Comparative efficacy of human papillomavirus vaccines: systematic review and network meta-analysis

ABSTRACT

Objectives

Despite their use, differences in human papillomavirus (HPV) vaccine efficacies remain uncertain. This study assesses efficacy differences among bivalent, quadrivalent, and nine-valent HPV (2vHPV, 4vHPV, and 9vHPV) vaccines.

Methods

PubMed, Web of Science, Embase, and the Cochrane Library were searched for randomized controlled trials comparing HPV vaccine efficacy against persistent infection (≥6 months) and cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Network meta-analysis yielded direct and indirect comparisons. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were reported, and robustness was evaluated via sensitivity analysis.

Results

In 11 randomized controlled trials with 58,881 healthy women, for persistent infection with HPV 16, 9vHPV was most effective at 97% (RR = 0.03, 95% CI: 0.01–0.08); for HPV 18, 2vHPV (Cecolin) was most effective at 98% (RR = 0.02, 95% CI: 0.00–0.29); for CIN2+ associated with HPV 16 and 18, 4vHPV was most effective at 99% (RR = 0.01, 95% CI: 0.00–0.10) and 97% (RR = 0.03, 95% CI: 0.00–0.45), respectively; for persistent infection with HPV 31, 33, 45, 52, and 58, 9vHPV was ≥ 95% effective; both 2vHPV vaccines were cross-effective against HPV 31, 33, and 45; and 4vHPV was cross-effective against HPV 31.

Conclusions

HPV vaccine efficacies differ for different HPV types. Additional data are needed to determine the cross-efficacy of 2vHPV (Cecolin).

KEYWORDS:

• Human papillomavirus
• network meta-analysis
• persistent infection
• vaccines
• vaccine efficacy

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A peer reviewer on this manuscript received honoraria for their review work. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

R Lin conceptualized and designed the study, performed data extraction and analysis, drafted the initial manuscript, and revised the manuscript. X Fu performed data extraction and analysis, reviewed and revised the manuscript. H Jin conceptualized and designed the study and critically revised and reviewed the manuscript. All authors approved the final manuscript as submitted.

Ethical approval

Patients or the public were not involved in setting the research question or the outcome measures, nor were they involved in the design or conduct of the study. No participants were asked to advise on interpreting or writing the manuscript. There are no plans to involve patients in the dissemination of the study findings.

Acknowledgments

We are grateful for the financial support from the Chinese National Natural Fund, Science Technology Demonstration Project for Emerging Infectious Diseases Control and Prevention, Jiangsu Provincial Six Talent Peak, Southeast University Novel Coronavirus Research, and Jiangsu Provincial Key Medical Discipline.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14760584.2023.2287135.

Additional information

Funding

This manuscript was funded by the Chinese National Natural Fund [81573258]; Science Technology Demonstration Project for Emerging Infectious Diseases Control and Prevention [BE2017749]; Jiangsu Provincial Six Talent Peak [WSN–002]; Southeast University Novel Coronavirus Research [3225002001C1]; and Jiangsu Provincial Key Medical Discipline [ZDXKA2016008]. The funders and sponsors did not participate in the work.