Table 4.
Summary of results in outcomes with pairwise and network meta-analysis
| Treatment comparison (vs reference) | Number of head-to-head studies | OR/IRR (95% CI), (95% PI)* | RR (95% CI) | VE (95% CI) | P-score | Credibility assessment (CINeMA) |
| Laboratory-confirmed influenza: OR (reference: placebo†), 9 RCTs, 6 intervention groups, 52 202 participants | ||||||
| IIV3-Adj | 0 | NMA: 0.24 (0.04 to 1.47), (0.02,3.10) | NMA: 0.28 (0.05 to 1.34) | NMA: 71.73 (−34.45 to 95.06) | 0.65 | Low |
| IIV3-HD | 0 | NMA: 0.23 (0.11 to 0.51), (0.08,0.70) | NMA: 0.27 (0.13 to 0.56) | NMA: 72.85 (43.50 to 86.64) | 0.78 | Low |
| IIV3-SD | 2 | NMA: 0.31 (0.15 to 0.67), (0.08,0.70) MA: 0.31 (0.13 to 0.75) |
NMA: 0.36 (0.18 to 0.72) MA: 0.36 (0.16 to 0.79) |
NMA: 64.08 (28.30 to 81.95) MA: 64.08 (21.08 to 84.29) |
0.45 | Low |
| IIV4-SD | 0 | NMA: 0.35 (0.12 to 1.07), (0.07,1.70) | NMA: 0.40 (0.15 to 1.06) | NMA: 59.81 (−5.53 to 85.46) | 0.37 | Low |
| RIV | 0 | NMA: 0.25 (0.08 to 0.73), (0.05,1.15) | NMA: 0.29 (0.10 to 0.77) | NMA: 70.63 (22.86 to 90.21) | 0.73 | Low |
| Number of vascular adverse events: IRR (reference: IIV3-SD†), 8 RCTs, 5 intervention groups, 57 677 participants | ||||||
| IIV3-Adj | 2 | NMA: 0.90 (0.54 to 1.50), (0.23,3.50) MA: 0.83 (0.54,1.27) | Not available | 0.23 | Very low | |
| IIV3-HD | 4 | NMA: 0.69 (0.49 to 0.97), (0.20,2.32) MA: 0.75 (0.43,1.29) | 0.48 | Very low | ||
| IIV4-Adj | 0 | NMA: 0.18 (0.07 to 0.43), (0.03,1.07) | 0.98 | Very low | ||
| IIV4-HD | 0 | NMA: 0.46 (0.21 to 1.00), (0.09,2.41) | 0.71 | Low | ||
| Outpatient visits: OR (reference: placebo†), 4 RCTs, 3 intervention groups, 41 995 participants | ||||||
| IIV3-HD | 0 | NMA: 0.65 (0.35 to 1.19), (0.01,41.95) | Not available | 0.49 | Very low | |
| IIV3-SD | 2 | NMA: 0.64 (0.36 to 1.14), (0.01,35.50) MA: 0.4 (0.07,2.14) | 0.93 | Very low | ||
| All-cause mortality: OR (reference: placebo†), 20 RCTs, 9 intervention groups, 140 577 participants | ||||||
| IIV3-Adj | 0 | NMA: 1.60 (0.44 to 5.85), (0.37,6.87) | Not available | 0.42 | Low | |
| IIV3-HD | 0 | NMA: 1.40 (0.41 to 4.84), (0.35,5.64) | 0.61 | Low | ||
| IIV3-SD | 2 | NMA: 1.47 (0.43 to 5.06), (0.37,5.89) MA: 1.47 (0.43,5.06) | 0.45 | Very low | ||
| IIV4-Adj | 0 | NMA: 8.00 (0.29 to 217.75), (0.20,326.89) | 0.42 | Low | ||
| IIV4-HD | 0 | NMA: 1.05 (0.12 to 9.29), (0.09,12.14) | 0.66 | Low | ||
| IIV4-SD | 0 | NMA: 1.42 (0.41 to 4.97), (0.35,5.80) | 0.55 | Very low | ||
| RIV | 0 | NMA: 1.01 (0.23 to 4.49), (0.19,5.40) | 0.75 | Low | ||
| Tdap | 0 | NMA: 8.24 (0.29 to 232.17), (0.19,350.04) | 0.17 | Low | ||
*Within network and between-study heterogeneity: laboratory-confirmed influenza τ=0.00, I2=0%; number of vascular adverse events τ=0.34, I2=97%; outpatient visits τ=0.11, I2=60.70%; all-cause mortality τ=0.00, I2=0%.
†Laboratory confirmed influenza P-score: Placebo P-score=0.02; Number of vascular adverse events P-score: IIV3-SD=0.10; outpatient visits P-score: placebo=0.07; all-cause mortality P-score: placebo=0.71.
Adj, adjuvanted; CINeMA, Confidence in Network Meta-Analysis; HD, high dosage; IIV3, inactivated influenza vaccine Trivalent; IIV4, IIV quadrivalent; IRR, incidence rate ratio; MA, meta-analysis; NMA, network MA; PI, prediction interval; RCT, randomised controlled trial; RIV, recombinant influenza vaccines; RR, relative risk; SD, standard dosage; tdap, tetanus–diphtheria–pertussis vaccine; VE, vaccine efficacy.