Ursodeoxycholic acid and severe COVID-19 outcomes in a cohort study using the OpenSAFELY platform

Costello, RE; Waller, KMJ; Smith, R; Mells, GF; Wong, AYS; Schultze, A; Mahalingasivam, V; Herrett, E; Zheng, B; Lin, L; MacKenna, B; Mehrkar, A; Bacon, SCJ; Goldacre, B; Tomlinson, LA; Tazare, J; Rentsch, CT

COVID-19 Collection

Journal article

Ursodeoxycholic acid and severe COVID-19 outcomes in a cohort study using the OpenSAFELY platform

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.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Costello, R. E., Waller, K. M. J., Smith, R., Mells, G. F., Wong, A. Y. S., Schultze, A., Mahalingasivam, V., Herrett, E., Zheng, B., Lin, L., MacKenna, B., Mehrkar, A., Bacon, S. C. J., Goldacre, B., Tomlinson, L. A., Tazare, J., & Rentsch, C. T. (2024). Ursodeoxycholic acid and severe COVID-19 outcomes in a cohort study using the OpenSAFELY platform. Communications Medicine, 4(1).

MLA Style

Costello, RE, et al. “Ursodeoxycholic Acid and Severe COVID-19 Outcomes in a Cohort Study Using the OpenSAFELY Platform.” Communications Medicine, vol. 4, no. 1, 2024.

Chicago Style

Costello, RE, KMJ Waller, R Smith, et al. 2024. “Ursodeoxycholic Acid and Severe COVID-19 Outcomes in a Cohort Study Using the OpenSAFELY Platform.” Communications Medicine 4 (1).
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