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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

Alam et al., European Journal of Medical and Health Sciences, doi:10.24018/ejmed.2020.2.6.599
Dec 2020  
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Case 91% Improvement Relative Risk Ivermectin for COVID-19  Alam et al.  Prophylaxis Does ivermectin reduce COVID-19 infections? Prospective study of 118 patients in Bangladesh Fewer cases with ivermectin (p<0.000001) c19ivm.org Alam et al., European J. Medical and H.., Dec 2020 Favorsivermectin Favorscontrol 0 0.5 1 1.5 2+
Ivermectin for COVID-19
4th treatment shown to reduce risk in August 2020
 
*, now with p < 0.00000000001 from 104 studies, recognized in 22 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19ivm.org
91% reduction in COVID-19 cases with ivermectin prophylaxis. 118 healthcare workers in Bangladesh, 58 receiving ivermectin 12mg monthly, showing RR 0.094, p < 0.0001.
This is the 27th of 104 COVID-19 controlled studies for ivermectin, which collectively show efficacy with p<0.0000000001 (1 in 1 sextillion).
51 studies are RCTs, which show efficacy with p=0.00000015.
risk of case, 90.6% lower, RR 0.09, p < 0.001, treatment 4 of 58 (6.9%), control 44 of 60 (73.3%), NNT 1.5.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Alam et al., 15 Dec 2020, prospective, Bangladesh, peer-reviewed, 13 authors, dosage 12mg monthly.
This PaperIvermectinAll
Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study
Mohammed Tarek Alam, Rubaiul Murshed, Pauline Francisca Gomes, Zafor Md. Masud, Mainul Sadia Saber, Mainul Alam Chaklader, Fatema Khanam, Monower Hossain, Abdul Basit Ibne Momen Momen, Naz Yasmin, Rafa Faaria Alam, Amrin Sultana, Rishad Choudhury Robin
European Journal of Medical and Health Sciences, doi:10.24018/ejmed.2020.2.6.599
I. BACKGROUND Submerged in the wave of Coronavirus disease 2019 (COVID-19), the world is weeping. Ever since the outbreak was first identified in December 2019 in Wuhan, China the world has not been the same [1] . An ongoing pandemic, the COVID-19 has proved to be the most devastating and unmanageable crisis the world has ever encountered. With the virus proudly lurking around in the atmosphere, millions of lives have already been compromised and many more uncountable innocents are still fighting to survive this war against the invisible rival. The call for an authentic treatment protocol against this virus was made long before
References
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Alam, Murshed, Bhiuyan, Saber, Alam et al., Case Series of 100 COVID-19 Positive Patients Treatedwith Combination of Ivermectin and Doxycycline, Journal of Bangladesh College of Physicians and Surgeons
Azeem, Ashraf, Rasheed, Anjum, Hameed, Evaluation of cytotoxicity and antiviral activity of ivermectin against Newcastle disease virus, Pak J Pharm Sci
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Caly, Druce, Catton, Jans, Wagstaff, The FDAapproved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro, Antiviral Res
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Lundberg, Pinkham, Baer, Nuclear import and export inhibitors alter capsid protein distribution in mammalian cells and reduce Venezuelan Equine Encephalitis Virus replication, Antiviral Research
Lv, Liu, Wang, Ivermectin inhibits DNA polymerase UL42 of pseudorabies virus entrance into the nucleus and proliferation of the virus in vitro and vivo, Antiviral Research
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Msd, MECTIZAN Donation Program
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Tielsch, Beeche, Impact of ivermectin on illness and disability associated with onchocerciasis, Tropical Medicine & International Health
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{ 'indexed': {'date-parts': [[2024, 3, 28]], 'date-time': '2024-03-28T16:38:09Z', 'timestamp': 1711643889880}, 'reference-count': 30, 'publisher': 'European Open Science Publishing', 'issue': '6', 'license': [ { 'start': { 'date-parts': [[2020, 12, 15]], 'date-time': '2020-12-15T00:00:00Z', 'timestamp': 1607990400000}, 'content-version': 'unspecified', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'abstract': '<jats:p>Introduction: While multiple vaccines are undergoing clinical trial across the globe, ' 'we yearn for an FDA approved drug to protect us from the devastating pandemic for the time ' 'being. This study aims to determine the effectiveness of Ivermectin when administered as ' 'pre-exposure prophylaxis for COVID-19.&#x0D;\n' 'Method: An observational study, with 118 healthcare providers who were enrolled purposively, ' 'was conducted in a tertiary hospital in Dhaka from May 2020 to August 2020. The subjects were ' 'divided into experimental and control groups; and the experimental group received an oral ' 'monthly dose of Ivermectin 12mg for 4 months. Both groups were exposed to COVID-19 positive ' 'patients admitted in the hospital during the course of study. The symptomatic subjects were ' 'evaluated by physical examination, COVID-19 RT-PCR and/or HRCT of chest. Differences between ' 'the variables were determined using the Chi-square test and the level of statistical ' 'significance was reached when p&lt;0.05.&#x0D;\n' 'Result: 73.3% (44 out of 60) subjects in control group were positive for COVID-19, whereas ' 'only 6.9% (4 out of 58) of the experimental group were diagnosed with COVID-19 (p-value &lt; ' '0.05).&#x0D;\n' 'Conclusion: Ivermectin, an FDA-approved, safe, cheap and widely available drug, should be ' 'subjected to large-scale trials all over the world to ascertain its effectiveness as ' 'pre-exposure prophylaxis for COVID-19.</jats:p>', 'DOI': '10.24018/ejmed.2020.2.6.599', 'type': 'journal-article', 'created': { 'date-parts': [[2020, 12, 20]], 'date-time': '2020-12-20T13:23:13Z', 'timestamp': 1608470593000}, 'source': 'Crossref', 'is-referenced-by-count': 9, 'title': 'Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected ' 'Tertiary Hospital in Dhaka – An Observational Study', 'prefix': '10.24018', 'volume': '2', 'author': [ {'given': 'Mohammed Tarek', 'family': 'Alam', 'sequence': 'first', 'affiliation': []}, {'given': 'Rubaiul', 'family': 'Murshed', 'sequence': 'additional', 'affiliation': []}, {'given': 'Pauline Francisca', 'family': 'Gomes', 'sequence': 'additional', 'affiliation': []}, {'given': 'Zafor Md.', 'family': 'Masud', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sadia', 'family': 'Saber', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mainul Alam', 'family': 'Chaklader', 'sequence': 'additional', 'affiliation': []}, {'given': 'Fatema', 'family': 'Khanam', 'sequence': 'additional', 'affiliation': []}, {'given': 'Monower', 'family': 'Hossain', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Abdul Basit Ibne Momen', 'family': 'Momen', 'sequence': 'additional', 'affiliation': []}, {'given': 'Naz', 'family': 'Yasmin', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rafa Faaria', 'family': 'Alam', 'sequence': 'additional', 'affiliation': []}, {'given': 'Amrin', 'family': 'Sultana', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rishad Choudhury', 'family': 'Robin', 'sequence': 'additional', 'affiliation': []}], 'member': '10105', 'published-online': {'date-parts': [[2020, 12, 15]]}, 'reference': [ { 'key': '7445', 'unstructured': 'World Health Organization. Coronavirus disease (COVID-19) update. 2020; ' 'https://www.who.int/bangladesh/emergencies/coronavirus-disease-(covid-19)-update.'}, { 'key': '7446', 'unstructured': "World Health Organization. WHO's COVID-19 response. 2020; " 'https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline.'}, { 'key': '7447', 'doi-asserted-by': 'crossref', 'unstructured': 'Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ' 'ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral ' 'Res. 2020; 178:104787.', 'DOI': '10.1016/j.antiviral.2020.104787'}, { 'key': '7448', 'doi-asserted-by': 'crossref', 'unstructured': 'Alam MT, Murshed R, Bhiuyan E, Saber S, Alam RF, Robin RC. Case Series ' 'of 100 COVID-19 Positive Patients Treatedwith Combination of Ivermectin ' 'and Doxycycline. Journal of Bangladesh College of Physicians and ' 'Surgeons. 2020;38(Supplement Issue).', 'DOI': '10.3329/jbcps.v38i0.47512'}, { 'key': '7449', 'unstructured': 'Professor Satoshi Ōmura. 2007; ' 'http://www.satoshi-omura.info/biography/.'}, { 'key': '7450', 'doi-asserted-by': 'crossref', 'unstructured': "Crump A, Ōmura S. Ivermectin, 'wonder drug' from Japan: the human use " 'perspective. Proceedings of the Japan Academy Series B, Physical and ' 'biological sciences. 2011;87(2):13-28.', 'DOI': '10.2183/pjab.87.13'}, { 'key': '7451', 'unstructured': 'MERCK. Over 30 Years: The Mectizan Donation Program. 2019; ' 'https://www.merck.com/stories/mectizan/.'}, { 'key': '7452', 'unstructured': 'Hopkins A. Treating neglected tropical diseases. Community eye health. ' '2013;26(82):26-27.'}, { 'key': '7453', 'doi-asserted-by': 'crossref', 'unstructured': 'Tielsch JM, Beeche A. Impact of ivermectin on illness and disability ' 'associated with onchocerciasis. Tropical Medicine & International ' 'Health. 2004;9(4): A45-A56.', 'DOI': '10.1111/j.1365-3156.2004.01213.x'}, { 'key': '7454', 'unstructured': 'MSD. MECTIZAN Donation Program. n.d; ' 'https://www.msdresponsibility.com/access-to-health/key-initiatives/mectizan-donation-program/.'}, { 'key': '7455', 'doi-asserted-by': 'crossref', 'unstructured': 'Barrows Nicholas J, Campos Rafael K, Powell ST, et al. A Screen of ' 'FDA-Approved Drugs for Inhibitors of Zika Virus Infection. Cell Host & ' 'Microbe. 2016;20(2):259-270.', 'DOI': '10.1016/j.chom.2016.07.004'}, { 'key': '7456', 'doi-asserted-by': 'crossref', 'unstructured': 'Götz V, Magar L, Dornfeld D, et al. Influenza A viruses escape from MxA ' 'restriction at the expense of efficient nuclear vRNP import. Scientific ' 'Reports. 2016;6(1):23138.', 'DOI': '10.1038/srep23138'}, { 'key': '7457', 'doi-asserted-by': 'crossref', 'unstructured': 'Lundberg L, Pinkham C, Baer A, et al. Nuclear import and export ' 'inhibitors alter capsid protein distribution in mammalian cells and ' 'reduce Venezuelan Equine Encephalitis Virus replication. Antiviral ' 'Research. 2013;100(3):662-672.', 'DOI': '10.1016/j.antiviral.2013.10.004'}, { 'key': '7458', 'doi-asserted-by': 'crossref', 'unstructured': 'Nguyen C, Burton T, Kuklinski W, Gray M, Foy BD. Ivermectin for the ' 'Control of West Nile Virus Transmission. New Horizons in Translational ' 'Medicine. 2015;2(4):127.', 'DOI': '10.1016/j.nhtm.2015.07.043'}, { 'key': '7459', 'doi-asserted-by': 'crossref', 'unstructured': 'Lee YJ, Lee C. Ivermectin inhibits porcine reproductive and respiratory ' 'syndrome virus in cultured porcine alveolar macrophages. Archives of ' 'Virology. 2016;161(2):257-268.', 'DOI': '10.1007/s00705-015-2653-2'}, { 'key': '7460', 'unstructured': 'Azeem S, Ashraf M, Rasheed MA, Anjum AA, Hameed R. Evaluation of ' 'cytotoxicity and antiviral activity of ivermectin against Newcastle ' 'disease virus. Pak J Pharm Sci. 2015;28(2):597-602.'}, { 'key': '7461', 'doi-asserted-by': 'crossref', 'unstructured': 'Varghese FS, Kaukinen P, Gläsker S, et al. Discovery of berberine, ' 'abamectin and ivermectin as antivirals against chikungunya and other ' 'alphaviruses. Antiviral Research. 2016; 126: 117-124.', 'DOI': '10.1016/j.antiviral.2015.12.012'}, { 'key': '7462', 'doi-asserted-by': 'crossref', 'unstructured': 'Wagstaff Kylie M, Sivakumaran H, Heaton Steven M, Harrich D, Jans David ' 'A. Ivermectin is a specific inhibitor of importin α/β-mediated nuclear ' 'import able to inhibit replication of HIV-1 and dengue virus. ' 'Biochemical Journal. 2012;443(3):851-856.', 'DOI': '10.1042/BJ20120150'}, { 'key': '7463', 'doi-asserted-by': 'crossref', 'unstructured': 'Mastrangelo E, Pezzullo M, De Burghgraeve T, et al. Ivermectin is a ' 'potent inhibitor of flavivirus replication specifically targeting NS3 ' 'helicase activity: new prospects for an old drug. Journal of ' 'Antimicrobial Chemotherapy. 2012;67(8):1884-1894.', 'DOI': '10.1093/jac/dks147'}, { 'key': '7464', 'doi-asserted-by': 'crossref', 'unstructured': 'Lv C, Liu W, Wang B, et al. Ivermectin inhibits DNA polymerase UL42 of ' 'pseudorabies virus entrance into the nucleus and proliferation of the ' 'virus in vitro and vivo. Antiviral Research. 2018; 159: 55-62.', 'DOI': '10.1016/j.antiviral.2018.09.010'}, { 'key': '7465', 'doi-asserted-by': 'crossref', 'unstructured': 'Wang X, Lv C, Ji X, Wang B, Qiu L, Yang Z. Ivermectin treatment inhibits ' 'the replication of Porcine circovirus 2 (PCV2) in vitro and mitigates ' 'the impact of viral infection in piglets. Virus Research. 2019; 263: ' '80-86.', 'DOI': '10.1016/j.virusres.2019.01.010'}, { 'key': '7466', 'doi-asserted-by': 'crossref', 'unstructured': 'Nguyen KY, Sakuna K, Kinobe R, Owens L. Ivermectin blocks the nuclear ' 'location signal of parvoviruses in crayfish, Cherax quadricarinatus. ' 'Aquaculture. 2014;420-421:288-294.', 'DOI': '10.1016/j.aquaculture.2013.11.022'}, { 'key': '7467', 'doi-asserted-by': 'crossref', 'unstructured': 'Raza S, Shahin F, Zhai W, et al. Ivermectin Inhibits Bovine Herpesvirus ' '1 DNA Polymerase Nuclear Import and Interferes with Viral Replication. ' 'Microorganisms. 2020;8(3).', 'DOI': '10.3390/microorganisms8030409'}, { 'key': '7468', 'doi-asserted-by': 'crossref', 'unstructured': 'Baraka OZ, Mahmoud BM, Marschke CK, Geary TG, Homeida MM, Williams JF. ' 'Ivermectin distribution in the plasma and tissues of patients infected ' 'with Onchocerca volvulus. Eur J Clin Pharmacol. 1996;50(5):407-410.', 'DOI': '10.1007/s002280050131'}, { 'key': '7469', 'doi-asserted-by': 'crossref', 'unstructured': "Crump A. Ivermectin: enigmatic multifaceted 'wonder' drug continues to " 'surprise and exceed expectations. J Antibiot (Tokyo). ' '2017;70(5):495-505.', 'DOI': '10.1038/ja.2017.11'}, { 'key': '7470', 'doi-asserted-by': 'crossref', 'unstructured': 'Muñoz J, Ballester MR, Antonijoan RM, et al. Safety and pharmacokinetic ' 'profile of fixed-dose ivermectin with an innovative 18mg tablet in ' 'healthy adult volunteers. PLoS neglected tropical diseases. 2018;12(1): ' 'e0006020-e0006020.', 'DOI': '10.1371/journal.pntd.0006020'}, { 'key': '7471', 'doi-asserted-by': 'crossref', 'unstructured': "Ivermectin. In: Aronson JK, ed. Meyler's Side Effects of Drugs " '(Sixteenth Edition). Oxford: Elsevier; 2016:379-390.', 'DOI': '10.1016/B978-0-444-53717-1.00934-3'}, { 'key': '7472', 'doi-asserted-by': 'crossref', 'unstructured': 'Adedokun KA, Olarinmoye AO, Mustapha JO, Kamorudeen RT. A close look at ' 'the biology of SARS-CoV-2, and the potential influence of weather ' 'conditions and seasons on COVID-19 case spread. 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