Study Evaluates Famotidine Use in Hospitalized COVID-19

Results from a recent study showed that famotidine was associated with a reduced risk of clinical deterioration leading to intubation or death in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes the novel coronavirus disease 2019 (COVID-19). 

However, despite the study findings, there is not enough data to support famotidine’s use in this treatment setting, as randomized, controlled trials are still needed. In late June, the Infectious Diseases Society of America recommended against the use of famotidine for the sole purpose of treating COVID-19 outside of a clinical trial.

Limitations of the study include its observational and single-center design, as well as the possibility of unmeasured confounders or hidden bias.

Famotidine, a histamine-2 receptor antagonist that functions to suppress gastric acid production, inhibits human immunodeficiency virus replication in vitro and has recently been evaluated as likely to inhibit viral replication of SARS-CoV-2. Famotidine has not been previously studied in patients for antiviral effects and relevant prior data is limited, according to investigators.

Circulated in the September publication of Gastroenterology, the study evaluated famotidine through a retrospective cohort study at Columbia University Irving Medical Center or its affiliate the Allen Pavilion, which was within the epicenter of the COVID-19 pandemic in the United States. Investigators reported that, in patients who were not initially intubated, famotidine use was linked to a 2-fold reduction in clinical deterioration.

Investigators included a total of 1620 patients 18 years or older who were admitted to the medical center between February 25, 2020 and April 13, 2020 and tested positive for SARS-CoV-2 by nasopharyngeal polymerase chain reaction within 72 hours of admission due to limited testing availability amid the early phase of the pandemic. Famotidine was administered intravenously or orally at any dose or duration.

Eighty-four patients (5.1%) received famotidine within 24 hours of hospital admission; home use of famotidine was recorded on admission medication reconciliation in 15% of patients who used the drug while hospitalized compared with 1% of patients who did not. The median duration of famotidine use was 5.8 days, with a total median dose of 136 mg (63-233 mg).

Investigators reported that 142 (8.8%) of patients were intubated and 238 (15%) died. A crude analysis showed that famotidine use was significantly associated with reduced risk for the composite outcome of death or intubation.

“In patients hospitalized with COVID-19 and not initially intubated, famotidine use was associated with a 2-fold reduction in clinical deterioration leading to intubation or death,” investigators wrote. “These findings are observational and should not be interpreted to mean that famotidine has a protective effect against COVID-19. Randomized controlled trials are under way.”

Reference:

1. Freedberg DE, Conigliaro J, Wang TC, et al. Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study. Gastroenterology. 2020;159(3): 1129-1131. doi: https://doi.org/10.1053/j.gastro.2020.05.053.