Outcome of ivermectin treated mild to moderate COVID-19 cases: a single-centre, open-label, randomised controlled study

Abstract

Background and objectives: Various existing non-antiviral drugs are being used to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based mostly on existing data from previous coronavirus outbreaks. Ivermectin is one of such agents being widely used to treat early-stage of COVID-19. This study evaluated the outcome of ivermectin treated mild to moderate COVID-19 cases compared to usual care.
 Methods: This open-label randomised controlled study was conducted at a sub-district (Upazila) health complex from 1st May 2020 to the end of July 2020. Consecutive RT-PCR positive eligible COVID-19 patients were randomised into control and intervention arms. In the intervention arm, ivermectin 200 micrograms/kg single dose was administered orally in addition to usual care and was followed up till recovery. Repeat RT-PCR was done on day ten since the first positive result. The end point with regard to treatment outcome was time required for the resolution of symptoms from the onset of the symptoms and following enrollement in the study.
 Results: A total of 62 mild to moderate COVID-19 patients were enrolled in the study. There were 30 patients in the control arm and 32 patients in the intervention arm. Total recovery time from the onset of symptoms to complete resolution of symptoms of the patients in the intervention arm was 10.09 ± 3.236 days, compared to 11.50 ± 5.32 days in the control arm (95% CI -0.860,3.627, p>. 05) and was not significantly different. The mean recovery time after enrolment in the intervention arm was 5.31 ± 2.48 days, which also did not differ significantly from the control arm of 6.33 ± 4.23 days (95% CI – 0.766, 2.808, p> 0.05). Results of negative repeat RT- PCR were not significantly different between control and intervention arms (control 90% vs intervention 95%, p>.05).
 Conclusion: Ivermectin had no beneficial effect on the disease course over usual care in mild to moderate COVID-19 cases.
 Ibrahim Med. Coll. J. 2020; 14(2): 11-18

Risk factors for mortality in hospitalized patients with COVID-19 from three hospitals in Peru: a retrospective cohort study

“… 40 However, this drug was consolidated in Peru over the following months after promoting its use through self-medication 41 and even subdermal application. 42 The use of these medical therapies based on studies with biases or design flaws 35 , 43 could have caused people to have false security and to have not gone to the hospital on the appearance of symptoms, thereby leading to disease progression and an increased risk of death or the development of severe illness. On the other hand, corticosteroids were administered in two out of three people, with a predominance of methylprednisolone, while dexamethasone, which was reported to reduce mortality in hospitalized COVID-19 patients in June, 44 was not the most widely used.…”

Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials

“…Our search yielded 256 citations with an additional nine citations identified in pre-print web pages; 253 records were excluded. After our assessment of 12 full-texts, we identified 10 RCTs [28][29][30][31][32][33][34][35][36][37] (n=1,173) (Figure 1). Two full-texts were excluded as there was no control group in one study, and an outcome of no interest (duration of fever) was the only one reported in another study.…”

“…Eight RCTs were at high RoB [28][29][30][31][32][35][36][37] (Figure S1). Podder et al [31] had high RoB in the randomization process, deviations from intended interventions, missing outcome data, and measurement of the outcome; Karamat et al [35] had high RoB in deviations from intended interventions and missing outcome data; Niaee et al [30] had high RoB in the measurement of the outcome, and selection of the reported results; Krolewiecki et al [29] and Ravikirti et al [37] had high RoB in missing outcome data; Lopez-Medina et al [36] had high RoB in deviations from the intended interventions; Ahmed et al [32] had high RoB in selection of the reported results; and Chachar et al [28] had high RoB in measurement of the outcome. Beltran et al [33] had some concerns of bias in the randomization process.…”

Moxidectin and ivermectin inhibit SARS-CoV-2 replication in Vero E6 cells but not in human primary airway epithelium cells

“…Currently (April 29 th , 2021), 65 clinical trials are registered that evaluate the efficacy of ivermectin as a prophylactic or therapeutic drug and 21 of these are completed (clinicaltrials.gov, 2021). Many of these trials have serious limitations such as small sample size, lack of binding, lack of pre-registration for some trials and therefore carries a risk of bias (Ahmed et al, 2021; Chaccour et al, 2021; Chowdhury et al, 2020; Elgazzar et al, 2020; Hashim et al, 2020; Okumuş et al, 2021; Podder et al, 2020; Rajter et al, 2021; Soto-Becerra et al, 2020; WHO, 2021b). Apart from the problem of bias, only five trials (April 29, 2021), directly compared ivermectin with standard of care and reported clinically crucial outcomes such as mortality (Gonzalez et al, 2021; Lopez-Medina et al, 2021; Mohan et al, 2021; Niaee et al, 2020; Ravikirti.…”