Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19
Authors: Andrew L. Schmidt, Matthew D. Tucker, Ziad Bakouny, Chris Labaki, Chih-Yuan Hsu, Yu Shyr, Andrew J. Armstrong, Tomasz M. Beer, Ragneel R. Bijjula, Mehmet A. Bilen, Cindy F. Connell, Scott Joseph Dawsey, Bryan Faller, Xin Gao, Benjamin A. Gartrell, David Gill, Shuchi Gulati, Susan Halabi, Clara Hwang, Monika Joshi, Ali Raza Khaki, Harry Menon, Michael J. Morris, Matthew Puc, Karen B. Russell, Dimpy P. Shah, Neil J. Shah, Nima Sharifi, Justin Shaya, Michael T. Schweizer, John Steinharter, Elizabeth M. Wulff-Burchfield, Wenxin Xu, Jay Zhu, Sanjay Mishra, Petros Grivas, Brian I. Rini, Jeremy Lyle Warner, Tian Zhang, Toni K. Choueiri, Shilpa Gupta, Rana R. McKay, Aakash Desai, Aaron M. Cohen, Adam J. Olszewski, Aditya Bardia, Ahmad Daher, Alaina J. Brown, Albert Yeh, Albert Hsiao, Alex Cheng, Alice Y. Zhou, Alicia Beeghly-Fadiel, Alicia K. Morgans, Alokkumar Jha, Alvaro G. Menendez, Alyson Fazio, Amanda Nizam, Amelie G. Ramirez, Amit A. Kulkarni, Amit K. Verma, Amro Elshoury, Andrea Verghese Rivera, Andrew Walden, Andrew J. Piper-Vallillo, Andrew L. Cook, Ang Li, Angela Shaw Cantrell, Angelo Cabal, Anju Nohria, Anne H. Angevine, Anthony P. Gulati, Antonio Giordano, Anup Kasi, Archana Ajmera, Arielle Elkrief, Ariffa Kariapper, Arturo Loaiza-Bonilla, Asha Jayaraj, Astha Thakkar, Atlantis D. Russ, Babar Bashir, Balazs Halmos, Barbara B. Logan, Barbara R. Wood, Becky Slawik, Becky Dixon, Benjamin French, Bertrand Routy, Blanche H. Mavromatis, Brandon Hayes-Lattin, Briana Barrow McCollough, Bridget Fleissner, Brittany Stith, Camille P. Wicher, Candice Schwartz, Carey C. Thomson, Carmen C. Solorzano, Carolina Granada, CarrieAnn Brown, Cassandra Hennessy, Catherine Stratton, Cecilia A. Castellano, Celina Ang, Chaitanya Mandapakala, Chen-Pin Wang, Chinmay Jani, Chris Su, Christian F. Misdary, Christina Chapman, Christopher McNair, Christopher A. Lemmon, Christopher L. Geiger, Christopher R. Friese, Christopher T. Su, Cindy McKeown, Claire Hoppenot, Clarke A. Low, Clement Pillainayagam, Cristiano Ferrario, Crosby D. Rock, Cyndi Gonzalez Gomez, Cynthia Masson, Daniel Mundt, Daniel Addison, Daniel B. Flora, Daniel G. Stover, Daniel H. Kwon, Daniel J. Hausrath, Daniel W. Bowles, Daniel Y. Reuben, Danielle Shafer, Danielle S. Bitterman, Darciann O' Sullivan, Daruka Mahadevan, Davendra P. S. Sohal, David Whaley, David A. Slosky, David D. Chism, Dawn L. Hershman, Deborah B. Doroshow, Deepak Ravindranathan, Dimitrios Farmakiotis, Divaya Bhutani, Donald C. Vinh, Dory A. Freeman, Douglas B. Johnson, Edward Hatton, Eliezer M. Van Allen, Elizabeth A. Griffiths, Elizabeth J. Davis, Elizabeth S. Nakasone, Elizabeth T. Loggers, Elizabeth V. Robilotti, Ellis Levine, Elwyn C. Cabebe, Emily Hsu, Emily Powell, Eneida R. Nemecek, Eric Lau, Eric B. Durbin, Eric H. Bernicker, Eric J. Small, Erin Cook, Erin A. Gillaspie, Erin G. Reid, Esperanza B. Papadopoulos, Eyob Tadesse, Firas H. Wehbe, Gary H. Lyman, Gary K. Schwartz, Gayathri Nagaraj, Genevieve Boland, George D. Demetri, Gerald Batist, Gerald Gantt Jr., Goetz Kloecker, Grace Shaw, Gregory J. Riely, Hala T. Borno, Haneen Saker, Hannah Dzimitrowicz, Heather H. Nelson, Hina Khan, Hira G. Shaikh, Hyma V. Polimera, James L. Chen, Jamie Stratton, Jared D. Acoba, Jaymin M. Patel, Jean M. Connors, Jeff Mather, Jeffrey P. Henderson, Jennifer Dill, Jennifer Girard, Jeremy L. Warner, Jerome J. Graber, Jesse Papenburg, Jessica Altman, Jessica E. Hawley, Jessica M. Clement, Ji (Janie) Park, Jian Li Campian, John Philip, John F. Deeken, Jonathan Riess, Jonathan E. Rosenberg, Jonathan M. Loree, Jonathon (Jack) W. Senefeld, Jordan Kharofa, Jorge A. Garcia, Joshua D. Palmer, Judy T. Lewis, Julie Guido, Julie C. Fu, Julie Tsu-Yu Wu, Jun Yang Jiang, Justin F. Gainor, Justin F. Klamerus, K. M. Steve Lo, Kanishka G. Patel, Karen de Cardenas, Karen Vega-Luna, Karen J. Goldsmith, Karla Hansen, Kathryn E. Huber, Keith E. Stockerl-Goldstein, Kelly J. Jeffords, Kent F. Hoskins, Kerry L. Reynolds, Kim Cerrone, Kimberly Cortez, Kyle T. Enriquez, Lane R. Rosen, Latoya N. Lashley, Lauren D. Pomerantz, Laurie J. Smith, Lawrence E. Feldman, Leslie A. Fecher, Leyre Zubiri, Li C. Liu, Lidia Schapira, Lisa Tachiki, Lisa B. Weissmann, Lori J. Rosenstein, Lucy L. Wang, Maggie Tomasini, Maheen Abidi, Mahir Khan, Mansi R. Shah, Marc A. Rovito, Margaret E. Gatti-Mays, Maria Escobedo, Mariam Alexander, Mark Bonnen, Mark A. Fiala, Mark A. Lewis, Mark E. Dailey, Mark E. Reeves, Mark H. Sueyoshi, Mary Portes, Mary Salazar, Mary F. Mulcahy, Mary M. Pasquinelli, Maryam B. Lustberg, Maryann Z. Fiebach, Matt Luders, Matthew D. Galsky, Matthias Weiss, Melanie J. Clark, Melissa Smits, Melissa K. Accordino, Merry-Jennifer Markham, Michael Gurley, Michael A. Thompson, Michael H. Bar, Michael J. Wagner, Michael J. Joyner, Michael J. Glover, Michael T. Wotman, Michelle Braccioforte, Michelle Marcum, Mildred E. Seletyn, Minh-Phuong Huynh-Le, Miriam Santos Dutra, Mitrianna Streckfuss, Mojtaba Akhtari, Na Tosha N. Gatson, Nadia Bahadur, Natalie Knox, Natasha C. Edwin, Nathan A. Pennell, Nathaniel Bouganim, Navid Hafez, Neeta K. Venepalli, Nicole O. Williams, Nino Balanchivadze, Nitin Ohri, Omar Butt, Orestis A. Panagiotou, Oscar K. Serrano, Pamela Bohachek, Pamela C. Egan, Pankil K. Shah, Paolo F. Caimi, Patricia LoRusso, Paul L. Weinstein, Peter Paul Yu, Philip E. Lammers, Pier Vitale Nuzzo, Poorva Bindal, Prakash Peddi, Punita Grover, Qamar U. Zaman, R. Alejandro Sica, Rachel P. Rosovsky, Rawad Elias, Rebecca L. Zon, Rikin Gandhi, Rimma Belenkaya, Robert L. Rice, Robin A. Buerki, Roy S. Herbst, Ruben A. Mesa, Ryan C. Lynch, Ryan H. Nguyen, Ryan S. Monahan, Sachin R. Jhawar, Saif I. Alimohamed, Salma K. Jabbour, Salvatore A. Del Prete, Sana Z. Mahmood, Sanjay Goel, Sanjay G. Revankar, Sara Matar, Sara Saif, Sarah Mushtaq, Sarah Wall, Sarah Croessman, Seth Kligerman, Shannon McWeeney, Sharad Goyal, Sharon Choi, Sharon S. Brouha, Sharona Taylor, Shaveta Vinayak, Shirish M. Gadgeel, Sibel H. Blau, Sigrun Hallmeyer, Sonya A. Reid, Staci P. Williamson, Stacy Fry, Stephanie May, Stephanie Berg, Stephany N. Duda, Steven Greenland, Sue Murdock, Suki Subbiah, Sumit A. Shah, Surbhi Shah, Susan Van Loon, Susan K. Ayre, Susie Owenby, Suzanne J. Rose, Syed A. Ahmad, Sylvia Zhang, Tahir Latif, Tanios S. Bekaii-Saab, Tara Cronin, Taylor K. Nonato, Terence D. Rhodes, Theresa M. Carducci, Thorvardur R. Halfdanarson, Tianyi Sun, Trisha M. Wise-Draper, Tyler Masters, Umit Topaloglu, Vadim S. Koshkin, Vasil Mico, Vidhya Karivedu, Wendy Walters, Wilson H. Miller Jr., Xuanyi (Lexi) Li, Young Soo Rho, Zhuoer Xie, Zohar Sachs
Journal: JAMA Network Open (2021)

<h3>Importance</h3> 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). <h3>Objective</h3> To examine whether ADT is associated with a decreased rate of 30-day mortality from SARS-CoV-2 infection among patients with prostate cancer. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Androgen deprivation therapy use was defined as prior bilateral orchiectomy or pharmacologic ADT administered within the prior 3 months of presentation with COVID-19. <h3>Main Outcomes and Measures</h3> 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. <h3>Results</h3> 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). <h3>Conclusions and Relevance</h3> 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.