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Minerva Urologica e Nefrologica 2021 Jan 13

DOI: 10.23736/S0393-2249.20.04081-3


language: English

Impact of chronic exposure to 5-alpha reductase inhibitors on the risk of hospitalization for COVID-19: a case-control study in male population from two COVID-19 regional centers of Lombardy (Italy)

Massimo LAZZERI 1 , Stefano DUGA 1, 2, Elena AZZOLINI 1, Vittorio FASULO 1, Nicolò BUFFI 1, 2, Alberto SAITA 1, Giovanni LUGHEZZANI 1, 2, Elvezia M. PARABOSCHI 1, 2, Rodolfo HURLE 1, Alessandro NOBILI 3, Maurizio CECCONI 1, 2, Giorgio GUAZZONI 1, 2, Paolo CASALE 1, Rosanna ASSELTA 1, 2, The Humanitas COVID-19 Task Force; The Humanitas Gavazzeni COVID-19 Task Force

1 Humanitas Clinical and Research Center - IRCCS -, Rozzano, Milano, Italy; 2 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; 3 Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy


BACKGROUND: There are sex differences in vulnerability to Coronavirus disease 2019 (COVID-19). The coronavirus S protein mediates viral entry into target cells employing the host cellular serine protease TMPRSS2 for S-protein priming. The TMPRSS2 gene expression is responsive to androgen stimulation and it could partially explain sex differences. We hypothesized that men chronically exposed to 5-alpha reductase inhibitors (5ARIs) for benign prostate hyperplasia (BPH) have a lower risk of hospitalization for COVID-19.
METHODS: This is a population-based case-control study on consecutive patients positive for SARS-CoV-2 virus who required hospitalization for COVID-19 (cases), age-matched to beneficiaries of the Lombardy Regional Health Service (controls). Data were collected by two high-volume COVID-19 regional centers of Lombardy (Italy). The primary outcome was to compare the prevalence of patients chronically exposed to 5ARIs, who required hospitalization for COVID-19, with the one of controls.
RESULTS: Overall, 943 males were enrolled; 45 (4.77%) were exposed to 5ARI. COVID-19 patients aged >55 years under 5ARI treatment were significantly less than expected on the basis of the prevalence of 5ARI treatment among age-matched controls (5.57 vs. 8.14%; p=0.0083, 95%CI=0.75-3.97%). This disproportion was higher for men aged >65 (7.14 vs. 12.31%; p=0.0001, 95%CI=2.83-6.97%). Eighteen 5ARIs-patients died; the mean age of men who died was higher than those who did not: 75.98±9.29 vs. 64.78±13.57 (p<0.001). Cox-regression and multivariable models did not show correlation between 5ARIs exposure and protection against intensive care unit admission/death.
CONCLUSIONS: Men exposed to 5ARIs might be less vulnerable to severe COVID-19, supporting its use in disease prophylaxis.

KEY WORDS: COVID-19; 5-alpha reductase inhibitors; Androgens; Sex

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