Effectiveness of Ivermectin in SARS-CoV-2/COVID-19 Patients

Chachar, Aijaz Zeeshan Khan; Khan, Khurshid; Asif, Mohsin; Tanveer, Khushbakht; Khaqan, Arous; Basri, Rabia

doi:10.18483/ijsci.2378

Cited by 29 publications

(19 citation statements)

References 7 publications

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“…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.…”

Section: Selection Of Studiesmentioning

confidence: 99%

“…All patients had positive RT-PCR for SARS-CoV-2 at baseline, except in 2 RCTs: Niaee et al [30] had 71% of positivity, and Ravikirti et al [37] had positive RT-PCR or rapid antigen test for SARS-CoV-2. The RCTs by Chachar et al [28], Chaccour et al [34], and López-Medina et al [36] were conducted in non-hospitalized patients. Mean/median age ranged from 26 to 56 years-old, the percentage of female patients ranged from 15% [35] to 78% [36], and most of patients did not have hypertension, diabetes or cardiovascular disease.…”

Section: Characteristics Of Rctsmentioning

confidence: 99%

“…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.…”

Section: Risk Of Bias Assessment Of Included Rctsmentioning

confidence: 99%

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

Roman

Burela

Pasupuleti³

et al. 2021

Preprint

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Background: We systematically assessed benefits and harms of the use of ivermectin (IVM) in COVID-19 patients. Methods: Published and preprint randomized controlled trials (RCTs) assessing IVM effects on COVID-19 adult patients were searched until March 15, 2021 in five engines. Primary outcomes were all-cause mortality, length of stay (LOS), and adverse events (AE). Secondary outcomes included viral clearance and severe AEs. We evaluated risk of bias (RoB) using the Cochrane RoB 2.0 tool. Inverse variance random effect meta-analyses were performed with quality of evidence (QoE) evaluated using GRADE methodology. Subgroup analyses by severity of disease and RoB, and sensitivity analyses by time of follow-up were conducted. Results: Ten RCTs (n=1173) were included. Controls were standard of care [SOC] in five RCTs and placebo in five RCTs. RCTs sample size ranged from 24 to 398 patients, mean age from 26 to 56 years-old, and severity of COVID-19 disease was mild in 8 RCTs, moderate in one RCT, and mild and moderate in one RCT. IVM did not reduce all-cause mortality vs. controls (RR 1.11, 95%CI 0.16-7.65, very low QoE). IVM did not reduce LOS vs. controls (MD 0.72 days, 95%CI -0.86 to 2.29, very low QoE). AEs, severe AE and viral clearance were similar between IVM and controls (low QoE for these three outcomes). Subgroup analyses by severity of COVID-19 disease or RoB were consistent with main analyses. Sensitivity analyses excluding RCTs with follow up <21 days showed no difference in all-cause mortality but diminished heterogeneity (I2=0%). Conclusions: In comparison to SOC or placebo, IVM did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease. IVM did not have effect on AEs or SAEs. IVM is not a viable option to treat COVID-19 patients.

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Section: Selection Of Studiesmentioning

confidence: 99%

Section: Characteristics Of Rctsmentioning

confidence: 99%

Section: Risk Of Bias Assessment Of Included Rctsmentioning

confidence: 99%

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

Roman

Burela

Pasupuleti³

et al. 2021

Preprint

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“…29 Several smaller RCTs have reported no benefit with ivermectin. 30, 31, 32, 33 A trial of 585 patients concluded that combined with azithromycin, the use of nitazoxanide, ivermectin, and hydroxychloroquine led to similar clinical outcomes which were better than those in a retrospective control group of patients who had not received any of these three drugs. 34…”

Section: Introductionmentioning

confidence: 99%

Ivermectin as a potential treatment for mild to moderate COVID-19 – A double blind randomized placebo-controlled trial

Ravikirti

Roy²,

Pattadar³

et al. 2021

Preprint

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ObjectiveIvermectin has been suggested as a treatment for COVID-19.This randomised control trial was conducted to test the efficacy of Ivermectin in the treatment of mild and moderate COVID-19.DesignParallel, double blind, randomised, placebo controlled trial Setting: A tertiary care dedicated COVID-19 hospital in Bihar, IndiaParticipantsAdult patients (> 18 years) admitted with mild to moderate COVID 19 disease (saturation > 90% on room air, respiratory rate < 30 and no features of shock) with no contraindications to ivermectin and willing to participate in the studyInterventionPatients in the intervention arm were given ivermectin 12 mg on day 1 and day 2 of admission. Patients in the placebo arm were given identical looking placebo tablets. Rest of the treatment was continued as per the existing protocol and the clinical judgment of the treating teams.Outcome MeasuresThe primary outcome measure was a negative RT-PCR test for SARS-CoV-2 on day 6 of admission. The secondary outcome measures were symptom status on day 6, discharge status on day 10, admission to ICU, need for invasive mechanical ventilation and in-hospital mortality.ResultsA total of 115 patients were enrolled for the study of which 112 were included in the final analysis. Of them, 55 were randomised to the intervention arm while 57 were randomised to the placebo arm. There was no significant difference in the baseline characteristics of the two arms. There was no significant difference in the primary outcome, i.e. negative RT-PCR status on day 6 between the two groups. Similarly, there was no significant difference between the two groups in most of the secondary outcome measures, viz. symptom status on day 6, discharge status on day 10, admission to ICU, and need for invasive mechanical ventilation. However, while there was no in-hospital mortality in the intervention arm, there were 4 deaths in the placebo arm. As a result, all patients in the intervention arm (n=56) were successfully discharged as compared to 93.1% (n=54/58) in the placebo arm (RR 1.1, 95% CI 1.0 to 1.2, p=0.019).ConclusionThere was no difference in the primary outcome i.e. negative RT-PCR status on day 6 of admission with the use of ivermectin. However, a significantly higher proportion of patients were discharged alive from the hospital when they received ivermectin.Strengths and Limitations of the StudyThis study was randomised and double blind, thereby minimizing the chance of bias.All outcome measures except symptom status on day 6 were objective and placebo control was used for comparison.Only single repeat RT-PCR was done. So median time to viral clearance in the two groups could not be calculated.Severe cases were not included in the study.

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“…On the contrary, one study conducted in Pakistan that comprised of 50 patients in total (equally divided into case group and control group where both groups received symptomatic treatments but ivermectin was only prescribed to case group) failed to demonstrate any statistically significant outcomes against COVID-19 infection and suggested that symptomatic treatments can be equally effective with or without ivermectin ( Chachar et al, 2020 ). In another study, conducted among 62 mild to moderate SARS-CoV-2 infected patients, ivermectin again failed to demonstrate significant beneficial effects.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effectiveness and Safety of Repurposing Drugs for the Treatment of COVID-19: Position Standing in 2021

et al. 2021

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COVID-19, transmitted by SARS-CoV-2, is one of the most serious pandemic situations in the history of mankind, and has already infected a huge population across the globe. This horrendously contagious viral outbreak was first identified in China and within a very short time it affected the world's health, transport, economic, and academic sectors. Despite the recent approval of a few anti-COVID-19 vaccines, their unavailability and insufficiency along with the lack of other potential therapeutic options are continuing to worsen the situation, with valuable lives continuing to be lost. In this situation, researchers across the globe are focusing on repurposing prospective drugs and prophylaxis such as favipiravir, remdesivir, chloroquine, hydroxychloroquine, ivermectin, lopinavir-ritonavir, azithromycin, doxycycline, ACEIs/ARBs, rivaroxaban, and protease inhibitors, which were preliminarily based on in vitro and in vivo pharmacological and toxicological study reports followed by clinical applications. Based on available preliminary data derived from limited clinical trials, the US National Institute of Health (NIH) and USFDA also recommended a few drugs to be repurposed i.e., hydroxychloroquine, remdesivir, and favipiravir. However, World Health Organization later recommended against the use of chloroquine, hydroxychloroquine, remdesivir, and lopinavir/ritonavir in the treatment of COVID-19 infections. Combining basic knowledge of viral pathogenesis and pharmacodynamics of drug molecules as well as in silico approaches, many drug candidates have been investigated in clinical trials, some of which have been proven to be partially effective against COVID-19, and many of the other drugs are currently under extensive screening. The repurposing of prospective drug candidates from different stages of evaluation can be a handy wellspring in COVID-19 management and treatment along with approved anti-COVID-19 vaccines. This review article combined the information from completed clinical trials, case series, cohort studies, meta-analyses, and retrospective studies to focus on the current status of repurposing drugs in 2021.

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Effectiveness of Ivermectin in SARS-CoV-2/COVID-19 Patients

Cited by 29 publications

References 7 publications

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

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

Ivermectin as a potential treatment for mild to moderate COVID-19 – A double blind randomized placebo-controlled trial

Therapeutic Effectiveness and Safety of Repurposing Drugs for the Treatment of COVID-19: Position Standing in 2021

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