A Population-Level Analysis of the Protective Effects of Androgen Deprivation Therapy Against COVID-19 Disease Incidence and Severity.
A Population-Level Analysis of the Protective Effects of Androgen Deprivation Therapy Against COVID-19 Disease Incidence and Severity.
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DOI：
10.3389/fmed.2022.774773
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发表时间：
2022
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
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冠状病毒病19（COVID-19）的发病率和严重程度在男性中明显较高。性激素可能是COVID-19在男性和女性中结果差异的潜在机制。我们假设接受雄激素剥夺治疗（ADT）的男性COVID-19的发病率和严重程度较低。我们对2020年2月15日至7月15日在退伍军人健康管理局接受治疗的男性退伍军人进行了观察性研究。我们开发了一个倾向评分模型来预测接受严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）检测的可能性。我们进行了经逆概率加权调整的多变量logistic回归建模，以检查ADT与COVID-19发病率之间的关系。我们对COVID-19患者进行了逻辑回归分析，以检验ADT与COVID-19严重程度之间的关联。我们确定了246，087名接受SARS-CoV-2检测的VA男性患者的大型队列，其中3，057名男性暴露于ADT，36，096名男性患有癌症而没有ADT。其中，295名ADT患者和2，427名未接受ADT的癌症患者患有严重的COVID-19疾病。在ADT患者与未接受ADT的癌症患者的主要倾向加权比较中，ADT与SARS-CoV-2检测阳性的可能性降低相关（校正OR，0.88 [95% CI，0.81-0.95]; p = 0.001）。此外，ADT与更少的严重COVID-19结局相关（OR 0.72 [95% CI 0.53-0.96]; p = 0.03）。ADT与男性退伍军人中COVID-19的发病率和严重程度降低相关。睾酮和雄激素受体信号传导可能增加SARS-CoV-2感染的风险，并导致男性严重的COVID-19病理生理学。
The incidence and severity of coronavirus disease 19 (COVID-19) is substantially higher in men. Sex hormones may be a potential mechanism for differences in COVID-19 outcome in men and women. We hypothesized that men treated with androgen deprivation therapy (ADT) have lower incidence and severity of COVID-19. We conducted an observational study of male Veterans treated in the Veterans Health Administration from February 15th to July 15th, 2020. We developed a propensity score model to predict the likelihood to undergo Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing. We performed multivariable logistic regression modeling adjusted with inverse probability weighting to examine the relationship between ADT and COVID-19 incidence. We conducted logistic regression analysis among COVID-19 patients to test the association between ADT and COVID-19 severity. We identified a large cohort of 246,087 VA male patients who had been tested for SARS-CoV-2, of whom 3,057 men were exposed to ADT, and 36,096 men with cancer without ADT. Of these, 295 ADT patients and 2,427 cancer patients not on ADT had severe COVID-19 illness. In the primary, propensity-weighted comparison of ADT patients to cancer patients not on ADT, ADT was associated with decreased likelihood of testing positive for SARS-CoV-2 (adjusted OR, 0.88 [95% CI, 0.81–0.95]; p = 0.001). Furthermore, ADT was associated with fewer severe COVID-19 outcomes (OR 0.72 [95% CI 0.53–0.96]; p = 0.03). ADT is associated with reduced incidence and severity of COVID-19 amongst male Veterans. Testosterone and androgen receptor signaling may confer increased risk for SARS-CoV-2 infection and contribute to severe COVID-19 pathophysiology in men.
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