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UDCA for COVID-19
22 studies with >40,000 patients
Serious outcome risk
Ursodeoxycholic acid
Control
Significantly lower risk for progression, recovery, and cases.
13 studies from 12 independent teams in 4 countries show significant benefit.
COVID-19 UDCA studies · October 2026
Recent:
Li
Song
Lim
Park.
Covid Analysis Ursodeoxycholic acid for COVID-19: real-time meta-analysis of 22 studies (Version 20)
Significantly lower risk is seen for progression, recovery, and cases. 13 studies from 12 independent teams in 4 countries show significant benefit. Meta-analysis using the most serious outcome reported shows 18% [-3‑36%] lower..
Apr 11
 Li et al., BMC Public Health, doi:10.1186/s12889-026-26908-1 Ursodeoxycholic acid treatment did not show protective effect for severe COVID-19 outcomes – a nationwide register study
9% lower mortality (p=0.82), 35% higher ICU admission (p=0.48), and 16% higher hospitalization (p=0.39). Retrospective nationwide register-based cohort study of 4,471 Swedish adults with liver/biliary diseases, showing no significant protective effect of ursodeoxycholic acid (UDCA) against severe COVID-19 outcomes. The study used a current-u..
Mar 31
 Song et al., Frontiers in Pharmacology, doi:10.3389/fphar.2026.1719144 Clinical effects of ursodeoxycholic acid in COVID-19 infection: a systematic review and dose–response meta-analysis
Systematic review and meta-analysis of 15 studies with 716,310 participants showing lower COVID-19 infection risk, severe infection risk, and ventilator use with ursodeoxycholic acid (UDCA) treatment. A dose-response relationship was obse..
Mar 3
 Lim et al., Annals of Internal Medicine, doi:10.7326/ANNALS-25-04883 Neither Metformin nor Ursodeoxycholic Acid Effectively Treats Postacute Sequelae of COVID-19
RCT 396 patients with existing long COVID, showing no significant benefit with metformin or UDCA.
Oct 17
2025
 Park et al., Biomolecules & Therapeutics, doi:10.4062/biomolther.2025.149 Ursodeoxycholic Acid Attenuates B Cell Susceptibility to SARS-CoV-2 Spike Protein by Interfering Its Binding to ACE2
In vitro study showing that ursodeoxycholic acid (UDCA) reduces SARS-CoV-2 spike protein binding to ACE2 and protects B cells from enhanced susceptibility caused by bisphenol A (BPA) exposure.
Feb 6
2025
 Hu et al., Frontiers in Medicine, doi:10.3389/fmed.2025.1494248 Ursodeoxycholic acid relieves clinical severity of COVID-19 in patients with chronic liver diseases
89% lower severe cases (p=0.02) and 25% fewer symptomatic cases (p<0.0001). Retrospective 926 outpatients with chronic liver diseases in China showing lower incidence of symptomatic COVID-19 and milder symptoms with ursodeoxycholic acid (UDCA) treatment.
Feb 1
2025
 Okushin et al., Internal Medicine, doi:10.2169/internalmedicine.4856-24 Use of Ursodeoxycholic Acid and the Risk of Severe Coronavirus Disease 2019 in Elderly Patients with Viral Hepatitis
72% higher mortality (p=0.03), 57% higher ventilation (p=0.48), 3% higher need for oxygen therapy (p=0.83), and 4% higher hospitalization (p=0.52). 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.
Nov 20
2024
 Tong et al., Research Square, doi:10.21203/rs.3.rs-5317838/v1 Ursodeoxycholic acid reduces ACE-2 activity in COVID-19 patients and Calu- 3 cells
Retrospective 142 COVID-19 patients (89 treated with UDCA, 53 UDCA-free) showing reduced ACE2 levels in serum, plasma, and blood cells, a shorter time to fever resolution, and no significant difference in respiratory improvement with UDCA..
Sep 27
2024
 Sakamaki et al., Discover Public Health, doi:10.1186/s12982-024-00225-7 Insights from a multicenter nationwide cohort analysis in Japan on the association of underlying conditions and pharmacological interventions with COVID-19 disease severity
79% higher severe cases (p<0.0001). Retrospective 650,317 COVID-19 patients in Japan showing higher risk of severe COVID-19 with UDCA use. There may be significant residual confounding because authors do not appear to have adjusted for liver diseases (details of adjustments..
Aug 27
2024
 Moon et al., Virology Journal, doi:10.1186/s12985-024-02464-1 Association between ursodeoxycholic acid use and COVID-19 in individuals with chronic liver disease: a nationwide case-control study in South Korea
33% lower severe cases (p=0.04) and 20% fewer cases (p<0.0001). Retrospective 74,074 individuals with chronic liver disease in South Korea, showing lower risk of COVID-19 infection and related severe outcomes with ursodeoxycholic acid (UDCA) use. The risk reduction was dose-dependent, with greater ben..
Aug 14
2024
 Lee et al., JMIR Public Health and Surveillance, doi:10.2196/59274 Association Between Ursodeoxycholic Acid and Clinical Outcomes in Patients With COVID-19 Infection: Population-Based Cohort Study
Retrospective 1,675,593 patients in the Jeonbuk CDM cohort and 8,528,533 patients in the NHIS cohort, showing ursodeoxycholic acid (UDCA) intake associated with significantly lower risk of COVID-19 infection and severe COVID-19.
Jul 31
2024
 Li et al., Frontiers in Pharmacology, doi:10.3389/fphar.2024.1381830 Evaluating the protective effectiveness and risk factors of ursodeoxycholic acid on COVID-19 among outpatients
21% fewer symptomatic cases (p=0.001), 19% fewer cases (p=0.004), and 18% lower progression (p=0.04). Retrospective 1,040 outpatients in China showing lower COVID-19 cases, less severe symptoms, and shorter symptom duration with ursodeoxycholic acid (UDCA) use.
Jul 25
2024
 Jia et al., Journal of Clinical Hepatology, doi:10.12449/JCH240714 Effect of ursodeoxycholic acid on symptoms after severe acute respiratory syndrome coronavirus 2 infection in patients with primary biliary cholangitis and their family members
Retrospective 171 primary biliary cholangitis (PBC) patients taking ursodeoxycholic acid (UDCA) and 128 family members, showing no reduction in SARS-CoV-2 infection rates but milder symptoms in PBC patients. All PBC patients and family me..
Jul 8
2024
 Yu et al., Expert Review of Anti-infective Therapy, doi:10.1080/14787210.2024.2376153 Ursodeoxycholic acid and COVID-19 outcomes: a cohort study and data synthesis of state-of-art evidence
3% lower mortality (p=0.5) and 32% lower severe cases (p=0.02). Meta analysis of 9 studies showing lower risk of severe/critical COVID-19 with UDCA. There was no significant difference for mortality. Authors also perform a retrospective study which is listed separately [Yu].
Jul 8
2024
 Yu et al., Expert Review of Anti-infective Therapy, doi:10.1080/14787210.2024.2376153 Ursodeoxycholic acid and COVID-19 outcomes: a cohort study and data synthesis of state-of-art evidence
39% faster recovery (p=0.04). Retrospective 115 hospitalized COVID-19 patients in China showing faster time to body temperature recovery with ursodeoxycholic acid (UDCA) treatment. Results were better for higher dose treatment (300mg vs. 150mg). Authors also perform a..
Jun 22
2024
 Zheng et al., Microorganisms, doi:10.3390/microorganisms12071269 The Value of Ursodeoxycholic Acid and Mesenchymal Stem Cells in the Treatment of Severe COVID-19
62% lower mortality (p=0.03). Retrospective 167 severe COVID-19 patients showing lower mortality with ursodeoxycholic acid (UDCA). Timing and duration of treatment is unknown - UDCA patients may have been on UDCA since before COVID-19.
Apr 4
2024
 Lee et al., Pharmacology Research & Perspectives, doi:10.1002/prp2.1194 Ursodeoxycholic acid may protect from severe acute respiratory syndrome coronavirus 2 Omicron variant by reducing angiotensin‐converting enzyme 2
Syrian hamster study showing ursodeoxycholic acid (UDCA) may protect against SARS-CoV-2 omicron variant transmission and infection. Hamsters treated prophylactically with oral UDCA had significantly less weight loss compared to untreated ..
Mar 20
2024
 Cui et al., Journal of Clinical Hepatology, doi:10.12449/JCH240309 Efficacy of ursodeoxycholic acid in the prevention and treatment of COVID-19 in patients with chronic hepatitis B
48% faster recovery (p=0.01) and 83% fewer cases (p=0.001). Retrospective 215 patients with chronic hepatitis B in China, showing lower risk of COVID-19 infection, milder symptoms, and faster recovery with ursodeoxycholic acid (UDCA) treatment.
Feb 13
2024
 Huang et al., Acta Pharmaceutica Sinica B, doi:10.1016/j.apsb.2024.02.011 Bile acids and coronavirus disease 2019
Review of the relationship between bile acids and COVID-19. Authors discuss emerging basic and clinical evidence linking bile acids to COVID-19 infection and potential mechanisms. Functionally, studies indicate that certain bile acids lik..
Jan 19
2024
 Corpechot et al., Journal of Medical Virology, doi:10.1002/jmv.29418 Exploring the impact of ursodeoxycholic acid therapy on COVID‐19 in a real‐world setting
19% lower ICU admission (p=1) and 40% lower hospitalization (p=0.17). Retrospective cohort study of 10,147 chronic liver disease patients in France, with 1,322 exposed to ursodeoxycholic acid (UDCA), showing lower risk of hospitalization for COVID-19 with UDCA exposure, without statistical significance (adj..
Dec 13
2023
 Costello et al., Communications Medicine, doi:10.1038/s43856-024-00664-y (date from preprint) Ursodeoxycholic acid and severe COVID-19 outcomes in a cohort study using the OpenSAFELY platform
24% lower mortality (p=0.13), 19% lower hospitalization (p=0.02), and 21% lower combined mortality/hospitalization (p=0.005). OpenSAFELY retrospective 11,305 primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) patients showing lower risk of COVID-19 hospitalization or death with ursodeoxycholic acid (UDCA) treatment.
Dec 9
2023
 Fiorucci et al., Biochemical Pharmacology, doi:10.1016/j.bcp.2023.115983 Bile acids and bile acid activated receptors in the treatment of Covid-19
Review of the potential role of bile acids and bile acid activated receptors in modulating SARS-CoV-2 infectivity and inflammation in COVID-19. Authors discuss mechanisms by which bile acids like ursodeoxycholic acid (UDCA), chenodeoxycho..
Nov 28
2023
 Gao et al., Blood, doi:10.1182/blood-2023-182862 Effect of Ursodeoxycholic Acid for Sars-Cov-2 Prevention in Hematological Malignancies: An Observational Real-World Study
12% fewer cases (p=0.03). Retrospective 393 hospitalized patients with hematologic disorders in China, showing lower risk of COVID-19 with UDCA use.
Nov 16
2023
 Ming et al., Microbiology and Infectious Diseases The American Medical Journal, doi:10.33590/microbiolinfectdisamj/10304488 A Retrospective Study in Patients With Varying Prescription Coverage With Ursodeoxycholic Acid and Association With Incidence of COVID-19 Diagnosis in Primary Care
13% fewer cases (p=0.03). Retrospective 8,964 primary care patients prescribed ursodeoxycholic acid (UDCA) in the UK. Higher categorized UDCA adherence (≥80%) was associated with lower COVID-19 incidence (OR 0.86), whereas adherence as a continuous variable was no..
Sep 21
2023
 Marrone et al., Liver International, doi:10.1111/liv.15736 Ursodeoxycholic acid does not affect the clinical outcome of SARS‐CoV‐2 infection: A retrospective study of propensity score‐matched cohorts
7% higher mortality (p=0.77). PSM retrospective 629 hospitalized COVID-19 patients showing no significant difference in survival between 108 patients taking UDCA prior to infection compared to 521 matched controls not taking the drug. The lack of observed benefit in t..
Aug 22
2023
 Ojeda-Fernández et al., Journal of Internal Medicine, doi:10.1111/joim.13711 UDCA treatment against COVID‐19: Do we have enough clinical evidence for drug repurposing?
7% higher mortality (p=0.67), 4% lower ICU admission (p=0.96), 6% higher hospitalization (p=0.66), and 3% fewer cases (p=0.77). Retrospective cohort study of 9,617 patients with liver disease in Italy, divided into UDCA users and non-users. UDCA exposure was not associated with reduced SARS-CoV-2 infection or improved COVID-19 outcomes including death, hospitaliza..
Aug 14
2023
 Colapietro et al., Viruses, doi:10.3390/v15081738 Ursodeoxycholic Acid Does Not Improve COVID-19 Outcome in Hospitalized Patients
no change in mortality (p=0.24). Retrospective 3,847 COVID-19 patients hospitalized in Italy, including 57 treated with UDCA. UDCA treatment was not associated with reduced mortality, however treatment was associated with a lower rate of CPAP use. It's not clear how the ..
Jul 27
2023
 Okushin et al., Journal of Internal Medicine, doi:10.1111/joim.13704 Ursodeoxycholic acid for coronavirus disease 2019 prevention
17% fewer symptomatic cases (p=0.81) and no change in cases (p=1). Retrospective 94 outpatients attending a university hospital gastroenterology clinic in Japan showing no significant difference in SARS-CoV-2 infection rates between ursodeoxycholic acid (UDCA)-treated patients and control groups without ..
Jun 29
2023
 Liu et al., Liver International, doi:10.1111/liv.15660 Ursodeoxycholic acid administration did not reduce susceptibility to SARS‐CoV‐2 infection in children
2% more cases (p=0.88). Retrospective 280 Chinese families with children previously seen in a liver clinic assessing whether ursodeoxycholic acid (UDCA) reduced SARS-CoV-2 infection risk. Among infected families, the study found no significant difference in conf..
May 4
2023
 Yu et al., medRxiv, doi:10.1101/2023.05.02.23289410 UDCA May Promote COVID-19 Recovery: A Cohort Study with AI-Aided Analysis
38% improved recovery (p=0.05). Retrospective 115 COVID-19 patients hospitalized during an Omicron outbreak in China, of which 65 received ursodeoxycholic acid (UDCA) treatment and 50 received standard care. It found that UDCA was associated with faster body temperature..
May 3
2023
 Li et al., Frontiers in Cellular and Infection Microbiology, doi:10.3389/fcimb.2023.1178590 Protective effect of ursodeoxycholic acid on COVID-19 in patients with chronic liver disease
80% lower severe cases (p=0.22), 80% fewer moderate/severe cases (p<0.0001), and 11% fewer cases (p=0.05). Retrospective propensity score matched cohort study of 225 chronic liver disease patients on UDCA therapy matched to 225 controls without UDCA in China. UDCA use was associated with lower COVID-19 infection rate (85% vs 94%), lower maximu..
Apr 5
2023
 John et al., Journal of Internal Medicine, doi:10.1111/joim.13630 Ursodeoxycholic acid is associated with a reduction in SARS‐CoV‐2 infection and reduced severity of COVID‐19 in patients with cirrhosis
42% lower mortality (p=0.28), 54% lower severe cases (p=0.03), 55% fewer moderate/severe cases (p=0.002), and 50% fewer symptomatic cases (p<0.0001). Retrospective 3,214 veterans with cirrhosis comparing 1,607 participants taking ursodeoxycholic acid (UDCA) to 1,607 propensity score matched controls not taking UDCA. UDCA use was associated with significantly lower odds of SARS-CoV-2 in..
Dec 5
2022
 Brevini et al., Nature, doi:10.1038/s41586-022-05594-0 FXR inhibition may protect from SARS-CoV-2 infection by reducing ACE2
94% lower mortality (p=0.13), 75% lower ICU admission (p=0.21), and 40% lower hospitalization (p=0.03). Retrospective study from two registries of 1,096 COVID-19 patients with chronic liver disease, including 31 treated with ursodeoxycholic acid (UDCA). Propensity score matching was used to compare outcomes between UDCA-treated and untreate..