Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study

Mm, Alam; Murshed, Rubaiul; Gomes, Pauline Francisca; Masud, Zafor Md; Saber, Sadia; Chaklader, Mainul Alam; Khanam, Fatema; Hossain, M. Amir; Momen, Abdul; Yasmin, Naz; Alam, Rafa Faaria; Sultana, Amrin; Robin, Rishad Choudhury

doi:10.24018/ejmed.2020.2.6.599

Cited by 18 publications

(31 citation statements)

References 22 publications

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“…The number of people affected by the disease was significantly higher in the CG when compared to the EG who followed the intervention. In agreement with our findings, Tarek Alacom et al in an observational prophylactic study conducted in 118 healthcare workers, they found that significant minor contagious in subjects which received ivermectin 26 . In the aforementioned study, a lower dose of ivermectin was used unlike the treatment proposed here, held for one month and iota carrageenan was used in conjunction with ivermectin.…”

Section: Discussionsupporting

confidence: 94%

“…The findings in our work, in agreement with Carvallo H et al, confirm the hypothesis that the association IVER/IOTACRC works by decreasing the possibility of infection with SARS-CoV-2 and possibly acts synergistically 27 . We interpret that a double viral barrier would be formed that would enhance its action and allow to increase the protective effect in the following way: i) The first barrier for viral protection would be at the entry of the virus into the nasal cavity where the carrageenan would behave as a mucolytic agent in the barrier of sulfacted polysaccharides with negative charge 28 ; ii) The other action of ivermectin is to decrease the viral load based on its systemic cellular action 29 . It is coincident with reports of viral clearance in other clin-ical trials which evaluate the use of ivermectin to treat COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…The copyright holder for this preprint this version posted March 30, 2021. ; https://doi.org/10.1101/2021.03. 26.21254398 doi: medRxiv preprint prevent access to the cell 13 . The second is carried out by destabilization of the importin heterodimer complex (IMP α / β 1) 13 .…”

Section: Introductionmentioning

confidence: 99%

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A Randomized Trial - Intensive Treatment Based in Ivermectin and Iota-Carrageenan as Pre-Exposure Prophylaxis for Covid- 19 in Healthcare Agents

Chahla¹,

Ruiz²,

Ortega³

et al. 2021

Preprint

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IMPORTANCE: The emergency of COVID-19 requires the implementation of urgent strategies to prevent the spread of the disease, mainly in health personnel, who are the most exposed and has the highest risk of becoming infected with the SARS-COV-2. Drug repurposing is a pragmatic strategy, a faster and cheaper option, compared to the new drug development that has proven successful for many drugs and can be a key tool in emergency situations such as the current one that requires quick action. In addition, considering the limited access to vaccines for developing countries, preventive use of ivermectin can be a palliative that minimizes the risks of infection. OBJECTIVE: To evaluate the protective effect of the combination Ivermectin / Iota- Carrageenan (IVER/IOTACRC), intensive treatment with repeated administration in oral- and nasal-spray, respectively, as a prophylaxis treatment prior to exposure to SARS-CoV-2, in health personnel at Public Healthcare Centers. PARTICIPANTS, DESIGN AND SETTING: Randomized controlled 1-1 clinical trial in Personal Health, n = 234. The subjects were divided into experimental (EG: n=117; 39.6 ± 9.4 years old, 65F) and control groups (CG: n=117; 38.4 ± 7.4 years old, 61F). The EG received Ivermectin orally 2 tablets of 6 mg = 12 mg every 7 days, and Iota-Carrageenan 6 sprays per day for 4 weeks. All participants were evaluated by physical examination COVID-19 diagnosed with negative RT-PCR at the beginning, final, and follow-up of the protocol. Differences between the variables were determined using the Chi-square test. The proportion test almost contagious subject and the contagion risk (Odds Ratio) were calculated using software STATA. The level of statistical significance was reached when p-Value < 0.05. RESULT: The number of subjects who were diagnosed with COVID-19 in EG was lower, only 4 of 117 (3.4%) than subjects in CG: 25 of 117 (21.4%) (P-Value = 1.10-5). Nineteen patients had mild symptoms, 4 were in EG whereas, 15 were in CG (p-Value = 0.001). Seven subjects were moderate, and 3 with severe diagnostics, all them in CG. The probability (Odds Ratio) of becoming ill with COVID-19 was significantly lower in EG with values of 0.13, 95% 0.03 to 0.40; p-Value = 1.10-4, this value (<1) indicates a protective effect of the IVER/IOTACRC in the EG. Logistic regression test demonstrated that treatment was effective to prevent COVID-19 (Odds Ratio 0.11, 95% 0.03 to 0.33; p-Value = 1.10-4). We also found that when increase the age, decrease contagious risk (Odds Ratio 0, 93, 95% 0.88 to 0.98, p-Value= 0, 02). On the other hand, the probability of contracting COVID-19 was dependent on the patient's preexisting comorbidity (Odds Ratio 5.58, 95% 2.20 to 14.16, p-Value = 1.10-5). The other variables sex and designation were independent. CONCLUSION: The intensive preventive treatment (short-term) with IVER/IOTACRC was able to reduce the number of health workers infected with COVID-19. This treatment had also effect in preventing the severity of the disease, since all patients treated were mild. We propose a new therapeutic alternative for prevention and short-term intervention scheme (intensive) that is of benefit of the health worker in this pandemic accelerated time. This intervention did not produce lack of adherence to treatment or adverse effects.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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A Randomized Trial - Intensive Treatment Based in Ivermectin and Iota-Carrageenan as Pre-Exposure Prophylaxis for Covid- 19 in Healthcare Agents

Chahla¹,

Ruiz²,

Ortega³

et al. 2021

Preprint

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“… 55 , 57 , 59 Similarly, with respect to ivermectin prophylaxis of frontline workers and those at risk, controlled observational studies from Bangladesh and Argentina (the latter which involved 1195 health care workers) have shown apparent reductions in COVID-19 transmission with ivermectin prophylaxis, including in some reports total protection (zero infections) where infection rates in the control group exceeded 50%. 122 , 123 A very large trial of ivermectin prophylaxis in health care workers in India 124 covered 3532 participants and reported risk ratios not significantly different from this meta-analysis (prophylaxis outcome).…”

Section: Discussionmentioning

confidence: 89%

Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines

Bryant

Lawrie

Dowswell

et al. 2021

American Journal of Therapeutics

189

106

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Background: Repurposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials. Areas of uncertainty: We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemoprophylaxis, among people with, or at high risk of, COVID-19 infection. Data sources: We searched bibliographic databases up to April 25, 2021. Two review authors sifted for studies, extracted data, and assessed risk of bias. Meta-analyses were conducted and certainty of the evidence was assessed using the GRADE approach and additionally in trial sequential analyses for mortality. Twenty-four randomized controlled trials involving 3406 participants met review inclusion. Therapeutic Advances: Meta-analysis of 15 trials found that ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19–0.73; n = 2438; I 2 = 49%; moderate-certainty evidence). This result was confirmed in a trial sequential analysis using the same DerSimonian–Laird method that underpinned the unadjusted analysis. This was also robust against a trial sequential analysis using the Biggerstaff–Tweedie method. Low-certainty evidence found that ivermectin prophylaxis reduced COVID-19 infection by an average 86% (95% confidence interval 79%–91%). Secondary outcomes provided less certain evidence. Low-certainty evidence suggested that there may be no benefit with ivermectin for “need for mechanical ventilation,” whereas effect estimates for “improvement” and “deterioration” clearly favored ivermectin use. Severe adverse events were rare among treatment trials and evidence of no difference was assessed as low certainty. Evidence on other secondary outcomes was very low certainty. Conclusions: Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally.

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“…Despite great successes in the production and roll-out of vaccines against SARS-CoV-2, new variants are on the rise and there is still no globally accepted treatment for COVID-19 ( https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1 ). During the last year many laboratories focused on screening FDA-approved drugs for quick implementation in clincal settings [ [4] , [5] , [6] ]. A compound of interest from such work is the racemic mixture ivermectin, typically used to treat helminth infections.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of the interaction of ivermectin with proteins of interest associated with SARS-CoV-2: A computational and biophysical approach

González

Hurtado-León

Lossada

et al. 2021

Biophysical Chemistry

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The SARS-CoV-2 pandemic has accelerated the study of existing drugs. The mixture of homologs called ivermectin (avermectin-B1a [HB1a] + avermectin-B1b [HB1b]) has shown antiviral activity against SARS-CoV-2 in vitro . However, there are few reports on the behavior of each homolog. We investigated the interaction of each homolog with promising targets of interest associated with SARS-CoV-2 infection from a biophysical and computational-chemistry perspective using docking and molecular dynamics. We observed a differential behavior for each homolog, with an affinity of HB1b for viral structures, and of HB1a for host structures considered. The induced disturbances were differential and influenced by the hydrophobicity of each homolog and of the binding pockets. We present the first comparative analysis of the potential theoretical inhibitory effect of both avermectins on biomolecules associated with COVID-19, and suggest that ivermectin through its homologs, has a multiobjective behavior.

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Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study

Cited by 18 publications

References 22 publications

A Randomized Trial - Intensive Treatment Based in Ivermectin and Iota-Carrageenan as Pre-Exposure Prophylaxis for Covid- 19 in Healthcare Agents

A Randomized Trial - Intensive Treatment Based in Ivermectin and Iota-Carrageenan as Pre-Exposure Prophylaxis for Covid- 19 in Healthcare Agents

Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines

Comparative study of the interaction of ivermectin with proteins of interest associated with SARS-CoV-2: A computational and biophysical approach

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