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Lower Response to Pfizer COVID Vaccine
in Older People With Advanced Fibrosis
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EASL International Liver Congress, June 23-26, 2021
Mark Mascolini
A study of 719 healthcare workers in Israel determined that the Pfizer-BioNTech COVID-19 vaccine has high efficacy in people with liver disease, but response is lower in older people and in those with more advanced fibrosis [1].
Researchers from Hebrew University of Jerusalem and Hadassah Medical Center in Jerusalem noted that Israel experienced three COVID-19 waves, with the third wave from December through March 2020-2021 resulting in a peak infection rate of 8450 new cases daily in mid-January. By June 13, 2021, 60.5% of the population in Israel had at least one vaccine dose and 56.8% were fully vaccinated. At Hadassah Medical Center, everyone at least 16 years old was eligible for vaccination.
First the Hadassah team evaluated vaccine response by anti-S IgG in 90 liver transplant recipients, including 65 males and 25 females. While 58.9% had an anti-S IgG titer at or above 19, 35.6% had a lower IgG response. One COVID-19 case emerged in transplant recipients after the first vaccine shot, while 4 emerged after the second shot. The researchers rated vaccine response a total failure in 37 liver transplant recipients (41%). Age was significantly older in nonresponders than in responders (60.4 vs 58.6, P = 0.0417).
Next the researchers evaluated vaccine effectiveness by anti-S IgG titer in 719 healthcare workers with nonalcoholic fatty liver disease (NAFLD) according to FIB-4, the noninvasive liver fibrosis scoring system. IgG results indicated that 708 people (98.5%) responded to the vaccine and 11 (1.5%) did not. Among the 708 responders, 501 (71%) had FIB-4 data available. All 501 had anti-S IgG above 19. Dividing IgG responses into brackets of 100, the researchers found higher proportions of men in lower IgG brackets: 50% with IgG 19-100, 32.9% with 101-200 (P = 0.05 vs 19-100), 32.8% with 201-300, 13.3% with 301-400, and 18.4% above 400. The proportion of men was significantly higher in the 19-100 IgG group than in the 201-300 group (P = 0.05), the 301-400 group (P < 0.0001), or the above-400 group (P = 0.004).
In these 501 people with FIB-4 data, average age was significantly younger in each higher IgG cluster: 61.0 with IgG 19-100, 54.0 with 101-200 (P = 0.005 vs 19-100), 50.2 with 201-300, 48.7 with 301-400, and 46.3 for above 400 (P < 0.0001 for the last three IgG clusters versus IgG 19-100).
In this same 501-person set, the proportion of people with anti-S IgG above 200 declined with worsening fibrosis: 68.0% with FIB-4 below 1.3, 56.9% with FIB-4 1.3-2, and 44.2% with FIB-4 above 2.The proportion of people with IgG 101-200 rose across these three ascending FIB-4 brackets (28.4% to 35.3% to 48.8%), as did the proportion with IgG 19-100 (3.7% to 7.8% to 7.0%).
In 140 people with NAFLD determined by histology, age averaged 61.5 in those with IgG below 200 versus 53.7 in those with IgG at or above 200, a significant difference (P < 0.0001). Neither body mass index nor sex differed significantly between the two IgG levels in this analysis. But several standard lab markers did differ significantly between the above-200 and below-200 groups: the liver disease marker gamma-glutamyl transferase (GGT) (66.1 vs 193.2, P = 0.02), platelets (229.9 vs 188.5, P = 0.008), and hemoglobin (13.7 vs 13.1, P = 0.047).
The Hadassah team concluded that the Pfizer-BioNTech COVID vaccine is "safe, simple, and flexible" in people with liver disease. But its overall high effectiveness is lower with older age, with advanced fibrosis, and in men. The researchers suggested that a third shot of this vaccine should be considered for people with advanced fibrosis or immunosuppression.
Reference
1. Hakimian D, Amer J, Shafrir A, et al. Elderly with advanced liver fibrosis had lower response to Pfizer's SARS-CoV-2 vaccine. EASL International Liver Congress, June 23-26, 2021. Abstract OS-2854.
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