Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19

Schmidt et al., JAMA Network Open, doi:10.1001/jamanetworkopen.2021.34330, Nov 2021

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https://c19hcq.org/schmidth.html

HCQ for COVID-19

1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 423 studies, used in 59 countries.

Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine treatments.

5,700+ studies for 169 treatments. c19hcq.org

Retrospective 1,106 prostate cancer patients, showing higher mortality with HCQ treatment.

Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved. Low-cost treatments were excluded, reducing the probability of treatment—especially early—due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.

Important missing comments or errors? Let us know.

Study covers HCQ and remdesivir.

risk of death, 333.0% higher, OR 4.33, p < 0.001, treatment 70, control 407, adjusted per study, propensity score matching, multivariable, RR approximated with OR, excluded in exclusion analyses: confounding by indication is likely and adjustments do not consider COVID-19 severity at baseline.

risk of severe case, 613.0% higher, OR 7.13, p < 0.001, treatment 70, control 407, adjusted per study, propensity score matching, multivariable, RR approximated with OR, excluded in exclusion analyses: confounding by indication is likely and adjustments do not consider COVID-19 severity at baseline.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

1. c19early.org, c19early.org/soc/usa.html.c19early.org/soc/usa.html.

Schmidt et al., 12 Nov 2021, retrospective, USA, peer-reviewed, 42 authors, study period 17 March, 2020 - 11 February, 2021.

This Paper HCQ All

Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19

MD Andrew L Schmidt, MD Matthew D Tucker, MD Ziad Bakouny, MD Chris Labaki, PhD; Chih-Yuan Hsu, PhD; Yu Shyr, MD Andrew J Armstrong, MD Tomasz M Beer, MD Ragneel R Bijjula, MD Mehmet A Bilen, MD Cindy F Connell, Scott Joseph Dawsey, MD Bryan Faller, MD Xin Gao, MD Benjamin A Gartrell, MD David Gill, MD Shuchi Gulati, PhD Susan Halabi, MD Clara Hwang, MD Monika Joshi, MD Ali Raza Khaki, MD Harry Menon, MD Michael J Morris, MD Matthew Puc, MD Karen B Russell, MD Dimpy P Shah, PhD Neil J Shah, MD Nima Sharifi, MD Justin Shaya, MD Michael T Schweizer, MD; John Steinharter, MD Elizabeth M Wulff-Burchfield, MD Wenxin Xu, MD Jay Zhu, PhD Sanjay Mishra, PhD Petros Grivas, PhD Brian I Rini, MD Jeremy Lyle Warner, MD Tian Zhang, MD Toni K Choueiri, MD Shilpa Gupta, MD Rana R Mckay, Aakash Desai, Aaron M Cohen, Adam J Olszewski, Aditya Bardia, Ahmad Daher, Alaina J Brown, Albert Yeh, Albert Hsiao, Alex Cheng, Alice Y Zhou, Alicia Beeghly-Fadiel, Alicia K Morgans, Alokkumar Jha, Alvaro G Menendez, Alyson Fazio, Amanda Nizam, Amelie G Ramirez, Amit A Kulkarni, Amit K Verma, Amro Elshoury, Andrea Verghese Rivera, Andrew Walden, Andrew J Piper-Vallillo, Andrew L Cook, Ang Li, Angela Shaw Cantrell, Angelo Cabal, Anju Nohria, Anne H Angevine, Anthony P Gulati, Antonio Giordano, Anup Kasi, Archana Ajmera, Arielle Elkrief, Ariffa Kariapper, Arturo Loaiza-Bonilla, Asha Jayaraj, Astha Thakkar, Atlantis D Russ, Babar Bashir, Balazs Halmos, Barbara B Logan, Barbara R Wood, Becky Slawik, Becky Dixon, Benjamin French, Bertrand Routy, Blanche H Mavromatis, Brandon Hayes-Lattin, Briana Barrow Mccollough, Bridget Fleissner, Brittany Stith, Camille P Wicher, Candice Schwartz, Carey C Thomson, Carmen C Solorzano, Carolina Granada, Carrieann Brown, Cassandra Hennessy, Catherine Stratton, Cecilia A Castellano, Celina Ang, Chaitanya Mandapakala, Chen-Pin Wang, Chinmay Jani, Chris Su, Christian F Misdary, Christina Chapman, Christopher Mcnair, Christopher A Lemmon, Christopher L Geiger, Christopher R Friese, Christopher T Su, Cindy Mckeown, Claire Hoppenot, Clarke A Low, Clement Pillainayagam, Cristiano Ferrario, Crosby D Rock, Cyndi Gonzalez Gomez, Cynthia Masson, Daniel Mundt, Daniel Addison, Daniel B Flora, Daniel G Stover, Daniel H Kwon, Daniel J Hausrath, Daniel W Bowles, Daniel Y Reuben, Danielle Shafer, Danielle S Bitterman, Darciann O' Sullivan, Daruka Mahadevan, Davendra P S Sohal, David Whaley, David A Slosky, David D Chism, Dawn L Hershman, Deborah B Doroshow, Deepak Ravindranathan, Dimitrios Farmakiotis, Divaya Bhutani, Donald C Vinh, Dory A Freeman, Douglas B Johnson, Edward Hatton, Eliezer M Van Allen, Elizabeth A Griffiths, Elizabeth J Davis, Elizabeth S Nakasone, Elizabeth T Loggers, Elizabeth V Robilotti, Ellis Levine, Elwyn C Cabebe, Emily Hsu, Emily Powell, Eneida R Nemecek, Eric Lau, Eric B Durbin, Eric H Bernicker, Eric J Small, Erin Cook, Erin A Gillaspie, Erin G Reid, Esperanza B Papadopoulos, Eyob Tadesse, Firas H Wehbe, Gary H Lyman, Gary K Schwartz, Gayathri Nagaraj, Genevieve Boland, George D Demetri, Gerald Batist, Gerald Gantt Jr., Goetz Kloecker, Grace Shaw, Gregory J Riely, Hala T Borno, Haneen Saker, Hannah Dzimitrowicz, Heather H Nelson, Hina Khan, Hira G Shaikh, Hyma V Polimera, James L Chen, Jamie Stratton, Jared D Acoba, Jaymin M Patel, Jean M Connors, Jeff Mather, Jeffrey P Henderson, Jennifer Dill, Jennifer Girard, MD Jeremy L Warner, Jerome J Graber, Jesse Papenburg, Jessica Altman, Jessica E Hawley, Jessica M Clement, Ji (janie) Park, Jian Li Campian, John Philip, John F Deeken, Jonathan Riess, Jonathan E Rosenberg, Jonathan M Loree, Jonathon (jack) W Senefeld, Jordan Kharofa, Jorge A Garcia, Joshua D Palmer, Judy T Lewis, Julie Guido, Julie C Fu, Julie Tsu-Yu Wu, Jun Yang Jiang, Justin F Gainor, Justin F Klamerus, K M Steve Lo, Kanishka G Patel, Karen De Cardenas, Karen Vega-Luna, Karen J Goldsmith, Karla Hansen, Kathryn E Huber, Keith E Stockerl-Goldstein, Kelly J Jeffords, Kent F Hoskins, Kerry L Reynolds, Kim Cerrone, Kimberly Cortez, Kyle T Enriquez, Lane R Rosen, Latoya N Lashley, Lauren D Pomerantz, Laurie J Smith, Lawrence E Feldman, Leslie A Fecher, Leyre Zubiri, Li C Liu, Lidia Schapira, Lisa Tachiki, Lisa B Weissmann, Lori J Rosenstein, Lucy L Wang, Maggie Tomasini, Maheen Abidi, Mahir Khan, Mansi R Shah

JAMA Network Open, doi:10.1001/jamanetworkopen.2021.34330

IMPORTANCE Androgen deprivation therapy (ADT) has been theorized to decrease the severity of SARS-CoV-2 infection in patients with prostate cancer owing to a potential decrease in the tissuebased expression of the SARS-CoV-2 coreceptor transmembrane protease, serine 2 (TMPRSS2). OBJECTIVE To examine whether ADT is associated with a decreased rate of 30-day mortality from SARS-CoV-2 infection among patients with prostate cancer.

Conflict of Interest Disclosures: Dr Bakouny reported grants from Genentech/imCORE; nonfinancial support from Bristol Myers Squibb; and personal fees from UpToDate outside the submitted work. Dr Shyr reported grants from the National Cancer Institute during the conduct of the study. Dr Armstrong reported grants from Bayer, Janssen, and Pfizer/Astellas; and personal fees from Bayer, Janssen, and Pfizer/Astellas outside the submitted work. Dr Beer reported grants paid to his institution from Alliance Foundation Trials, Astellas Pharma, Bayer, Boehringer Ingelheim, Corcept Therapeutics, Endocyte Inc, Freenome, Grail Inc, Harpoon Therapeutics, Janssen Research and Development, Medivation Inc, Sotio, Theraclone Sciences/OncoResponse, and Zenith Epigenetics; personal fees from Arvinas, Astellas Pharma, AstraZeneca, Bayer, Bristol Myers Squib, Clovis Oncology, Constellation, GlaxoSmithKline, Grail Inc, Janssen, Merck & Co, Myovant Sciences, Novartis, Pfizer, Sanofi, and Tolero; and stock ownership in Arvinas Inc and Salarius Pharmaceuticals outside the submitted work. Dr Bilen reported grants to his institution from AAA, AstraZeneca, Bayer, Bristol Myers Squibb, Genentech/Roche, Genome and Company, Incyte, Nektar, Peloton Therapeutics, Pfizer, SeaGen, Tricon Pharmaceuticals, and Xencor outside the submitted work; and personal fees from AstraZeneca, Bayer, Bristol Myers Squibb, Calithera Biosciences, Eisai, EMD Serono, Exelixis, Genomic Health, Janssen, Nektar, Pfizer, Sanofi,..

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Late treatment
is less effective

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