Liver and Bile
J Hepatol. 2022;77(5):1349–58
Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis
Background and aims: Cirrhosis is associated with immune dysregulation and hyporesponsiveness to several vaccines including those against COVID-19. The aim of this study was to compare outcomes between patients with cirrhosis who received 3 doses of either the Pfizer BNT162b2 mRNA or Moderna mRNA-1273 vaccines to a propensity-matched control group of patients at similar risk of infection who received 2 doses.
Methods: This was a retrospective cohort study of patients with cirrhosis who received 2 or 3 doses of a COVID-19 mRNA vaccine at the Veterans Health Administration. Participants who received 3 doses of the vaccine (n = 13,041) were propensity score matched with 13,041 controls who received 2 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 COVID-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 in COVID-19 (95% confidence interval [CI]: 39.2–89.1, p < 0.001), an 80.4% reduction in symptomatic COVID-19 (95% CI: 36.8–88.9, p < 0.0001), an 80% reduction in moderate, severe or critical COVID-19 (95% CI: 34.5–87.6, p = 0.005), a 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 rather 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 patients with cirrhosis than in the general population, suggesting that the third dose can overcome vaccine hyporesponsiveness in this population.