ABSTRACT
Background: As the COVID-19 pandemic continues, most of the world population are now recommended to have the 3rd dose COVID-19 vaccination (booster dose). However, details of humoral immune response after the booster dose vaccine are scarce, especially in patients with cirrhosis. We studied the antibody (Ab) responses in patients with cirrhosis after receiving the different type of booster vaccines. Method(s): We conducted a prospective observational study of patients with cirrhosis who had completed prior two doses of COVID-19 vaccines and voluntarily received their booster dose between Nov 2021 and April 2022. The types of vaccine were according to the government policy and patients' preference, the investigators had no role in the selection of the type of the booster vaccine. Patients who had history of SARS-CoV- 2 infection after the second dose of vaccination, and ones who obtained immunosuppressive drugs were excluded. The patients' blood samples were collected at three time-points i.e., before the first dose vaccination, 4-week post the 2nd dose of vaccination, and after the booster dose vaccine for 4 weeks. The anti-spike receptor-binding domain protein (RBD) IgG was measured using the Abbott SARS-CoV- 2 IgGIIQuant assay to determine Ab response. The comparisons between 2 types of booster vaccine were analysed: ChAdOx1-nCoV- 19 vaccine (AZ) and mRNA vaccine (BNT162b2 Pfizer-BioNTech or mRNA-1273 Moderna). Result(s): A total of 24 patients with cirrhosis who received a booster dose SARS-CoV- 2 vaccine were eligible. Nine patients got AZ vaccine, whereas 15 patients received mRNA vaccine. Baseline characteristics were similar between both groups, the mean age was 65.6+11.1 and 60.1+14.8 years in the AZ and mRNA groups, respectively (p=0.353), 75% were in CTP class A. The primary regimens for the first 2 doses were similar between the two groups (p=0.217). Post-booster Ab titers in mRNA vaccine were nonsignificantly higher than in AZ vaccine (4566.8+3706.7 vs 1960.5+2434.1 BAU/mL, P=0.74). Of note, the changes of Ab titers after the 3rd dose compared to the 2nd dose in patients who received mRNA vaccine were significantly higher than those who received AZ vaccine (the median change of +2523.7 [IQR: 1365.6,6924.5] vs +398 (IQR: -87.8,1015.6), P=0.015). Additionally, one patient from each groups (AZ/AZ/AZ =1, AZ/AZ/PZ =1) developed symptomatic COVID-19 after the booster dose and all had mild symptoms. Conclusion(s): In patients with cirrhosis, one who received a booster dose with mRNA vaccine had a greater Ab responses more than that in AZ vaccine. Further research exploring in a larger number of patients is warrant to aid selecting the booster vaccine of choice for cirrhotic patients. (Figure Presented).
ABSTRACT
Objectives: In the situation of COVID-19 pandemic in Thailand, healthcare facility supply and access are limited. There was an announcement promoting Andrographolide (ADG) use in treatment of mild COVID-19 patients, but misconception of taking for prevention might occur. Moreover, the effect of ADG on liver function test (LFT) has not been established. We aim to study the prevalence of ADG use and effect on LFTs in patients with gastrointestinal (GI) problems. Materials and Methods: We conducted a cross-sectional study including GI patients at our center who voluntarily filled the ADG questionnaire in Aug-Sep 2021. LFT data at that visit and at the prior visit (if available) were obtained. The changes in LFT within the same person were analyzed using Wilcoxon signed-rank test. Wilcoxon rank-sum and Chi-square test were used to compare between patients with and without ADG consumption. Results: A total of 886 patients completed the survey, 170 patients (19.2%) took ADG within the past month. Patients who took ADG were more likely to have history of COVID-19 infection in their closed companies (5.6% vs 1.5%) compared with who did not (control group). LFT data were available in 486 (54.8%) patients, the median ALT change compared with the prior visit was higher in ADG vs control group (2 vs 0, p = 0.026), and 45% had increased ALT ([3 U/L) vs 32.2% in ADG and control group, respectively (p = 0.023). Multivariable logistic regression analysis found that factors independently associated with an increased ALT were ADG exposure (adjusted OR [aOR] of 1.62, p = 0.042), and patients with NAFLD who gained weight (aOR of 2.37, p = 0.046). Conclusion: One-fifth of GI patients recently took ADG, in which currently not indicated as it has no effect on preventing COVID-19 infection. Those who took ADG are more likely to experience an increase in ALT than who did not. Warning should be made regarding this issue.