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Adults with cirrhosis have a lower and slower immune response to mRNA COVID-19 vaccines, resulting in a “delayed but modest” reduction in COVID-19 infections, according to a retrospective study of US veterans.
Although the data suggest a “lower benefit” in patients with cirrhosis compared with that observed in randomized clinical trials in the general population, “they appear to be highly associated with a reduction in hospitalization and death due to COVID-19,” write the authors, led by Binu V. John, MD, MPH, from the University of Miami Miller School of Medicine and the Bruce W. Carter VA Medical Center in Miami, Florida.
“These findings strengthen the hope that these vaccines may mitigate the effects of the COVID-19 pandemic on individuals with cirrhosis in the US,” the authors add.
The study appears in the October issue of JAMA Internal Medicine.
Addressing a Knowledge Gap
Immune dysregulation in patients with cirrhosis is associated with a diminished response to several vaccines, including hepatitis B and pneumococcal vaccines.
However, the efficacy of COVID-19 vaccines in this disease, particularly among those with decompensated cirrhosis, represents a “significant knowledge gap,” the authors note.
To investigate, they studied a cohort of 20,037 US veterans with cirrhosis who received at least one dose of either the Pfizer/BioNTech or Moderna mRNA COVID-19 vaccine. Those veterans were then compared against an identical number of propensity score-matched veterans with cirrhosis unvaccinated against COVID-19.
Virtually all (99.7%) veterans who received a first dose of vaccine and who had a follow-up of at least 42 days received their second dose within this recommended timeframe.
There was no difference between the vaccinated and unvaccinated veterans in the first 28 days after the first dose, indicating a slow immune response in the setting of cirrhosis.
After the first dose of either vaccine, 83 vaccinated patients developed COVID-19, compared with 105 unvaccinated controls. The number of COVID-19 infections in the vaccine and control groups was similar in days 0 to 7, 7 to 14, 14 to 21, and 21 to 28 after administration of the first dose. However, after the first 28 days, receipt of one dose of either vaccine was associated with a 64.8% reduction in COVID-19 infections. Seven days after the second dose of vaccine, this improved to a 78.6% decrease.
“More importantly, receipt of either vaccine was associated with a 100% reduction in hospitalization or death due to COVID-19 infection,” the authors report.
There was a trend toward lower protection from vaccination in patients with decompensated cirrhosis compared with compensated cirrhosis. However, the authors noted that “this needs to be confirmed in future studies because the number of patients and events among patients with decompensated cirrhosis were low.”
The authors have disclosed no relevant financial relationships. Support for this research was provided by a National Institutes of Health (NIH)/National Cancer Institute (NCI) Cancer Center support grant.
JAMA Intern Med. 2021;181:1306-14. Full text