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Ivermectin for COVID-19

The Cochrane Group published a review (July 28,2021) of ivermectin and COVID infections. They found:

  • 14 quality trials (all small), containing a total of 1678 participants, comparing ivermectin to no treatment, placebo, or standard of care.
    • 9 studies of patients with moderate COVID-19 in inpatient settings
    • 4 studies of patients with mild COVID‐19 cases in outpatient settings
    • 1 study of ivermectin for prevention of infection
    • 8 had an open label design, six were double blind and placebo controlled
    • 1/3 were felt to have a high risk of bias
    • Dosing and treatment duration varied among the studies
  • 31 trials in progress
  • 18 trials awaiting classification until publication of results or clarification of inconsistencies

Conclusions “Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat people with COVID‐19 in the inpatient and outpatient settings and to prevent a SARS‐CoV‐2 infection in people after having high‐risk exposure. There is also no evidence available from the study pool as to which is the best dose and regimen of ivermectin. Overall, the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized controlled trials (RCTs). With respect to the number of identified studies in trial registries and with accordance to the living approach of this review, we will continually update our search and include eligible trials.”

Other recommendations:

  • FDA does not recommend ivermectin for treatment of COVID.
  • National Institute of Health (NIH) (updated July 19,2021) notes “There are insufficient data for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19.”
  • Merck (the manufacturer of Ivermectin) in February 2021, notes “Company scientists continue to carefully examine the findings of all available and emerging studies of ivermectin for the treatment of COVID-19 for evidence of efficacy and safety. It is important to note that, to-date, our analysis has identified:
    • No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies;
    • No meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and;
    • A concerning lack of safety data in the majority of studies.
    • We do not believe that the data available support the safety and efficacy of ivermectin beyond the doses and populations indicated in the regulatory agency-approved prescribing information.”
  • The European EMA, in March 2021 stated “EMA has reviewed the latest evidence on the use of ivermectin for the prevention and treatment of COVID-19 and concluded that the available data do not support its use for COVID-19 outside well-designed clinical trials.”
  • The WHO, in March, 2021, warned against the use of ivermectin for COVID outside of a scientific study.
  • The CDC published a health advisory in August 2021, warning of a large increase in ivermectin prescriptions being filled in the U.S. coincident with the spike in COVID cases due to the delta variant. They also warned of increased calls to poison control centers due to adverse effects of ingestion of large doses of ivermectin by people using products intended for veterinary use (oral liquid and topical formulations).
  • One of the largest trials to date using Ivermectin as treatment for COVID-19 was withdrawn. The Egyptian trial was included in two meta-analyses published in the American Journal of Therapeutics, accounting for up to 15% of the total patients in the review. However, after the research trial’s publication in pre-print, anomalies were noted in the statements made and results claimed. Ultimately the trial, which included 400 participants, was withdrawn. This trial was not included in the Cochrane review. More on reasons for the withdrawal of the paper here.

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