Includes an interesting sidenote about famotidine inhibiting hiv replication.
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This retrospective study found that, in patients hospitalized with COVID-19, famotidine use was associated with a reduced risk of clinical deterioration leading to intubation or death. The study was premised on the assumption that use of famotidine represented a continuation of home use, but documentation of why famotidine was given was poor. The results were specific for famotidine (no protective association was seen for PPIs) and also specific for COVID-19 (no protective association in patients without COVID-19). A lower peak ferritin value was observed among users of famotidine, supporting the hypothesis that use of famotidine may decrease cytokine release in the setting of SARS-CoV-2 infection. A randomized controlled trial is currently under way to determine whether famotidine can improve clinical outcomes in hospitalized patients with COVID-19 (NCT04370262).
Famotidine has not previously been studied in patients for antiviral effects, and there are limited relevant prior data. An untargeted computer modeling analysis identified famotidine as one of the highest-ranked matches for drugs predicted to bind 3CLpro, a SARS-CoV-2 protease that generates nonstructure proteins critical to viral replication.
In the 1990s, histamine-2 receptor antagonists including famotidine were shown to inhibit human immunodeficiency virus replication without affecting lymphocyte viability in vitro.
There are limitations to the study. It was observational, and we cannot exclude the possibility of unmeasured confounders or hidden bias that account for the association between famotidine use and improved outcomes. No samples were gathered, and mechanism cannot be directly assessed. Finally, this was a single-center study, which may limit generalizability of the findings.
In sum, 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. 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.
https://www.gastrojournal.org/article/S0016-5085(20)34706-5/fulltext
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This retrospective study found that, in patients hospitalized with COVID-19, famotidine use was associated with a reduced risk of clinical deterioration leading to intubation or death. The study was premised on the assumption that use of famotidine represented a continuation of home use, but documentation of why famotidine was given was poor. The results were specific for famotidine (no protective association was seen for PPIs) and also specific for COVID-19 (no protective association in patients without COVID-19). A lower peak ferritin value was observed among users of famotidine, supporting the hypothesis that use of famotidine may decrease cytokine release in the setting of SARS-CoV-2 infection. A randomized controlled trial is currently under way to determine whether famotidine can improve clinical outcomes in hospitalized patients with COVID-19 (NCT04370262).
Famotidine has not previously been studied in patients for antiviral effects, and there are limited relevant prior data. An untargeted computer modeling analysis identified famotidine as one of the highest-ranked matches for drugs predicted to bind 3CLpro, a SARS-CoV-2 protease that generates nonstructure proteins critical to viral replication.
In the 1990s, histamine-2 receptor antagonists including famotidine were shown to inhibit human immunodeficiency virus replication without affecting lymphocyte viability in vitro.
There are limitations to the study. It was observational, and we cannot exclude the possibility of unmeasured confounders or hidden bias that account for the association between famotidine use and improved outcomes. No samples were gathered, and mechanism cannot be directly assessed. Finally, this was a single-center study, which may limit generalizability of the findings.
In sum, 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. 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.
https://www.gastrojournal.org/article/S0016-5085(20)34706-5/fulltext
