Hartford, CT⎯Pharmacists might expect another run on Pepcid after a new study suggests that famotidine use in hospitalized COVID-19 patients might be protective against severe illness and death.

The report in the American Journal of Gastroenterology notes that patients receiving the heartburn medication had a lower risk of mortality, lower risk of the combined outcome of mortality and intubation, and lower levels of serum markers for severe disease in patients hospitalized with novel coronavirus infection.

Hartford Hospital–led researchers refer to a theory that famotidine’s effects are related to its antagonism or inverse-agonism of the histamine-2 receptor. That model posits that SARS-CoV-2 infection is at least partially mediated by pathological histamine release.

The authors report the results of a retrospective propensity-matched comparison of COVID-19 patients treated with and without famotidine.

Conducted between February 24, 2020, and May 13, 2020, the study involved 878 patients, with 9.5% of them receiving famotidine. Compared with patients not treated with the drug, patients on famotidine were younger—median age 63.5 years versus 67.5 years—but otherwise had similar characteristics.

Results indicate that use of the drug, sold OTC as formulations of Pepcid, was associated with decreased risk of in-hospital mortality, with an odds ratio of 0.47. It also lowered levels of median peak C-reactive protein, procalcitonin, and, in a nonsignificant trend, ferritin.

Researchers also report that logistic regression analysis revealed that famotidine was an independent predictor of lower mortality and combined death/intubation in contrast to older age, BMI greater than 30 kg/m2, chronic kidney disease, the national early warning score, and higher neutrophic-lymphocye ratio, which were predictors of both adverse outcomes.

“The findings in this report should be interpreted with caution in light of the single-center, retrospective and observational nature of the study,” the authors write. “Assessment of the possible effects of additional H2 receptor antagonists (such as cimetidine, nizatidine, or ranitidine) was not possible due to limited cases. Additional studies are needed to ascertain the potential efficacy of famotidine in the COVID-19 patient, including the impact of drug dose, route of administration, and timing of therapy.”

Earlier in the pandemic, after previous studies suggested some benefit for famotidine in COVID-19 patients, including those recovering at home, Pepcid shortages were reported. Some pharmacies and chains continue to limit how much can be purchased at one time.

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