Evaluating the protective effectiveness and risk factors of ursodeoxycholic acid on COVID-19 among outpatients
Di Li, Qimei Fang, Zhiwei Chen, Jing Tang, Haoling Tang, Nan Cai, Ke Qiu, Mingyang Zhu, Xuemei Yang, Lu Yang, Yujie Yang, Yong Huang, Xiaomei Lei, Huanhuan Zhang, Qiankai Lin, Qiang Mao, Te Xu, Yan Li, Yang Zheng, Mingli Peng, Peng Hu
Frontiers in Pharmacology, doi:10.3389/fphar.2024.1381830
Objective: This study aimed to assess the chemopreventive effect of ursodeoxycholic acid (UDCA) against COVID-19 and to analyze infection risk factors, symptoms, and recovery in outpatients with UDCA exposure.
Methods: The study enrolled outpatients prescribed UDCA from the Second Affiliated Hospital of Chongqing Medical University, China, between 01 July 2022, and 31 December 2022. Data on demographics, comorbidities, and drug combinations were collected using electronic medical records. COVID-19 infection, symptoms, severity, prognosis, vaccinations, and UDCA administration were surveyed by telephone interviews. UDCA non-users served as controls and were matched in a 1:2 ratio with UDCA users using propensity score matching with the nearest neighbor algorithm. Infection rates, symptomatology, severity, and prognosis were compared between matched and control cohorts, and risk factors and infection and recovery symptoms were analyzed in UDCA-exposed outpatients. Results: UDCA-exposed outpatients (n = 778, 74.8%) and matched UDCA users (n = 95, 74.2%) showed significantly lower SARS-CoV-2 infection rates than control patients (n = 59, 92.2%) (p < 0.05). The matched UDCA group exhibited substantially lower fever, cough, sore throat, and fatigue rates than controls (p < 0.05). Participants with UDCA exposure generally experienced mild symptoms, while those without UDCA had moderate symptoms. The matched UDCA group also had significantly shorter durations of fever and cough (p < 0.05). Risk factors such as age over 60, less than 1 month of UDCA administration, diabetes mellitus, and coronary artery disease significantly increased SARS-CoV-2 infection rates (p < 0.05), while smoking led to a decrease (p < 0.05). Hypertension was associated with a prolonged COVID-19 recovery (p < 0.05), while smoking, vaccination, and fatty liver disease were associated with shorter recovery periods (p < 0.05). The main symptoms in the full UDCA cohort were fever, cough, and sore throat, with fatigue, cough, and hyposthenia being the most persistent.
Ethics statement The studies involving humans were approved by The Institutional Review Board of The Second Affiliated Hospital of Chongqing Medical University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
Author contributions
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fphar.2024.1381830/ full#supplementary-material
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'abstract': '<jats:p><jats:bold>Objective:</jats:bold> This study aimed to assess the chemopreventive '
'effect of ursodeoxycholic acid (UDCA) against COVID-19 and to analyze infection risk factors, '
'symptoms, and recovery in outpatients with UDCA '
'exposure.</jats:p><jats:p><jats:bold>Methods:</jats:bold> The study enrolled outpatients '
'prescribed UDCA from the Second Affiliated Hospital of Chongqing Medical University, China, '
'between 01 July 2022, and 31 December 2022. Data on demographics, comorbidities, and drug '
'combinations were collected using electronic medical records. COVID-19 infection, symptoms, '
'severity, prognosis, vaccinations, and UDCA administration were surveyed by telephone '
'interviews. UDCA non-users served as controls and were matched in a 1:2 ratio with UDCA users '
'using propensity score matching with the nearest neighbor algorithm. Infection rates, '
'symptomatology, severity, and prognosis were compared between matched and control cohorts, '
'and risk factors and infection and recovery symptoms were analyzed in UDCA-exposed '
'outpatients.</jats:p><jats:p><jats:bold>Results:</jats:bold> UDCA-exposed outpatients (n = '
'778, 74.8%) and matched UDCA users (n = 95, 74.2%) showed significantly lower SARS-CoV-2 '
'infection rates than control patients (n = 59, 92.2%) (<jats:italic>p</jats:italic> &lt; '
'0.05). The matched UDCA group exhibited substantially lower fever, cough, sore throat, and '
'fatigue rates than controls (<jats:italic>p</jats:italic> &lt; 0.05). Participants with '
'UDCA exposure generally experienced mild symptoms, while those without UDCA had moderate '
'symptoms. The matched UDCA group also had significantly shorter durations of fever and cough '
'(<jats:italic>p</jats:italic> &lt; 0.05). Risk factors such as age over 60, less than '
'1\xa0month of UDCA administration, diabetes mellitus, and coronary artery disease '
'significantly increased SARS-CoV-2 infection rates (<jats:italic>p</jats:italic> &lt; '
'0.05), while smoking led to a decrease (<jats:italic>p</jats:italic> &lt; 0.05). '
'Hypertension was associated with a prolonged COVID-19 recovery (<jats:italic>p</jats:italic> '
'&lt; 0.05), while smoking, vaccination, and fatty liver disease were associated with '
'shorter recovery periods (<jats:italic>p</jats:italic> &lt; 0.05). The main symptoms in '
'the full UDCA cohort were fever, cough, and sore throat, with fatigue, cough, and hyposthenia '
'being the most persistent.</jats:p><jats:p><jats:bold>Conclusion:</jats:bold> UDCA '
'demonstrated chemopreventive effect against SARS-CoV-2 in outpatients by significantly '
'reducing infection incidence and mitigating COVID-19 symptoms, severity, and recovery '
'duration. Old age, short UDCA course, and comorbidities such as diabetes mellitus and CAD '
'increased infection rates, while hypertension prolonged recovery. Smoking, vaccination, and '
'fatty liver disease reduced infection rates and shortened recovery. UDCA had minimal impact '
'on symptom types. Larger and longer-term clinical studies are needed further to assess UDCA’s '
'effectiveness in COVID-19 prevention or treatment.</jats:p>',
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