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0 0.5 1 1.5 2+ Recovery 38% Improvement Relative Risk UDCA for COVID-19  Yu et al.  Prophylaxis Is prophylaxis with ursodeoxycholic acid beneficial for COVID-19? Retrospective 107 patients in China (December - December 2022) Improved recovery with ursodeoxycholic acid (not stat. sig., p=0.053) Yu et al., medRxiv, May 2023 Favors ursodeoxycholic acid Favors control

UDCA May Promote COVID-19 Recovery: A Cohort Study with AI-Aided Analysis

May 2023  
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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 recovery, with a hazard ratio of 1.62 (95% CI 0.99-2.60, p=0.053) compared to standard care after adjusting for covariates. Patients receiving higher UDCA doses (≥300mg daily) had significantly faster recovery than the standard care group, with a hazard ratio of 1.82 (95% CI 1.07-3.10, p=0.028). To further analyze the exposure-response relationship, the authors developed an AI model called VirtualBody that accurately predicted individualized UDCA pharmacokinetic profiles. Additional analysis using VirtualBody-generated data found UDCA AUC, indicating total exposure over time, had a stronger correlation with clinical outcome than cumulative dose. Overall, the study suggests UDCA may shorten recovery time from COVID-19, especially at higher doses, warranting further investigation.
risk of no recovery, 38.3% lower, HR 0.62, p = 0.05, treatment 62, control 45, inverted to make HR<1 favor treatment.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Yu et al., 4 May 2023, retrospective, China, preprint, 11 authors, study period 10 December, 2022 - 30 December, 2022.
This PaperUDCAAll
UDCA May Promote COVID-19 Recovery: A Cohort Study with AI-Aided Analysis
Yang Yu, Guo Yu, Lu-Yao Han, Jian Li, Zhi-Long Zhang, Tian-Shuo Liu, Ming-Feng Li, De-Chuan Zhan, Shao-Qiu Tang, Zhi-Hua Zhou, Guang-Ji Wang
To investigate the impact of ursodeoxycholic acid (UDCA) treatment on the clinical outcome of mild and moderate COVID-19 cases, a retrospective analysis was conducted to evaluate the efficacy of UDCA on patients diagnosed with COVID-19 during the peak of the Omicron outbreak in China. This study presents promising results, demonstrating that UDCA significantly reduced the time to Body Temperature Recovery after admission and a higher daily dose seems to be associated with a better outcome without observed safety concerns. We also introduced VirtualBody, a physiologically plausible artificial neural network model, to generate an accurate depiction of the drug concentration-time curve individually, which represented the absorption, distribution, metabolism, and excretion of UDCA in each patient. It exhibits exceptional performance in modeling the complex PK-PD profile of UDCA, characterized by its endogenous and enterohepatic cycling properties, and further validates the effectiveness of UDCA as a treatment option from the drug exposure-response perspective. Our work highlights the potential of UDCA as a novel treatment option for periodic outbreaks of COVID-19 and introduces a new paradigm for PK-PD analysis in retrospective studies to provide evidence for optimal dosing strategies. The COVID-19 pandemic has caused an enormous global burden on public health, affecting civil societies, and hindering economic development 1 . In China, the number of COVID-19 infections skyrocketed in November 2022, following the government's active optimization and refinement of its COVID-19 response. The most prevalent strains were BA.5.2 (70.8%) and BF.7 (23.4%) 2,3 . Therefore, given the emergence of new variants and the persistent risk of periodic outbreaks during the era of Omicron, the need for accessible, oral therapeutic options to treat COVID-19 remains urgent, especially for individuals who have already been vaccinated 4-6 . Currently, only two oral antivirals, ritonavir-boosted nirmatrelvir and molnupiravir, have been approved for the treatment of mild or moderate COVID-19 under Emergency Use Authorization 7-10 . However, their availability is predominantly limited to individuals with affluent financial resources, and their efficacy against the Omicron (B.1.1.529) variant in vaccinated patients is not well established. Recent studies have explored the potential of UDCA, a classic FXR inhibitor, as a treatment option for COVID-
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