Evaluating Ivermectin as a COVID-19 Therapeutic

Volume 20, Issue 4

In the early days of the COVID-19 pandemic, few therapies existed to treat the infection. This forced clinicians to turn to any treatment modality out of desperation, even those with questionable evidence.

Ivermectin is an antiparasitic drug used to treat onchocerciasis and strongyloidiasis. After an in vitro study linked it to possible antiviral activity, ivermectin emerged as a potential therapy for COVID-19. However, several prior studies have provided conflicting results, which has spurred ongoing controversy.

While the United States has oral options to treat outpatients with mild to moderate COVID-19 infections, these agents are not available worldwide. Hence there is ongoing interest in identifying new treatment options that could be less expensive and more available on a global scale.

In this week’s issue of Talking Therapeutics, we explore a new study in JAMA which evaluated ivermectin for treating outpatients with early mild to moderate COVID-19 infections.

Point 1: Ivermectin Doesn’t Work

In the randomized study, 817 patients received ivermectin at a dose of 400 μg/kg daily for 3 days, and 774 patients received placebo. The primary outcome was time to sustained recovery, which investigators defined as at least 3 consecutive days without symptoms. Key secondary outcomes included a composite of hospitalization or death by day 28.

Researchers reported the median time to recovery was 12 days (IQR, 11-13) in the ivermectin group and 13 days (IQR, 12-14) in the placebo group. Hospitalization or death were uncommon, occurring in 10 patients (1.2%) who received ivermectin and 9 patients (1.2%) who received placebo (HR, 1.1 [95% CI, 0.4-2.6]). One patient in the ivermectin group died.

Point 2: Ivermectin Probably Won’t Go Away

Despite this study and others before it, many people continue to plug ivermectin as a COVID-19 therapy on social media. Some have suggested that states pass laws that would ban pharmacists from refusing to fill prescriptions for medications like ivermectin, despite the absence of robust data to support its use.

It is my opinion that practicing pharmacists should continue to have the right to refuse to fill prescriptions. It is also important that pharmacists become involved in advocacy efforts to combat these laws at the state level, in order to safely practice pharmacy and protect the public good.