Introduction
A study conducted by Reed B. Hogan II and colleagues explored the effects of dual-histamine receptor blockade using Cetirizine-Famotidine on COVID-19 patients with severe pulmonary symptoms. The researchers aimed to determine if this combination could mitigate the cytokine storm, a significant cause of acute respiratory distress syndrome (ARDS) in COVID-19, by blocking histamine-1 (H1) and histamine-2 (H2) receptors.
Methods
- Study Design: The study was a physician-sponsored cohort study conducted on 110 high-acuity hospitalized COVID-19 patients. The main goal was to assess whether the combination of cetirizine and famotidine could improve patient outcomes.
- Participants: The study involved patients with severe to critical pulmonary symptoms. Participants were treated with cetirizine 10 mg and famotidine 20 mg, both administered twice daily in addition to the standard care protocols.
Results
- Intubation Rate: The overall intubation rate among the treated patients was 16.4%. This rate dropped to 7.3% after patients received a minimum of 48 hours of dual-histamine receptor blockade treatment.
- Inpatient Mortality Rate: The mortality rate for patients who received the dual treatment was 15.5%. When excluding patients with Do Not Resuscitate (DNR) directives, this rate was 8.2%.
- Hospital Stay: The average duration of hospitalization for patients was 11 days, suggesting that the treatment may help reduce the length of stay in the hospital.
These results indicate that the combination of cetirizine and famotidine could provide beneficial outcomes compared to published data on similar patient populations not receiving this combination treatment.
Discussion
- Histamine’s Role: Histamine plays a crucial role in inflammation and cytokine release. Blocking histamine receptors can potentially mitigate these effects, making antihistamines a promising intervention for COVID-19.
- Safety Profile: Both cetirizine and famotidine are known for their safety, being widely available and used globally for other conditions like allergies and acid reflux. This established safety profile supports their use in this novel context.
- Patient Comorbidities: The study cohort had high rates of comorbidities, including hypertension (78.2%), obesity (58.2%), and diabetes (42.7%). These comorbid conditions often complicate COVID-19 cases, making the positive results of the treatment even more significant.
- Concomitant Treatments: Alongside the dual-histamine blockade, other treatments were used, such as hydroxychloroquine (which was associated with worse outcomes), tocilizumab, methylprednisolone, and convalescent plasma. The effects of these treatments were considered in the study’s analysis.
Conclusions
- Efficacy: The dual-histamine receptor blockade showed potential in reducing the severity of COVID-19 symptoms, decreasing the need for ventilation, and lowering mortality rates.
- Study Limitations: This study was not a placebo-controlled, randomized trial, and relied on historical controls from other regions for comparison. These factors limit the ability to generalize the results.
- Future Directions: Further randomized controlled trials are necessary to confirm these findings and to explore optimal dosing and combination strategies for different patient populations.
Overall, this proof-of-concept study supports the potential of cetirizine and famotidine as a safe and effective treatment for reducing COVID-19 severity and improving patient outcomes.
Supplementary data to this article can be found online at doi.org/10.1016/j.pupt.2020.101942.
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