In Reply–Use of Famotidine and Risk of Severe Course of Illness in Patients With COVID-19: A Meta-analysis

Abstract

Kow and colleagues' interest in our recent letter to the editor1Ghosh R. Chatterjee S. Dubey S. Lavie C.J. Famotidine against SARS-CoV2: a hope or hype?.Mayo Clin Proc. 2020; 95: 1797-1799Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar regarding the potential for famotidine in COVID-19 infection was much appreciated. Obviously, their meta-analysis is small and probably not adequately powered but still suggested 37% and 7% reductions in severe disease in the general and adjusted analyses, respectively: obviously, with wide confidence intervals that were not close to statistical significance. A large-scale randomized study that was adequately powered, preferably with famotidine, started early in COVID-19, would be required to fully determine the full potential of the benefits of famotidine in COVID-19; this type of study is likely not coming in this pandemic. However, their meta-analysis does not provide much reason for concern regarding significant harms or risks with famotidine in COVID-19. At present, many clinicians are recommending not only famotidine but several other nonprescription fairly harmless therapies including vitamins C and D, zinc, melatonin, and H1 antihistamine agents for outpatient therapy in COVID -19, all with various degrees of evidence.2McCarty M.F. DiNicolantonio J.J. Nutraceuticals have potential for boosting the type 1 interferon response to RNA viruses including influenza and coronavirus.Prog Cardiovasc Dis. 2020; 63: 383-385Crossref PubMed Scopus (104) Google Scholar At present, an old generic prescription medication, colchicine, typically used for gout,3Kaul S. Gupta M. Bandyopadhyay D. et al.Gout pharmacotherapy in cardiovascular diseases: a review of utility and outcomes.Am J Cardiovasc Drugs. 2020; 28: 1-14Google Scholar but also for pericarditis, is now used with considerable evidence for coronary artery disease.3Kaul S. Gupta M. Bandyopadhyay D. et al.Gout pharmacotherapy in cardiovascular diseases: a review of utility and outcomes.Am J Cardiovasc Drugs. 2020; 28: 1-14Google Scholar Colchicine is now being considered in COVID-19, originally based on the Greek Study in the Effects of Colchicine in Covid-19 Complications Prevention (GREECO-19) study4Deftereos S.G. Giannopoulos G. Vrachatis D.A. et al.Effect of colchicine vs standard care on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019: the GRECCO-19 randomized clinical trial.JAMA Netw Open. 2020; 3: e2013136Crossref PubMed Scopus (276) Google Scholar,5Rizk J.G. Kalantar-Zadeh K. Mehra M.R. Lavie C.J. Rizk Y. Forthal D.N. Authors' reply to Vrachatis et al. Pharmaco-immunomodulatory therapy in COVID-19.Drugs. 2020; 80: 1501-1503Crossref PubMed Scopus (4) Google Scholar and now with considerably more evidence in the recently released Colchicine Coronavirus SARS-CoV2 (COLCORONA) trial.6Tardif J.C. Bouabdallaoui N. L’Allier P.L. et al.for the COLCORONA InvestigatorsEfficacy of colchicine in non-hospitalized patients with COVID-19. medRxiv.https://doi.org/10.1101/2021.01.26.21250494Google Scholar In this latter major trial, 4159 patients with polymerase chain reaction-confirmed COVID-19, colchicine (0.5 mg twice daily for 3 days, then once daily for 27 days) reduced the primary end point of hospitalization and death significantly by 25%, including significant reductions in hospitalization by 25%, and trends for mechanical ventilation and death (–50% and –44%, respectively). Certainly, evidence for various therapies in COVID-19 continues to evolve rapidly.7Rizk J.G. Kalantar-Zadeh K. Mehra M.R. Lavie C.J. Rizk Y. Forthal D.N. Pharmaco-immunomodulatory therapy in COVID-19.Drugs. 2020; 80: 1267-1292Crossref PubMed Scopus (169) Google Scholar,8Rizk J.G. Forthal D.N. Kalantar-Zadeh K. et al.Expanded access programs, compassionate drug use, and emergency use authorizations during the COVID-19 pandemic.Drug Discov Today. 2021; 26: 593-603Crossref PubMed Scopus (35) Google Scholar Famotidine Against SARS-CoV2: A Hope or Hype?Mayo Clinic ProceedingsVol. 95Issue 8PreviewCoronavirus disease 2019 (COVID-19) is globe-trotting, and thousands of researchers and stakeholders are spending repose-less days and sleepless nights in search of effective therapies. Currently, the entire research sphere is dealing with a pandemic triad: hypes, hypotheses, and hopes. In the absence of a specific antiviral agent or vaccine against novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), “repurposing” of old time-tested medications is being tried. Famotidine is the most recent addition to this trend, creating a lot of hustle among the public and stirring criticism in the scientific arena. Full-Text PDF Use of Famotidine and Risk of Severe Course of Illness in Patients With COVID-19: A Meta-analysisMayo Clinic ProceedingsVol. 96Issue 5PreviewThe article by Ghosh et al,1 in which they discuss the potential of famotidine to regulate innate and adaptive immune responses, provides a rationale to repurpose famotidine for the treatment of coronavirus disease 2019 (COVID-19). There have been few studies evaluating the use of famotidine in patients with COVID-19, and thus we performed a meta-analysis to summarize the overall effect of famotidine on the clinical outcomes in this patient population. Full-Text PDF