Preclinical studies
The histamine H2 receptor antagonist famotidine (the active compound in the heartburn drug Pepcid) was associated to a reduced risk of intubation and death in 84 patients with COVID-19 in an earlier retrospective study posted as a non-peer-reviewed preprint. Work led by Darrell Ricke at Massachusetts Institute of Technology compares the biochemical action and pharmacokinetics of famotidine with those of cimetidine, a H2 antagonist that has not shown clinical benefits in patients with COVID-19, as well as relating a case report of a COVID-19 patient treated with famotidine. The study, a preprint which has not yet been peer-reviewed, shows that famotidine has stronger binding to H2 than cimetidine (confirming previous data) and that famotidine serum levels exceed its half-maximum inhibitory concentration (IC50) at all dosing regimens, while cimetidine failed to reach its IC50 when used at its standard dose. Unlike cimetidine, famotidine acts a partial agonist of arrestin recruitment. The authors propose that mast cell activation and histamine release may be central to lung pathology in patients with COVID-19.