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5α-Reductase Inhibitors Are Associated with Reduced Risk of SARS-CoV-2 Infection: A Matched-Pair, Registry-Based Analysis

Lyon et al., Journal of Urology, doi:10.1097/JU.0000000000002180, Jan 2022

Antiandrogens for COVID-19

7th treatment shown to reduce risk in September 2020, now with p = 0.000000056 from 49 studies.
Lower risk for mortality, ventilation, ICU, hospitalization, recovery, cases, and viral clearance.

No treatment is 100% effective.
Protocols combine treatments.

6,700+ studies · 220+ treatments

c19early.org
Meta-analysis
Retrospective 944 5ARI users in the USA and 944 matched controls, showing lower risk of COVID-19 cases with treatment.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
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OutcomeImprovementEffect · pTreatmentControl
risk of death 16.9% lower · RR 0.83 · p = 0.61 16.9% lowerRR 0.83p = 0.61 15 of 944 (1.6%) 19 of 994 (1.9%) treatment 15 of 944 (1.6%), control 19 of 994 (1.9%)NNT 310
risk of case 7.2% lower · RR 0.93 · p = 0.04* 7.2% lowerRR 0.93p = 0.04* 399 of 944 (42.3%) 446 of 994 (44.9%) treatment 399 of 944 (42.3%), control 446 of 994 (44.9%)NNT 38adjusted per studyodds ratio converted to relative riskmultivariable

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates. * p < 0.05

Lyon et al., 31 Jan 2022, retrospective, USA, peer-reviewed, 8 authors, study period 8 March, 2020 - 15 February, 2021.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2026 USA Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines Vietnam Japan Argentina Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Bosnia-Herzegovina Jordan Georgia Switzerland Dominican Republic Bolivia Côte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia Iceland New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel Haiti North Macedonia Hong Kong Qatar Panama Serbia USA favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2026 USA Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines Vietnam Japan Argentina Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Taiwan Fiji Zambia Jordan Georgia Switzerland Dominican Rep. Bolivia Côte d'Ivoire Eritrea Togo Sri Lanka Bulgaria Greece Slovakia New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel North Macedonia Hong Kong Qatar Panama Serbia USA favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
DOI record: { "DOI": "10.1097/ju.0000000000002180", "ISSN": [ "0022-5347", "1527-3792" ], "URL": "http://dx.doi.org/10.1097/ju.0000000000002180", "alternative-id": [ "10.1097/JU.0000000000002180" ], "author": [ { "affiliation": [ { "name": "Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio" } ], "family": "Lyon", "given": "Madison", "sequence": "first" }, { "affiliation": [ { "name": "Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio" } ], "family": "Li", "given": "Jianbo", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio" } ], "family": "Cullen", "given": "Jennifer", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio" } ], "family": "Milinovich", "given": "Alex", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio" } ], "family": "Kattan", "given": "Michael", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio" } ], "family": "Jehi", "given": "Lara", "sequence": "additional" }, { "affiliation": [ { "name": "Genitourinary Malignancies Research Center, Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio" } ], "family": "Sharifi", "given": "Nima", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio" } ], "family": "Klein", "given": "Eric A.", "sequence": "additional" } ], "container-title": [ "Journal of Urology" ], "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2021, 8, 26 ] ], "date-time": "2021-08-26T08:00:48Z", "timestamp": 1629964848000 }, "deposited": { "date-parts": [ [ 2022, 3, 25 ] ], "date-time": "2022-03-25T00:29:55Z", "timestamp": 1648168195000 }, "indexed": { "date-parts": [ [ 2022, 3, 25 ] ], "date-time": "2022-03-25T01:14:45Z", "timestamp": 1648170885055 }, "is-referenced-by-count": 2, "issn-type": [ { "type": "print", "value": "0022-5347" }, { "type": "electronic", "value": "1527-3792" } ], "issue": "1", "issued": { "date-parts": [ [ 2022, 1 ] ] }, "journal-issue": { "issue": "1", "published-print": { "date-parts": [ [ 2022, 1 ] ] } }, "language": "en", "member": "276", "original-title": [], "page": "183-189", "prefix": "10.1097", "published": { "date-parts": [ [ 2022, 1 ] ] }, "published-print": { "date-parts": [ [ 2022, 1 ] ] }, "publisher": "Ovid Technologies (Wolters Kluwer Health)", "reference-count": 0, "references-count": 0, "relation": {}, "resource": { "primary": { "URL": "http://www.jurology.com/doi/10.1097/JU.0000000000002180" } }, "score": 1, "short-container-title": [ "Journal of Urology" ], "short-title": [], "source": "Crossref", "subject": [ "Urology" ], "subtitle": [], "title": [ "5α-Reductase Inhibitors Are Associated with Reduced Risk of SARS-CoV-2 Infection: A Matched-Pair, Registry-Based Analysis" ], "type": "journal-article", "volume": "207" }