Ivermectin for Prevention and Treatment of COVID-19 Infection

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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.

Abstract


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.

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Ministry of Health Malaysia starts Ivermectin trial for high risk COVID-19 patients (I-TECH Study)


Effective pharmacologic treatments for COVID-19 remains a challenge. The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial showed dexamethasone, a steroid, improved mortality outcomes for COVID-19 patients in severe stage of disease when oxygen supplementation or mechanical ventilation is required. But for the management of mild and moderate cases, there is lack of treatment, either to prevent disease progression or cut viral transmission.

The COVID-19 clinical characterisation study by MOH specialists and researchers found that for cases admitted to hospitals, 95% had mild illness but about 3.5% subsequently progressed to severe disease. They were mostly of older age (≥51 years) or had underlying co-morbidities such as chronic kidney disease and chronic pulmonary disease that increased their risk for severe disease. However, for high-risk COVID-19 patients, many repurposed antiviral therapies were found ineffective. The World Health Organization (WHO) COVID-19 Solidarity Trial for COVID-19 Treatments (SOLIDARITY) which included Malaysia, found insufficient evidence for the use of remdesivir, hydroxychloroquine, interferon, lopinavir in terms of mortality outcomes. Currently, the Malaysian Consensus Management Guidelines for COVID-19 maintains Favipiravir, as the only antiviral therapy for the management of COVID-19 cases. Even this recommendation may change as more evidence becomes available.

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