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Febuxostat may decrease the incidence of COVID-19 infection among patients with gout: a retrospective cohort study
Weijie Wang1, Shiow-Ing Wang2,3, Yang Cheng4
1State Key Clinical Specialty of Rheumatology, Department of Rheumatology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Insights
Febuxostat significantly lowered COVID-19 infection and hospitalization risks in gout patients compared to Allopurinol. This urate-lowering therapy may offer protection, even for those with kidney issues or tophi.
Area of Science:
- Nephrology
- Infectious Diseases
- Rheumatology
Background:
- COVID-19 can cause kidney dysfunction and hypouricemia.
- Gout is a risk factor for severe COVID-19 outcomes.
- The effect of urate-lowering therapy on COVID-19 risk in gout patients is unknown.
Purpose of the Study:
- To investigate whether Febuxostat reduces COVID-19 incidence in gout patients.
- To compare the efficacy of Febuxostat versus Allopurinol in managing COVID-19 risk among gout patients.
Main Methods:
- Retrospective cohort study using electronic health records (N=663,729 gout patients).
- Propensity score matching identified 5,466 patients on Febuxostat and 5,466 on Allopurinol.
- Hazard ratios (HRs) for COVID-19 incidence and hospitalization were calculated.
Main Results:
- Febuxostat significantly reduced COVID-19 incidence (HR=0.878) and hospitalization (HR=0.874) versus Allopurinol.
- Benefits were more pronounced in males, the elderly, unvaccinated individuals, and those with serum uric acid <10 mg/dL.
- Febuxostat also reduced hospitalization risk in patients with renal impairment or tophi (HR=0.652).
Conclusions:
- Febuxostat use is associated with a lower risk of COVID-19 in gout patients.
- The protective effect of Febuxostat was observed over a 3-year follow-up, including in those with renal impairment or tophi.
Background:
As COVID-19 infection causes a kidney proximal tubule dysfunction with urinary loss of uric acid. Hypouricemia has been found in patients with severe COVID-19 disease. However, gout is a risk factor for COVID-19 incidence and COVID-19-related death. It is not known whether urate-lowering therapy could reduce the risk of infection of COVID-19 in gout patients or not.
Methods:
Data from collaborative electronic health records were used in this study. A total of 663,729 patients with gout were enrolled between January 1, 2020 and December31, 2022 from 35,528,077 participants in US Collaborative Network with at least two visits. After exclusion and propensity score matching, 5,466 patients with Febuxostat and 5,466 patients with Allopurinol in the comparison group were selected. The hazard ratios (HRs) and 95% confidence intervals of COVID-19 incidence, and mechanical utilization were calculated between Febuxostat and Allopurinol groups. Subgroup analyses on sex, age, levels of serum uric acid, with vaccination group and sensitivity analyses for gout patients due to renal impairment or with tophus, different follow-up durations and considered competing risk were performed.
Results:
Compared to Allopurinol group, Febuxostat significantly reduced the risk of COVID-19 incidence (HR = 0.878 [0.801-0.963]) and hospitalization (HR = 0.874 [0.772-0.989]). Febuxostat appears to be more effective in male, elder, without record of COVID-19 vaccination, and gout patients with serum uric acid<10 mg/dL in reducing the risk of COVID-19 infection. In addition, Febuxostat markedly reduced the hospitalization (HR = 0.652 [0.485-0.877]) in gout patients due to renal impairment or with tophus and the risks of COVID-19 incidence (HR = 0.878 [0.801-0.963]).
Conclusion:
In this retrospective cohort study, Febuxostat use was associated with a lower risk of COVID-19 among patients with gout for 3 years follow-up, even with renal impairment or tophus.
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