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The over-the-counter antacid Pepcid is trending online and it’s not because we all have collective heartburn because of the coronavirus epidemic.
Earlier this week, news was released that a New York-based health network was testing high intravenous doses of famotidine in patients with COVID-19, according to a report from a working American infectious disease doctor in China.
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“Unfortunately, sometimes there is all this buzz up front because of some discoveries in test tubes or something like that, but it doesn’t end up lasting in patients,” said Jim Lewis, clinical supervisor infectious diseases in the pharmacy services department. at Oregon Health & Science University in Portland, Oregon.
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“We cannot reiterate loud enough not to take this medication without first talking to your health care provider,” he said.
Famotidine, sold under the name Pepcid, is used to treat excess stomach acid by blocking the H2 receptors on the surface of stomach cells that release acid.
The idea came from something Michael Callahan, an infectious disease doctor at Massachusetts General Hospital, saw while working in the Chinese city of Wuhan as the coronavirus epidemic began to take off.
Doctors have noticed that many survivors of COVID-19 tend to be poorer, he told a journalist for Science in an article published in his news section on Sunday. They noted that many survivors suffered from chronic heartburn and were taking famotidine rather than omeprazole, which is sold in the United States under the name Prilosec, which is much more expensive.
Chinese doctors examined more than 6,000 patients and found a slightly higher number of those taking recovered famotidine than those who had not taken the medicine. The number was not high enough to be statistically significant, which means that it could just as easily be attributed to chance.
To find out if this was significant, Callahan contacted Kevin Tracey at Northwell Health in New York. Partly funded by the American Biomedical Advanced Research and Development Authority, a randomized, double-blind study was launched on April 14, according to Science.
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Their working theory is that famotidine could bind to a protein that helps the SARS-CoV-2 virus to reproduce.
Lewis noted that the targeting mechanism could be similar to some HIV drugs that have also been tried on COVID-19 but unfortunately were not effective.
Study patients receive an IV dose of famotidine nine times more than the dose people take for heartburn. Famotidine can cause heart problems in people with reduced kidney function, so they were excluded from the study.
Since many Northwell Health patients were also being treated with hydroxychloroquine, an anti-inflammatory drug that also has not been proven to be an effective treatment for COVID-19, they could only test one combination of both drugs.
It was not a controlled study, which means that a group of patients receives a drug and a similar group does not. This makes it very difficult to know if the patients would have improved without the drug.
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Instead, the researchers plan to compare patients receiving the drugs with patients treated earlier in the epidemic. Tracey of Northwell told Science, “Is this good science? No. It’s the real world. “
Doctors warn that most COVID-19 patients recover despite the lack of approved treatments.
Currently, mortality rates for COVID-19 patients hospitalized for severe symptoms appear to be between 5 and 10%, so the majority of patients will be better on their own, said medical specialist Adarsh Bhimraj. infectious at Cleveland Clinic.
It is too easy for clinicians to assume that a patient is doing better “it is because of the medicine we gave them, and if they do not improve, we assume it is because of the disease” said Bhimraj.
The lack of data does not allow us to know if famotidine has a real effect on COVID-19 patients. As scientists like to say, “correlation is not a causal link.” This means that just because two things tend to happen together does not cause one to cause the other.
Chinese farmers may have improved in greater numbers because they are more physically fit, drink less (or more) alcohol, or spend more time outdoors and therefore had higher levels of vitamin D in the sunlight. Or famotidine may actually help treat COVID-19.
Until scientifically valid data from a well-designed clinical study becomes available, it is impossible to know.
John Scott, chair of the Department of Pharmacology at the University of Washington Faculty of Medicine, said he did not know why or how this particular H2 blocker was supposed to work against COVID-19, but researchers seem to be applying the principles appropriate scientists.
“The fact that the authors recognize that the results are not yet statistically significant suggests that they are taking a rational and empirical approach to their analyzes,” he said.
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