assessment	№ of patients	Effect	Certainty	Importance
Incidence of participants with positive test for SARS-CoV-2 infection^b^c
1 ^d	randomised trials	not serious ^e	not serious	serious ^f	not serious	none	161/8597	346/8580	Rate ratio 0.46 (0.38 to 0.55)	-- per 1000 patient(s) per years (from -- to --)	⨁⨁⨁◯ MODERATE
Incidence of symptomatic COVID-19 confirmed with positive test for SARS-CoV-2^b^c
1 ^d	randomised trials	not serious ^e	not serious	serious ^f	not serious	none	84/8597	248/8580	Rate ratio 0.33 (0.26 to 0.43)	-- per 1000 patient(s) per years (from -- to --)	⨁⨁⨁◯ MODERATE
Incidence of hospitalization or death due to confirmed COVID-19^b^c
1 ^d	randomised trials	not serious	not serious	serious ^f	serious ^g	none	0/12408 (0.0%)	9/12104 (0.1%)	RR 0.05 (0.00 to 0.88)	71 fewer per 100,000 (from 9 fewer to --)	⨁⨁◯◯ LOW
Severe or critical disease due to COVID-19^b^h
1 ⁱ	randomised trials	not serious	not serious	serious ^f	very serious ^j	none	0/12021 (0.0%)	1/11724 (0.0%)	RR 0.33 (0.01 to 7.98)	6 fewer per 100,000 (from 8 fewer to 60 more)	⨁◯◯◯ VERY LOW
All-cause mortality ^b^k
1 ⁱ	randomised trials	not serious	not serious	serious ^f	very serious ^j	none	1/12282 (0.0%)	4/11962 (0.0%)	RR 0.49 (0.09 to 2.66)	17 fewer per 100,000 (from 30 fewer to 56 more)	⨁◯◯◯ VERY LOW
Incidence of any adverse events^b^l
1 ⁱ	randomised trials	not serious	not serious	serious ^f	not serious	none	95/12021 (0.8%)	126/11724 (1.1%)	RR 0.74 (0.56 to 0.96)	279 fewer per 100,000 (from 473 fewer to 43 fewer)	⨁⨁⨁◯ MODERATE
Incidence of serious adverse events (SAEs)^b^k
1 ⁱ	randomised trials	not serious	not serious	serious ^f	serious ^m	none	108/12282 (0.9%)	127/11962 (1.1%)	RR 0.83 (0.64 to 1.07)	180 fewer per 100,000 (from 382 fewer to 74 more)	⨁⨁◯◯ LOW

Certainty assessment

№ of patients

Effect

Certainty

Importance

№ of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

ChAdOx1

MenACWY

Relative
(95% CI)

Absolute
(95% CI)

Incidence of participants with positive test for SARS-CoV-2 infection^b^c

1 ^d

randomised trials

not serious ^e

not serious

serious ^f

not serious

none

161/8597

346/8580

Rate ratio 0.46
(0.38 to 0.55)

-- per 1000 patient(s) per years
(from -- to --)

⨁⨁⨁◯
MODERATE

Incidence of symptomatic COVID-19 confirmed with positive test for SARS-CoV-2^b^c

1 ^d

randomised trials

not serious ^e

not serious

serious ^f

not serious

none

84/8597

248/8580

Rate ratio 0.33
(0.26 to 0.43)

-- per 1000 patient(s) per years
(from -- to --)

⨁⨁⨁◯
MODERATE

Incidence of hospitalization or death due to confirmed COVID-19^b^c

1 ^d

randomised trials

not serious

serious ^f

serious ^g

none

0/12408 (0.0%)

9/12104 (0.1%)

RR 0.05
(0.00 to 0.88)

71 fewer per 100,000
(from 9 fewer to --)

⨁⨁◯◯
LOW

Severe or critical disease due to COVID-19^b^h

1 ⁱ

randomised trials

not serious

serious ^f

very serious ^j

none

0/12021 (0.0%)

1/11724 (0.0%)

RR 0.33
(0.01 to 7.98)

6 fewer per 100,000
(from 8 fewer to 60 more)

⨁◯◯◯
VERY LOW

All-cause mortality ^b^k

1 ⁱ

randomised trials

not serious

serious ^f

very serious ^j

none

1/12282 (0.0%)

4/11962 (0.0%)

RR 0.49
(0.09 to 2.66)

17 fewer per 100,000
(from 30 fewer to 56 more)

⨁◯◯◯
VERY LOW

Incidence of any adverse events^b^l

1 ⁱ

randomised trials

not serious

serious ^f

not serious

none

95/12021 (0.8%)

126/11724 (1.1%)

RR 0.74
(0.56 to 0.96)

279 fewer per 100,000
(from 473 fewer to 43 fewer)

⨁⨁⨁◯
MODERATE

Incidence of serious adverse events (SAEs)^b^k

1 ⁱ

randomised trials

not serious

serious ^f

serious ^m

none

108/12282 (0.9%)

127/11962 (1.1%)

RR 0.83
(0.64 to 1.07)

180 fewer per 100,000
(from 382 fewer to 74 more)

⨁⨁◯◯
LOW

a. Last updated: February 26, 2021

b. Pooled interim analysis of COV001, COV002, COV003 and COV005

c. >14 days after second dose; median follow-up 4 months

d. AstraZeneca: Voysey M, 2021

e. Despite some concerns with deviations from intervention, not downgraded for risk of bias.

f. Indirectness downgraded by one level: data are from an interim analysis of the trial, with a short duration of follow-up. Estimates may change over a longer duration of follow-up.

g. Imprecision downgraded by one level: due to few events observed.

h. >14 days after second dose; median follow-up 2 months

i. AstraZeneca: Voysey M, 2020

j. Imprecision downgraded by 2 levels: due to wide confidence interval consistent with the possibility for benefit and the possibility for harm and few events.

k. mean follow-up 4.1 months

l. median follow-up 3.4 months

m. Imprecision downgraded by 1 level: due to wide confidence interval consistent with the possibility for no effect and the possibility for benefit.

Explanations