# P-1649. Impact of Ursodeoxycholic Acid on COVID-19 Outcomes: A Systematic Review and Meta-Analysis

## TL;DR

This study reviews whether ursodeoxycholic acid (UDCA) affects outcomes in patients with COVID-19.

## Contribution

It is the first systematic review and meta-analysis to evaluate UDCA's impact on mortality, hospitalization, and symptoms in COVID-19 patients.

## Key findings

- UDCA did not significantly reduce mortality or hospitalization in COVID-19 patients.
- UDCA significantly improved symptoms like cough, muscle/joint pain, and pharyngalgia in infected individuals.

## Abstract

The efficacy of ursodeoxycholic acid (UDCA) in managing cholestatic liver disease is well-established. UDCA inhibits the farnesoid X receptor (FXR), leading to the down-regulation of ACE2, a critical entry receptor for SARS-CoV-2. Despite this mechanism, the impact of UDCA on patients with COVID-19 remains controversial. This study aims to assess the association between UDCA administration and COVID-19-related mortality, hospitalization, and symptoms.Figure 1.Forest plot of studies comparing mortality between UDCA and Control groups

Forest plot of studies comparing mortality between UDCA and Control groups

We conducted a systematic search of PubMed, Scopus, and Web of Science (WOS), and all studies involving patients treated with UDCA and infected with COVID-19 were included. We utilized Review Manager (RevMan 5.4 for Windows) for statistical analysis.

Nine observational studies published between 2023 and 2024, encompassing 30,066 patients, were included in the meta-analysis. We found no statistically significant differences between UDCA and non-UDCA groups regarding mortality (RR = 0.99; 95% CI [0.80, 1.23]; P = 0.94), or COVID-19-related hospitalization (RR = 0.98; 95% CI [0.89, 1.08]; P = 0.74). However, the UDCA group demonstrated significant improvements in COVID-19 symptoms, including cough (OR = 0.43; 95% CI [0.31, 0.60]; P < 0.00001), muscle or joint pain (OR = 0.70; 95% CI [0.51, 0.96]; P = 0.03), and pharyngalgia (OR = 0.28; 95% CI [0.09, 0.82]; P = 0.02).

Our results showed a limited role of UDCA in reducing mortality rates or COVID-19-related hospitalization. However, they provide insights into the efficacy of UDCA in managing mild to moderate symptoms of COVID-19 as cough, muscle or joint pain, and pharyngalgia.

All Authors: No reported disclosures