Abstract: Gastroenterology 2021;160:919–921 Famotidine Use Is Not Associated With 30-day Mortality: A Coarsened Exact Match Study in 7158 Hospitalized Patients With Coronavirus Disease 2019 From a Large Healthcare System Samrat Yeramaneni,1 Pratik Doshi,1 Kenneth Sands,2 Mandelin Cooper,2 Dax Kurbegov,1 and Gregg Fromell3 1 Sarah Cannon Research Institute, HCA Healthcare, Nashville, Tennessee; 2Clinical Operations Group, HCA Healthcare, Nashville, Tennessee; 3HCA Research Institute, HCA Healthcare, Nashville, Tennessee P revious reports have found that in-hospital famotidine use in coronavirus disease 2019 (COVID-19) patients was associated with reduced risk of death or intubation.1,2 In 1 of these studies the authors proposed that famotidine inhibits the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) protease, 3-chymotrypsin-like protease, that is essential for breakdown of the immature SARS-CoV-2 protein particles that contribute to the inflammatory response seen in some COVID-19–infected individuals,1 which in turn can lead to acute respiratory distress syndrome, multiorgan dysfunction, physiologic deterioration, and death.3 In a global pandemic with a lack of US Food and Drug Administration–approved targeted therapeutic agents, identification and repurposing of well-established drugs with a proven track record of safety, affordability, and widespread availability are necessary.4 The purpose of this study was to evaluate the reported protective effect of famotidine on mortality in hospitalized COVID-19 patients. Methods Refer to Supplementary Methods for complete details. In brief, admitted adults to affiliated hospitals who tested positive for SARS-CoV-2 by reverse transcriptase polymerase chain reaction between February 11, 2020 and May 8, 2020 were included. Exclusion criteria were death or intubation within 48 hours of admission or if famotidine was received >24 hours after admission. The primary outcome was 30-day all-cause mortality. Primary exposure was in-hospital famotidine use, regardless of dose and route, within 24 hours of admission. To mitigate bias from nonrandomized assignment of treatment, a coarsened exact matching (CEM)5 technique was used for famotidine users and nonusers on age (by 10-year intervals), sex, race, ethnicity, body mass index, comorbidities, and in-hospital hydroxychloroquine (HCQ) use. A multivariable logistic regression model within the CEM cohort and adjusted for baseline World Health Organization (WHO) severity and use of other medications was performed to evaluate the association between famotidine use and 30-day mortality. Results A total of 8915 patients were assessed for eligibility. Of these, 1441 patients (16.2%) were excluded because of death (1.4%), intubation (5.0%), or famotidine >24 hours after admission (9.8%). Of the 7474 eligible patients, 316 patients were excluded for missing discharge disposition status (0.9%) or >30-day mortality (3.4%), resulting in a final sample of 7158 patients. Of the 7158 patients included in the analysis, 1127 patients (15.7%) were exposed and 6031 patients (84.3%) were unexposed. After CEM of the 1156 patients, 410 patients (35.5%) were exposed and 746 patients (64.5%) were unexposed (Supplementary Figure 1). Prematch and Postmatch Characteristics Overall, 15.7% of patients (n ¼ 1127) received famotidine and 84.3% (n ¼ 6031) did not. Mean age was 57.9 ± 19.3 years, 50.9% were women, 44.6% white, and 25.2% black. Famotidine was used for a median of..