Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection (preprint)

Ivermectin is an antiparasitic drug being investigated for repurposing to SARS-CoV-2. In-vitro, ivermectin showed limited antiviral activity and a COVID-19 animal model demonstrated pathological benefits but no effect on viral RNA. This meta-analysis investigated ivermectin in 18 randomized clinical trials (2282 patients) identified through systematic searches of PUBMED, EMBASE, MedRxiv and trial registries. Ivermectin was associated with reduced inflammatory markers (C-Reactive Protein, d-dimer and ferritin) and faster viral clearance by PCR. Viral clearance was treatment dose- and duration-dependent. In six randomized trials of moderate or severe infection, there was a 75% reduction in mortality (Relative Risk=0.25 [95%CI 0.12-0.52]; p=0.0002); 14/650 (2.1%) deaths on ivermectin; 57/597 (9.5%) deaths in controls) with favorable clinical recovery and reduced hospitalization. Many studies included were not peer reviewed and meta-analyses are prone to confounding issues. Ivermectin should be validated in larger, appropriately controlled randomized trials before the results are sufficient for review by regulatory authorities.

Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic (preprint)

Background: Up-to-date, there is no recognized effective treatment or vaccine for the treatment of COVID-19 that emphasize urgency around distinctive effective therapies. This study aims to evaluate the anti-parasitic medication efficacy "Ivermectin" plus standard care in the treatment of mild/moderate and severely ill cases with COVID 19 infection, as well as prophylaxis of health care and/ or household contacts.Subject and methods: 600 subjects; 400 symptomatic confirmed COVID-19 patients and 200 health care and household contacts distributed over 6 groups; Group I: 100 patients with mild/moderate COVID-19 infection received a 4-days course of Ivermectin plus standard of care; Group II: 100 patients with mild/moderate COVID-19 infection received hydroxychloroquine plus standard care; Group III: 100 patients with severe COVID-19 infection received Ivermectin plus standar care; Group IV: 100 patients with Severe COVID-19 infection received hydroxychloroquine plus standard care. Routine laboratory investigations and rT-PCR, were reported before and after initiation of treatment. Group V stick to personal protective measures (PPM ) plus Ivermectin o.4mg / kg on empty stomach to be repeated after one week, and group VI stick to PPM only .Both groups V&VI were followed for two weeks ..Results:  Patients received ivermectin early reported substantial recovery of laboratory investigations; and significant reduction in rT-PCR conversion days. A substantial improvement and reduction in mortality rate in Ivermectin treated groups; group I (99% & 0.0%, respectively) and group III (94% & 2.0% respectively) versus hydroxychloroquine plus standard care treated groups; group II  (74% and 4%, respectively) and group IV  (50% and 20%, respectively). Ivermectin had significantly reduced the incidence of infection in health care and household contacts up to 2% compared to 10% in non ivermectin group when used as a prophylaxis. Conclusion: Early addition of Ivermectin to standard care is very effective drug for treatment of COVID-19 patients with significant reduction in mortality,rt-PCR conversion days , recovery time hospital stay compared to Hydroxychloroquine plus standard care. Early use of Ivermectin is very useful for controlling COVID 19 infections; prophylaxis and improving cytokines storm