WASHINGTON—People with cirrhosis appeared to be significantly more protected from the SARS-CoV-2 virus if they received a third dose of a COVID-19 mRNA vaccine instead of just the initial two doses, according to a study of over 26,000 adults presented at The Liver Meeting 2022.
Receiving a third dose of the mRNA vaccines during the delta- and omicron-predominant phases of the pandemic (December 2020 through Feb. 11, 2022) was associated with an 80% reduction in SARS-CoV-2 infection, symptomatic COVID-19, and moderate, severe or critical COVID-19, said investigator Binu John, MD, MPH, an associate professor at the University of Miami, and a gastroenterologist and hepatologist at the Bruce W. Carter VA Medical Center, in Miami. In addition, the third dose was associated with a 100% decrease in deaths from COVID-19, although Dr. John noted that COVID-19–related deaths were extremely rare in both groups, with no deaths among those who had received three doses.
“Our data suggest that a third dose may be able to overcome the vaccine hyporesponsiveness seen in patients with cirrhosis,” Dr. John said.
In a retrospective cohort study, he and co-investigators from Miami VA Healthcare System/University of Miami, Virginia Commonwealth University, Philadelphia VA/University of Pennsylvania and West Haven VA/Yale University used data from the national Veteran’s Outcome and Cost Associated with Liver disease cohort, which has 129,000 well-characterized patients with cirrhosis. Then, they analyzed dates and types of COVID-19 vaccines administered using the Veterans Affairs COVID-19 shared data resource. They included adults aged 18 years and older with cirrhosis who received either two or three doses of the BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) COVID-19 vaccines during the study period. They excluded liver transplant recipients, unvaccinated or partially vaccinated patients, and those who received a non-mRNA vaccine. The earliest patient received the third dose in July 2021.
The median age of the 26,082 patients was 63 years. Most (97%) were male, and 4.4% had prior COVID-19 infections. Patients in the three-dose arm were matched 1:1 with patients in the two-dose arm based on age, sex, race/ethnicity, etiology of cirrhosis, date of second dose, Alcohol Use Disorders Identification Test score, tobacco use, diabetes and other comorbidities. The primary outcome was SARS-CoV-2 infection as measured by a positive polymerase chain reaction test during the study period. Secondary outcomes were symptomatic COVID-19, moderate/severe/critical COVID-19, severe/critical COVID-19 and COVID-19–related death.
| Table. Outcomes With Two Versus Three Doses Based on John et al, The Liver Meeting 2022. | ||||
| Outcome | Two-dose group, n | Three-dose group, n | Effectiveness, % (95% CI) | P value |
|---|---|---|---|---|
| SARS-CoV-2 infection | 57 | 11 | 80.7 (39.2-89.1) | <0.0001 |
| Symptomatic COVID-19 | 46 | 9 | 80.4 (36.8-88.9) | <0.0001 |
| Moderate/severe/critical COVID-19 | 15 | 3 | 80.0 (34.5-87.6) | <0.0001 |
| Severe/critical COVID-19 | 7 | 0 | 100 (99.2-100) | <0.0081 |
For all outcomes, having three doses versus two was statistically significant (Table), Dr. John said. “The third dose appears to make a significant difference in patients with cirrhosis.”
—Karen Blum
Dr. John reported financial relationships with Exact Sciences, Exelixis, Glycotest and GSK.
This article is from the January 2023 print issue.