Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients

Camprubí et al., PLoS ONE, 15:11, doi:10.1371/journal.pone.0242184

Nov 2020

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Tiny 26 patient retrospective study of very late treatment with ivermectin 200 μg/kg, median 12 days after symptoms, not showing significant differences. Authors suggest the dose is too low and recommend evaluation of higher doses. All patients received HCQ which may reduce the potential benefit for adding ivermectin.

Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture. Porter show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.

This is the 18th of 99 COVID-19 controlled studies for ivermectin, which collectively show efficacy with p<0.0000000001 (1 in 2 sextillion). 46 studies are RCTs, which show efficacy with p=0.00000014.

1. Porter et al., The ratio between SARS-CoV-2 RNA viral load and culturable viral titer differs depending on stage of infection, medRxiv, doi:10.1101/2023.07.06.23292300.medrxiv.org, doi.org.

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risk of mechanical ventilation, 40.0% lower, RR 0.60, p = 0.67, treatment 3 of 13 (23.1%), control 5 of 13 (38.5%), NNT 6.5.

risk of ICU admission, 33.3% lower, RR 0.67, p = 1.00, treatment 2 of 13 (15.4%), control 3 of 13 (23.1%), NNT 13, ICU at day 8.

risk of no improvement at day 8, 33.3% higher, RR 1.33, p = 1.00, treatment 4 of 13 (30.8%), control 3 of 13 (23.1%).

risk of no viral clearance, 25.0% higher, RR 1.25, p = 1.00, treatment 5 of 13 (38.5%), control 4 of 13 (30.8%), tests done between days 3-5, primary outcome.

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Camprubí et al., 11 Nov 2020, retrospective, Spain, peer-reviewed, 9 authors, average treatment delay 12.0 days, dosage 200μg/kg single dose.

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Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients

Daniel Camprubí, Alex Almuedo-Riera, Helena Martí-Soler, Alex Soriano, Juan Carlos Hurtado, Carme Subirà, Berta Grau-Pujol, Alejandro Krolewiecki, Jose Muñoz

PLOS ONE, doi:10.1371/journal.pone.0242184

Ivermectin has recently shown efficacy against SARS-CoV-2 in-vitro. We retrospectively reviewed severe COVID-19 patients receiving standard doses of ivermectin and we compared clinical and microbiological outcomes with a similar group of patients not receiving ivermectin. No differences were found between groups. We recommend the evaluation of high-doses of ivermectin in randomized trials against SARS-CoV-2.

Author Contributions Conceptualization: Daniel Camprubı ´, Alex Almuedo-Riera, Alejandro Krolewiecki, Jose Muñoz. Data curation: Juan Carlos Hurtado, Carme Subirà. Formal analysis: Daniel Camprubı ´, Helena Martı ´-Soler. Investigation: Juan Carlos Hurtado, Jose Muñoz. Methodology: Daniel Camprubı ´, Alex Almuedo-Riera, Jose Muñoz. Writing -original draft: Daniel Camprubı ´, Jose Muñoz. Writing -review & editing: Alex Almuedo-Riera, Helena Martı ´-Soler, Alex Soriano, Carme Subirà, Berta Grau-Pujol, Alejandro Krolewiecki, Jose Muñoz.

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Late treatment
is less effective

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