In the midst of a pandemic in which second and third “waves” of infections are already being experienced around the world, together with the appearance of new strains, the search for an effective treatment against SARSCoV2 is urgent.
This leads to many potential findings being seen as a reality and starting to be used even when they do not have the corresponding authorizations.
This is the case with ivermectin, an antiparasitic that is promoted as an effective treatment against coronavirus disease (COVID-19). But is it actually effective? Is it safe to use? What do specialists say about it? Here we are going to review it.
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Ivermectin is an antiparasitic drug widely used in people and animals. It has defined doses to maintain a tolerance and safety pattern for known indications.
For example, in humans it is used in tablet form to treat diseases caused by parasites, such as elephantiasis or onchocerciasis, two debilitating diseases very common among people living in the poorest regions of Africa.
It is also useful against roundworms, including roundworms, very common in children and adults who live under poor hygiene conditions, and can be used as a cream against rosacea.
In the veterinary field it is usually used by injection, and, to a lesser extent, by oral route in equines, cattle, sheep, dogs and cats, to combat nematodiasis, ticks and scabies, among others.
Ivermectin is considered one of the most useful medicines ever discovered and is often referred to as a “breakthrough drug.”
This is because it has contributed to practically eliminating onchocerciasis in Africa, also called “river blindness”, a disease that, as its name suggests, is one of the main causes of blindness on the continent.
But how did an antiparasitic come to be positioned as an alternative to the use of vaccines that already have clinical trials?
Use of ivermectin for COVID
In early April 2020, a couple of months after the pandemic was announced, a group of Australian researchers published in Antiviral Research an investigation in which they indicated that ivermectin could inhibit the replication of SARS-CoV-2 in cell cultures.
“Ivermectin warrants further investigation of possible benefits in humans,” the authors detailed.
A couple of weeks after this publication, Dr Tarek Alam from Bangladesh Medical College shared new results on the relationship between ivermectin and COVID.
Within 4-14 days, Alam used a combination of ivermectin with an antibiotic called doxycycline, and said that “98% of his COVID-19 patients were cured.”
This combination of drugs had considerable success not only in reducing the viral load of patients, but also in reducing the severity of the cases, Alam detailed in an interview with TrialSite News.
Argentina is another country where the potential of ivermectin as an antiviral in patients with COVID-19 was analyzed.
For that, they formed a public-private consortium between research teams from the Tandil Veterinary Research Center (CIVETAN, CONICET-UNCPBA-CICPBA), the Tropical Diseases Research Institute of the National University of Salta (IIET, UNSa), the National University of Quilmes (UNQ), the Virology and Molecular Epidemiology Unit of the Hospital “Prof. Dr. Juan P. Garrahan ”and the Elea Phoenix SA Laboratory, which also collaborated in the co-financing of the project, as reported by the National Council for Scientific and Technical Research (CONICET).
At the end of September 2020, they reported that the administration of ivermectin at a dose of 0.6 milligrams per kilo produces the fastest and most profound elimination of the virus, provided that the treatment begins in the early stages of the infection, that is, up to 5 days from the appearance of symptoms.
These results were known after analyzing 45 patients with mild or moderate COVID-19, among whom 30 received ivermectin.
Controversy over ivermectin
All these studies aroused controversy in much of the scientific community.
In the first work, the doses of ivermectin used exceeded 10 times the amount commonly used in people, so its implementation in clinical trials is not feasible, since they could put patients at risk.
In the case of Dr. Alam’s findings, it should be noted that the provision of ivermectin among his patients was not part of a controlled study, and since a large number of people with COVID-19 recover without medication, the true is not known. incidence of ivermectin in that group.
Regarding the research of the Argentine specialists, the Argentine Society of Infectious Diseases (SADI), stressed that the results are preliminary, it has no publication or review by its peers and the doses used exceed up to three times the usual measures.
They also recalled that ivermectin is not a harmless drug and even with therapeutic doses there is a high probability that it causes adverse side effects, ranging from mild to severe.
Experts conclude that larger studies are needed to understand the true effects of ivermectin in diverse population groups with COVID-19.
Advice from health authorities
Probably due to not differentiating results from in vitro studies from those obtained in clinical trials, added to the despair and crisis caused by the current situation, many people began to promote the use of ivermectin to prevent or treat COVID-19.
This represents a huge problem as it makes it difficult to carry out formal investigations. In many cases, this self-medication implies the administration of little or no precise doses, the incorrect use of the drug, and a lack of monitoring or recording of other drugs with which it is combined.
Furthermore, in many regions a shortage of ivermectin was generated, which is why it was decided to resort to the variant intended for veterinary use.
The US Food and Drug Administration (FDA) notes that the side effects that may be associated with ivermectin are:
- Swelling, especially of the face and extremities.
- Nausea and vomiting
- Dizziness, confusion, and seizures.
- Severe hospitalization.
Currently, the use of ivermectin in humans is only approved for the treatment of some parasitic worms (intestinal strongyloidiasis and onchocerciasis) or for external parasites, such as lice and skin conditions, such as rosacea. Always under medical recommendation and supervision.
There is no authorization to use ivermectin preventively or as a treatment for COVID-19.
This does not unequivocally mean that it has no potential to combat SARSCoV2. But, for now, specialists and health authorities insist that the available evidence is disparate, has limitations, does not allow drawing conclusions or knowing the true risks of this practice.