Abstract: [ Chest Infections Original Research ] Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019 The Ivermectin in COVID Nineteen Study Juliana Cepelowicz Rajter, MD; Michael S. Sherman, MD, FCCP; Naaz Fatteh, MD; Fabio Vogel, PharmD, BCPS; Jamie Sacks, PharmD; and Jean-Jacques Rajter, MD BACKGROUND: Ivermectin was shown to inhibit severe acute respiratory syndrome coronavirus 2 replication in vitro, which has led to off-label use, but clinical efficacy has not been described previously. RESEARCH QUESTION: Does ivermectin benefit hospitalized coronavirus disease 2019 (COVID-19) patients? Charts of consecutive patients hospitalized at four Broward Health hospitals in Florida with confirmed COVID-19 between March 15 and May 11, 2020, treated with or without ivermectin were reviewed. Hospital ivermectin dosing guidelines were provided, but treatment decisions were at the treating physician’s discretion. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, and length of stay. Severe pulmonary involvement was defined as need for FIO2 $ 50%, noninvasive ventilation, or invasive ventilation at study entry. Logistic regression and propensity score matching were used to adjust for confounders. STUDY DESIGN AND METHODS: Two hundred eighty patients, 173 treated with ivermectin and 107 without ivermectin, were reviewed. Most patients in both groups also received hydroxychloroquine, azithromycin, or both. Univariate analysis showed lower mortality in the ivermectin group (15.0% vs 25.2%; OR, 0.52; 95% CI, 0.29-0.96; P ¼ .03). Mortality also was lower among ivermectin-treated patients with severe pulmonary involvement (38.8% vs 80.7%; OR, 0.15; 95% CI, 0.05-0.47; P ¼ .001). No significant differences were found in extubation rates (36.1% vs 15.4%; OR, 3.11; 95% CI, 0.88-11.00; P ¼ .07) or length of stay. After multivariate adjustment for confounders and mortality risks, the mortality difference remained significant (OR, 0.27; 95% CI, 0.09-0.80; P ¼ .03). One hundred ninety-six patients were included in the propensity-matched cohort. Mortality was significantly lower in the ivermectin group (13.3% vs 24.5%; OR, 0.47; 95% CI, 0.22-0.99; P < .05), an 11.2% (95% CI, 0.38%22.1%) absolute risk reduction, with a number needed to treat of 8.9 (95% CI, 4.5-263). RESULTS: Ivermectin treatment was associated with lower mortality during treatment of COVID-19, especially in patients with severe pulmonary involvement. Randomized controlled trials are needed to confirm these findings. CHEST 2021; 159(1):85-92 INTERPRETATION: KEY WORDS: hospitalized COVID-19; in-hospital mortality; ivermectin; mechanical ventilation; number needed to treat; severe pulmonary involvement; survival ABBREVIATIONS: COVID-19 = coronavirus disease 2019; IQR = interquartile range; MAP = mean arteria pressure; QTc = corrected QT interval; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2 chestjournal.org AFFILIATIONS: From the Broward Health Medical Center, Fort Lauderdale, FL (J. C. R., N. F., F. V., J. S., and J.-J. R.); the Drexel University College of Medicine (M. S. S.), 85 Take-home Points Is ivermectin associated with lower mortality rate in patients hospitalized with coronavirus disease 2019 (COVID-19)? Results: A retrospective cohort study of consecutive patients..