Famotidine therapy lowers death, intubation risk in COVID-19 patients

Treatment with famotidine in hospitalized patients with the novel coronavirus disease (COVID-19) may help reduce the risk of death, results of a study have shown. It is also associated with a lower risk of the combined outcome of mortality and intubation, as well as decreased levels of serum markers for those with severe disease.

“[W]e found that famotidine is associated with improved clinical outcomes in hospitalized patients with COVID-19, including lower in-hospital mortality, a lower composite of death and/or intubation, and lower levels of serum markers for serious disease,” the researchers said.

This retrospective, propensity-matched observation study compared outcomes in patients hospitalized with COVID-19 receiving famotidine therapy with those not receiving the study drug between 24 February 2020 and 13 May 2020.

A total of 873 patients were analysed, of whom 83 (9.5 percent) received famotidine. Patients treated with famotidine were younger than those not treated with the study drug (63.5±15.0 vs 67.5±15.8 years; p=0.021), but there was no between-group difference in baseline demographics or pre-existing comorbidities. [Am J Gastroenterol 2020;115:1617-1623]

Famotidine therapy resulted in a reduced risk of in-hospital mortality (odds ratio [OR], 0.37, 95 percent confidence interval [CI], 0.16–0.86; p=0.021) and combined death or intubation (OR, 0.47, 95 percent CI, 0.23–0.96; p=0.040). Propensity score matching to adjust for age difference between the two treatment groups did not affect the outcomes.

Patients treated with famotidine also showed lower levels of serum markers for severe disease, including lower median peak C-reactive protein levels (9.4 vs 12.7 mg/dL; p=0.002), lower median procalcitonin levels (0.16 vs 0.30 ng/mL; p=0.004), and a nonsignificant trend to lower median mean ferritin levels (797.5 vs 964.0 ng/mL; p=0.076).

In logistic regression analysis, famotidine independently predicted both lower mortality and combined death or intubation, while older age, body mass index >30 kg/m², chronic kidney disease, National Early Warning Score, and higher neutrophil-lymphocyte ratio were all predictive of both adverse outcomes.

“Our results on mortality and combined mortality/intubation corroborate the findings from the recent report by Freedberg [and colleagues] that examined the effect of famotidine use on clinical outcomes in 1,620 consecutive hospitalized patients with COVID-19 infection from 25 February 2020 to 13 April 2020,” the researchers said. [Gastroenterology 2020;doi:10.1053/j.gastro.2020.05.053]

The authors found that famotidine therapy within 24 hours of hospital admission led to a reduced risk of death (adjusted hazard ratio [HR], 0.42, 95 percent CI, 0.21–0.85) and death alone (HR, 0.30, 95 percent CI, 0.11–0.80). The outcomes were unchanged after baseline patient characteristics were balanced.

“The mechanism by which famotidine might improve COVID-19 outcomes is currently unknown,” the researchers said. “One theory, based on earlier reports on the efficacy of famotidine in inhibiting human immunodeficiency virus replication, is that famotidine may directly inhibit the SARS-CoV-2 virus.” [Life Sci 1996;59:365-370]

However, recent studies using a Vero E6 cell-based assay have failed to display any direct inhibitory effect of famotidine on SARS-CoV-2 infection. [Preprint Res Sq 2020;doi:10.21203/rs.3.rs-30934]

“Additional studies are warranted to fully evaluate the impact of famotidine in the COVID-19 population,” the researchers said.