Maybe this time, we can bury ivermectin as a treatment for COVID-19. Because we have a robust randomized clinical trial that says it’s worthless. Of course, I’m not a fool, I’m sure someone will claim that the reptilians did not want ivermectin for humans, so they fixed the clinical trial to have negative results. As a reptilian, I beg to differ.
Seriously, this clinical trial should put to rest any lingering thoughts that ivermectin has any usefulness for anything, except for treating parasitic infections in livestock and humans. It is basically useless for COVID-19.
As I always do, I will do a critical analysis of the paper, so that maybe you can use it if your Uncle Bob tries to tell you that we don’t need vaccines, just ivermectin.
What is ivermectin?
Let me start with ivermectin itself. It is an antiparasitic drug. It was discovered in 1975, and its first uses were in veterinary medicine to prevent and treat heartworm and acariasis. It was approved for human use in 1987 — it is used to treat infestations including head lice, scabies, river blindness, strongyloidiasis, trichuriasis, ascariasis, and lymphatic filariasis.
William Campbell and Satoshi Ōmura won the 2015 Nobel Prize in Physiology or Medicine for its discovery and applications. The Nobel Prize was for the discoverers of such an important medicine — it is not given for the drug itself, despite wild claims on the internet.
As you will notice, there are no claims that ivermectin has any effect on viruses, including SARS-CoV-2 which causes COVID-19. The myth that ivermectin had some effect on SARS-CoV-2 was the result of an in vitro study. Of course, less than 1% of drugs that work in vitro ever end up with any clinical usefulness.
Then a series of very badly designed trials, with serious methodological issues, tried to show that the ivermectin worked to treat COVID-19, but most scientists rejected those claims. However, anti-vaxxers being their usual anti-science selves, decided that ivermectin was all that was needed, not vaccines.
The clinical trial
In a paper published 18 February 2022 in the peer-reviewed JAMA Internal Medicine, Steven Chee Loon Lim and colleagues studied ivermectin treatment given to high-risk patients with mild-to-moderate COVID-19 during the first week of illness. The researchers found that ivermectin did not prevent progression to severe disease.
Here are some key points:
- The randomized, open label trial was conducted at 20 public hospitals and a COVID-19 quarantine center in Malaysia between 31 May and 25 October 2021.
- Participants (average age 62.5 and 54.5% women) were randomly assigned 1:1 to receive either a 5-day course of oral ivermectin (0.4 mg/kg body weight daily for 5 days) plus standard of care (n = 241) or standard of care alone (n = 249). Standard of care included symptomatic therapy and monitoring for early deterioration, based on clinical findings, laboratory tests, and chest imaging.
- 21.6% of individuals in the ivermectin group and 17.3% in the control group progressed to severe disease. there was no statistical difference in risk of progressing to severe disease for either group.
- Mechanical ventilation occured in four patients in the ivermectin group vs 10 patients in the control group. There was no statistical difference in risk.
- ICU admission occured in six patients in the ivermectin group vs eight in the control group. There was no statistical difference in risk.
- 28-day in-hospital death occured in three patients in the ivermectin group vs 10 in the control.
- The most common adverse event was diarrhea, reported by 5.8% in the ivermectin group and 1.6% of the control group.
- Just more than half of participants (51.8%) were fully vaccinated with two doses of COVID-19 vaccines. Among the fully-vaccinated patients, 17.7% in the ivermectin group and 9.2% in the control group developed severe disease. Again, this was not statistically different risks.
The authors concluded:
In this open-label randomized clinical trial of high-risk patients with COVID-19 in Malaysia, a 5-day course of oral ivermectin administered during the first week of illness did not reduce the risk of developing severe disease compared with standard of care alone. The study findings do not support the use of ivermectin for patients with COVID-19.
This appeared to be a well-constructed, robust clinical trial that lacked bias and other methodological issues that were observed with other ivermectin studies.
The only concern I have is that I wish it was much larger, say around 2500-3000 patients, and that the groups were double-blinded.
Someone without skills in statistical analysis will say “only three patients died in the ivermectin group while 10 died in the control group, so that means ivermectin works.” But when you look at it statistically, there isn’t a difference between the groups. A larger clinical trial could have better shown no difference between the groups.
Otherwise, this just shows that the horse dewormer doesn’t do anything for COVID-19 patients. But some of us knew that a year ago.
Get the COVID-19 vaccine. It actually works.
- Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020 Jun;178:104787. doi: 10.1016/j.antiviral.2020.104787. Epub 2020 Apr 3. PMID: 32251768; PMCID: PMC7129059.
- Campbell WC. History of avermectin and ivermectin, with notes on the history of other macrocyclic lactone antiparasitic agents. Curr Pharm Biotechnol. 2012 May;13(6):853-65. doi: 10.2174/138920112800399095. PMID: 22039784.
- Laing R, Gillan V, Devaney E. Ivermectin – Old Drug, New Tricks? Trends Parasitol. 2017 Jun;33(6):463-472. doi: 10.1016/j.pt.2017.02.004. Epub 2017 Mar 9. PMID: 28285851; PMCID: PMC5446326.
- Lim SCL, Hor CP, Tay KH, Mat Jelani A, Tan WH, Ker HB, Chow TS, Zaid M, Cheah WK, Lim HH, Khalid KE, Cheng JT, Mohd Unit H, An N, Nasruddin AB, Low LL, Khoo SWR, Loh JH, Zaidan NZ, Ab Wahab S, Song LH, Koh HM, King TL, Lai NM, Chidambaram SK, Peariasamy KM; I-TECH Study Group. Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities: The I-TECH Randomized Clinical Trial. JAMA Intern Med. 2022 Feb 18. doi: 10.1001/jamainternmed.2022.0189. Epub ahead of print. PMID: 35179551.
- Molyneux DH, Ward SA. Reflections on the Nobel Prize for Medicine 2015–The Public Health Legacy and Impact of Avermectin and Artemisinin. Trends Parasitol. 2015 Dec;31(12):605-607. doi: 10.1016/j.pt.2015.10.008. Epub 2015 Nov 6. PMID: 26552892.
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