Rationale for inclusion of famotidine in the “MATH+” hospital treatment protocol for COVID-19 patients.

Key Messages

This article comes from the clinical expert panel of the Front-Line COVID-19 Critical Care Alliance (www.flccc.net).

Based on the shared early impressions of "what was working and what wasn't working", reviews of the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, the FLCCC experts developed a treatment protocol for hospitalized COVID-19 patients, known as the MATH+ protocol.

The scientific and clinical rationale behind the drugs included in the MATH+ protocol are provided. This article includes a section on famotidine and its usefulness for treating COVID-19.

Journal of Intensive Care Medicine

Publication Date: December 15, 2020
Peer Reviewed: Yes
Publication Type: Review/Commentary/Letter
DOI: https://www.doi.org/10.1177/0885066620973585

Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Pierre Kory, G. Umberto Meduri, Jose Iglesias, Joseph Varon, Paul E. Marik

Abstract

In December 2019, COVID-19, a severe respiratory illness caused by the new coronavirus SARS-CoV-2 (COVID-19) emerged in Wuhan, China. The greatest impact that COVID-19 had was on intensive care units (ICUs), given that approximately 20% of hospitalized cases developed acute respiratory failure (ARF) requiring ICU admission. Based on the assumption that COVID-19 represented a viral pneumonia and no anti-coronaviral therapy existed, nearly all national and international health care societies’ recommended “supportive care only” avoiding other therapies outside of randomized controlled trials, with a specific prohibition against the use of corticosteroids in treatment. However, early studies of COVID-19-associated ARF reported inexplicably high mortality rates, with frequent prolonged durations of mechanical ventilation (MV), even from centers expert in such supportive care strategies. These reports led the authors to form a clinical expert panel called the Front-Line COVID-19 Critical Care Alliance (www.flccc.net). The panel collaboratively reviewed the emerging clinical, radiographic, and pathological reports of COVID-19 while initiating multiple discussions among a wide clinical network of front-line clinical ICU experts from initial outbreak areas in China, Italy, and New York. Based on the shared early impressions of “what was working and what wasn’t working,” the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, a treatment protocol was created for the hospitalized patients based on the core therapies of methylprednisolone, ascorbic acid, thiamine, heparin and co-interventions (MATH+). This manuscript reviews the scientific and clinical rationale behind MATH+ based on published in-vitro, pre-clinical, and clinical data in support of each medicine, with a special emphasis of studies supporting their use in the treatment of patients with viral syndromes and COVID-19 specifically. The review concludes with a comparison of published multi-national mortality data with MATH+ center outcomes.