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

José Barreto Campello Carvalheira,Frederico Leal,Juliana Luz Passos Argenton,Mateus Bringel Oliveira Duarte

doi:10.1186/s13027-021-00406-y

Abstract

BackgroundPrevious 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.MethodsWe 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.ResultsWe 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.ConclusionsThe active use of ADT was not associated with a reduced risk of death in patients with COVID-19.

Highlights

The pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus has been a challenge to health systems worldwide [1]
We identified that 199 patients had performed androgen deprivation therapy (ADT) for prostate cancer treatment
In the propensity score-based pair matching, we found that active use of ADT was not associated to mortality

Summary

Introduction

The pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus has been a challenge to health systems worldwide [1]. In vitro studies demonstrated that androgen blockade could reduce the expression of angiotensinconverting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors, resulting in reduced infectivity by the SARS-CoV2 virus [13, 14]. Previous studies hypothesized that androgen deprivation therapy (ADT) may reduce severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infectivity. It is unknown whether there is an association between ADT and a higher survival in prostate cancer patients with COVID-19

Methods

Results

Conclusion