Could Ivermectin be an effective antiviral against SARS-CoV-2?
A double-blind, randomized, placebo-controlled clinical trial conducted at the All India Institute of Medical Sciences, India, has recently demonstrated that Ivermectin, an anti-parasitic drug, can reduce in-hospital mortality rate of coronavirus disease 2019 (COVID-19) patients. The study is currently available on the medRxiv* preprint server.
Background
Since its emergence in December 2019 in China, highly infectious and deadly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, has already infected more than 86 million people and claimed more than 1.8 million lives globally. Because of the unavailability of specific therapeutics against SARS-CoV-2, the treatment of moderately or severely affected COVID-19 patients is mostly carried out by repurposed antiviral medicines, these have included hydroxychloroquine, lopinavir, interferon, and remdesivir. In addition, low dose steroids and convalescent plasma have been tried clinically to treat in-hospital patients with severe COVID-19. Except for reducing the symptom severity, most repurposed medicines have failed to significantly improve the COVID-19 outcomes and reduce the mortality rate.
Ivermectin is an anti-parasitic drug primarily used to treat onchocerciasis, lymphatic filariasis, strongyloidiasis, cutaneous larva migrans, and scabies. The drug is known to induce paralysis by activating ligand-gated chlorine channels in invertebrates. Moreover, the drug is known to exert antiviral activity against RNA viruses, probably by inhibiting the import of host and viral proteins to the nucleus. Regarding COVID-19 treatment, several observational studies, clinical trials, and in vitro studies have shown that ivermectin has the potential to be used as an antiviral medicine against SARS-CoV-2 infection.
Current study design
In the current clinical trial, the scientists studied the efficacy of ivermectin in treating mild and moderately affected COVID-19 patients.
A total of 112 adult COVID-19 patients were enrolled for the trial; of them, 55 were administered with 12 mg of ivermectin on days 1 and 2 of the hospital admission, whereas 57 were administered with a similar-looking placebo medicine. In addition, all patients received the standard of care treatment.
Specifically, the scientists compared the status of viral clearance on day 6 of admission between the ivermectin-treated and placebo-treated groups. In addition, they investigated whether there is any difference in symptom severity, duration of hospital stay, admission to intensive care unit (ICU), requirement for mechanical ventilation, and in-hospital mortality between the two groups.
Important observations
The study findings reveal that about 23% of patients receiving ivermectin and 31% of patients receiving placebo drug tested negative for SARS-CoV-2 via polymerase chain reaction (PCR) on day 6 of admission. This indicates that ivermectin is not effective in speeding up the viral clearance process. However, the scientists have mentioned that further studies are required to get a comprehensive information on viral clearance, because serial PCR tests have not been conducted in the current study. Moreover, conclusive PCR reports could not be achieved in 32% of patients.
In addition, no significant differences in symptomatic status, hospital discharge status, ICU admission, and need for mechanical ventilation have been observed between the ivermectin-treated and placebo-treated groups.
Although ivermectin fails to show any added benefit over the placebo medicine, no in-hospital mortality has been observed in the ivermectin-treated group; whereas, 4 patients in the placebo-treated group have died during their hospital stay. Taken together, these findings indicate that ivermectin has the potential to improve the in-hospital survival rate of patients with mild or moderate form of COVID-19.
In line with the current study findings, previous studies have shown that treatment of COVID-19 patients with ivermectin and doxycycline effectively reduces the in-hospital mortality rate.
*Important Notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
