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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.
Frontiers in Pharmacology
|November 14, 2025
Summary
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.
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