Ivermectin for Preventing and Treating CoVID 19: Systemic Review

Cochrane Database of Systematic Reviews ^ | August 4, 2021 | Maria Popp et al

[gas_dr]

Background

Ivermectin, an antiparasitic agent used to treat parasitic infestations, inhibits the replication of viruses in vitro. The molecular hypothesis of ivermectin's antiviral mode of action suggests an inhibitory effect on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) replication in the early stages of infection. Currently, evidence on efficacy and safety of ivermectin for prevention of SARS‐CoV‐2 infection and COVID‐19 treatment is conflicting.

Objectives

To assess the efficacy and safety of ivermectin compared to no treatment, standard of care, placebo, or any other proven intervention for people with COVID‐19 receiving treatment as inpatients or outpatients, and for prevention of an infection with SARS‐CoV‐2 (postexposure prophylaxis).

Search methods

We searched the Cochrane COVID‐19 Study Register, Web of Science (Emerging Citation Index and Science Citation Index), medRxiv, and Research Square, identifying completed and ongoing studies without language restrictions to 26 May 2021.

Selection criteria

We included randomized controlled trials (RCTs) comparing ivermectin to no treatment, standard of care, placebo, or another proven intervention for treatment of people with confirmed COVID‐19 diagnosis, irrespective of disease severity, treated in inpatient or outpatient settings, and for prevention of SARS‐CoV‐2 infection.

Co‐interventions had to be the same in both study arms.

We excluded studies comparing ivermectin to other pharmacological interventions with unproven efficacy.

Data collection and analysis

We assessed RCTs for bias, using the Cochrane risk of bias 2 tool. The primary analysis excluded studies with high risk of bias. We used GRADE to rate the certainty of evidence for the following outcomes 1. to treat inpatients with moderate‐to‐severe COVID‐19: mortality, clinical worsening or improvement, adverse events, quality of life, duration of hospitalization, and viral clearance; 2. to treat outpatients with mild COVID‐19: mortality, clinical worsening or improvement, admission to hospital, adverse events, quality of life, and viral clearance; (3) to prevent SARS‐CoV‐2 infection: SARS‐CoV‐2 infection, development of COVID‐19 symptoms, adverse events, mortality, admission to hospital, and quality of life.

Main results

We found 14 studies with 1678 participants investigating ivermectin compared to no treatment, placebo, or standard of care. No study compared ivermectin to an intervention with proven efficacy. There were nine studies treating participants with moderate COVID‐19 in inpatient settings and four treating mild COVID‐19 cases in outpatient settings. One study investigated ivermectin for prevention of SARS‐CoV‐2 infection. Eight studies had an open‐label design, six were double‐blind and placebo‐controlled. Of the 41 study results contributed by included studies, about one third were at overall high risk of bias.

Ivermectin doses and treatment duration varied among included studies.

We identified 31 ongoing and 18 studies awaiting classification until publication of results or clarification of inconsistencies.

Ivermectin compared to placebo or standard of care for inpatient COVID‐19 treatment

We are uncertain whether ivermectin compared to placebo or standard of care reduces or increases mortality (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.14 to 2.51; 2 studies, 185 participants; very low‐certainty evidence) and clinical worsening up to day 28 assessed as need for invasive mechanical ventilation (IMV) (RR 0.55, 95% CI 0.11 to 2.59; 2 studies, 185 participants; very low‐certainty evidence) or need for supplemental oxygen (0 participants required supplemental oxygen; 1 study, 45 participants; very low‐certainty evidence), adverse events within 28 days (RR 1.21, 95% CI 0.50 to 2.97; 1 study, 152 participants; very low‐certainty evidence), and viral clearance at day seven (RR 1.82, 95% CI 0.51 to 6.48; 2 studies, 159 participants; very low‐certainty evidence). Ivermectin may have little or no effect compared to placebo or standard of care on clinical improvement up to 28 days (RR 1.03, 95% CI 0.78 to 1.35; 1 study; 73 participants; low‐certainty evidence) and duration of hospitalization (mean difference (MD) −0.10 days, 95% CI −2.43 to 2.23; 1 study; 45 participants; low‐certainty evidence). No study reported quality of life up to 28 days.

Ivermectin compared to placebo or standard of care for outpatient COVID‐19 treatment

We are uncertain whether ivermectin compared to placebo or standard of care reduces or increases mortality up to 28 days (RR 0.33, 95% CI 0.01 to 8.05; 2 studies, 422 participants; very low‐certainty evidence) and clinical worsening up to 14 days assessed as need for IMV (RR 2.97, 95% CI 0.12 to 72.47; 1 study, 398 participants; very low‐certainty evidence) or non‐IMV or high flow oxygen requirement (0 participants required non‐IMV or high flow; 1 study, 398 participants; very low‐certainty evidence). We are uncertain whether ivermectin compared to placebo reduces or increases viral clearance at seven days (RR 3.00, 95% CI 0.13 to 67.06; 1 study, 24 participants; low‐certainty evidence). Ivermectin may have little or no effect compared to placebo or standard of care on the number of participants with symptoms resolved up to 14 days (RR 1.04, 95% CI 0.89 to 1.21; 1 study, 398 participants; low‐certainty evidence) and adverse events within 28 days (RR 0.95, 95% CI 0.86 to 1.05; 2 studies, 422 participants; low‐certainty evidence). None of the studies reporting duration of symptoms were eligible for primary analysis. No study reported hospital admission or quality of life up to 14 days.

Ivermectin compared to no treatment for prevention of SARS‐CoV‐2 infection

We found one study. Mortality up to 28 days was the only outcome eligible for primary analysis. We are uncertain whether ivermectin reduces or increases mortality compared to no treatment (0 participants died; 1 study, 304 participants; very low‐certainty evidence). The study reported results for development of COVID‐19 symptoms and adverse events up to 14 days that were included in a secondary analysis due to high risk of bias. No study reported SARS‐CoV‐2 infection, hospital admission, and quality of life up to 14 days.

Authors' conclusions

Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID‐19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials.

[gas_dr]

Safety about the drug oven for COVID not overall. But fair point

[gas_dr]

It may hurt you if it delays proper care — that is the main concern. The paper declares its bias, so it is well written and reports that there could be bias in the exact same way that VAERS which is considered the holy grail by some states it has a bias in terms of reporting — the paper handled that issue

[gas_dr]

You have nicely stated what my position is — if Ivermectin is procured (mostly from farm stores to hear it told her) does not turn you around in 24 hours — its time to skip it and get to monoclonals.

[rolling_stone]

On the other hand, at least the trolls sure to swarm your post won’t have worms!

roflmao glad someone still has a sense of humor!

[kiryandil]

They kind of ruined their credibility at the end when they stated they are uncertain of the safety of a drug that has been given billions of times.

Plaquenil and Stromectol gonna kill ya - unless you're taking them for malarial prevention or roundworms.

Otherwise, it's like ingesting supercyanide.

Axe any quack - they'll tell ya. And you'll get to see Big Pharm move their lips at the same time...

[rolling_stone]

It will hurt you if this five days of treatment, does not work, and this delays getting treatments that will work.

what treatments might that be???

[phoneman08]

:)

[kiryandil]

It will hurt you if this five days of treatment, does not work, and this delays getting treatments that will work.

They have no treatments.

Deliberately.

[kiryandil]

Magic unicorns and the skittles that are their stool.

[catnipman]

“Doctors on this site”

what “doctors”? ... the only “doctors” claiming or implying that they’re doctors here are absolute fakes and therefore the worst sort of trolls ... REAL doctors are generally NOT going to offer medical opinions on a site like this: WAY too much liability and ethical issues, AND they don’t get paid!

[Bobalu]

If used as a prophylactic you could perhaps fend off the coof
and if it fails and you see the first signs of infection you can seek out monoclonal antibody infusion....

People should search on the web for their nearest location to get monoclonal antibody infusions, it’s always best to be prepared...

[gas_dr]

A more than reasonable approach

[grey_whiskers]

"Safety about the drug oven"

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[gas_dr]

Monoclonals are excellent treatments with exceptional degree of stopping the disease in its tracks. You offer no evidence contrary that monoclonals are not treatments, and in fact, the treatment of choice in phase I and II disease.

[MustKnowHistory]

I have not yet reached this level of cynicism and despair. Maybe next week, but not yet.

[gas_dr]

Real doctors educate when there is misinformation as many of my colleagues do (Mom MD / Ark). There are not ethical issues to present the facts, and there is no liability as I am not specifically treating someone. I am, however, offering data to clarify misinformation from those who attempt to practice medicine without a license, which may in fact be unethical and illegal.

You are implying a double standard to discredit several well respected physicians — it is a very poor argument.

[ptsal]

Bkmk

[gas_dr]

It was a typo — although this is interesting information.

[ground_fog]

Ordered my Ivermectin the other day from medicinevilla.com. Many have apparently gone there

[Mom MD]

It’s Ok. Ive come to realize the google and armchair quarterback crowd do not want to be confronted with reality. They just want their echo chamber and to hurl abuse at anyone that disagrees with their expertise. It’s the inky way they can feel adequate. I do t read most of their replies. They can stew in their own fantasy world