Science magazine: preliminary studies of famotidine against COVID-19 (caused by SARS-COV-2) are encouraging; inhibits papainlike protease needed for viral replication

photo by Petra Goeschel courtesy of pixabay.com

A report from Science magazine dated April 26 describes an effort at Northwell Health (a large hospital/clinic chain in New York City) to test the efficacy (positive effects) of famotidine against the novel coronavirus (SARS-COV-2).  Famotidine is an over-the-counter remedy for heartburn that has been available for years.  It is less expensive than the more potent and powerful drug omeprazole, which is widely used here for acid reflux and peptic ulcers.

Dr Michael Callahan, an infectious disease specialist, was in China (coincidentally) during the early days of the pandemic that started there.  He was in Nanjing to study avian flu and he followed his colleagues to Wuhan in mid-January to study the new cases of COVID-19 that were appearing.  He became curious as to why poorer patients were not dying as rapidly as those more well-off, and discovered that many were taking famotidine for chronic heartburn because it was much cheaper than omeprazole.  He found that those who had been on famotidine were dying at half the rate of those who were not.  The data was crude, and it was impossible to conduct a statistical analysis because there were so many confounders (other factors that might have influenced the outcome).

When he returned to the US, he began to analyze the effects of famotidine and discovered that it inhibited a key enzyme that the virus uses in its growth process: papainlike protease.  He began to organize efforts to conduct a clinical study.  His work was complicated by the fact that, at that time, hydroxychloroquine (HCQ) was grabbing all the attention.  He was forced to include HCQ as a standard treatment in his study, which devolved (grew into) a combination of HCQ by itself and HCQ with famotidine.  That was the only way he could do a study, which he deplores, but Kevin Tracey, who is in charge of Northwell’s research efforts, said, “Is it good science? No… it’s the real world.”

It took weeks to obtain enough famotidine for injection (as opposed to the oral form of tablets, which is in good supply), but once this was available, the study began on April 7.  The researchers aim to include a thousand patients in this protocol, which will take several weeks to complete.

In the meantime, encouragement came from anecdotal reports by people with acute COVID-19 who consumed the oral form of famotidine and showed rapid improvement.  These reports cause concern among researchers because there could be a run on famotidine by anxious people who want to try the drug on themselves, either for prevention or because they think they have the disease already.  There is a distinct possibility that people will try this on their own and consume the available supply of over-the-counter tablets long before scientific results are available.

I don’t recommend that anyone run out and buy this drug on their own, particularly since they are unlikely to take it at the right time.  Many people have an unreasoning fear of this virus (not entirely unjustified) and are willing and able to try anything, no matter how far fetched, that might work.  This was shown when a man and his wife consumed chloroquine intended as a component of an aquarium cleaner because they had heard that [redacted] called HCQ a “game changer” for the pandemic.  The man died and his wife became critically ill but recovered.  Famotidine is unlikely to cause such drastic effects, but it may be toxic in people with bad kidneys.

The time to take famotidine would be when you know you have the virus, when you have a headache and fever, but before you get pneumonia– but who is able to make rational decisions when they are acutely ill?  Especially when this virus appears to cause neurological problems and possibly infect the brain.  Hallucinations may follow, encephalopathy and strokes.

Nevermind.  Try not to think about it right now, just think about all the smart, experienced people who are working on cures that will come before you get sick.  Don’t let xenophobia or fear of other countries distract you from the work that people all over the world are doing to find the answers.  As the Science article’s concluding paragraph says:

Callahan has kept busy since his return from China. Kadlec deployed him on medical evacuation missions of Americans on two heavily infected cruise ships. Now back to doing patient rounds in Boston, he says the famotidine lead underscores the importance of science diplomacy in the face of an infectious disease that knows no borders. When it comes to experience with COVID-19, he says, “No amount of smart people at the [National Institutes of Health] or Harvard or Stanford can outclass an average doctor in Wuhan.”