Does Ivermectin Help COVID-19?

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I’ve had a ton of requests to review the science on Ivermectin and COVID-19. What is it? Why are people talking about it? Let’s dig in.

What is Ivermectin?

Ivermectin is an anti-parasitic drug. The two most common indications would be its use in treating head lice in humans and heartworms in animals. It had positive effects in the lab against the SARS-Cov-2 virus, hence it began to be studied as a treatment for COVID-19 (6).

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Reviewing the Research

I excluded some studies that were just too small and poorly designed to yield much useful information.

Lower Quality Research

These are retrospective studies. This means that the patients were treated and then someone went back and looked at the records and outcomes. This is generally considered lower-level data.

First up is a retrospective study out of India (2), This retrospective study enrolled a total of 325 from April to June 2020. 248 adult COVID-19 patients were looked at in two groups, 115 received ivermectin plus standard care (SC), while 133 received only standard care (SC). This study showed that Ivermectin was efficient at rapidly clearing SARS-CoV-2 from nasal swabs (median 4 days). This was much shorter than in the COVID-19 patients receiving only SC (15 days) or receiving a combination of three antiviral drugs (7–12 days). In addition, fewer Ivermectin patients developed respiratory distress leading to ICU admission. In fact, with Ivermectin, there was a quick hospital discharge (median 9 days) in 114 out of 115 patients; the one remaining patient had been admitted with advanced disease.

A Florida study is the next one to review (3). This is also retrospective and included 280 patients, 173 treated with ivermectin and 107 without ivermectin. Most patients in both groups also received hydroxychloroquine, azithromycin, or both, which is a bit of a problem in this study. Mortality was lower in the ivermectin group (15.0% vs 25.2%). Mortality also was lower among ivermectin-treated patients with severe pulmonary involvement (38.8% vs 80.7%). There were no significant differences in length of hospital stay.

Higher Quality Research

These are prospective randomized controlled trials. Here, there was a game plan to give patients specific treatments randomly and then monitor the results.

This randomized controlled trial out of Iran (pre-print) used Ivermectin and Doxycycline in mild, moderate, and severe hospitalized COVID-19 patients (1). No patients in the mild and moderate COVID-19 category died and 18% of the severe patients perished taking this medication combo. In the control group, no mild-moderate patients died, but 27% of the severe COVID patients died. The patients who also got Ivermectin had a shorter recovery.

The next one is out of Iran again, which was a randomized, double-blind, placebo-controlled, multicenter, phase 2 clinical trial at five hospitals and 180 patients with mild to severe disease (4). Ivermectin as an adjunct reduced the rate of mortality, the duration of low oxygen saturation, and the duration of hospitalization.

Next up is a large study out of Egypt (5). 1,300 patients were included in this randomized controlled trial. Patients who received ivermectin early reported significant recovery of their positive viral labs. There was a substantial improvement and reduction in mortality rate in the Ivermectin treated groups; group I with the mild-moderate disease showed that 99% recovered with no deaths. Group III with severe COVID-19 showed a 94% survival and 2.0% deaths versus the hydroxychloroquine plus standard care treated groups; group II  (74% and 4%, respectively) and group IV  (50% and 20%, respectively). When used prophylactically, Ivermectin also significantly reduced the prevalence of infection in health care workers and household contacts. That infection rate in the Ivermectin group was 2% compared to 10% in the non-ivermectin group.

Conclusions?

We have three RCTs that show that this drug worked. Regrettably, one study used Ivermectin and Doxycycline. The other two look solid. Does this mean that Ivermectin, without a shadow of a doubt is a miracle cure? Nope. It is very encouraging data and given that this drug is dirt cheap and widely available with minimal side effects if I were treating COVID-19 patients, I can’t think of a reason why I wouldn’t want to use it.

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How Much Ivermectin?

The largest study used 0.4mg/kg body weight with a maximum of 4 tablets (6mg/tablet) once a day. So for the average 120-pound woman that would be 54kg x 0.4mg or 21.6 mg. That would be close to the max dose of 4 x 6mg tabs. Everyone heavier would get the max dose of 24 mg a day.

The upshot? There’s some hopeful data on Ivermectin. For now, it’s cheap and widely available. Time will tell if it becomes a standard in treating COVID-19.

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(1) Hashim A. Hashim, Mohammed F. Maulood, Anwar M. Rasheed, Dhurgham F. Fatak, Khulood K. Kabah, Ahmed S. Abdulamir. Controlled randomized clinical trial on using Ivermectin with Doxycycline for treating COVID-19 patients in Baghdad, Iraq. medRxiv 2020.10.26.20219345; doi: https://doi.org/10.1101/2020.10.26.20219345

(2) Khan MS, Khan MS, Debnath Cr, Nath PN, Mahtab MA. Ivermectin treatment may improve the prognosis of patients with COVID-19. Archivos de Bronconeumologia 2020.

(3) Rajter JC, Sherman MS, Fatteh N, Vogel F, Sacks J, Rajter JJ. ICON (Ivermectin in COvid Ninteen) study: Use of ivermectin is associated with lower mortality in hospitalized patients with COVID-19. Chest 2020.

(4) Niaee MS, Gheibl N, Namdar P, Allami A, Javadi A. Ivermectin as an adjunct treatment for hospitalized adult COVID-19 patients: A randomized multi-center clinical trial. Research Square 2020.

(5) Elgazzar A, Hany B, Youssef SA, Hany B, Hafez M. Efficacy and safety of ivermectin for treatment and prophylaxis of COVID-19 pandemic. Research Square 2020

(6) Heidary F, Gharebaghi R (June 2020). “Ivermectin: a systematic review from antiviral effects to COVID-19 complementary regimen”. The Journal of Antibiotics. 73 (9): 593–602. doi:10.1038/s41429-020-0336-z. PMC 7290143. PMID 32533071.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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