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All Studies   Meta Analysis       

Effectiveness of Ivermectin as add-on Therapy in COVID-19 Management (Pilot Trial)

Jul 2020  
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Mortality 71% Improvement Relative Risk Hospitalization time 42% Recovery 71% primary Ivermectin for COVID-19  Gorial et al.  LATE TREATMENT Is late treatment with ivermectin beneficial for COVID-19? Retrospective 87 patients in Iraq Shorter hospitalization with ivermectin (p=0.00005) c19ivm.org Gorial et al., medRxiv, July 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 105 studies, recognized in 23 countries.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 112 treatments. c19ivm.org
Small trial of hospitalized patients with 16 of 87 patients being treated with ivermectin, showing a significantly lower mean hospital stay with ivermectin: 7.62 vs. 13.22 days, p=0.00005. 0 of 16 ivermectin patients died vs. 2 of 71 control patients.
This is the 1st of 105 COVID-19 controlled studies for ivermectin, which collectively show efficacy with p<0.0000000001 (1 in 774 quintillion).
52 studies are RCTs, which show efficacy with p=0.00000021.
risk of death, 71.0% lower, RR 0.29, p = 1.00, treatment 0 of 16 (0.0%), control 2 of 71 (2.8%), NNT 36, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
hospitalization time, 42.0% lower, relative time 0.58, p < 0.001, treatment 16, control 71.
risk of no recovery, 71.0% lower, RR 0.29, p = 1.00, treatment 0 of 16 (0.0%), control 2 of 71 (2.8%), NNT 36, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), primary outcome.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gorial et al., 8 Jul 2020, retrospective, Iraq, preprint, 9 authors, dosage 200μg/kg single dose, trial NCT04343092 (history).
This PaperIvermectinAll
Effectiveness of Ivermectin as add-on Therapy in COVID-19 Management (Pilot Trial)
Faiq I Gorial, Sabeeh Mashhadani, Hend M Sayaly, Basim Dhawi Dakhil, Marwan M Almashhadani, Adnan M Aljabory, Hassan M Abbas, Mohammed Ghanim, Jawad I Rasheed
doi:10.1101/2020.07.07.20145979
Background: To date no effective therapy has been demonstrated for COVID-19. In vitro, studies indicated that ivermectin (IVM) has antiviral effect. Objectives: To assess the effectiveness of ivermectin (IVM) as add-on therapy to hydroxychloroquine (HCQ) and azithromycin (AZT) in treatment of COVID-19. Methods: This Pilot clinical trial conducted on hospitalized adult patients with mild to moderate COVID-19 diagnosed according to WHO interim guidance. Sixteen Patients received a single dose of IVM 200Mcg /kg on admission day as add on therapy to hydroxychloroquine ( HCQ)and Azithromycin (AZT) and were compared with 71 controls received HCQ and AZT matched in age, gender, clinical features, and comorbidities. The primary outcome was percentage of cured patients, defined as symptoms free to be discharged from the hospital and 2 consecutive negative PCR test from nasopharyngeal swabs at least 24 hours apart. The secondary outcomes were time to cure in both groups and evaluated by measuring time from admission of the patient to the hospital till discharge. Results: Of 87 patients included in the study,t he mean age ± SD (range) of patients in the IVM group was similar to controls [44.87 ± 10.64 (28-60) vs 45.23 ± 18.47 (8-80) years, p=0.78] Majority of patients in both groups were male but statistically not significant [11(69%) versus 52 (73%), with male: female ratio 2.21 versus 2.7-, p=0.72) All the patients of IVM group were cured compared with the controls [ 16 (100 %) vs 69 (97.2 %)]. Two patients died in the controls. The mean time to stay in the hospital was significantly lower in IVM group compared with the controls (7.62 ± 2.75 versus 13.22 ±5.90 days, p=0.00005, effect size= 0.82). No adverse events were observed Conclusions : Add-on use of IVM to HCQ and AZT had better effectiveness, shorter hospital stay, and relatively safe compared with controls. however, a larger prospective study with longer follow up may be needed to validate these results.
References
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Caly, Druce, Catton, Jans, Wagstaff, The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro, Antiviral Research Available online
Canga, Prieto, Liébana, Martínez, Vega et al., The pharmacokinetics and interactions of ivermectin in humans-a mini-review, The AAPS journal
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Patel, Usefulness of Ivermectin in COVID-19 Illness
Poschet, Perkett, Timmins, Deretic, Azithromycin and ciprofloxacin have a chloroquine-like effect on respiratory epithelial cells, bioRxiv, doi:10.1101/2020.03.29.008631
Whitehead, Julious, Cooper, Campbell, Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for acontinuous outcome variable, Stat Meth Med Res
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Late treatment
is less effective
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