Third-dose mRNA vaccine beats hyporesponsiveness in COVID-19 patients with cirrhosis

A third-dose administration of a COVID-19 mRNA vaccine results in a more substantial decrease in COVID-19 in patients with cirrhosis compared with the general population, according to a study. This suggests that the third dose can overcome vaccine hyporesponsiveness in this population.

A retrospective cohort study was conducted involving patients with cirrhosis who received two or three doses of a COVID-19 mRNA vaccine at the Veterans Health Administration. Those who received three doses of the vaccine (n=13,041) were propensity-score matched with controls who received two doses (n=13,041). Participants were assessed between 18 July 2021 and 11 February 2022, when delta and omicron were the predominant variants.

Finally, the researchers aggregated outcomes as all cases with COVID-19, symptomatic COVID-19, with at least moderate COVID-19, or severe or critical COVID-19.

Receipt of the third dose of an mRNA vaccine led to an 80.7-percent reduction in COVID-19 (95 percent confidence interval [CI], 39.2‒89.1; p<0.001); an 80.4-percent decrease in symptomatic COVID-19; an 80-percent reduction in moderate, severe, or critical COVID-19; a 100-percent decrease in severe or critical COVID-19 (95 percent CI, 99.2‒100.0; p=0.01); and a 100-percent reduction in COVID-19‒related death (95 percent CI, 99.8‒100.0; p=0.007).

The extent of decrease in COVID-19 was higher with a third dose of NT 162b2 than mRNA-1273 and among participants with compensated rather than decompensated cirrhosis.

“Cirrhosis is associated with immune dysregulation and hyporesponsiveness to several vaccines including those against COVID-19,” the researchers said.