Ivermectin in COVID-19: Taking another look

Ivermectin in COVID, this is the second time I cover this medication during this pandemic. 

This paper has NOT been peer reviewed.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. 

Observational trial with all the limitation 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).

n=1408, 704 got the study drug
Drug: 150mcg/kg x 1 dose

Primary outcome: mortality
If on mechanical ventilation: Mortality 7.3% vs 21.3% (NNT=7.1)
Overall death rates: 1.4% vs. 8.5% (NNT=14.1)<0 .0001="" font="">

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). 

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 who was one of my mentors during training for sharing this paper with me. 

Link to Article

Ivermectin for COVID

This paper was sent to me by @itskatiesway, @bug_drugs, @sanamoh92, @sy_doctornetwork, @paul.neil95, @nascarnora. Thank you all for sending data to me. Also, I am getting somewhere around 50-100 messages per day from the community. Much love to you all. I cannot answer every single question bc I wouldn't be able to live my own life. Thanks for understanding.


Let's get started. It bears repeating that I like simple and cheap stuff. Ivermectin, has been around since 1998 and many of us learned about it as a treatment for scabies. It's about $5 a tab per UpToDate. This paper is quite different than what I am used to reading (since I mainly read clinical trial data which is written a particular way). This is far more science-y than what I am accustomed to understanding. Even this nerd has his limitations.


Let's start off with the first and glaringly obvious limitation to this study. It works in vitro. No data that it work in vivo. Made simple means we have absolutely zero data that it would work in a human body.


Basically they infected cells with SARS-CoV-2 and then added ivermectin. They followed up later to see if there was a reduction of viral RNA at different time points and there was! They noted that "a single dose was able to control viral replication within 24-48 hours" in their system. Don't get too excited now. Again, this is in vitro. They provide some mechanisms which are way over my head.


They recommend trying multiple regimens on COVID-19 patients to assess for a clinical response. At least could postulate, perhaps erroneously, that we could see a change in 24-48 hours. I am not holding my breath but this seems like something that should be attempted early in the disease course, like plaquenil, and may not have too much benefit once the patient is in my hands in the ICU. I can't wait for a good. The best thing is that the Australians discovered this and the know how to put together some great trials with their ANZICS group. A hat tip to the authors!

- EJ

Link to Article

Link to FULL PDF (this link may not work extremely well, go to the article and sort it out there)


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