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Minerva Medica 2023 May 19

DOI: 10.23736/S0026-4806.23.08538-5


language: English

Antiandrogen agents in COVID-19: a meta-analysis of randomized trials

Yuki KOTANI 1, 2, 3, Giovanni LANDONI 1, 2 , Tommaso SCQUIZZATO 1, Nadia MOHAMED 1, Martina BAIARDO REDAELLI 1, Rosaria SOFIA 1, Stefano FRESILLI 1, Alberto ZANGRILLO 1, 2, Maria L. AZZOLINI 1

1 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 2 School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; 3 Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan

INTRODUCTION: Antiandrogen therapy can reduce the expression of transmembrane protease 2, which is essential for severe acute respiratory syndrome coronavirus-2 to enter the host cells. Prior trials suggested the efficacy of antiandrogen agents in patients with COVID-19. We investigated whether antiandrogen agents reduce mortality compared to placebo or usual care.
EVIDENCE ACQUISITION: We searched for randomized controlled trials comparing antiandrogen agents with placebo or usual care alone in adults with COVID-19 in PubMed, EMBASE, the Cochrane Library, the reference lists of retrieved articles, and publications by manufacturers of antiandrogen agents. The primary outcome was mortality at the longest follow-up available. The secondary outcomes included clinical worsening, the need for invasive mechanical ventilation, admission to the intensive care unit, hospitalization, and thrombotic events. We registered this systematic review and meta-analysis in PROSPERO International Prospective Register of Systematic Reviews (CRD42022338099).
EVIDENCE SYNTHESIS: We included 13 randomized controlled trials enrolling 1934 COVID-19 patients. We found that antiandrogen agents reduced mortality at the longest follow-up available (91/1021 [8.9%] vs. 245/913 [27%]; risk ratio =0.40; 95% confidence interval, 0.25-0.65; P=0.0002; I2=54%). Antiandrogen therapy also reduced clinical worsening (127/1016 [13%] vs. 298/911 [33%]; risk ratio =0.44; 95% confidence interval, 0.27-0.71; P=0.0007; I2=70%) and hospitalization (97/160 [4.4%] vs. 24/165 [15%]; risk ratio =0.24; 95% confidence interval, 0.10-0.58; P=0.002; I2=44%). There was no significant difference in the other outcomes between the two treatment groups.
CONCLUSIONS: Antiandrogen therapy reduced mortality and clinical worsening in adult patients with COVID-19.

KEY WORDS: Systematic review; Meta-analysis; Androgen antagonists; COVID-19; Mortality

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