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Use of Ursodeoxycholic Acid and the Risk of Severe Coronavirus Disease 2019 in Elderly Patients with Viral Hepatitis

Okushin et al., Internal Medicine, doi:10.2169/internalmedicine.4856-24
Feb 2025  
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Mortality -72% Improvement Relative Risk Ventilation -57% Oxygen therapy -3% Hospitalization -4% UDCA for COVID-19  Okushin et al.  Prophylaxis Is prophylaxis with ursodeoxycholic acid beneficial for COVID-19? PSM retrospective 1,156 patients in Japan (February 2020 - December 2022) Higher mortality with ursodeoxycholic acid (p=0.033) c19early.org Okushin et al., Internal Medicine, Feb 2025 FavorsUDCA Favorscontrol 0 0.5 1 1.5 2+
Retrospective 6,413 elderly patients with viral hepatitis in Japan showing increased mortality with ursodeoxycholic acid (UDCA) use in COVID-19 patients. There was no significant difference in hospitalization or oxygen therapy.
risk of death, 72.0% higher, RR 1.72, p = 0.03, treatment 43 of 578 (7.4%), control 25 of 578 (4.3%), propensity score matching.
risk of mechanical ventilation, 57.1% higher, RR 1.57, p = 0.48, treatment 11 of 578 (1.9%), control 7 of 578 (1.2%), propensity score matching.
risk of oxygen therapy, 3.1% higher, RR 1.03, p = 0.83, treatment 131 of 578 (22.7%), control 127 of 578 (22.0%), propensity score matching.
risk of hospitalization, 3.8% higher, RR 1.04, p = 0.52, treatment 325 of 578 (56.2%), control 313 of 578 (54.2%), propensity score matching.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Okushin et al., 1 Feb 2025, retrospective, Japan, peer-reviewed, median age 73.0, 10 authors, study period February 2020 - December 2022. Contact: takeyatsutsumi@g.ecc.u-tokyo.ac.jp.
This PaperUDCAAll
Use of Ursodeoxycholic Acid and the Risk of Severe Coronavirus Disease 2019 in Elderly Patients with Viral Hepatitis
Kazuya Okushin, Kazuhiko Ikeuchi, Makoto Saito, Toshiyuki Kishida, Akira Kado, Mitsuhiro Fujishiro, Kyoji Moriya, Hiroshi Yotsuyanagi, Kazuhiko Koike, Takeya Tsutsumi
doi:10.2169/internalmedicine.4856-24Intern
Objective Although the management of coronavirus disease 2019 (COVID-19) has improved, chemoprevention remains a challenge. We recently identified that ursodeoxycholic acid (UDCA) is associated with subclinical infection with severe acute respiratory syndrome coronavirus, implying a reduction in the severity of COVID-19. We analyzed a large medical database to assess the utility of UDCA in the reduction of COVID-19 severity. Methods This retrospective observational study was conducted using a large-scale healthcare administrative claims database. We extracted data on patients who were diagnosed with either chronic hepatitis B or C. Among them, patients >50 years of age diagnosed with COVID-19 before December 2022 were analyzed. Patients were divided into two groups: those with or without a prescription of UDCA. The primary outcome was the in-hospital mortality rate. A propensity score-matching analysis was performed using logistic regression. Results A total of 6,413 patients diagnosed with COVID-19 (UDCA group, n =579; non-UDCA group, n = 5,834) were analyzed. The median age was 73.0 (IQR, 64.0-81.0) years, and 57.8% of the patients were men. The UDCA group had significantly more complications with liver cirrhosis, hepatocellular carcinoma, type 2 diabetes, and hypertension. The UDCA group had a higher in-hospital mortality rate than the non-UDCA group, even after propensity score matching (7.4% vs. 4.3%, p =0.03), whereas there was no difference in the risks of hospitalization, oxygen therapy, or ventilation. Conclusions Although the observed increase in mortality among UDCA users could have been due to unmeasured confounding factors, UDCA did not reduce the severity of COVID-19 in viral hepatitis patients.
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