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Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis
Cirrhosis is associated with immune dysregulation and hyporesponsiveness to several vaccines including those against COVID-19. Our aim 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...
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| Published in: | Journal of hepatology 2022-11, Vol.77 (5), p.1349-1358 |
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| creator | John, Binu V. Ferreira, Raphaella D. Doshi, Akash Kaplan, David E. Taddei, Tamar H. Spector, Seth A. Paulus, Elizabeth Deng, Yangyang Bastaich, Dustin Dahman, Bassam |
| description | Cirrhosis is associated with immune dysregulation and hyporesponsiveness to several vaccines including those against COVID-19. Our aim 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.
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 COVD-19, with at least moderate COVID-19, or severe or critical COVID-19.
Receipt of the third dose of a COVID-19 mRNA vaccine was associated with an 80.7% reduction in COVID-19 (95% CI 39.2-89.1, p |
| doi_str_mv | 10.1016/j.jhep.2022.07.036 |
| format | article |
| fullrecord | <record><control><sourceid>elsevier_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9519143</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0168827822030021</els_id><sourcerecordid>S0168827822030021</sourcerecordid><originalsourceid>FETCH-LOGICAL-c455t-f00f00cf633f52339f8b36e207f22465fa93b1dc5b0899b5f0465acf7d5f60573</originalsourceid><addsrcrecordid>eNp9kN2K1DAUx4Mo7rj6Al5IXqD1JGnSBkRYxq-FxQVZvQ1pemIzbJuS1Mq-vRlGB70RAoH8P87Jj5CXDGoGTL0-1IcRl5oD5zW0NQj1iOyYAqhANewx2RVTV3W87S7Is5wPACBAN0_JhVCsY7prd2S6G0Ma6BAz0ujp_vbb9buKaTp9-XxFN-tcmJHaZUGbMl0jjRsmFyc8a-PDEhPmJc45bDhjzjTMdLFrwHnN9GdYR-pCSmPMIT8nT7y9z_ji931Jvn54f7f_VN3cfrzeX91UrpFyrTxAOc4rIbzkQmjf9UIhh9Zz3ijprRY9G5zsodO6lx7Ko3W-HaRXIFtxSd6eepcf_YSDK6ske2-WFCabHky0wfyrzGE03-NmtGSaNaIU8FOBSzHnhP6cZWCO8M3BHOGbI3wDrSnwS-jV31PPkT-0i-HNyYDl71vAZLIrmBwOIaFbzRDD__p_AZ_7mCI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis</title><source>ScienceDirect Freedom Collection</source><creator>John, Binu V. ; Ferreira, Raphaella D. ; Doshi, Akash ; Kaplan, David E. ; Taddei, Tamar H. ; Spector, Seth A. ; Paulus, Elizabeth ; Deng, Yangyang ; Bastaich, Dustin ; Dahman, Bassam</creator><creatorcontrib>John, Binu V. ; Ferreira, Raphaella D. ; Doshi, Akash ; Kaplan, David E. ; Taddei, Tamar H. ; Spector, Seth A. ; Paulus, Elizabeth ; Deng, Yangyang ; Bastaich, Dustin ; Dahman, Bassam</creatorcontrib><description>Cirrhosis is associated with immune dysregulation and hyporesponsiveness to several vaccines including those against COVID-19. Our aim 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.
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 COVD-19, with at least moderate COVID-19, or severe or critical COVID-19.
Receipt of the third dose of a COVID-19 mRNA vaccine was associated with an 80.7% reduction in COVID-19 (95% CI 39.2-89.1, p <0.001), an 80.4% reduction in symptomatic COVID-19, 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.
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.
Cirrhosis is associated with decreased responsiveness to several vaccines, including those against COVID-19. In this study of 26,082 participants with cirrhosis during the delta and omicron surge, receipt of the third dose of the vaccine was associated with an 80% reduction in COVID-19, a 100% reduction in severe/critical COVID-19, and a 100% reduction in COVID-19-related death. These findings support the importance of a third dose of mRNA vaccine among patients with cirrhosis.
[Display omitted]
•Study comparing 3 vs. 2 doses of an mRNA vaccine among patients with cirrhosis during the Delta and Omicron surge.•3 doses associated with 81% reduction in COVID-19, 100% reduction in severe/critical COVID-19.•Protection greater in patients with compensated than decompensated cirrhosis.•3 doses of the Pfizer BNT162b2 superior to 3 doses of Moderna mRNA-1273 vaccine.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2022.07.036</identifier><identifier>PMID: 36181987</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>BNT162 Vaccine ; BNT162b2 mRNA ; booster dose ; chronic liver disease ; COVID-19 - epidemiology ; COVID-19 - prevention & control ; COVID-19 vaccines ; COVID-19 Vaccines - adverse effects ; hepatic decompensation ; Humans ; Liver Cirrhosis - complications ; mRNA Vaccines ; mRNA-1273 ; Retrospective Studies ; SARS-CoV-2 ; Vaccines ; Vaccines, Synthetic</subject><ispartof>Journal of hepatology, 2022-11, Vol.77 (5), p.1349-1358</ispartof><rights>2022</rights><rights>Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-f00f00cf633f52339f8b36e207f22465fa93b1dc5b0899b5f0465acf7d5f60573</citedby><cites>FETCH-LOGICAL-c455t-f00f00cf633f52339f8b36e207f22465fa93b1dc5b0899b5f0465acf7d5f60573</cites><orcidid>0000-0002-3839-336X ; 0000-0002-8724-0378 ; 0000-0002-2182-2471 ; 0000-0003-4990-4839 ; 0000-0002-2002-9682</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36181987$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>John, Binu V.</creatorcontrib><creatorcontrib>Ferreira, Raphaella D.</creatorcontrib><creatorcontrib>Doshi, Akash</creatorcontrib><creatorcontrib>Kaplan, David E.</creatorcontrib><creatorcontrib>Taddei, Tamar H.</creatorcontrib><creatorcontrib>Spector, Seth A.</creatorcontrib><creatorcontrib>Paulus, Elizabeth</creatorcontrib><creatorcontrib>Deng, Yangyang</creatorcontrib><creatorcontrib>Bastaich, Dustin</creatorcontrib><creatorcontrib>Dahman, Bassam</creatorcontrib><title>Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>Cirrhosis is associated with immune dysregulation and hyporesponsiveness to several vaccines including those against COVID-19. Our aim 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.
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 COVD-19, with at least moderate COVID-19, or severe or critical COVID-19.
Receipt of the third dose of a COVID-19 mRNA vaccine was associated with an 80.7% reduction in COVID-19 (95% CI 39.2-89.1, p <0.001), an 80.4% reduction in symptomatic COVID-19, 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.
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.
Cirrhosis is associated with decreased responsiveness to several vaccines, including those against COVID-19. In this study of 26,082 participants with cirrhosis during the delta and omicron surge, receipt of the third dose of the vaccine was associated with an 80% reduction in COVID-19, a 100% reduction in severe/critical COVID-19, and a 100% reduction in COVID-19-related death. These findings support the importance of a third dose of mRNA vaccine among patients with cirrhosis.
[Display omitted]
•Study comparing 3 vs. 2 doses of an mRNA vaccine among patients with cirrhosis during the Delta and Omicron surge.•3 doses associated with 81% reduction in COVID-19, 100% reduction in severe/critical COVID-19.•Protection greater in patients with compensated than decompensated cirrhosis.•3 doses of the Pfizer BNT162b2 superior to 3 doses of Moderna mRNA-1273 vaccine.</description><subject>BNT162 Vaccine</subject><subject>BNT162b2 mRNA</subject><subject>booster dose</subject><subject>chronic liver disease</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - prevention & control</subject><subject>COVID-19 vaccines</subject><subject>COVID-19 Vaccines - adverse effects</subject><subject>hepatic decompensation</subject><subject>Humans</subject><subject>Liver Cirrhosis - complications</subject><subject>mRNA Vaccines</subject><subject>mRNA-1273</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Vaccines</subject><subject>Vaccines, Synthetic</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kN2K1DAUx4Mo7rj6Al5IXqD1JGnSBkRYxq-FxQVZvQ1pemIzbJuS1Mq-vRlGB70RAoH8P87Jj5CXDGoGTL0-1IcRl5oD5zW0NQj1iOyYAqhANewx2RVTV3W87S7Is5wPACBAN0_JhVCsY7prd2S6G0Ma6BAz0ujp_vbb9buKaTp9-XxFN-tcmJHaZUGbMl0jjRsmFyc8a-PDEhPmJc45bDhjzjTMdLFrwHnN9GdYR-pCSmPMIT8nT7y9z_ji931Jvn54f7f_VN3cfrzeX91UrpFyrTxAOc4rIbzkQmjf9UIhh9Zz3ijprRY9G5zsodO6lx7Ko3W-HaRXIFtxSd6eepcf_YSDK6ske2-WFCabHky0wfyrzGE03-NmtGSaNaIU8FOBSzHnhP6cZWCO8M3BHOGbI3wDrSnwS-jV31PPkT-0i-HNyYDl71vAZLIrmBwOIaFbzRDD__p_AZ_7mCI</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>John, Binu V.</creator><creator>Ferreira, Raphaella D.</creator><creator>Doshi, Akash</creator><creator>Kaplan, David E.</creator><creator>Taddei, Tamar H.</creator><creator>Spector, Seth A.</creator><creator>Paulus, Elizabeth</creator><creator>Deng, Yangyang</creator><creator>Bastaich, Dustin</creator><creator>Dahman, Bassam</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3839-336X</orcidid><orcidid>https://orcid.org/0000-0002-8724-0378</orcidid><orcidid>https://orcid.org/0000-0002-2182-2471</orcidid><orcidid>https://orcid.org/0000-0003-4990-4839</orcidid><orcidid>https://orcid.org/0000-0002-2002-9682</orcidid></search><sort><creationdate>20221101</creationdate><title>Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis</title><author>John, Binu V. ; 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Our aim 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.
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 COVD-19, with at least moderate COVID-19, or severe or critical COVID-19.
Receipt of the third dose of a COVID-19 mRNA vaccine was associated with an 80.7% reduction in COVID-19 (95% CI 39.2-89.1, p <0.001), an 80.4% reduction in symptomatic COVID-19, 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.
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.
Cirrhosis is associated with decreased responsiveness to several vaccines, including those against COVID-19. In this study of 26,082 participants with cirrhosis during the delta and omicron surge, receipt of the third dose of the vaccine was associated with an 80% reduction in COVID-19, a 100% reduction in severe/critical COVID-19, and a 100% reduction in COVID-19-related death. These findings support the importance of a third dose of mRNA vaccine among patients with cirrhosis.
[Display omitted]
•Study comparing 3 vs. 2 doses of an mRNA vaccine among patients with cirrhosis during the Delta and Omicron surge.•3 doses associated with 81% reduction in COVID-19, 100% reduction in severe/critical COVID-19.•Protection greater in patients with compensated than decompensated cirrhosis.•3 doses of the Pfizer BNT162b2 superior to 3 doses of Moderna mRNA-1273 vaccine.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>36181987</pmid><doi>10.1016/j.jhep.2022.07.036</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3839-336X</orcidid><orcidid>https://orcid.org/0000-0002-8724-0378</orcidid><orcidid>https://orcid.org/0000-0002-2182-2471</orcidid><orcidid>https://orcid.org/0000-0003-4990-4839</orcidid><orcidid>https://orcid.org/0000-0002-2002-9682</orcidid><oa>free_for_read</oa></addata></record> |
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| source | ScienceDirect Freedom Collection |
| subjects | BNT162 Vaccine BNT162b2 mRNA booster dose chronic liver disease COVID-19 - epidemiology COVID-19 - prevention & control COVID-19 vaccines COVID-19 Vaccines - adverse effects hepatic decompensation Humans Liver Cirrhosis - complications mRNA Vaccines mRNA-1273 Retrospective Studies SARS-CoV-2 Vaccines Vaccines, Synthetic |
| title | Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis |
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