Link between ADT and reduced COVID-19 risk proposed
medwireNews: An analysis of Italian patients suggests a potential protective role of androgen deprivation therapy (ADT) against SARS-CoV-2 infection.
The researchers explain that “[c]ell entry of SARS-CoV-2 depends on binding of the viral spike (S) proteins to ACE2 and on S protein priming by TMPRSS2,” which in turn is regulated by the androgen receptor (AR) protein.
They therefore hypothesized that ADT “may protect patients affected by prostate cancer from SARS-CoV-2 infections.”
And indeed, among the 42,434 men with prostate cancer in the Veneto region of Italy, SAR-CoV-2 infection occurred in just four of the 5273 men who received ADT versus 114 of the 37,161 men who did not receive ADT.
The estimated number of SARS-CoV-2 cases per 100,000 individuals was 76 in the ADT and 318 in the no ADT group, which translated into a significant 4.05-fold increased risk for SARS-CoV-2 in the no ADT group, report Andrea Alimonti (Università della Svizzera Italiana, Bellinzona, Switzerland) and colleagues in the Annals of Oncology.
When ADT-treated prostate cancer patients were compared with 79,661 patients with other tumors, the SARS-CoV-2 risk for the latter group was even greater, at a 5.17-fold increased risk, while the estimated total SARS-CoV-2 cases per 100,000 individuals were 76 and 392, respectively.
Alimonti et al emphasize that “these data need to be further validated in additional large cohorts of SARS-CoV-2 infected patients and corrected for multiple variables,” but they propose that ADT, via luteinizing hormone-releasing hormone agonists or antagonists or AR inhibitors, “may be considered to prevent SARS-CoV-2 infections or complications in high-risk male populations.”
The team continues: “Given that the effects of these compounds are reversible, they could be used transiently (e.g. one month) in patients affected by SARS-CoV-2, thereby reducing the risk of side effects due to a long-term administration.”
In a press release, the journal’s editor-in-chief Fabrice André (Institut Gustave Roussy, Villejuif, France) added a note of caution: “We decided to publish this study because it provides a rationale to evaluate the efficacy of ADT prospectively in patients infected with COVID-19.
“Nevertheless, the study does not provide a definitive conclusion about the role of ADT in patients infected with COVID-19, and this class of drugs should not be used for this purpose until prospective trials have confirmed its efficacy.”
The study also examined the SARS-CoV-2 risk among male cancer patients, using data from 4532 men who tested positive for SARS-CoV-2 in the Veneto region up to the data cutoff of 1 April 2020. The incidence of SARS-CoV-2-positivity was 0.3% for cancer patients versus 0.2% for men without cancer, which equated to a significant 1.79-fold higher risk for men with cancer.
Men tended to have worse COVID-19 outcomes than women, say Alimonti and colleagues with even poorer outcomes among men with cancer than those without. For instance, 67.2% of male cancer patients were hospitalized due to COVID-19 versus 47.0% of those without cancer, while the corresponding mortality rates were 17.4% and 6.9%.
“Our data are in line with recent reports from China that demonstrated […] similar trends in male patients and those with cancer,” write the researchers.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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