S1458 Famotidine versus Pantoprazole Use and Clinical Outcomes in Patients Hospitalized With COVID-19: A Retrospective Study

Abstract

Introduction: Both famotidine (Pepcid) and pantoprazole (Protonix) have been used as supportive treatment for Covid-19 patients. We compare famotidine use, pantoprazole use, or non-use for clinical outcomes in patients hospitalized with Covid-19. Methods: This retrospective study included 2,184 patients ages 18 years or older treated for Covid-19 from March 2020 through March 2021. We excluded those who received both famotidine and pantoprazole treatments. Multivariate logistic regression was conducted for the primary outcome of all-cause mortality and the secondary outcomes of mechanical ventilation, vasopressor use, acute kidney injury, and gastrointestinal bleed. Covariates were demographics, chronic diseases, and symptoms. Additional covariates for all-cause mortality were vasopressor use and mechanical ventilation and for mechanical ventilation the covariate of vasopressor use. Results: There were 638 (29.2%) that received famotidine, 727 (33.3%) that received pantoprazole, and 819 (37.5%) that received neither. Overall sample characteristics included age (M = 63.0, SD = 19.61) and sex (female: 1,003, 45.9%; male: 1,181, 54.1%). Famotidine (OR: 0.30, 95% CI: 0.20, 0.44, P < 0.001) and pantoprazole (OR: 0.47, 95% CI: 0.33, 0.66, P < 0.001) were significantly associated with decreased odds for in-hospital all-cause mortality as compared to non-use. When famotidine was compared to pantoprazole, famotidine had lower odds for in-hospital mortality (OR:0.65, 95% CI:0.45, 0.95, P = 0.03), mechanical ventilation (OR:0.38, 95% CI:0.25, 0.58, P < 0.001), vasopressor use (OR:0.19, 95% CI:0.14, 0.27, P < 0.001), acute kidney injury (OR:0.40, 95% CI:0.30, 0.54, P < 0.001), and gastrointestinal bleed (OR:0.15, 95% CI:0.08, 0.29, P < 0.001). Conclusion: Famotidine use in hospitalized patients with Covid-19 is associated with lower odds for all-cause mortality, mechanical ventilation, vasopressor use, acute kidney injury, and gastrointestinal bleed as compared to pantoprazole. It is possible that clinicians treated more severely ill patients with pantoprazole. However, we adjusted for many relevant covariates to potentially address this concern. Future research with a clinical trial is necessary to support the preferential use of famotidine over pantoprazole in hospitalized Covid-19 patients.