Use of 5-Alpha-Reductase Inhibitors Tied to Lower Risk of COVID-19

By Lorraine L. Janeczko

September 20, 2021

NEW YORK (Reuters Health) - Drugs commonly used to treat lower urinary-tract symptoms in men with enlarged prostate may also help protect them from COVID-19 infection, according to a matched-pair, registry-based analysis.

"SARS-CoV-2 has a disproportionately severe effect on men, suggesting that the androgen pathway plays a role in the disease," researchers write in The Journal of Urology. "Use of the 5ARIs (5 alpha-reductase inhibitors) was associated with a lower risk of community acquired infection with SARS-CoV-2 in an ambulatory population of men."

Senior author Dr. Eric A. Klein of Cleveland Clinic in Ohio and his colleagues conducted a prospective registry study that included more than 60,000 males without prostate cancer who were twenty years of age and above. Participants were tested for SARS-CoV-2 between March 2020 and February 2021 at one institution.

The researchers matched men using 5ARIs with nonusers and investigated the link between 5ARI use and rates of SARS-CoV-2 positivity and severity.

Overall, 1,079 men reported treatment with 5ARI, and 55,100 were available to be matched. Each final matched cohort included 944 men, and the mean duration of 5ARI use was 60 months. The absolute risk for infection was 42% (399/944) in 5ARI users and 47% (446/944) among nonusers (odds ratio, 0.81; P=0.026).

Multivariable logistic regression analysis of the entire tested population showed that men taking 5ARIs were less likely to be infected with SARS-COV-2 (absolute risk reduction, 5.3%; OR, 0.88; P=0.042) than men who did not take the drugs; but the research team found no link between 5ARI use and disease severity.

"The study was intended to help elucidate whether drugs that affect testosterone might be helpful against COVID-19," Dr. Klein told Reuters Health by email.

He does not envision a direct effect on patient care for now. "This was an observational study that is hypothesis generating," he explained. "Only a well-powered, placebo-controlled, randomized trial can determine if taking these drugs is safe and effective in mitigating the risk of getting COVID or in mitigating the risk of severe disease."

"This study DOES NOT justify routine use of these drugs in men at risk for COVID-19," he cautioned. "Only a large, randomized trial can determine if that is safe and effective."

Researchers worldwide are searching for ways to reduce or mitigate COVID-19 in different populations, said Dr. Sriram Eleswarapu, an assistant professor of urology and director of andrology research in the department of urology at David Geffen School of Medicine at UCLA in Los Angeles.

"5ARIs are an (Food and Drug Administration)-approved class of medications commonly used to treat prostate enlargement or hair loss in men," he added by email. "These findings add to the growing evidence base that androgen-receptor pathways may be important in SARS-CoV-2 infection."

"Though the researchers show there is 'signal in the noise' for a potential modest effect of 5ARIs, clinicians and patients should be cautious in interpretation," advised Dr. Eleswarapu. "We cannot definitively conclude that 5ARI use prevents COVID-19, but the data in this study certainly suggest pathways for further laboratory and clinical research."

The study was not funded. The authors did not state any conflicts of interest.

SOURCE: https://bit.ly/3k5zbec The Journal of Urology, online August 26, 2021.

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