Third dose of COVID-19 mRNA vaccine offers cirrhosis patients strong protection against virus

Liver cirrhosis is associated with decreased responsiveness to many vaccines, including those that protect against COVID-19. But new research, led by researchers at the University of Miami’s Miller School of Medicine and published in the Journal of Hepatologysuggests that obtaining a third dose of the COVID-19 mRNA vaccine could overcome the diminished response, providing patients with cirrhosis with strong protection against the virus, severe illness and death from COVID-19.

We studied more than 26,000 patients with cirrhosis who received two or three doses of a COVID-19 mRNA vaccine at the Veterans Health Administration, between December 18, 2020 and February 11, 2022. We found that, by compared to patients who received two doses of the vaccine, having the third dose of a COVID-19 mRNA vaccine, was associated with a greater than 80% reduction in overall COVID-19 infection, a reduction in 80% reduction in symptomatic COVID-19 and an 80% reduction in moderate/severe or critical COVID-19 infection, with a 100% reduction in COVID-19 deaths.”

Binu V. John, MD, MPH, senior study author, associate professor, Miller School Department of Medicine and chief of gastroenterology and hepatology, Bruce W. Carter VA Medical Center in Miami

According to Dr John, who led a study published last year in JAMA internal medicine who found that COVID-19 mRNA vaccine reactivity was weaker and slower in patients with cirrhosis. In fact, studies have shown that in general, chronic liver disease, especially the most severe liver disease called decompensated cirrhosis, is associated with decreased responsiveness to several commonly used vaccines, including hepatitis vaccines. B, pneumococcus and influenza.

Critical third dose to overcome diminished response

The results of the latest study suggest that it is crucial that people with cirrhosis receive the third dose of a COVID-19 mRNA vaccine to help overcome the diminished vaccine response typically seen in patients with cirrhosis who do not only received two doses of the vaccine, Dr. John said.

The authors also reported that three doses of Pfizer BNT162b2 were superior to three doses of the Moderna mRNA-1273 vaccine.

This is much-needed information, given the limited inclusion of patients with cirrhosis and chronic liver disease in the clinical trials that resulted in the approval of the mRNA COVID-19 vaccine.

“Clinicians need to rely on real post-approval data like this to guide their patients with cirrhosis,” Dr. John said. “The University of Miami and the Miami VA have led the body of literature on COVID-19 vaccines in cirrhosis with several key publications on the topic. It is important to remember that cirrhosis is the 11th leading cause of death and the 15th leading cause of morbidity worldwide.Studying COVID-19 in cirrhotic patients and including this population in clinical trials is crucial to achieving immunity through vaccination globally.

Co-authors of the Miller School study include medical student Akash Doshi and surgical oncologists Seth A. Spector, MD, and Elizabeth Paulus, MD


University of Miami Health System, Miller School of Medicine

Journal reference:

John, BV, et al. (2022) Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis. Journal of Hepatology.

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