A heartburn drug was associated with improved clinical outcomes among COVID-19 patients. The outcomes of those treated with statistically significant, compared to those treated with other investigational drugs.
The observational study of the heartburn drug among COVID-19 patients was conducted by Hartford Hospital. The drug called famotidine has been observed to reduce in-hospital death and ventilation use among patients. While researchers could not pinpoint the exact reason, they speculated the antihistamine and antiviral properties recognized on the drug. They published their findings in the American Journal of Gastroenterology.
What is Famotidine?
According to the Mayo Clinic, an American not-for-profit medical center, famotidine is the generic name of branded heartburn relievers like Pepcid. It is frequently prescribed as a treatment for stomach ulcers, heartburn or acid indigestion, and even gastroesophageal reflux disease or GERD. Certain conditions, such as multiple endocrine neoplasia and Zollinger-Ellison syndrome, are treated as well with famotidine. The main goal of the drug is to control acid secretion in the stomach to prevent discomfort and damage to the organ.
Famotidine belongs to a class of medications known as histamine H2-receptor antagonists, which are commonly called H2-blockers. The active ingredients specifically block the receptor to limit the acid secretion of specific cells in the stomach. Because the drug regulates stomach acid production, doctors are likely to recommend some precautions. By default, stomach acid kills microbes in food and drink. But limiting the acid's concentration in the stomach may increase the bacteria in the gut. In turn, it increases the risk of food poisoning.
If a patient develops side effects or adverse reactions to famotidine, they need to consult their doctor immediately. The drug may trigger an allergic reaction to those who are sensitive. While others may experience multiple side effects. These events indicate replacing the drug with something else. Also, the patient needs to tell their doctor of other drugs they are taking due to drug interactions. There are medications like mesoridazine and pimozide that can interact with famotidine and cause unwanted results.
Some people with chronic illnesses may not be recommended to use famotidine. For example, patients with moderate to severe kidney disease must use the drug with caution. This is because the effects may increase due to the slow removal of the drug from the body. Kidneys are responsible for filtering contents in the blood, and compromised kidneys do not function optimally.
Famotidine and COVID-19
As of this moment, no drug has been approved as a treatment for COVID-19. But there are some drugs classified as investigational because of observed effects. These drugs have been linked to better outcomes of COVID-19 patients. Recently, a group of researchers identified a possible relationship between famotidine and COVID-19. Their study showed that patients given with the drug had favorable clinical results.
"The main finding of our single-center, retrospective study of hospitalized COVID-19 patients is that use of famotidine is associated with improved clinical outcome including lower in-hospital mortality and a lower composite endpoint of death and/or intubation," said Jeffrey F. Mather, the first author of the study and from the division of research administration at Hartford, quoted American news channel Fox News.
In the study, researchers performed a retrospective, propensity-matched observation of COVID-19 patients between February 24, 2020, and May 13, 2020. A total of 878 COVID-19 patients were observed and 83 of them received famotidine. The patients were derived from an electric database at Hartford Hospital. The patients were confirmed with COVID-19 via nasopharyngeal PCR tests.
A total of 394 patients received hydroxychloroquine, 391 received azithromycin, 27 received remdesivir, and 377 received corticosteroids. Their outcomes were compared to the famotidine group. In the famotidine group, 55 patients received the drug as inpatients, 24 were taking the drug before admission and received it as inpatients, and four others were taking it before admission but did not receive as inpatients. About 83% of the famotidine group received the oral form and 17% received the intravenous form.
Results showed statistical differences between the famotidine group and non-famotidine groups. In the famotidine group, 12 patients died in the hospital, 18 had to be intubated, and six had combined intubation and death. These figures were lower compared to the 179 patients who died in the hospital, 221 who had to be intubated, and 95 who had combined intubation and death in the non-famotidine groups.
Researchers concluded that famotidine could improve clinical outcomes of COVID-19 patients. They highlighted two possible explanations for the outcomes. First, the drug might have interfered with SARS-CoV-2. Previous studies suggested the drug's effects on the replication of HIV. The same might have occurred against the coronavirus. And second, the drug might have hindered the targets of SARS-CoV-2. Certain proteases are critical to the replication of the coronavirus. The drug might be binding and inhibiting these proteases.
In addition to those theories, researchers proposed exploring famotidine further. As an H2-blocker, the drug could have reduced the mechanisms facilitating cytokine storms in patients. The drug might have acted on the release of histamine and the activation of mast cells. The disruption potentially prevented the fundamentals of system-wide inflammation, which likely avoided other complications like acute respiratory distress syndrome and sepsis.
Researchers clarified that their study was only observational and could not prove the cause and effect. Future studies must be conducted to prove famotidine's efficacy against COVID-19. If the drug is effective, it is important to determine the dose, administration route, and therapy timing. These factors can specify which patients will likely benefit the most from the drug.
As of early June 2020, the global COVID-19 cases were nearly 7 million. More than 400,000 deaths were reported around the world at that time. An estimated 80% of patients reported mild or moderate symptoms, and the remaining 20% developed severe or critical COVID-19. Mortality due to COVID-19 in hospitals was between 10% and 26%. But the rate could be higher in patients admitted to intensive care and those mechanically ventilated.
The observational study is not the first to notice famotidine in COVID-19 cases. But it supports earlier studies that detected the link.