Patients with gout may be at higher risk for severe COVID-19 even after vaccination
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Patients with gout, and especially women, may be at higher risk for SARS-CoV-2 infection and severe outcomes regardless of vaccination status, according to data published in Arthritis & Rheumatology.
“Since studies have found that waning vaccine effectiveness is greater in individuals with underlying medical conditions, assessing the effectiveness of COVID-19 vaccination against breakthrough infection and its severe outcomes in gout patients has important clinical and public health implications,” Dongxing Xie, MD, PhD, of Central South University in Changsha, China, and colleagues wrote.
“Unlike other inflammatory rheumatic diseases, such as rheumatoid arthritis and lupus, there is a paucity of data on the risk of SARS-CoV-2 infection among gout patients, particularly on the risk of breakthrough infection after vaccination,” they added.
To investigate outcomes of SARS-CoV-2 infection in patients with gout, Xie and colleagues consulted the IQVIA Medical Research Database, a population-based, representative cohort of patients in the United Kingdom. The database includes sociodemographic characteristics, anthropometric factors, lifestyle details and information from visits to general practitioners, according to the researchers.
For the current study, patients were eligible for inclusion if they were aged 18 to 90 years between Dec. 8, 2020, and Oct. 31, 2021, and had 2 or more years of continuous enrollment with a general practitioner. Additionally, patients could have no documented SARS-CoV-2 infection.
The researchers compared the risk for breakthrough infection, hospitalization and death from SARS-CoV-2 in patients with and without gout, and in vaccinated and unvaccinated cohorts. In the vaccinated cohort, the follow-up period for patients began the day after they received their first COVID-19 vaccine dose, and lasted until one of the outcomes of interest occurred. Patients who were unvaccinated had follow-up begin Dec. 8, 2020, with the period lasting until they received the vaccine, one of the outcomes of interest occurred or the study period ended.
The primary outcome was a confirmed diagnosis of SARS-CoV-2 infection. Secondary outcomes included hospitalization and death in patients with SARS-CoV-2.
The analysis included a 54,576 patients with gout and 1,336,377 individuals without gout. According to the researchers, there were 1,955 breakthrough cases of SARS-CoV-2 infection in patients with gout, for a rate of 4.68 per 1,000 person-months, and 52,468 cases in patients without gout, for a rate of 3.76 per 1,000 person-months. This resulted in a rate difference of 0.91 cases per 1,000 person-months (95% CI, 0.62-1.2) and a partially adjusted HR of 1.24 (95% CI, 1.19-1.3).
Additionally, patients with gout demonstrated a higher risk for hospitalization (HR = 1.3; 95% CI, 1.1-1.53) and death (HR = 1.36; 95% CI, 0.87-2.13) from COVID-19. Meanwhile, women with gout were also more likely to be hospitalized (HR = 1.55; 95% CI, 1.15-2.1) or die (HR = 2.46; 95% CI, 1.12-5.41) following SARS-CoV-2 infection. “Similar associations” were also present in the unvaccinated cohort, the researchers wrote.
“Our study findings suggest that individuals with gout, especially women, have a higher risk of severe outcomes of SARS-CoV-2 infection than the general population, even after COVID-19 vaccination,” Xie and colleagues wrote. “This finding informs individuals with gout, especially women, that additional measures, even after vaccination, should be considered in order to mitigate the risk of SARS-CoV-2 infection and its severe sequelae.”
References:
Andrews N, et al. N Engl J Med. 2022;doi: 0.1056/NEJMoa2115481.
Perspective
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As COVID-19 infections continue and different variants emerge, there have been additional opportunities to learn about the disease and how it affects various patient populations. This study conducted by Xie and colleagues examines how these infections impact patients with gout. The study time frame between December 2020 and October 2021 seeks to identify the association between gout and COVID-19 infection, including any differences seen in patients who have been vaccinated.
The study concludes that individuals with gout have a higher risk for severe outcomes due to COVID-19, with worse outcomes in women, despite vaccination. Although more research is necessary, this study highlights the importance of taking measures to reduce the risk of becoming infected with COVID-19.
Conversations with patients on infection risks, as well as infection prevention, are necessary at every level. These conversations often take place with patients who are on immunosuppressive medications. However, this emphasizes the importance of continued diligence in reminding all patients of COVID-19’s risks and how to prevent the spread of infection.
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