Cleveland, Ohio: The use of 5-alpha-reductase inhibitors (5ARIs) in men without prostate cancer is related to a reduction in community-acquired infection with SARS-CoV-2, reveals a recent study. This implies that the use of 5ARIs has the potential to reduce the burden of COVID-19. The results of the study were published in the Journal of Urology on 1 Jan 2022.
5-alpha-reductase inhibitors are a drug class that are used for the treatment of an enlarged prostate gland (benign prostatic hyperplasia) and male pattern hair loss. Drugs in this class include dutasteride (marketed as Avodart) and finasteride (marketed as Proscar [finasteride 5 mg] and Propecia [finasteride 1 mg]).
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to disproportionately affect men with both more severe disease and higher mortality. This suggests that androgen pathway may play a role in the disease. Also, 5ARI use in men with COVID-19 have shown to be beneficial in some studies. Madison Lyon, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, and colleagues therefore aimed to assess the association of 5ARI use on risk of community acquired SARS-CoV-2 infection.
The study included a total of 60,474 males in a prospective registry of people tested for SARS-CoV-2 between March 8, 2020 and February 15, 2021. Men using 5ARIs were matched 1:1 to non5ARI users, using a matched cohort design. The researchers completed independent analysis using unconditional multivariable logistic regression on the entire unmatched data set for validation.
Primary outcome measures were the association of the use of 5ARI on rates of SARS-Cov-2 positivity and disease severity. Of the men 1,079 (1.8%) were reported to be using 5ARI and 55,100 were available for matching. The final matched cohorts included 944 men each. Mean duration of use was 60.4 months.
Study's key findings include:
Absolute risk for infection was significantly lower in 5ARI users compared to nonusers, 42.3% vs 47.2%, respectively (absolute risk reduction [ARR] 4.9%, OR 0.81).
Unconditional multivariable logistic regression analysis of the entire study cohort of 55,100 men confirmed the protective association of 5ARI use (ARR 5.3%, OR=0.877).
Use of 5ARIs was not associated with disease severity.
"The findings indicate that 5ARIs use is associated with a lower risk of community acquired infection with SARS-CoV-2 in an ambulatory population of men," wrote the authors." "The mechanism behind this association is not fully understood but this could be related to inhibition of the ACE2 virus co-receptor and estradiol-associated pro-immune effects."
Reference:
The study titled, "5α-Reductase Inhibitors Are Associated with Reduced Risk of SARS-CoV-2 Infection: A Matched-Pair, Registry-Based Analysis," was published in the Journal of Urology.
DOI: https://doi.org/10.1097/JU.0000000000002180