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0 0.5 1 1.5 2+ Discharge -8% Improvement Relative Risk Viral clearance -8% primary Viral clearance (b) -220% Kishoria et al. Ivermectin for COVID-19 RCT LATE Is late treatment with ivermectin beneficial for COVID-19? RCT 32 patients in India 47% vs. 23% >40 years old in the treatment group, unadjusted Kishoria et al., Paripex - Indian J. Research, doi:10.36106/paripex/4801859 Favors ivermectin Favors control
Ivermectin as adjuvant to hydroxychloroquine in patients resistant to standard treatment for SARS-CoV-2: results of an open-label randomized clinical study
Kishoria et al., Paripex - Indian Journal of Research, doi:10.36106/paripex/4801859
Kishoria et al., Ivermectin as adjuvant to hydroxychloroquine in patients resistant to standard treatment for SARS-CoV-2:.., Paripex - Indian Journal of Research, doi:10.36106/paripex/4801859
Aug 2020   Source   PDF  
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Small RCT of hospitalized patients in India with 19 ivermectin patients and 13 control patients, with all receiving SOC including HCQ, showing no significant differences. The patient population is biased because the study recruited patients that did not respond to standard treatment.
Authors do not specify the treatment delay but it is likely relatively late because the patients had already undergone standard treatment. Criteria for discharge are not provided. The time of discharge status is not specified and may not have been an equal time since treatment initiation for all patients.
Authors indicate 19 treatment and 16 control patients, but the results only show 13 control patients. Authors do not indicate why the other 3 are missing.
Randomization in this small sample resulted in very large differences in the groups, with over twice as many in the ivermectin group with age >40, and the only 2 patients with age >60 both in the ivermectin group. Authors did not adjust for these differences. This study is excluded in the after exclusion results of meta analysis: excessive unadjusted differences between groups.
risk of no hospital discharge, 7.5% higher, RR 1.08, p = 1.00, treatment 11 of 19 (57.9%), control 7 of 13 (53.8%).
risk of no viral clearance, 7.5% higher, RR 1.08, p = 1.00, treatment 11 of 19 (57.9%), control 7 of 13 (53.8%), day 3, primary outcome.
risk of no viral clearance, 220.0% higher, RR 3.20, p = 0.45, treatment 1 of 5 (20.0%), control 0 of 6 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm), day 5.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Kishoria et al., 31 Aug 2020, Randomized Controlled Trial, India, peer-reviewed, 7 authors, dosage 12mg single dose.
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Abstract: PARIPEX - INDIAN JOURNAL OF RESEARCH | Volume - 9 | Issue - 8 | August - 2020 | PRINT ISSN No. 2250 - 1991 | DOI : 10.36106/paripex ORIGINAL RESEARCH PAPER Medicine IVERMECTIN AS ADJUVANT TO HYDROXYCHOLOROQUINE IN PATIENTS RESISTANT TO STANDARD TREATMENT FOR SARS-CoV-2: KEY WORDS: RESULTS OF AN OPEN-LABEL RANDOMIZED CLINICAL STUDY Dr. Naveen Kishoria* Dr. S.L Mathur Dr.Veeram Parmar Dr. Rimple Jeet Kaur Dr. Harish Agarwal Dr. B.S Parihar Department of Medicine, Dr. S. N. Medical College, Jodhpur*Corresponding Author Dr Somil Verma Department of Medicine, Dr. S. N. Medical College, Jodhpur Department of Medicine, Dr. S. N. Medical College, Jodhpur Department of Medicine, Dr. S. N. Medical College, Jodhpur Department of Pharmacology, Dr. S. N. Medical College, Jodhpur Department of Medicine, Dr. S. N. Medical College, Jodhpur Department of Medicine, Dr. S. N. Medical College, Jodhpur BACKGROUND: A cluster of pneumonia cases of unknown etiology was reported from the city of Wuhan, in the Hubei province of China, in December 2019. A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the causative agent of the disease which was subsequently termed as the coronavirus disease (COVID-19) by the World Health Organization (WHO). SARS-CoV-2 mainly affects the lower respiratory tract and manifests as pneumonia in humans.1 The incidence of COVID-19 continues to rise, with 9,653,048 laboratory-confirmed cases and 491,128 deaths worldwide and India has reported 508,953 cases and 15,685 deaths till 27th, June 2020.2 The clinical manifestations of COVID-19 range from fever, cough, fatigue, sore throat, shortness of breath and less common symptoms such as headache, nausea and diarrhea.3,4 The most common abnormalities in vital signs are increased temperature and tachypnea. The most common radiological findings are bilateral pulmonary infiltrates, ground glass opacities and consolidation. The most common findings associated with severe disease are older age, d- dimer levels greater, higher SOFA score, elevated IL-6, increased Lactate Dehydrogenase, hyperferritinemia and lymphopenia on admission.5,6The most common complications are sepsis, respiratory failure, acute respiratory distress syndrome (ARDS), cardiac injury and acute kidney injury. As per WHO the mild COVID-19 illness may include: uncomplicated upper respiratory tract viral infection symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore throat, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhoea, nausea, and vomiting.7 According to a recent Chinese study, about 80% of patients present with mild disease and the overall case-fatality rate is about 2.3% but reaches 8.0% in patients aged 70 to 79 years and 14.8% in those aged ≥80 years.7 However, there is probably an important number of asymptomatic carriers in the population, and thus the mortality rate is probably overestimated. India is facing the COVID-19 wave with more than 145,380 cases, as of May 2020. Thus, there is an urgent 50 need for an effective treatment to treat asymptomatic patients and to decrease the duration of virus carriage in order to limit the transmission in the community. Among candidate drugs to treat COVID-19, repositioning of old drugs for use as antiviral treatment is an interesting strategy because knowledge on safety profile, side effects, posology and drug..
Late treatment
is less effective
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