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Real-world effectiveness of COVID-19 vaccination in liver cirrhosis: a systematic review with meta-analysis of 51,834 patients.

ABSTRACT: SARS-CoV-2 vaccinations were found to be highly effective in phase 3 clinical trials. However, these trials have not reported data regarding the subgroup of liver disease or excluded patients with liver disease. The effectiveness of COVID-19 vaccines among liver cirrhosis (LC) patients is unclear. We conducted this meta-analysis to assess the effectiveness of SARS-CoV-2 vaccination in LC patients. A comprehensive literature search was conducted to include all the relevant studies that compared the outcomes of LC patients who received SARS-CoV-2 vaccines vs. unvaccinated patients. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated by the Mantel-Haenszel method within a random-effect model. Four studies with 51,834 LC patients (20,689 patients received at least one dose vs 31,145 were unvaccinated) were included. COVID-19-related complications, including hospitalization (RR 0.73, 95% CI 0.59-0.91, P = 0.004), mortality (RR 0.29, 95% CI 0.16-0.55, P = 0.0001), and need for invasive mechanical ventilation (RR 0.29, 95% CI 0.11-0.77, P = 0.01), were significantly lower in the vaccinated group compared to the unvaccinated group. SARS-CoV-2 vaccination in LC patients reduced COVID-19-related mortality, intubation, and hospitalization. SARS-CoV-2 vaccination is highly effective in LC. Further prospective studies, preferably randomized controlled trials, are necessary to validate our findings and determine which vaccine is superior in patients with LC.

SUBMITTER: Beran A

PROVIDER: S-EPMC9980592 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Real-world effectiveness of COVID-19 vaccination in liver cirrhosis: a systematic review with meta-analysis of 51,834 patients.

Beran Azizullah A Mhanna Asmaa A Mhanna Mohammed M Hassouneh Ramzi R Abuhelwa Ziad Z Mohamed Mouhand F H MFH Sayeh Wasef W Musallam Rami R Assaly Ragheb R Abdeljawad Khaled K

Proceedings (Baylor University. Medical Center) 20230117 2

SARS-CoV-2 vaccinations were found to be highly effective in phase 3 clinical trials. However, these trials have not reported data regarding the subgroup of liver disease or excluded patients with liver disease. The effectiveness of COVID-19 vaccines among liver cirrhosis (LC) patients is unclear. We conducted this meta-analysis to assess the effectiveness of SARS-CoV-2 vaccination in LC patients. A comprehensive literature search was conducted to include all the relevant studies that compared t ...[more]

PMID: 36876272

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Project description:IntroductionReal-world safety studies can provide important evidence on the thromboembolic risk associated with COVID-19 vaccines, considering that millions of people have been already vaccinated against COVID-19. In this study, we aimed to estimate the incidence of thromboembolic events after COVID-19 vaccination and to compare the Oxford-AstraZeneca vaccine with other COVID-19 vaccines.MethodsWe conducted a retrospective real-world safety study using data from two different data sources: the Italian Pharmacovigilance database (Rete Nazionale di Farmacovigilanza, RNF) and the Campania Region Health system (Sistema INFOrmativo saNità CampanIA, SINFONIA). From the start date of the COVID-19 vaccination campaign (27 December 2021) to 27 September 2022, information on COVID-19 vaccinations and thromboembolic events were extracted from the two databases. The reporting rate (RR) and its 95% confidence interval (95%CI) of thromboembolic events for 10,000 doses was calculated for each COVID-19 vaccine. Moreover, the odds of being vaccinated with the Oxford-AstraZeneca vaccine vs. the other COVID-19 vaccines in cases with thromboembolic events vs. controls without thromboembolic events were computed.ResultsA total of 12,692,852 vaccine doses were administered in the Campania Region, of which 6,509,475 (51.28%) were in females and mostly related to the Pfizer-BioNtech vaccine (65.05%), followed by Moderna (24.31%), Oxford-AstraZeneca (9.71%), Janssen (0.91%), and Novavax (0.02%) vaccines. A total of 641 ICSRs with COVID-19 vaccines and vascular events were retrieved from the RNF for the Campania Region, of which 453 (70.67%) were in females. Most ICSRs reported the Pfizer-BioNtech vaccine (65.05%), followed by Oxford-AstraZeneca (9.71%), Moderna (24.31%), and Janssen (0.91%). A total of 2451 events were reported in the ICSRs (3.8 events for ICSRs), of which 292 were thromboembolic events. The higher RRs of thromboembolic events were found with the Oxford-AstraZeneca vaccine (RR: 4.62, 95%CI: 3.50-5.99) and Janssen vaccine (RR: 3.45, 95%CI: 0.94-8.82). Thromboembolic events were associated with a higher likelihood of exposure to the Oxford-AstraZeneca vaccine compared to Pfizer-BioNtech (OR: 6.06; 95%CI: 4.22-8.68) and Moderna vaccines (OR: 6.46; 95%CI: 4.00-10.80).ConclusionWe observed a higher reporting of thromboembolic events with viral-vector-based vaccines (Oxford-AstraZeneca and Janssen) and an increased likelihood of being exposed to the Oxford-AstraZeneca vaccine compared to the mRNA vaccines (Pfizer-BioNtech and Moderna) among thromboembolic cases.

Project description:BackgroundThere is a knowledge gap regarding the effectiveness and utility of various preventive interventions during the COVID-19 pandemic. In this study, we aimed to evaluate the cost-effectiveness of various COVID-19 preventive interventions, including non-medical interventions (NMIs) and vaccination programs, using real-world data across different demographic and socioeconomic contexts worldwide.MethodsWe searched Medline, Cochrane Library, Embase, and Web of Science Core Collection from December 2019 to March 2024. We identified 75 studies which compared 34 COVID-19 preventive interventions. We conducted a network meta-analysis to assess the incremental net benefits (INB) of these interventions from both societal and health care system perspectives. We adjusted purchasing power parity (PPP) and standardised willingness to pay (WTP) to enhance the comparability of cost-effectiveness across different economic levels. We performed sensitivity and subgroup analyses to examine the robustness of the results.ResultsMovement restrictions and expanding testing emerged as the most cost-effective strategies from a societal perspective, with WTP-standardised INB values of USD 21 050 and USD 11 144. In contrast, combinations of NMIs with vaccination were less cost-effective, particularly in high-income regions. From a health care system perspective, vaccination plus distancing and test, trace, and isolate strategy were highly cost-effective, while masking requirements were less economically viable. The effectiveness of interventions varied significantly across different economic contexts, underlining the necessity for region-specific strategies.ConclusionsIn this study, we highlight significant variations in the cost-effectiveness of COVID-19 preventive interventions. Tailoring strategies to specific regional economic and infrastructural conditions is crucial. Continuous evaluation and adaptation of these strategies are essential for effective management of ongoing and future public health threats.RegistrationPROSPERO: CRD42023385169.

Dataset Information

Real-world effectiveness of COVID-19 vaccination in liver cirrhosis: a systematic review with meta-analysis of 51,834 patients.

Publications

Real-world effectiveness of COVID-19 vaccination in liver cirrhosis: a systematic review with meta-analysis of 51,834 patients.

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