antiandrogen agents in cOVid-19: a meta-analysis of randomized trials

Abstract

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.