Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study
Freedberg et al.
, Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity..
, Gastroenterology, doi:10.1053/j.gastro.2020.05.053
PSM retrospective 1,620 hospitalized patients in the USA, 84 with existing famotidine use, showing lower risk of combined death/intubation with treatment.
risk of death/intubation, 57.0% lower, RR 0.43, p = 0.02, treatment 8 of 84 (9.5%), control 332 of 1,536 (21.6%), NNT 8.3, propensity score matching.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Freedberg et al., 21 May 2020, retrospective, propensity score matching, USA, peer-reviewed, 15 authors.
Abstract: Gastroenterology 2020;159:1129–1131
Famotidine Use Is Associated With Improved Clinical Outcomes
in Hospitalized COVID-19 Patients: A Propensity Score Matched
Retrospective Cohort Study
Daniel E. Freedberg,1 Joseph Conigliaro,2,3 Timothy C. Wang,1 Kevin J. Tracey,4
Michael V. Callahan,5,6 and Julian A. Abrams,1 on behalf of the Famotidine Research Group
Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, New
York, New York; 2Division of General Internal Medicine, Department of Medicine, Northwell Health, Manhasset, New York;
Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; 4Feinstein Institutes for Medical Research, Northwell
Health, Manhasset, New York; 5Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; and
Ofﬁce of the Assistant Secretary for Public Health Preparedness and Response, U.S. Department of Health and Human
Services, Washington, DC
See Covering the Cover synopsis on page 803.
Keywords: Coronavirus 2019; SARS-CoV-2; Famotidine; Histamine-2 Receptor Antagonists.
oronavirus Disease 2019 (COVID-19) caused 2
million cases and more than 150,000 deaths worldwide as of mid-April 2020.1 Clinical trials are under way to
assess the efﬁcacy of a variety of antiviral drugs; however,
many of these drugs have toxicities and thus far no drug has
been proven to improve outcomes in patients with COVID-19.
Famotidine is a histamine-2 receptor antagonist that
suppresses gastric acid production. In vitro, famotidine inhibits human immunodeﬁciency virus replication.2 Recently,
Wu et al.3 used computational methods to predict structures
of proteins encoded by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome and identiﬁed
famotidine as one of the drugs most likely to inhibit the 3chymotrypsin-like protease (3CLpro), which processes proteins essential for viral replication.4 We hypothesized that
famotidine would be associated with improved clinical
outcomes among hospitalized patients with COVID-19. To
explore this, we performed a retrospective cohort study at a
single academic center located at the epicenter of the
COVID-19 pandemic in the United States.
Complete methods are available in the Supplementary
Materials. In brief, adults were eligible for the study if they
were admitted to our institution from February 25, 2020, to
April 13, 2020, and tested positive for SARS-CoV-2 within no
more than 72 hours following admission. Patients were excluded
if they died or were intubated within 48 hours following hospital
admission. The primary exposure was use of famotidine (any
dose, form of administration, or duration), classiﬁed as present if
famotidine was received within 24 hours of hospital admission
and otherwise as absent. The primary outcome was a composite
of death or endotracheal intubation from hospital day 2 to day 30
(intubation-free survival). This follow-up period avoided
immortal time bias because the exposure was classiﬁed based on
the 24-hour period after hospitalization and the at-risk period
began on hospital day 2. Cox proportional hazards modeling was
performed on the full cohort, and a matched subset was examined with propensity scoring matching to balance baseline
characteristics based on use of famotidine.
Population and Use of Famotidine
A total of 1620 patients met criteria for analysis,
including 84 patients (5.1%) who received famotidine
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