P0903 - A Retrospective Review: Famotidine Use Is Not Associated With Improved Outcomes in Hospitalized Patients With COVID-19

Eugene Stolow, MD, MPH¹, Bara El-Kurdi, MD¹, Allison Harrington, MD¹, Sylvia Keiser, DO¹, Saatchi Kuwelker, MD¹, Aziz Tejani, MD¹, Phillip Acosta, BS¹, Zaid Imam, MD, MBBS², Juan Echavarria, MD^3
1UT Health San Antonio, San Antonio, TX; ²William Beaumont Hospital, Royal Oak, MI; ³University of Texas Health Science Center at San Antonio, San Antonio, TX

Introduction: The COVID-19 pandemic has taken the lives of over 3.8 million people worldwide. Recently, multiple publications have suggested that famotidine might be effective in reducing disease severity in the inpatient and outpatient settings. Therefore, we conducted a retrospective analysis of the effects of inpatient, as well as outpatient, use of famotidine and proton pump inhibitors (PPIs) on admitted COVID-19 patients.

Methods: COVID-19 positive patients >18-years-old admitted to our tertiary care center between June and August 2020 were included. Those dismissed from the ED were excluded from the study. Univariate and multivariate regression analysis was conducted to determine the effect of famotidine and PPIs on the occurrence of mortality, ICU admission and acute kidney injury (AKI). Patient age, sex, body mass index, and comorbidities (hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD)) were included as covariates. Odds ratios for respective variables were calculated and recorded.

Results: 489 patients were included in our study. 43 patients were on PPI therapy on admission. 26 patients were on famotidine on admission. 137 were treated with famotidine while inpatient. On univariate analysis, inpatient famotidine use, age, male sex and DM were associated with increased mortality (Figure.1Aa). Both inpatient as well as outpatient famotidine use along with male sex were associated with increased ICU admission (Figure.1Ab). Inpatient famotidine use, age, male sex, HTN, DM, CKD and CHF were associated with increased AKI (Figure.1Ac). On multivariate analysis, patient age, male sex and inpatient famotidine were associated with increased mortality (Figure.1Ba). Both inpatient and outpatient famotidine use as well as male sex were associated with increased ICU admission (Figure.1Bb). Inpatient famotidine, male sex, CKD and CHF were associated with increased AKI (Figure.1Bc). PPI use was not associated with changed outcomes in our patient population.

Discussion: While recent publications suggested that famotidine use might be effective in reducing severity of COVID-19 infection, our experience has been to the contrary. It is unclear why the use of famotidine was significantly associated with worse outcomes in our patient population. These findings are consistent with a recent study by Yeramaneni et al. (PMID: 33058865). Further studies with randomized-controlled trials are needed to better evaluate the role of famotidine in COVID-19 patients.

Figure 1A			Figure 1B
a) Mortality			Outpatient Famotidine			Inpatient Famotidine			PPI
Variable	p-value	OR				a) Mortality
Out-Famotidine	0.36	1.60	Variable	p-value	OR	Variable	p-value	OR	Variable	p-value	OR
In-Famotidine	0.00	5.84	Out-Famotidine	0.345	1.668	In-Famotidine	0.000	6.189	PPI	0.420	0.659
PPI	0.74	0.85	Age	0.002	1.033	Age	0.001	1.038	Age	0.001	1.035
Age	0.00	1.03	Sex	0.026	1.966	Sex	0.055	1.846	Sex	0.030	1.914
Sex	0.04	1.80	HTN	0.424	0.766	HTN	0.557	0.812	HTN	0.394	0.753
HTN	0.21	1.41	DM	0.217	1.469	DM	0.406	1.311	DM	0.198	1.495
DM	0.04	1.77	CKD	0.545	1.274	CKD	0.353	1.480	CKD	0.573	1.254
CKD	0.11	1.77	CHF	0.419	1.484	CHF	0.469	1.440	CHF	0.344	1.590
CHF	0.20	1.77	BMI	0.962	1.001	BMI	0.989	1.000	BMI	0.958	1.001
BMI	0.28	0.98
						b) ICU
b) ICU			Variable	p-value	OR	Variable	p-value	OR	Variable	p-value	OR
Variable	p-value	OR	Out-Famotidine	0.036	2.452	In-Famotidine	0.000	24.896	PPI	0.402	0.739
Out-Famotidine	0.03	2.41	Age	0.232	1.009	Age	0.153	1.103	Age	0.172	1.010
In-Famotidine	0.00	23.56	Sex	0.002	1.925	Sex	0.008	2.024	Sex	0.003	1.848
PPI	0.61	0.84	HTN	0.189	0.728	HTN	0.359	0.755	HTN	0.177	0.722
Age	0.23	1.01	DM	0.178	1.354	DM	0.831	1.063	DM	0.161	1.371
Sex	0.01	1.70	CKD	0.534	1.221	CKD	0.267	1.551	CKD	0.538	1.218
HTN	0.86	1.04	CHF	0.143	1.749	CHF	0.246	1.724	CHF	0.096	1.885
DM	0.08	1.40	BMI	0.304	1.011	BMI	0.363	1.103	BMI	0.299	1.011
CKD	0.41	1.27
CHF	0.09	1.84				c) AKI
BMI	0.60	1.01	Variable	p-value	OR	Variable	p-value	OR	Variable	p-value	OR
			Out-Famotidine	0.443	1.413	In-Famotidine	0.000	2.993	PPI	0.097	0.510
c) AKI			Age	0.134	1.102	Age	0.133	1.102	Age	0.095	1.103
Variable	p-value	OR	Sex	0.001	2.186	Sex	0.002	2.075	Sex	0.001	2.175
In-Famotidine	0.00	2.83	HTN	0.277	1.319	HTN	0.174	1.427	HTN	0.322	1.288
PPI	0.24	0.64	DM	0.164	1.385	DM	0.329	1.265	DM	0.127	1.434
Out-Famotidine	0.42	1.40	CKD	0.001	3.047	CKD	0.000	3.309	CKD	0.001	2.975
Age	0.00	1.02	CHF	0.011	2.772	CHF	0.018	2.629	CHF	0.007	3.034
Sex	0.01	1.76	BMI	0.716	0.996	BMI	0.648	0.995	BMI	0.751	0.996
HTN	0.00	2.17
DM	0.00	2.11
CKD	0.00	4.03
CHF	0.00	3.49
BMI	0.25	0.99

Table: Figure 1A. Univariate analysis of association of famotidine use with mortality, ICU admission, and acute
kidney injury (AKI) in COVID-19 patients
Figure 1B. Multivariate analysis of association of famotidine use with mortality, ICU admission, and acute
kidney injury (AKI) in COVID-19 patients

In-Famotidine: inpatient famotidine; Out-Famotidine: outpatient famotidine; PPI: proton pump inhibitor


Disclosures:
Eugene Stolow indicated no relevant financial relationships.
Bara El-Kurdi indicated no relevant financial relationships.
Allison Harrington indicated no relevant financial relationships.
Sylvia Keiser indicated no relevant financial relationships.
Saatchi Kuwelker indicated no relevant financial relationships.
Aziz Tejani indicated no relevant financial relationships.
Phillip Acosta indicated no relevant financial relationships.
Zaid Imam indicated no relevant financial relationships.
Juan Echavarria indicated no relevant financial relationships.


Eugene Stolow, MD, MPH¹, Bara El-Kurdi, MD¹, Allison Harrington, MD¹, Sylvia Keiser, DO¹, Saatchi Kuwelker, MD¹, Aziz Tejani, MD¹, Phillip Acosta, BS¹, Zaid Imam, MD, MBBS², Juan Echavarria, MD³. P0903 - A Retrospective Review: Famotidine Use Is Not Associated With Improved Outcomes in Hospitalized Patients With COVID-19, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.