1. Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19
- Author
-
Ziad Bakouny, Karen B Russell, Tomasz M. Beer, Chris Labaki, Chih-Yuan Hsu, Andrew Schmidt, Rana R. McKay, Benjamin A. Gartrell, Nima Sharifi, Sanjay Mishra, Ali Raza Khaki, John A. Steinharter, Neil J. Shah, Michael J. Morris, Cindy F Connell, Jay Zhu, Xin Gao, Elizabeth Marie Wulff-Burchfield, Tian Zhang, Matthew Puc, Shuchi Gulati, Matthew D Tucker, Justin Shaya, Brian I. Rini, Wenxin Xu, Yu Shyr, Petros Grivas, Harry Menon, Susan Halabi, Mehmet Asim Bilen, Shilpa Gupta, Clara Hwang, Toni K. Choueiri, Michael T. Schweizer, Ragneel R Bijjula, David Gill, Monika Joshi, Bryan A. Faller, Jeremy L. Warner, Andrew J. Armstrong, and Scott J. Dawsey
- Subjects
Male ,medicine.medical_specialty ,Urology ,TMPRSS2 ,Androgen deprivation therapy ,Cohort Studies ,Prostate cancer ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Original Investigation ,Aged ,Aged, 80 and over ,business.industry ,Research ,Cancer ,COVID-19 ,Prostatic Neoplasms ,Correction ,Androgen Antagonists ,General Medicine ,Middle Aged ,medicine.disease ,Tennessee ,Online Only ,Propensity score matching ,Other ,business ,Body mass index ,Kidney disease ,Cohort study - Abstract
Key Points Question Given the higher COVID-19–related mortality rate observed among men than among women, is androgen deprivation therapy associated with decreased rate of 30-day mortality from COVID-19 among patients with prostate cancer? Findings In this cohort study of 1106 patients, no statistically significant difference was found in the rates of all cause 30-day mortality following COVID-19 infection among men with prostate cancer receiving androgen deprivation therapy (15%) vs those not receiving androgen deprivation therapy (14%). Meaning The findings of this cohort study do not support an association between androgen deprivation therapy and 30-day mortality among patients with COVID-19 infection., Importance Androgen deprivation therapy (ADT) has been theorized to decrease the severity of SARS-CoV-2 infection in patients with prostate cancer owing to a potential decrease in the tissue-based expression of the SARS-CoV-2 coreceptor transmembrane protease, serine 2 (TMPRSS2). Objective To examine whether ADT is associated with a decreased rate of 30-day mortality from SARS-CoV-2 infection among patients with prostate cancer. Design, Setting, and Participants This cohort study analyzed patient data recorded in the COVID-19 and Cancer Consortium registry between March 17, 2020, and February 11, 2021. The consortium maintains a centralized multi-institution registry of patients with a current or past diagnosis of cancer who developed COVID-19. Data were collected and managed using REDCap software hosted at Vanderbilt University Medical Center in Nashville, Tennessee. Initially, 1228 patients aged 18 years or older with prostate cancer listed as their primary malignant neoplasm were included; 122 patients with a second malignant neoplasm, insufficient follow-up, or low-quality data were excluded. Propensity matching was performed using the nearest-neighbor method with a 1:3 ratio of treated units to control units, adjusted for age, body mass index, race and ethnicity, Eastern Cooperative Oncology Group performance status score, smoking status, comorbidities (cardiovascular, pulmonary, kidney disease, and diabetes), cancer status, baseline steroid use, COVID-19 treatment, and presence of metastatic disease. Exposures Androgen deprivation therapy use was defined as prior bilateral orchiectomy or pharmacologic ADT administered within the prior 3 months of presentation with COVID-19. Main Outcomes and Measures The primary outcome was the rate of all-cause 30-day mortality after COVID-19 diagnosis for patients receiving ADT compared with patients not receiving ADT after propensity matching. Results After exclusions, 1106 patients with prostate cancer (before propensity score matching: median age, 73 years [IQR, 65-79 years]; 561 (51%) self-identified as non-Hispanic White) were included for analysis. Of these patients, 477 were included for propensity score matching (169 who received ADT and 308 who did not receive ADT). After propensity matching, there was no significant difference in the primary end point of the rate of all-cause 30-day mortality (OR, 0.77; 95% CI, 0.42-1.42). Conclusions and Relevance Findings from this cohort study suggest that ADT use was not associated with decreased mortality from SARS-CoV-2 infection. However, large ongoing clinical trials will provide further evidence on the role of ADT or other androgen-targeted therapies in reducing COVID-19 infection severity., This cohort study using data from the COVID-19 and Cancer Consortium registry examines whether androgen deprivation therapy is associated with decreased rates of mortality within 30 days of COVID-19 diagnosis among patients with prostate cancer.
- Published
- 2021