ivermectin need in COVID-19

Throughout the COVID-19 pandemic, numerous therapeutic agents have been repurposed and applied empirically and within clinical trials. Prophylactic medications for COVID-19 could have a huge benefit, but studies to date haven’t panned out. Initially many therapeutic medications were used late in the illness, and one of the criticisms of these negative studies was that the drugs were applied too late in the disease and therefore did not show any benefit. There were also numerous studies showing associations of benefit, but subsequent randomized clinical trials have failed to prove effectiveness in reducing mortality (i.e. Remdesivir, hydroxychloroquine, lopinavir/ritonavir, convalescent plasma, monoclonal antibody therapy).

Ivermectin is an interesting medication that had fallen off my radar until recently. It is an anti-parasitic medication, with potential anti-viral, and anti-inflammatory properties against SARS-CoV-2 and COVID-19. In this post, we will review some of the current evidence in using Ivermectin as a prophylactic and therapeutic agent in COVID-19.

In Vitro Evidence

Cells infected with SARS-CoV-2 RNA

Added Ivermectin or nothing (control) to cells and analyzed RT-PCR for replication of SARS-CoV-2 RNA at days 0 to 3

24h = 93% reduction in viral RNA present

48h = 99.8% reduction in viral RNA present

By 48hrs there was a ≈5000-fold reduction in viral RNA in Ivermectin treated cells compared to control samples

With a single dose of Ivermectin viral replication was controlled effectively eliminating all viral material by 48hrs

No toxicity was observed at anytime

Proposed anti-viral mechanism of action

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Evidence from Egypt

RCT of 600 patients (400 symptomatic confirmed COVID-19 & 200 healthcare and household contacts)

Group 1: 100 pts with mild/moderate COVID-19 infection + 4d course of 400ug/kg Ivermectin qD (max dose 24mg) + standard of care

Group 2: 100 pts with mild/moderate COVID-19 infection + 400mg hydroxychloroquine BID x1d, then 200mg BID for 5d + standard of care

Group 3: 100 pts with severe COVID-19 + 4d course of 400ug/kg Ivermectin qD (max dose 24mg) + standard of care

Group 4: 100 pts with severe COVID-19 + 400mg hydroxychloroquine BID x1d, then 200mg BID for 5d + standard of care

Group 5: 100 healthcare and/or household contacts PPE + ivermectin 400mcg/kg x1 and repeated in 1 week

Group 6: 100 healthcare and/or household contacts PPE only

Excluded pregnant, lactating, and critical cases (respiratory failure requiring mechanical ventilation, presence of shock, another organ failure)

Mild Cases = Mild symptoms such as anosmia, loss of taste, fever, respiratory or GI tract symptoms

Moderate Cases = Symptoms such as fever, respiratory tract or GI symptoms + pneumonia manifestations on chest imaging

Severe Cases =

RR >30/min

O2 sat <93%

PaO2/FiO2 < 200

Lung infiltrates >50% of lung fields or rapid progression within 24 – 48hrs

Respiratory support (i.e. HFNC or NIV or IVM)

Primary Endpoint: Improvement in clinical/laboratory investigations and/or 2 consecutive negative PCR tests taken at least 48hours apart, and hospital LOS

Results:

In mild, moderate, and severe COVID-19 patients there was an improvement in lymphocyte count, CRP, ferritin, d-dimer, and RT-PCR conversion days in the Ivermectin group compared to the hydroxychloroquine group after one week of treatment

Mortality:

Ivermectin Group 1: 0%

Hydroxychloroquine Group 2: 4%

Ivermectin Group 3: 2%

Hydroxychloroquine Group 4: 20%

Mean Hospital LOS:

Ivermectin Group 1: 5 +/- 1d

Hydroxychloroquine Group 2: 15 +/- 8d

Ivermectin Group 3: 6 +/- 1d

Hydroxychloroquine Group 4: 18 +/- 8

Prevention of COVID-19 Infection in Healthcare or Household Contacts of COVID-19:

Ivermectin Group 5: 2%

No Ivermectin Group 6: 10%

Limitations:

Multiple primary endpoints with many being subjective/soft

Trial not registered at clinicaltrials.gov so can’t check on what outcomes were originally set as primary outcomes and what was added or found through analysis

Conclusion: Ivermectin in addition to standard care was more effective in treatment and prophylaxis compared to hydroxychloroquine in addition to standard care according to the authors. Without a placebo arm, we do not know if ivermectin is superior to standard care alone. Additionally, the methodology has concerning issues including multiple primary outcomes. buy ivermectin | buy ivermectin India | buy ivermectin | buy ivermectin India | ivermectin tablet for humans | ivermectin tablet price ||ivermectin 12 mg tablet price in India | ivermectin buy online | where to buy ivermectin for humans | ivermectin dosage | where to buy ivermectin UK | ivermectin uses | ivermectin | Stromectol |buy ivermectin online | buy ivermectin online UK | buy ivermectin online NZ | buy ivermectin online south Africa | buy ivermectin online Malaysia | Buy Stromectol (ivermectin) Online at Lowest Price | Buy Ivermectin for Covid 19 Over the Counter | Buy Ivermectin for Humans and Ivermectin 3mg | Ivermectin Online Prescription | Buy Ivermectin Online (@buyivermectin) | order/ Buy Ivermectin Online Nz | No Prescription ivermectin | Ivermectol 12mg Tablet 2'S - Buy Medicines online | What's New |