A population-level analysis of the protective effects of androgen deprivation therapy against COVID-19 disease incidence and severity

ABSTRACT Importance: The incidence and severity of coronavirus disease 19 (COVID-19) is higher in men. Sex hormones potentially offer one explanation for differences by sex. Objective: To determine whether men exposed to androgen deprivation therapy (ADT) have lower incidence and severity of COVID-19. Design: We conducted an observational study of male Veterans treated in the Veterans Health Administration from February 15th to July 15th, 2020. We developed a propensity score model to predict the likelihood to undergo Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing. We performed multivariable logistic regression modeling adjusted with inverse probability weighting to examine the relationship between ADT and COVID-19 incidence. We conducted logistic regression analysis among COVID-19 patients to test the association between ADT and COVID-19 severity. Setting: The U.S. Department of Veterans Affairs Participants: The study sample consisted of 6,250,417 male Veterans who were alive as of February 15, 2020. Exposure: Exposure to ADT was defined as having any prescription for a luteinizing hormone releasing hormone analogue or an antiandrogen in the six months prior to the index date. Main Outcomes and Measures: To assess incidence, we used a binary variable indicating any positive reverse transcriptase polymerase chain reaction SARS-CoV-2 test result through July 15, 2020. To measure severity, we constructed a binary variable indicating whether a patient was admitted to the intensive care unit, placed on mechanical ventilation, or dead in the 60 days following a positive test up to July 15, 2020. Results: We identified 246,087 patients who had been tested for SARS-CoV-2, of whom 3,057 were exposed to ADT, and 36,096 patients with cancer and no ADT exposure. Of these, 295 ADT patients and 2,427 other cancer patients had COVID-19 illness. In the primary, propensity-weighted comparison of ADT patients to cancer patients not on ADT, ADT was associated with decreased likelihood of testing positive for SARS-CoV-2 (adjusted OR, 0.88 [95% CI, 0.81-0.95]; p=0.001). ADT was associated with fewer severe COVID-19 outcomes (OR 0.72 [95% CI 0.53-0.96]; p=0.03). Conclusions and Relevance: ADT is associated with reduced incidence and severity of COVID-19 amongst male Veterans. Repurposing of drugs that modulate androgen production and/or action may represent viable potential treatments for COVID-19.

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Androgen Deprivation Therapy and Cardiovascular Disease Incidence in Young Nonmetastatic Prostate Cancer Patients: A Nationwide Database Study

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2019.06.1861 ◽

2019 ◽

Vol 105 (1) ◽

pp. E304

Author(s):

H.V. Polimera ◽

D. Ba ◽

S. Holder ◽

G. Liu ◽

T.A. Ahmad ◽

...

Keyword(s):

Prostate Cancer ◽

Cardiovascular Disease ◽

Cancer Patients ◽

Androgen Deprivation Therapy ◽

Disease Incidence ◽

Androgen Deprivation ◽

Database Study ◽

Nationwide Database ◽

Cardiovascular Disease Incidence

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Receipt of Pharmacotherapy for Alcohol Use Disorder by Male Justice-Involved U.S. Veterans Health Administration Patients

Criminal Justice Policy Review ◽

10.1177/0887403416644011 ◽

2016 ◽

Vol 29 (9) ◽

pp. 875-890 ◽

Cited By ~ 3

Author(s):

Andrea K. Finlay ◽

Ingrid Binswanger ◽

Christine Timko ◽

Joel Rosenthal ◽

Sean Clark ◽

...

Keyword(s):

Logistic Regression ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Logistic Regression Model ◽

Veterans Health Administration ◽

Mixed Effects ◽

Veterans Health ◽

Health Administration ◽

Male Veterans ◽

Number Of Patients

This study examined whether, among Veterans Health Administration (VHA) patients, veterans with recent or current justice involvement have equal receipt of pharmacotherapy for alcohol use disorder compared with veterans with no justice involvement. Using national VHA records, we calculated the overall and facility rates of receipt as the number of patients who received pharmacotherapy for alcohol use disorder divided by the number of patients diagnosed with an alcohol use disorder. Using a mixed-effects logistic regression model, we tested whether justice involvement was associated with pharmacotherapy receipt. Male veterans with jail/court involvement had significantly higher odds of receiving pharmacotherapy for alcohol use disorder compared with other male veterans. Justice-involved veterans had equal or better receipt of pharmacotherapy for alcohol use disorder compared with veterans with no justice involvement. Pharmacotherapy rates are low overall, suggesting that more work can be done to connect veterans to these medications.

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Impact of androgen deprivation therapy on mortality of prostate cancer patients with COVID-19: a propensity score-based analysis

Infectious Agents and Cancer ◽

10.1186/s13027-021-00406-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Mateus Bringel Oliveira Duarte ◽

Frederico Leal ◽

Juliana Luz Passos Argenton ◽

José Barreto Campello Carvalheira

Keyword(s):

Prostate Cancer ◽

Propensity Score ◽

Cancer Patients ◽

Androgen Deprivation Therapy ◽

Protective Factor ◽

Androgen Deprivation ◽

Estimation Model ◽

Propensity Score Model ◽

Risk Of Death ◽

Double Robust

Abstract Background Previous studies hypothesized that androgen deprivation therapy (ADT) may reduce severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infectivity. However, it is unknown whether there is an association between ADT and a higher survival in prostate cancer patients with COVID-19. Methods We performed a retrospective analysis of prostate cancer (PC) patients hospitalized to treat COVID-19 in Brazil’s public health system. We compared patients with the active use of ADT versus those with non-active ADT, past use. We constructed propensity score models of patients in active versus non-active use of ADT. All variables were used to derive propensity score estimation in both models. In the first model we performed a pair-matched propensity score model between those under active and non-active use of ADT. To the second model we initially performed a multivariate backward elimination process to select variables to a final inverse-weight adjusted with double robust estimation model. Results We analyzed 199 PC patients with COVID-19 that received ADT. In total, 52.3% (95/199) of our patients were less than 75 years old, 78.4% (156/199) were on active ADT, and most were using a GnRH analog (80.1%; 125/156). Most of patients were in palliative treatment (89.9%; 179/199). Also, 63.3% of our cohort died from COVID-19. Forty-eight patients under active ADT were pair matched against 48 controls (non-active ADT). All patients (199) were analyzed in the double robust model. ADT active use were not protective factor in both inverse-weight based propensity score (OR 0.70, 95% CI 0.38–1.31, P = 0.263), and pair-matched propensity score (OR 0.67, 95% CI 0.27–1.63, P = 0.374) models. We noticed a significant imbalance in the propensity score of patients in active and those in non-active ADT, with important reductions in the differences after the adjustments. Conclusions The active use of ADT was not associated with a reduced risk of death in patients with COVID-19.

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