Dr. Roach: How to decide among COVID-19 booster options

Keith Roach
To Your Health

Dear Dr. Roach: I am a 65-year-old man in good health. In March 2021 I received the Johnson & Johnson vaccine. I understand I am eligible to receive a booster. I also understand that the Centers for Disease Control and Prevention says I may receive any of the three vaccines, but that they do not recommend one over the other.

I am torn on which one to receive. I hear that the Moderna booster will boost the antibodies multiple-fold over receiving another J&J shot. I also read somewhere that the J&J shot seems to offer longer protection, although less of it. Is that true? Also, I don’t believe there are any long-term studies on the effects of mixing the two type vaccines.

Is there any proof that having more antibodies protects one better? So, if it got the Moderna booster, I’d be protected better than if I got the J & J booster? What are your thoughts?

— C.M.

Dr. Keith Roach

Dear C.M.: Antibody tests showing immunity to COVID-19 are not yet standardized, and we don’t know what level is protective. I don’t order antibody testing, as I’m just not sure how to interpret the results.

A recent study presented in October at the Advisory Committee on Immunization Practices, the external advisory committee to the CDC, did show that both the Moderna vaccine and the Pfizer vaccine dramatically increased antibody levels in people who had had the J&J vaccine (the Moderna 76-fold; the Pfizer 35-fold).

As far as duration of immunity, other studies have shown that the Moderna and Pfizer vaccines seemed to have longer-lasting protection than the J&J vaccine, although these data are relatively new and not yet confirmed by other studies.

Based on the ACIP data, I am recommending my patients who had the J&J vaccine to get either of the mRNA vaccines (Moderna or Pfizer). This recommendation is based on fairly preliminary data and may change when new studies are published.

Dear Dr. Roach: In one of your recent columns you mentioned that some of your patients found success taking ibuprofen for prostate symptoms. Could you expound on this please? I have not been able to find anything on the web to support this. The prescription meds for prostate have negative side effects, so something simple and over-the-counter like Advil would be great if there is evidence to support it.

— P.C.

Dear P.C.: Several studies have indeed shown that ibuprofen — along with other anti-inflammatories, such as celecoxib (Celebrex) — reduces urinary symptoms in men with enlarged prostates, such as the number of times needed to get up during the night, as well as flow rates. The side effect profile of low-dose ibuprofen at nighttime is pretty good, although any medicine can cause side effects, such as stomach upset. My clinical experience is that ibuprofen is helpful for most but not all men, but that it isn’t as effective as commonly prescribed medicines like tamsulosin (Flomax), which also may have side effects. I think ibuprofen is worth a try in men with mild to moderate symptoms.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.