An international Phase 3 trial testing pancreatic digestive enzymes and ursodeoxycholic acid in severely malnourished acutely ill children stopped early after interim analyses indicated neither treatment reduced deaths. The study enrolled across Bangladesh, Kenya, Malawi, and Uganda. The results close the door on two biologically plausible interventions as mortality-reducing strategies for this high-risk population, leaving clinicians to rely on current supportive and nutritional protocols. The decision highlights the challenge of translating mechanistic hypotheses in pediatric nutrition into survival benefit, particularly in complex, resource-limited settings. For biotech and clinical researchers, the setback refocuses attention on identifying subgroups and endpoints that better capture biological effects while maintaining death as the decisive measure.