Ivermectin and COVID
Starting a thread on Ivermectin because I continue to get questions about this drug for COVID. Bottom Line: Ivermectin is the new hydroxychloroquine, which doesn’t prevent infection with SARS-CoV-2 and is unlikely to show any significant benefit.
First, what is ivermectin? Ivermectin is an FDA approved anti-parasitic drug used in humans primarily for treatment of some neglected tropical diseases; however, you’ll more commonly find the drug used in veterinary medicine to prevent heart worm or treat some parasitic diseases.
Ivermectin is NOT an anti-viral drug. In fact, there have been very few effective anti-viral medications ever developed in the history of medicine.
We now have drugs that can cure chronic Hepatitis C, a viral infection — called ledipasvir-sofosbuvir (Harvoni) — but other than that, anti-viral drugs primarily function to reduce viral loads or duration of symptoms and are not actually curative.
Think oseltamivir (Tamiflu) here. There is essentially no good data to show that oseltamivir has any significant efficacy in the treatment of influenza infections, except maybe in the severely ill. We saw the same story play out, predictably, with remdesivir for COVID.
That’s the thing about viral illnesses — they’re just hard to treat, which is what is so difficult and frustrating. Trust me when I tell you that those of us treating patients with COVID are more frustrated than anyone, and I know you all wish this were easier. I do too.
But we do have a way out of this without discovering a “magic bullet” treatment, which is for everyone to get vaccinated. Truly. We could have shut this down already if everyone just got vaccinated. That’s just the reality of how viral transmission works. I don’t make the rules.
Anyways, we still have to talk about ivermectin because people won’t get vaccinated and want to know about taking an unproven drug instead.
Which I frankly find interesting because a lot of the people reluctant to get vaccinated say that they won’t because they don’t trust the pharmaceutical industry, but who do y’all think make and sell the drug ivermectin? The same pharmaceutical companies.
So, what does the FDA say about the use of ivermectin for COVID? In a word: No.
Additionally, “studies suggest that achieving the plasma concentrations necessary for the antiviral efficacy detected in vitro would require administration of doses up to 100-fold higher than those approved for use in humans.”
Basically, anything can be toxic and the dose makes the poison. What the FDA is saying here is that while this could have some plausible effect at high concentrations, such high concentrations are unsafe in humans and therefore safe concentrations are unlikely to have an effect.
“But why aren’t there any studies? Why are they trying to hide this?” they’ll say. Well, there are studies, and no, no one is trying to hide anything. This is just how science works. What do the studies say? An example.
“Ivermectin had no significant effect on preventing hospitalization of patients with COVID-19. Patients who received ivermectin required invasive mechanical ventilation earlier in their treatment. No significant differences were observed in any of the other secondary outcomes.” https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06348-5
This study randomized over 500 non-hospitalized patients who tested positive for COVID to start taking ivermectin within 48 hours. There was no demonstrated reduction in hospitalization, reduction in viral load, or shorter course of infection.
In fact, in the group that was randomized to take ivermectin, patients ended up intubated even sooner than those in the placebo group.
Original thread from Twitter (on June 14, 2021): https://twitter.com/tnicholsmd/status/1415422725816930304
