Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis.

ABSTRACT:

Background and aims

Cirrhosis is associated with immune dysregulation and hypo-responsiveness to several vaccines including against COVID-19. Our aim was to study the association of the receipt of three doses of either the Pfizer BNT162b2 mRNA or Moderna mRNA-1273 vaccines in patients with cirrhosis, compared to a propensity-matched control group of patients at similar risk of infection who received two doses.

Methods

This was a retrospective cohort study of patients with cirrhosis who received two or three doses of a COVID-19 mRNA vaccine at the Veterans Health Administration. Participants who received three doses of the vaccine (n=13,041) were propensity matched with 13,041 controls who received two doses, and studied between July 18, 2021 and February 11, 2022, when B.1.617.2 (Delta) and B.1.1.529 (Omicron) were the predominant variants. Outcomes were aggregated as all cases with COVID-19, symptomatic COVD-19, with at least moderate COVID-19, or severe or critical COVID-19.

Results

Receipt of the third dose of a COVID-19 mRNA vaccine was associated with an 80.7% reduction COVID-19 (95% CI 39.2-89.1, p<0.001), 80.4% reduction in symptomatic COVID-19, 80% reduction in moderate/ severe or critical COVID-19, (95% CI 34.5-87.6%, p=0.005), 100% reduction in severe or critical COVID-19 (95% CI 99.2-100.0, p=0.01), and a 100% reduction in COVID-19-related death (95% CI 99.8-100.0, p=0.007). The magnitude of reduction in COVID-19 was greater with the third dose of BNT 162b2 than mRNA-1273 and among participants with compensated than decompensated cirrhosis.

Conclusions

Administration of a third dose of a COVID-19 mRNA vaccine was associated with a more significant reduction in COVID-19 in cirrhosis than reported in the general population, suggesting that the third dose can overcome vaccine hyporesponsiveness in this population.

Lay summary

Cirrhosis is associated with decreased responsiveness to several vaccines, including against COVID-19. In this study of 26,082 participants with cirrhosis during the delta and omicron surge, receipt of the third dose of the vaccine was associated with 80% reduction in COVID-19, 100% reduction in severe/critical COVID-19, and 100% reduction in COVID-19-related death. The findings support the third dose of mRNA vaccine among patients with cirrhosis.

SUBMITTER: John BV 

PROVIDER: S-EPMC9519143 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature