Impact of Ursodeoxycholic Acid Therapy in Autoimmune Liver Disease Patients with COVID-19 and Its Clinical Prognosis

Overview

Journal Biosaf Health

Date 2025 Mar 13

PMID 40078729

Authors

Minghui Li

Weihua Cao

Tingting Jiang

Wen Deng

Shiyu Wang

Shuling Wu

Lu Zhang

Yao Lu

Min Chang

Ruyu Liu

Xiaoyan Ding

Ge Shen

Yuanjiao Gao

Hongxiao Hao

Xiaoxue Chen

Leiping Hu

Mengjiao Xu

Yuyong Jiang

Wei Yi

Yao Xie

Rui Song

Affiliations

Soon will be listed here.

Abstract

To explore the impact of ursodeoxycholic acid (UDCA) on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and clinical outcomes in patients with autoimmune liver disease (AILD). Patients diagnosed with AILD were enrolled and divided into a UDCA group and a non-UDCA group based on whether they received UDCA treatment. Relevant data were collected regarding AILD diagnosis, treatment, biochemical indicators, and imaging examination. The incidence of SARS-CoV-2 infection and the prognosis of AILD patients were observed. A total of 1,138 patients completed follow-up. The usage rate of hormone ( = 0.003) and immunosuppressant ( = 0.001) used for treating AILD in the non-UDCA group was markedly lower than in the UDCA group. The UDCA usage rate was markedly lower in SARS-CoV-2 infected patients than in uninfected patients ( = 0.003). The rate of SARS-CoV-2 infection in the non-UDCA group was significantly higher than in the UDCA group ( = 0.018). Logistic regression analysis showed that UDCA use ( = 0.003) was correlated to a lower incidence of SARS-CoV-2, while immunosuppressant use ( = 0.017) increased the incidence. Recovery time from SARS-CoV-2 infection was markedly longer for those receiving UDCA treatment than those in the non-UDCA group ( = 0.018). UDCA is associated with low SARS-CoV-2 incidence in AILD patients, while immunosuppressant increases its incidence instead. Patients receiving UDCA treatment have a longer recovery time after being infected.

References

Zhang C, Shi L, Wang F . Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020; 5(5):428-430. PMC: 7129165. DOI: 10.1016/S2468-1253(20)30057-1. View

Ozaslan E, Efe C, Heurgue-Berlot A, Kav T, Masi C, Purnak T . Factors associated with response to therapy and outcome of patients with primary biliary cirrhosis with features of autoimmune hepatitis. Clin Gastroenterol Hepatol. 2013; 12(5):863-9. DOI: 10.1016/j.cgh.2013.09.021. View

. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J Hepatol. 2017; 67(1):145-172. DOI: 10.1016/j.jhep.2017.03.022. View

Corpechot C, Abenavoli L, Rabahi N, Chretien Y, Andreani T, Johanet C . Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis. Hepatology. 2008; 48(3):871-7. DOI: 10.1002/hep.22428. View

Kuiper E, Hansen B, de Vries R, den Ouden-Muller J, van Ditzhuijsen T, Haagsma E . Improved prognosis of patients with primary biliary cirrhosis that have a biochemical response to ursodeoxycholic acid. Gastroenterology. 2009; 136(4):1281-7. DOI: 10.1053/j.gastro.2009.01.003. View

Poupon R, Chazouilleres O, Corpechot C, Chretien Y . Development of autoimmune hepatitis in patients with typical primary biliary cirrhosis. Hepatology. 2006; 44(1):85-90. DOI: 10.1002/hep.21229. View

Lohse A, zum Buschenfelde K, Franz B, Kanzler S, Gerken G, Dienes H . Characterization of the overlap syndrome of primary biliary cirrhosis (PBC) and autoimmune hepatitis: evidence for it being a hepatitic form of PBC in genetically susceptible individuals. Hepatology. 1999; 29(4):1078-84. DOI: 10.1002/hep.510290409. View

Mehta P, McAuley D, Brown M, Sanchez E, Tattersall R, Manson J . COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020; 395(10229):1033-1034. PMC: 7270045. DOI: 10.1016/S0140-6736(20)30628-0. View

Feld J, Dinh H, Arenovich T, Marcus V, Wanless I, Heathcote E . Autoimmune hepatitis: effect of symptoms and cirrhosis on natural history and outcome. Hepatology. 2005; 42(1):53-62. DOI: 10.1002/hep.20732. View

10.

Brevini T, Maes M, Webb G, John B, Fuchs C, Buescher G . FXR inhibition may protect from SARS-CoV-2 infection by reducing ACE2. Nature. 2022; 615(7950):134-142. PMC: 9977684. DOI: 10.1038/s41586-022-05594-0. View

11.

Al-Chalabi T, Boccato S, Portmann B, McFarlane I, Heneghan M . Autoimmune hepatitis (AIH) in the elderly: a systematic retrospective analysis of a large group of consecutive patients with definite AIH followed at a tertiary referral centre. J Hepatol. 2006; 45(4):575-83. DOI: 10.1016/j.jhep.2006.04.007. View

12.

Strassburg C, Obermayer-Straub P, Manns M . Autoimmunity in liver diseases. Clin Rev Allergy Immunol. 2000; 18(2):127-39. DOI: 10.1385/CRIAI:18:2:127. View

13.

Lindor K, Bowlus C, Boyer J, Levy C, Mayo M . Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018; 69(1):394-419. DOI: 10.1002/hep.30145. View

14.

Verhelst X, Somers N, Geerts A, Degroote H, Van Vlierberghe H . Health status of patients with autoimmune hepatitis is not affected by the SARS-CoV-2 outbreak in Flanders, Belgium. J Hepatol. 2020; 74(1):240-241. PMC: 7481274. DOI: 10.1016/j.jhep.2020.08.035. View

15.

DAntiga L . Coronaviruses and Immunosuppressed Patients: The Facts During the Third Epidemic. Liver Transpl. 2020; 26(6):832-834. DOI: 10.1002/lt.25756. View

16.

Gerussi A, Rigamonti C, Elia C, Cazzagon N, Floreani A, Pozzi R . Coronavirus Disease 2019 in Autoimmune Hepatitis: A Lesson From Immunosuppressed Patients. Hepatol Commun. 2020; 4(9):1257-1262. PMC: 7300554. DOI: 10.1002/hep4.1557. View

17.

Czaja A, Carpenter H . Distinctive clinical phenotype and treatment outcome of type 1 autoimmune hepatitis in the elderly. Hepatology. 2006; 43(3):532-8. DOI: 10.1002/hep.21074. View

18.

Banales J, Huebert R, Karlsen T, Strazzabosco M, LaRusso N, Gores G . Cholangiocyte pathobiology. Nat Rev Gastroenterol Hepatol. 2019; 16(5):269-281. PMC: 6563606. DOI: 10.1038/s41575-019-0125-y. View

19.

Lleo A, Invernizzi P, Lohse A, Aghemo A, Carbone M . Management of patients with autoimmune liver disease during COVID-19 pandemic. J Hepatol. 2020; 73(2):453-455. PMC: 7151539. DOI: 10.1016/j.jhep.2020.04.002. View

20.

Strassburg C . [Autoimmune liver diseases and their overlap syndromes]. Praxis (Bern 1994). 2006; 95(36):1363-81. DOI: 10.1024/1661-8157.95.36.1363. View