Exploring the impact of ursodeoxycholic acid therapy on COVID‐19 in a real‐world setting

Abstract

AbstractRecent data suggest that ursodeoxycholic acid (UDCA) therapy may reduce susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and even improve clinical outcomes when coronavirus disease‐2019 (COVID‐19) was diagnosed. However, clinical evidence of UDCA's ability to prevent severe forms of COVID‐19 remains limited and contradictory. We evaluated the association between UDCA exposure and the risk of hospitalization for COVID‐19 in a large multicenter population of patients with chronic liver disease (CLD) followed during the pandemic period before vaccination. An exposed/unexposed cohort study and a nested case–control study were performed. The primary endpoint was severe COVID‐19, defined as SARS‐CoV2 infection requiring hospitalization. The secondary endpoint was COVID‐19‐associated intensive care unit (ICU) admission or death. Adjusted odds ratios (aOR) and their confidence intervals (CI) were determined after controlling for age, gender, comorbidities at risk for COVID‐19, severity of CLD, and prior hospitalizations. A total of 10 147 patients, including 1322 exposed and 8825 not exposed to UDCA, totaling 21 867 person‐years of follow‐up, were included in the cohort analysis, while 88 patients hospitalized for COVID‐19 and 840 matched controls were eligible for the nested case–control analysis. In both analyses, exposure to UDCA was not associated with a significant reduction in the risk of hospitalization for COVID‐19, with aOR (95% confidence interval) values of 0.48 (0.20–1.19) and 0.93 (0.26–3.29), respectively. Furthermore, there was no significant reduction in the risk of ICU admission or death. In this large population of patients with CLD, UDCA exposure was not associated with a reduced risk of severe COVID‐19.