Daniel Freedberg, MD, "Famotidine and COVID-19"

Dr. Freedberg presented a retrospective analysis on Columbia patients on the use of Famotidine, the active ingredient in Pepcid AC, for mitigating COVID-19. The evidence for persuing Famotidine as a therapeutic strategy for COVID-19 patients include: 1) unpublished observations from Wuhan by Michael Callahan; 2) an old study of H2RAs and HIV replication in vitro where in an HIV-infected lymphocyte cell culture model they found that Famotidine may have some anti-viral activity to HIV (Bourinbaiar et al. 1996); and 3) drug modeling studies. In one drug modeling study, from Robert Malone at Alchem, they screened known drug compounds vs. the SARAS-Co-V-2 papain-like protease (PLpro) catalytic site (ubiquitinase) and found that Famotidine was a top hit at high concentrations (80 mg). In another drug modeling study, Wu et al. modeled 20 SARS-Co-V-2 structures, screened ~3,000 compounds and found that Famotidine was a top hit for the 3CLpro catalytic site but not for PLpro (Wu et al. 2020). Before joining a Northwell Health large, prospective randomized clinical trial study on the use of Famotidine for COVID-19, they decided to do a retrospective analysis on the clinical data available at Columbia to see if the hypothesis was valid. They included adults that were hospitalized from February 25 to April 13 and were diagnosed with COVID-19 within 72h, excluded those that died or were intubated within 48h, monitored exposure to Famotidine within 24h at any dose/duration, and the outcome measure was death or intubation. For statistical analysis they used Cox (time-to-event) analysis and the parameters were a 7-day follow-up minimum and up to a 30-day follow-up maximum. They looked at 84 famotidine (5.2%) and 1536 non-famotidine patients. The famotidine patients took a range of doses via IV (28%) or orally (72%) and they found that famotidine patients were less likely to die or be intubated (HR 0.40, 95% CI 0.20-0.81). Based on these results, Columbia has joined the Northwell health study as an enrolling site.

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