In 2015, the Nobel Committee for Physiology or Medicine, in its only award for treatments of infectious diseases since six decades prior, honored the discovery of ivermectin (IVM), a multifaceted drug deployed against some of the world’s most devastating tropical diseases.
Recently, Dr Satoshi Omura, the Nobel co-laureate for the discovery of IVM, and colleagues conducted a comprehensive review of IVM clinical activity against COVID-19, concluding that the preponderance of the evidence demonstrated major reductions in mortality and morbidity.
RCTs for IVM treatment and prevention of COVID-19
IVM has been safely used in 3.7 billion doses worldwide since 1987, well tolerated even at much greater than standard doses. IVM has been used in RCTs (randomized clinical trials) for COVID-19 treatment at cumulative doses of 1500 μg/kg, 1600 μg/kg and 3000 μg/kg over 4 or 5 days with only small percentages of mild or transient adverse effects.
Supporting the findings of IVM efficacy in COVID-19 treatment were indications of activity against SARS-CoV-2 in prevention studies. Three RCTs evaluated the prophylactic effect of IVM administered to cohorts of 100, 117 and 203 subjects exposed to COVID-19 patients.
These studies, all using IVM in doses of at least 150 μg/kg per week, reported statistically significant reductions in COVID-19 incidences, with respective RRs of 20%, 26% and 13% as compared with controls, and greater reductions in incidences of moderate and severe cases.
14-fold reductions in excess deaths with IVM use in Peru, then 13-fold increase after IVM restricted
Referring to the figure below, these decreased 14-fold from 1st August through 1st December 2020; then, after IVM use was restricted, increased 13-fold through 1st February.
Nationwide, excess deaths decreased 14-fold over four months through 1st December 2020. After a restrictive IVM treatment policy was enacted under a new Peruvian president who took office on 17th November, however, deaths increased 13-fold over the two months following 1st December through 1st February 2021.
In the current international emergency of COVID-19, with mutant viral strains, vaccination refusals and potentially waning immunities over months presenting new challenges, IVM can be an effective component of the mix of therapeutics deployed against this pandemic.
Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19: https://pubmed.ncbi.nlm.nih.gov/34466270/