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0 0.5 1 1.5 2+ Mortality 95% Improvement Relative Risk Severe case 75% Case 75% Antiandrogens  Montopoli et al.  Prophylaxis Is prophylaxis with antiandrogens beneficial for COVID-19? Retrospective 42,434 patients in Italy Lower severe cases (p=0.014) and fewer cases (p=0.0044) c19early.org Montopoli et al., Annals of Oncology, May 2020 Favors various Favors control

Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (N = 4532)

Montopoli et al., Annals of Oncology, doi:10.1016/j.annonc.2020.04.479
May 2020  
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7th treatment shown to reduce risk in September 2020
 
*, now known with p = 0.000000056 from 49 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments. c19early.org
Retrospective 5,273 prostate cancer patients on androgen-deprivation therapy (ADT), and 37,161 not on ADT, showing lower risk of cases with treatment.
risk of death, 95.4% lower, RR 0.05, p = 0.15, treatment 0 of 5,273 (0.0%), control 18 of 37,161 (0.0%), NNT 2064, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of severe case, 74.5% lower, RR 0.25, p = 0.01, treatment 1 of 5,273 (0.0%), control 31 of 37,161 (0.1%), NNT 1551, inverted to make RR<1 favor treatment, odds ratio converted to relative risk.
risk of case, 75.3% lower, RR 0.25, p = 0.004, treatment 4 of 5,273 (0.1%), control 114 of 37,161 (0.3%), NNT 433, inverted to make RR<1 favor treatment, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Montopoli et al., 6 May 2020, retrospective, Italy, peer-reviewed, 12 authors.
This PaperAntiandrogensAll
Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (N = 4532)
M Montopoli, S Zumerle, R Vettor, M Rugge, M Zorzi, C V Catapano, G M Carbone, A Cavalli, F Pagano, E Ragazzi, T Prayer-Galetti, Prof A Andrea Alimonti
Annals of Oncology, doi:10.1016/j.annonc.2020.04.479
Background: Cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on binding of the viral spike (S) proteins to angiotensin-converting enzyme 2 and on S protein priming by TMPRSS2. Inhibition of TMPRSS2 may work to block or decrease the severity of SARS-CoV-2 infections. Intriguingly, TMPRSS2 is an androgen-regulated gene that is up-regulated in prostate cancer where it supports tumor progression and is involved in a frequent genetic translocation with the ERG gene. First-or second-generation androgen-deprivation therapies (ADTs) decrease the levels of TMPRSS2. Here we put forward the hypothesis that ADTs may protect patients affected by prostate cancer from SARS-CoV-2 infections. Materials and methods: We extracted data regarding 9280 patients (4532 males) with laboratory-confirmed SARS-CoV-2 infection from 68 hospitals in Veneto, one of the Italian regions that was most affected by the coronavirus disease 2019 (COVID-19) pandemic. The parameters used for each COVID-19-positive patient were sex, hospitalization, admission to intensive care unit, death, tumor diagnosis, prostate cancer diagnosis, and ADT. Results: There were evaluable 9280 SARS-CoV-2-positive patients in Veneto on 1 April 2020. Overall, males developed more severe complications, were more frequently hospitalized, and had a worse clinical outcome than females. Considering only the Veneto male population (2.4 million men), 0.2% and 0.3% of non-cancer and cancer patients, respectively, tested positive for SARS-CoV-2. Comparing the total number of SARS-CoV-2-positive cases, prostate cancer patients receiving ADT had a significantly lower risk of SARS-CoV-2 infection compared with patients who did not receive ADT (OR 4.05; 95% CI 1.55e10.59). A greater difference was found comparing prostate cancer patients receiving ADT with patients with any other type of cancer (OR 4.86; 95% CI 1.88e12.56). Conclusion: Our data suggest that cancer patients have an increased risk of SARS-CoV-2 infections compared with noncancer patients. However, prostate cancer patients receiving ADT appear to be partially protected from SARS-CoV-2 infections.
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