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. 2023 Aug 20;12(16):5411.
doi: 10.3390/jcm12165411.

SARS-CoV-2 Vaccination Response in Japanese Patients with Autoimmune Hepatitis: Results of Propensity Score-Matched Case-Control Study

Kei Moriya  1   2 , Tomoko Nakakita  3 , Natsuki Nakayama  3 , Yuya Matsuo  1 , Yusuke Komeda  1   2 , Junichi Hanatani  1   2 , Daisuke Kaya  1   2 , Shinsaku Nagamatsu  1   2 , Hideki Matsuo  1   2 , Masakazu Uejima  2   4 , Fumihiko Nakamura  3
Affiliations

SARS-CoV-2 Vaccination Response in Japanese Patients with Autoimmune Hepatitis: Results of Propensity Score-Matched Case-Control Study

Kei Moriya et al. J Clin Med. .

Abstract

Background/aims: Although the World Health Organization declared the end of the public health emergency of international concern focusing on COVID-19 in May 2023, this bothersome virus continues to mutate, and the possibility of the emergence of mutant strains with high infectivity and severe disease rates has not disappeared. Thus, medical evidence must be accumulated, which is indispensable for protecting both patients under immunosuppressive treatments and the healthy population. This study examined SARS-CoV-2 vaccination responses in Japanese patients with autoimmune hepatitis (AIH) compared with healthy controls.

Methods: This observational study registered 22 patients with histologically diagnosed AIH and 809 healthy controls in our hospital. Their Elecsys anti-SARS-CoV-2 spike antibody concentrations before and after vaccination were evaluated.

Results: In this study, 72.7% and 18.2% of patients with AIH received steroids and azathioprine, respectively. Significant negative correlations were found between age and anti-SARS-CoV-2 spike antibody concentration in both groups; however, no sex differences were found. Although anti-SARS-CoV-2 spike antibody concentration was drastically augmented after the second vaccination (p < 0.05) in the AIH group, these levels were significantly lower than those in the controls (p < 0.05). In the age- and sex-matched analysis, the population ratio with a minimum response (≤100 binding antibody units (BAU/mL) was higher among patients with AIH than among controls 26 weeks after the second vaccination (44% vs. 7%, p < 0.05).

Conclusions: The anti-SARS-CoV-2 spike antibody concentration in AIH patients was significantly lower than that in controls after the second vaccination. Continued and widespread vaccination, particularly for patients requiring medical immunomodulation, is recommended.

Keywords: COVID-19; SARS-CoV-2; autoimmune hepatitis; case–control studies; propensity score; vaccination.

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Conflict of interest statement

The authors declare no conflict of interest for this article.

Figures

Figure 1
Figure 1
Relationship between aging and humoral vaccination response in the study population. (a) Humoral vaccination response in healthy controls 12 weeks after the second vaccination. (b) Humoral vaccination response in healthy controls 26 weeks after the second vaccination. (c) Humoral vaccination response in patients with AIH 12 weeks after the second vaccination. (d) Humoral vaccination response in patients with AIH 26 weeks after the second vaccination. AIH, autoimmune hepatitis; BAU, binding antibody units.
Figure 2
Figure 2
Changes in humoral vaccination response over time in patients with autoimmune hepatitis. * p < 0.05. BAU, binding antibody units; NS, not significant.
Figure 3
Figure 3
Changes in humoral vaccination response over time in the original study population. (a) Humoral vaccination response over time in the study population. (b) Distribution of antibody levels in the study groups based on the cutoff for “minimum response” (<100 BAU/mL) and “tolerable response” (≤264 BAU/mL). AIH, autoimmune hepatitis; BAU, binding antibody units; HC, healthy controls; NS, not significant. ** p < 0.005.
Figure 4
Figure 4
Changes in humoral vaccination response over time in the propensity-matched study population. (a) Humoral vaccination response over time in the study population. (b) Distribution of antibody levels in the study groups based on the cutoff for “minimum response” (<100 BAU/mL) and “tole response” (≤264 BAU/mL). AIH, autoimmune hepatitis; BAU, binding antibody units; HC, healthy controls; NS, not significant. * p < 0.05.
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