Author information

¹London School of Hygiene and Tropical Medicine, London, UK. ruth.costello@lshtm.ac.uk.

²Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.

³NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.

⁴Department of Gastroenterology & Hepatology, Concord Repatriation General Hospital, Concord, NSW, Australia.

⁵Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

⁶Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK.

⁷London School of Hygiene and Tropical Medicine, London, UK.

⁸Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

⁹Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.

Abstract

Background: Biological evidence suggests ursodeoxycholic acid (UDCA)-a common treatment of cholestatic liver disease-may prevent severe COVID-19 outcomes. We aimed to compare the hazard of COVID-19 hospitalisation or death between UDCA users versus non-users in a population with primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC).

Methods: With the approval of NHS England, we conducted a population-based cohort study using primary care records between 1 March 2020 and 31 December 2022, linked to death registration data and hospital records through the OpenSAFELY-TPP platform. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between time-varying UDCA exposure and COVID-19 related hospitalisation or death, stratified by geographical region and considering models unadjusted and fully adjusted for pre-specified confounders.

Results: We identify 11,305 eligible individuals, 640 were hospitalised or died with COVID-19 during follow-up, 400 (63%) events among UDCA users. After confounder adjustment, UDCA is associated with a 21% relative reduction in the hazard of COVID-19 hospitalisation or death (HR 0.79, 95% CI 0.67-0.93), consistent with an absolute risk reduction of 1.35% (95% CI 1.07%-1.69%).

Conclusions: We found evidence that UDCA is associated with a lower hazard of COVID-19 related hospitalisation and death, support calls for clinical trials investigating UDCA as a preventative measure for severe COVID-19 outcomes.