Ivermectin in COVID, this is the second time I cover this medication during this pandemic. Please note the date this blog post was written as things could have changed since then. This is NOT medical advice. This paper has NOT been peer reviewed. I will try to peer review it myself. Ultimately, I recommend you not trust me and read the paper for yourself. A healthy dose of skepticism is needed for peer-reviewed papers these days, much more for these non-peer reviewed. Read about the first in-vitro study HERE.
ADDENDUM ON 10/13/2020. THIS PAPER HAS NOW BEEN PEER REVIEWED. PLEASE SCROLL TO THE BOTTOM OF THE PAGE FOR THOSE DETAILS.
This is an observational trial with all the limitations that come with it. This is not a randomized controlled trial. At least the authors went through the trouble of propensity matching some controls to help out with the outcomes. This was also international and multicenter. I’m a fan of ivermectin as it is widely available and inexpensive (ahem, tocilizumab, remdesivir).
Same size and dose used:
n=1408, 704 got the study drug
Drug: 150mcg/kg x 1 dose
Primary Outcome of Ivermectin in COVID
If on mechanical ventilation: Mortality 7.3% vs 21.3% (NNT=7.1)
Overall death rates: 1.4% vs. 8.5% (NNT=14.1, p<0.0001)
My issues with the paper
Issues: no comment on PF ratio of these patients, their underlying organ dysfunction, adverse effects of the study drug. We also don’t know where in the course of the illness did they get the study drug. We also don’t know if they were getting other therapies outside of them being matched in the two groups.
The patients in the Ivermectin group seems sicker at baseline: more CAD (p=0.03), more COPD/asthma, black race (which seems to be harder hit), more immunocompromised (these are not statistically significant, but there is a trend).
Wrapping it up
Ivermectin was associated with a higher likelihood of survival. The authors claim a shorter length of stay but this is not reported anywhere in the paper. The authors recommend an RCT, I agree.
Credit to Dr. Tim Connelly. He was one of my mentors during training and shared this paper with me.
UPDATED ON 10/13/2020
This has now been peer-reviewed. It is titled “Outcomes of Ivermectin use in Covid-19 infection” and will carry the name ICON study. Of course they are recommending a full RCT. Part of the problem is that since this original trial came out, until it has been published in CHEST, several months have passed. Extremely frustrating stuff. I feel like this could have been peer-reviewed in a more timely manner.
There’s a study in clinicaltrials.gov out of Bangladesh that shows improved results with doxycycline. Click here.
Study out of Iraq where given a prophylaxis after exposure showing fewer symptoms. Click here.
Rajter JC, Sherman MS, Fatteh N, Vogel F, Sacks J, Rajter JJ, Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID-19 (ICON study), CHEST (2020), doi: https://doi.org/10.1016/j.chest.2020.10.009.
Link to Article
Link to FULL FREE PDF
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