COVID-19 vaccination in patients with autoimmune hepatitis

Background Coronavirus disease (COVID)-19 caused by SARS-CoV-2 first emerged in December 2019 and soon became pandemic. Management of patients with autoimmune hepatitis (AIH) receiving immunosuppressive therapy has been challenging due to the potentially aggravated course of viral infection and lack of evidence-based treatment recommendations. Although vaccine development has been a major step in fighting the pandemic, its efficacy in immunosuppressed patients has not been sufficiently evaluated.

Methods Patients with AIH receiving azathioprine underwent vaccination against SARS-CoV-2 with mRNA-1273 (Moderna Biotech) and were compared to an age- and sex-matched control group without immunosuppression. Antibody titers were analyzed at the day of the first vaccination (baseline) and second vaccination (day 35) using an RBD enzyme-linked immunosorbent assay and SARS-CoV-2 neutralization assays using wildtype and pseudo-typed viruses. On day 70, both, the antibody titer as well as the presence of SARS-CoV-2 specific T cells directed against the spike (S) and nucleocapsid (N) proteins assessed by an interferon gamma release assay (IGRA) will be measured.

Results To date, 6 patients (mean age 56.2 years) with AIH as well as 25 healthy controls (mean age 60.2 years) were enrolled. There was a significant increase of antibody titers in both groups (AIH baseline: 1.4 ± 0.5 vs. day 35: 98,9 ± 119,6; p <0.001; controls baseline: 1.3 ± 0.7 vs. day 35: 171,1 ± 157,5; p <0.001). Contrarily, when comparing absolute values between both groups, there was no significant difference at baseline (p = 0.412) or at day 35 (p = 0.117) as well as the respective delta between both time points (p = 0.105). Antibody titers and SARS-CoV-2 specific T cell immunity at day 70 remain to be analyzed.

Conclusion Vaccination with mRNA-1273 induces a significant seroconversion in AIH patients receiving immunosuppressive therapy with azathioprine.

Publication History

Article published online:
01 September 2021