A Phase 2 Trial of the Effect of Antiandrogen Therapy on COVID-19 Outcome: No Evidence of Benefit, Supported by Epidemiology and In Vitro Data.

Abstract

BACKGROUND:

Men are more severely affected by COVID-19. Testosterone may influence SARS-CoV-2 infection and the immune response.

OBJECTIVE:

To clinically, epidemiologically, and experimentally evaluate the effect of antiandrogens on SARS-CoV-2 infection.

DESIGNS, SETTINGS, AND PARTICIPANTS:

A randomized phase 2 clinical trial (COVIDENZA) enrolled 42 hospitalized COVID-19 patients before safety evaluation. We also conducted a population-based retrospective study of 7894 SARS-CoV-2-positive prostate cancer patients and an experimental study using an air-liquid interface three-dimensional culture model of primary lung cells.

INTERVENTION:

In COVIDENZA, patients were randomized 2:1 to 5 d of enzalutamide or standard of care.

OUTCOME MEASUREMENTS:

The primary outcomes in COVIDENZA were the time to mechanical ventilation or discharge from hospital. The population-based study investigated risk of hospitalization, intensive care, and death from COVID-19 after androgen inhibition.

RESULTS AND LIMITATIONS:

Enzalutamide-treated patients required longer hospitalization (hazard ratio [HR] for discharge from hospital 0.43, 95% confidence interval [CI] 0.20-0.93) and the trial was terminated early. In the epidemiological study, no preventive effects were observed. The frail population of patients treated with androgen deprivation therapy (ADT) in combination with abiraterone acetate or enzalutamide had a higher risk of dying from COVID-19 (HR 2.51, 95% CI 1.52-4.16). In vitro data showed no effect of enzalutamide on virus replication. The epidemiological study has limitations that include residual confounders.

CONCLUSIONS:

The results do not support a therapeutic effect of enzalutamide or preventive effects of bicalutamide or ADT in COVID-19. Thus, these antiandrogens should not be used for hospitalized COVID-19 patients or as prevention for COVID-19. Further research on these therapeutics in this setting are not warranted.

PATIENT SUMMARY:

We studied whether inhibition of testosterone could diminish COVID-19 symptoms. We found no evidence of an effect in a clinical study or in epidemiological or experimental investigations. We conclude that androgen inhibition should not be used for prevention or treatment of COVID-19.

• Authors: Karin Welén, Ebba Rosendal, Magnus Gisslén, Annasara Lenman, Eva Freyhult, Osvaldo Fonseca-Rodríguez, Daniel Bremell, Johan Stranne, Åse Östholm Balkhed, Katarina Niward, Johanna Repo, David Robinsson, Anna J Henningsson, Johan Styrke, Martin Angelin, Elisabeth Lindquist, Annika Allard, Miriam Becker, Stina Rudolfsson, Robert Buckland, Camilla Thellenberg Carlsson, Anders Bjartell, Anna C Nilsson, Clas Ahlm, Anne-Marie Fors Connolly, Anna K Överby, Andreas Josefsson
• Journal: European urology (Eur Urol) Vol. 81 Issue 3 Pg. 285-293 (03 2022) ISSN: 1873-7560 [Electronic] Switzerland
• PMID: 34980495 (Publication Type: Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

Chemical References

• Androgen Antagonists
• Androgens
• Anilides
• Benzamides
• Nitriles
• Tosyl Compounds
• Phenylthiohydantoin
• Testosterone
• enzalutamide
• bicalutamide

Topics

• Aged
• Aged, 80 and over
• Androgen Antagonists (therapeutic use)
• Androgens (therapeutic use)
• Anilides (therapeutic use)
• Benzamides (therapeutic use)
• COVID-19 (diagnosis, epidemiology)
• COVID-19 Nucleic Acid Testing
• Female
• Hospitalization
• Humans
• Male
• Middle Aged
• Nitriles (therapeutic use)
• Phenylthiohydantoin (therapeutic use)
• Retrospective Studies
• SARS-CoV-2 (isolation & purification)
• Sweden (epidemiology)
• Testosterone
• Tosyl Compounds (therapeutic use)
• Treatment Outcome
• COVID-19 Drug Treatment