There has been recent speculation surrounding whether famotidine, the active ingredient in a common heartburn medicine, Pepcid, could serve as an antiviral that may inhibit coronavirus replication. A report by Freedberg et al. revealed a decrease in intubation and death in patients who received famotidine upon admission.1 Our examination of EHR data did not show an obvious difference between the worst severity level of COVID-19 patients who were administered famotidine and those who were not.
This sample consisted of 29,168 active adult patients who were admitted for COVID-19 and had either been discharged or died. Of the admitted COVID-19 patients, 3,345 (11.4%) were administered famotidine, either intravenously or by mouth, within one day of being admitted. As famotidine is often given to patients on a ventilator, for patients who were on ventilators we included them only if they were on famotidine for at least one day before intubation.
As shown in Figure 1, 17% of admitted patients who received famotidine died, compared to 16% who did not receive famotidine. This does not support the finding that famotidine patients experience reduced COVID-19 severity compared to patients not treated with famotidine.
Similar results are seen when considering the percent of admitted patients treated with famotidine who required advanced respiratory support or ventilation compared to those not treated with famotidine.
There were 2,970 adult patients who were admitted for COVID-19 but did not have a known outcome (either survived or died), as of May 20, 2020. Of these patients, 485 (16%) were administered famotidine and 2485 (84%) were not. To remain consistent with prior analyses, 1 this sample did not include these patients.
To see if a possible effect might be hidden by either age or sex, we broke down the data and found that the stratified results were similar to the overall sample. Therefore, it appears that the possible effects of famotidine are not being masked by differences based on age or sex.
Further analyses should investigate possible effects of other factors, such as underlying comorbidities, that may prevent seeing an effect from famotidine. For example, it remains possible that patients in our population with other illnesses that were treated with famotidine were more likely to have severe COVID-19 infections, which were mitigated by famotidine.
Data were pooled from electronic medical records at 37 health systems in the United States, spanning 19 states and covering approximately 42 million patients.
1Freedberg DE, Conigliaro J, Sobieszczyk M, et al. Famotidine Use is Associated with Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study. medRxiv. https://www.medrxiv.org/content/10.1101/2020.05.01.20086694v2. Posted May 19, 2020.