Photo: SAPS / Twitter
Scientists conducted a meta-analysis of randomised control trials to ascertain the effectiveness of Ivermectin in treating Covid-19 patients.
Photo: SAPS / Twitter
Scientists have questioned whether the reluctance of medical professionals to administer Ivermectin to Covid-19 patients amounts to a case of “crying wolf” following the failure of other drugs to treat the disease.
In a paper published in the scientific open source journal Signa Vitae, a team of scientists reported on their meta-analysis of randomised clinical trials (RCTs) investigating the impact of ivermectin on mortality in COVID-19 patients. The paper was titled “Crying wolf in time of Corona: the strange case of ivermectin and hydroxychloroquine. Is the fear of failure withholding potential life-saving treatment from clinical use?”
The main finding was that hospitalised Covid-19 patients who were given Ivermectin had a lower mortality rate. The article by Pasquale Nardelli, Alberto Zangrillo, Gabriele Sanchini, Valery V Likhvantsev, Andrey G Yavorovskiy, Carolina Soledad Romero Garcia, et al. was published on 12 March.
Nardelli works for the department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute in Milan, Italy and Zangrillo is with the Vita-Salute San Raffaele University in Milan, Italy.
“Since the beginning of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, over a hundred million people contracted the virus, putting a high pressure over hospitals and healthcare systems. Hydroxychloroquine, lopinavir/ritonavir and azithromycin have been extensively used attempting to prevent or cure Coronavirus Disease 2019 (COVID-19) during the first wave,” the scientists wrote.
However, they said that over the past few months large clinical trials had demonstrated the lack of efficacy of these treatments.
“Ivermectin is widely used to treat roundworms and ectoparasites infestation, but also has antiviral effects against RNA viruses. COVID-19 drug repurposing research focused on its possible clinical use. Ivermectin was able to inhibit SARSCoV-2 replication in monkey kidney cell culture,” the scientists wrote.
“While its empirical use grew in Latin America, more than 45 trials investigating ivermectin in COVID-19 are ongoing all over the world.”
The scientists said that they had included all randomised control trials (RCTs) reporting mortality data, comprising both published and preprints manuscripts, in their analysis.
“A total of 1323 patients were randomised in 7 RCTs performed in 6 countries. Four trials were multicentric. Ivermectin treatment resulted in a lower mortality when compared to placebo: 14/703 (2%) vs 57/620 (9%),” the scientists reported.
“Findings were confirmed at the Influence analysis (removing one study at time). All the mentioned RCTs included only hospitalised patients. Four trials were placebo-controlled.”
The Ivermectin doses ranged between 12-24 mg for an average 60 kilograms subject, while the treatment duration ranged between one and five days.
“In the present meta-analysis of RCTs, administration of ivermectin reduced mortality among patients hospitalised for COVID-19. A possible rationale for these findings, other than a direct activity of ivermectin against SARS-CoV-2, may involve Strongyloides hyperinfection, an uncommon complication of dexamethasone administration, which is overprescribed worldwide in COVID-19 patients,” the scientists said.
The scientists noted that Ivermectin for the treatment of COVID-19 had followed the opposite pathway of hydroxychloroquine. The use of hydroxychloroquine was supported at first by medical agencies worldwide and later proven ineffective by several RCTs.
“On the contrary, ivermectin was mostly neglected so far and only used in a few countries; nevertheless, scientific community is progressively building a body of randomised evidence which points in favor of its use,” the scientists said.
“After the ruinous experience during the first wave, however, physicians became more “skeptical” and less prone to use repurposed drugs in COVID-19 patients. Having cried wolf for too long may be preventing the spread of ivermectin use allover the world,” the scientists said.
“While modern medicine cannot do without ironclad evidence, in an emergency situation the use of a cheap medication without major side effects may be reasonable even if strong verification of its efficacy is still lacking. While there is an urge of large high quality RCTs, results from the reported trials all point in the same direction, and cannot be overlooked.”