tetano
Editor, Senior Moderator
J Intern Med
. 2023 Apr 5.
doi: 10.1111/joim.13630. Online ahead of print.
Ursodeoxycholic acid is associated with a reduction in SARS-CoV-2 infection and reduced severity of COVID-19 in patients with cirrhosis
Binu V John[SUP] 1 2 [/SUP], Dustin Bastaich[SUP] 3 [/SUP], Gwilym Webb[SUP] 4 [/SUP], Teresa Brevini[SUP] 5 [/SUP], Andrew Moon[SUP] 6 [/SUP], Raphaella D Ferreira[SUP] 1 [/SUP], Allison M Chin[SUP] 7 [/SUP], David E Kaplan[SUP] 8 9 [/SUP], Tamar H Taddei[SUP] 10 11 [/SUP], Marina Serper[SUP] 8 [/SUP], Nadim Mahmud[SUP] 8 [/SUP], Yangyang Deng[SUP] 3 [/SUP], Hann-Hsiang Chao[SUP] 12 [/SUP], Fotios Sampaziotis[SUP] 5 4 [/SUP], Bassam Dahman[SUP] 3 [/SUP]
Affiliations
Abstract
Background and aims: Studies have demonstrated that reducing farnesoid X receptor activity with ursodeoxycholic acid (UDCA) downregulates angiotensin-converting enzyme in human lung, intestinal and cholangiocytes organoids in vitro, in human lungs and livers perfused ex situ, reducing internalization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the host cell. This offers a potential novel target against coronavirus disease 2019 (COVID-19). The objective of our study was to compare the association between UDCA exposure and SARS-CoV-2 infection, as well as varying severities of COVID-19, in a large national cohort of participants with cirrhosis.
Methods: In this retrospective cohort study among participants with cirrhosis in the Veterans Outcomes and Costs Associated with Liver cohort, we compared participants with exposure to UDCA, with a propensity score (PS) matched group of participants without UDCA exposure, matched for clinical characteristics, and vaccination status. The outcomes included SARS-CoV-2 infection, symptomatic, at least moderate, severe, or critical COVID-19, and COVID-19-related death.
Results: We compared 1607 participants with cirrhosis who were on UDCA, with 1607 PS-matched controls. On multivariable logistic regression, UDCA exposure was associated with reduced odds of developing SARS-CoV-2 infection (adjusted odds ratio [aOR] 0.54, 95% confidence interval [CI] 0.41-0.71, p < 0.0001). Among patients who developed COVID-19, UDCA use was associated with reduced disease severity, including symptomatic COVID-19 (aOR 0.54, 95% CI 0.39-0.73, p < 0.0001), at least moderate COVID-19 (aOR 0.51, 95% CI 0.32-0.81, p = 0.005), and severe or critical COVID-19 (aOR 0.48, 95% CI 0.25-0.94, p = 0.03).
Conclusions: In participants with cirrhosis, UDCA exposure was associated with both a decrease in SARS-CoV-2 infection, and reduction in symptomatic, at least moderate, and severe/critical COVID-19.
Keywords: COVID-19; SARS-CoV-2; UDCA; farnesoid X receptor; primary biliary cholangitis.
. 2023 Apr 5.
doi: 10.1111/joim.13630. Online ahead of print.
Ursodeoxycholic acid is associated with a reduction in SARS-CoV-2 infection and reduced severity of COVID-19 in patients with cirrhosis
Binu V John[SUP] 1 2 [/SUP], Dustin Bastaich[SUP] 3 [/SUP], Gwilym Webb[SUP] 4 [/SUP], Teresa Brevini[SUP] 5 [/SUP], Andrew Moon[SUP] 6 [/SUP], Raphaella D Ferreira[SUP] 1 [/SUP], Allison M Chin[SUP] 7 [/SUP], David E Kaplan[SUP] 8 9 [/SUP], Tamar H Taddei[SUP] 10 11 [/SUP], Marina Serper[SUP] 8 [/SUP], Nadim Mahmud[SUP] 8 [/SUP], Yangyang Deng[SUP] 3 [/SUP], Hann-Hsiang Chao[SUP] 12 [/SUP], Fotios Sampaziotis[SUP] 5 4 [/SUP], Bassam Dahman[SUP] 3 [/SUP]
Affiliations
- PMID: 37018129
- DOI: 10.1111/joim.13630
Abstract
Background and aims: Studies have demonstrated that reducing farnesoid X receptor activity with ursodeoxycholic acid (UDCA) downregulates angiotensin-converting enzyme in human lung, intestinal and cholangiocytes organoids in vitro, in human lungs and livers perfused ex situ, reducing internalization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the host cell. This offers a potential novel target against coronavirus disease 2019 (COVID-19). The objective of our study was to compare the association between UDCA exposure and SARS-CoV-2 infection, as well as varying severities of COVID-19, in a large national cohort of participants with cirrhosis.
Methods: In this retrospective cohort study among participants with cirrhosis in the Veterans Outcomes and Costs Associated with Liver cohort, we compared participants with exposure to UDCA, with a propensity score (PS) matched group of participants without UDCA exposure, matched for clinical characteristics, and vaccination status. The outcomes included SARS-CoV-2 infection, symptomatic, at least moderate, severe, or critical COVID-19, and COVID-19-related death.
Results: We compared 1607 participants with cirrhosis who were on UDCA, with 1607 PS-matched controls. On multivariable logistic regression, UDCA exposure was associated with reduced odds of developing SARS-CoV-2 infection (adjusted odds ratio [aOR] 0.54, 95% confidence interval [CI] 0.41-0.71, p < 0.0001). Among patients who developed COVID-19, UDCA use was associated with reduced disease severity, including symptomatic COVID-19 (aOR 0.54, 95% CI 0.39-0.73, p < 0.0001), at least moderate COVID-19 (aOR 0.51, 95% CI 0.32-0.81, p = 0.005), and severe or critical COVID-19 (aOR 0.48, 95% CI 0.25-0.94, p = 0.03).
Conclusions: In participants with cirrhosis, UDCA exposure was associated with both a decrease in SARS-CoV-2 infection, and reduction in symptomatic, at least moderate, and severe/critical COVID-19.
Keywords: COVID-19; SARS-CoV-2; UDCA; farnesoid X receptor; primary biliary cholangitis.