Ursodeoxycholic acid administration did not reduce susceptibility to SARS‐CoV‐2 infection in children

Abstract

Background and AimsA recent study suggested that administration of ursodeoxycholic acid (UDCA) at dosages usually employed clinically may reduce rates of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. A recent surge of SARS‐CoV‐2 omicron infection in China allowed study of whether UDCA administration reduced susceptibility to SARS‐CoV‐2 infection in children with liver disease.MethodsThrough WeChat groups, a questionnaire was distributed to families (n = 300) in which a child had been admitted to our liver service in the past 5 years. Among the families/households in which someone was infected with SARS‐CoV‐2, the proportion in which a child taking UDCA was infected was compared with the proportion in which a child not taking UDCA was infected.ResultsOf the 300 questionnaire answers, 280 (93.3%) were valid. SARS‐CoV‐2 infection was confirmed in 226 families (80.7%): 146 children were taking UDCA (10‐20 mg/kg/day) and 80 children were not taking UDCA. SARS‐CoV‐2 infection was confirmed in 95 children taking UDCA (65.1%) and in 51 children not taking UDCA (63.8%) (p = 0.843); SARS‐CoV‐2 infection was suspected in 23 children taking UDCA (15.8%) and in 11 children not taking UDCA (13.8%) (p = 0.687).ConclusionsThese results indicate that UDCA administration does not reduce susceptibility to SARS‐CoV‐2 infection in children with liver disease.

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

“…In this study, neither UDCA exposure (97%) nor exposure to obeticholic acid (10%), a potent FXR agonist that, according to the work of Brevini et al, should increase the risk of SARS‐CoV‐2 infection, was associated with susceptibility to COVID‐19. These data, together with our own and those recently obtained by independent teams, 5‐7,12 therefore, do not support the protective effect of UDCA therapy against SARS‐CoV‐2 infection suggested by previous studies.…”

“…Regarding secondary outcomes, we found no reduction in the risk of ICU admissions for COVID‐19 or COVID‐19‐related deaths. While these findings, which argue against a protective role of UDCA against SARS‐CoV‐2 infection, challenge two previous multicenter retrospective cohort studies, both derived largely from the same US health data registry, as well as two other studies carried out China, 1‐4 they are, however, entirely consistent with more recent publications 5‐7 …”

“…argue against a protective role of UDCA against SARS-CoV-2 infection, challenge two previous multicenter retrospective cohort studies, both derived largely from the same US health data registry, as well as two other studies carried out China, [1][2][3][4] they are, however, entirely consistent with more recent publications. [5][6][7] Several arguments can be advanced to explain the differences observed between these studies. We may hypothesize a lack of power in the more recent studies and, conversely, an overestimation in earlier studies of the inverse association between UDCA exposure and the risk of severe forms of COVID-19.…”

“…In this study, an association between UDCA exposure and improved clinical outcomes following COVID‐19 was also identified using retrospective registry data on a limited number of liver transplant (LT) recipients and patients with chronic liver disease (CLD). However, although this association was confirmed by other authors, 1,3,4 the supposed protective effect of UDCA treatment against SARS‐CoV‐2 infection and its complications has been called into question by several recent independent studies, in both adults and children 5‐7 . Therefore, in this context of conflicting results, our aim was to evaluate, in a very large population of CLD patients, the association between UDCA exposure and the risk of hospitalization for COVID‐19 as a primary endpoint.…”

“…However, although this association was confirmed by other authors, 1,3,4 the supposed protective effect of UDCA treatment against SARS-CoV-2 infection and its complications has been called into question by several recent independent studies, in both adults and children. [5][6][7] Therefore, in this context of conflicting results, our aim was to evaluate, in a very large population of CLD patients, the association between UDCA exposure and the risk of hospitalization for COVID-19 as a primary endpoint.…”