Posts Tagged ‘Ivermectin’

The Covid-19 pandemic has presented a unique challenge to the healthcare community. The novel disease spread like wildfire and, with it, the need for information followed just as swiftly.

In response, we developed vaccines to help prevent the spread, and continued to develop treatments for the disease, which were lacking early on. As a result, novel medications were tried and created.

Alongside synthesis of novel Covid-19 treatments, other research has focused on finding effective antiviral treatment in existing and unconventional medications. Unfortunately, few pilot studies have yet to produce robust data supporting use of such medications. However, interest in these medications has remained at the forefront of discussion, often due to political motivations and cost-considerations compared to novel medications.

These factors have propelled small pilot studies to the forefront of discussion and granted enough of a platform to persuade a portion of the population to believe in the efficacy of these medications. While there have been previous examples of these medications, namely hydroxychloroquine, the most recent example is the medication ivermectin.

Ivermectin is approved as an antiparasitic used in a variety of organisms including hookworm, scabies, lice, and more exotic parasites, and has noted antiviral, antibacterial, and antineoplastic properties. In addition, the safety profile of ivermectin makes the large-scale use of the medication feasible.

Proposal of ivermectin as a treatment for Covid-19 began as a study performed by Monash Biomedicine Institute in Australia, led by Kylie Wagstaff. The study involved in vitro exposure of Sars-Cov2 infected cells over a period of 48 hours, which demonstrated a decrease in viral load compared to the control group.

The cell-line used in the experiment was Vero/hSLAM, which had previously been used as a receptacle for measles and related viruses. The scope of the trial was limited and was presented as a proof-of-concept about the use of ivermectin as a novel Sars-Cov2 treatment and was unable to demonstrate clinical efficacy in vivo. The study instead suggested clinical trials be performed.

Since that point, multiple trials have been performed to test the efficacy of ivermectin in vivo. The results of those trials have themselves been subject to a meta-analysis review to determine significance of the data.

One such meta-analysis performed concluded that the evidence for use of Ivermectin remains a low certainty of evidence. Of note, this meta-analysis included mostly pre-prints, or studies that have not yet been subject to peer review, represented the most optimistic data for the use of ivermectin.

On paper, the proposal of ivermectin for Sars-Cov2 treatment is reasonable and is reinforced by in vitro data. However, multiple clinical trials, both approved and pre-approved, have failed to yet demonstrate the efficacy required for clinical use.

Use of ivermectin itself may have limited safety concerns, however, evidence-based medical practice should dictate other options be preferred, such as novel therapies. Use of poorly evidenced medication can lead to patients receiving suboptimal therapy and should be avoided if at all possible.

With our current data, use of ivermectin is not optimal at this time, and more robust data is required for clinical use.

References: 

1. 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.
2. Deng J, Zhou F, Ali S, Heybati K, Hou W, Huang E, Wong CY. Efficacy and safety of ivermectin for the treatment of COVID-19: a systematic review and meta-analysis. QJM. 2021 Dec 20;114(10):721-732. doi: 10.1093/qjmed/hcab247. PMID: 34570241; PMCID: PMC8500108.
3. Deng J, Zhou F, Ali S, Heybati K, Hou W, Huang E, Wong CY. Efficacy and safety of ivermectin for the treatment of COVID-19: a systematic review and meta-analysis. QJM. 2021 Dec 20;114(10):721-732. doi: 10.1093/qjmed/hcab247. PMID: 34570241; PMCID: PMC8500108.
4. Zein AFMZ, Sulistiyana CS, Raffaelo WM, Pranata R. Ivermectin and mortality in patients with COVID-19: A systematic review, meta-analysis, and meta-regression of randomized controlled trials. Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102186. doi: 10.1016/j.dsx.2021.102186. Epub 2021 Jun 27. PMID: 34237554; PMCID: PMC8236126.