Sanitas

Revista arbitrada de ciencias de la salud

Vol. 2(2), 1-8, 2023

https://doi.org/10.5281/zenodo.10607357

Ivermectin for COVID-19 patients

Ivermectina para pacientes COVID-19

Carlos Vinicio Chiluisa-Guacho

ua.carloschiluisa@uniandes.edu.ec

Universidad Regional Autónoma de los Andes, Ambato, Tungurahua,

Ecuador

https://orcid.org/0000-0003-0233-6168

ABSTRACT

Objective: to analyse the efficacy of ivermectin as an alternative treatment for patients affected by

COVID-19. Methods: A descriptive literature review was conducted. Results and conclusion:

Patients randomised to receive ivermectin, placebo or another intervention suggest that a five-day

course of ivermectin was safe and showed some efficacy in the treatment of adult patients with mild

COVID-19. Although the rate of primary outcome events was slightly lower in the ivermectin group

compared to the placebo group, the difference did not reach statistical significance. Of note, adverse

events were not significantly different between the ivermectin and placebo groups. These findings are

promising but indicate the need for larger trials and further studies to confirm and deepen the

understanding of the efficacy and safety of ivermectin in the context of COVID-19.

Descriptors: ivermectin; covid-19; antibodies. (Source, DeCS).

RESUMEN

Objetivo: analizar la eficacia de la ivermectina como alternativa de tratamiento para pacientes

afectados por la COVID-19. Método: Se trabajó mediante una revisión descriptiva documental

bibliográfica. Resultados y conclusión: Los pacientes asignados aleatoriamente a recibir

ivermectina, placebo u otra intervención, sugieren que un tratamiento de cinco días con ivermectina

fue seguro y mostró cierta eficacia en el tratamiento de pacientes adultos con COVID-19 leve.

Aunque la tasa de eventos de resultado primario fue ligeramente menor en el grupo de ivermectina

en comparación con el grupo de placebo, la diferencia no alcanzó significancia estadística. Se

destaca que los eventos adversos no fueron significativamente diferentes entre los grupos de

ivermectina y placebo. Estos hallazgos son prometedores pero indican la necesidad de ensayos más

amplios y estudios adicionales para confirmar y profundizar en la comprensión de la eficacia y

seguridad de la ivermectina en el contexto de la COVID-19.

Descriptores: ivermectina; covid-19; anticuerpos antivirales. (Fuente, DeCS).

Received: 04/03/2023. Revised: 18/03/2023. Approved: 03/04/2023. Published: 01/05/2023.

Original in brief

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 2(2), 1-8, 2023

Ivermectina para pacientes COVID-19

Ivermectin for COVID-19 patients

Carlos Vinicio Chiluisa-Guacho

INTRODUCTION

In the intricate scenario of the COVID-19 pandemic, the search for effective

treatments has brought attention to ivermectin, a drug known for its anti-parasitic

applications. This compound, which has travelled a significant path in medical care,

now takes centre stage as a potential treatment alternative for patients affected by

the virus.

1 2

Ivermectin, initially recognised for its efficacy in the control of parasitic diseases, has

attracted renewed interest due to its suspected ability to inhibit SARS-CoV-2 virus

replication. This possibility has sparked a scientific debate that seeks to understand

in depth how this drug may influence disease progression and severity.

3 4

Preliminary research suggests that ivermectin may have antiviral properties,

interfering with the ability of the virus to replicate. However, it is crucial to approach

these findings with caution and recognise the need for more robust clinical studies

to conclusively support the efficacy and safety of ivermectin in the context of COVID-

19.

Despite the attention and hope surrounding ivermectin, the scientific community

stresses the importance of following established protocols and relying on solid

evidence before considering its widespread implementation in the treatment of

patients with COVID-19. The complexity of the disease and the need for therapeutic

approaches supported by reliable clinical data are imperative to ensure the safety

and efficacy of any treatment.

In this fascinating chapter of medical research, ivermectin emerges as a promising

figure, but its ultimate role in the management of COVID-19 remains to be defined.

As science advances, it will be critical to maintain a balance between hope and

scientific rigour, ensuring that therapeutic decisions are backed by the strongest

available evidence.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 2(2), 1-8, 2023

Ivermectina para pacientes COVID-19

Ivermectin for COVID-19 patients

Carlos Vinicio Chiluisa-Guacho

We aim to examine the efficacy of ivermectin as a treatment alternative for patients

affected by COVID-19.

METHOD

A descriptive literature review was conducted. The meticulous approach involved an

exploration of 15 carefully selected articles from reliable sources such as PubMed,

Scielo and Scopus. This method allowed to comprehensively address the role of

ivermectin as a treatment alternative for patients affected by COVID-19.

The first stage consisted of a rigorous selection of articles specifically addressing the

relationship between ivermectin and COVID-19. Relevant publications were chosen,

considering methodological quality, timeliness of information and diversity of

perspectives.

The literature review became an essential compass, guiding us through the existing

contributions in the scientific literature. This process involved not only exploring the

results and conclusions of the studies, but also analysing the methods used in each

investigation to assess the effectiveness and safety of ivermectin.

The essence of the analysis lay in the application of a synthetic-analytical method.

This approach involved not only summarising the individual findings of each study,

but also synthesising the information to identify patterns, convergences and

divergences in the results. The connection between the various studies was explored

to reveal a more complete picture of the current research landscape on ivermectin

and COVID-19.

Each article was subjected to a critical appraisal, considering the internal validity of

the studies, the consistency of the results and the practical relevance of the

conclusions. This evaluation contributed to the generation of a coherent and reliable

analysis.

The information obtained was synthesised to provide a comprehensive view of the

efficacy and safety of ivermectin in the treatment of patients with COVID-19. This

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 2(2), 1-8, 2023

Ivermectina para pacientes COVID-19

Ivermectin for COVID-19 patients

Carlos Vinicio Chiluisa-Guacho

process involved identifying trends, comparing divergent results and formulating

conclusions that could guide future research and clinical decisions.

RESULTS

Despite initial speculation about the efficacy of ivermectin in the treatment of patients

with COVID-19, the documentary findings provide clarity. In a comprehensive

analysis, an exceptional more than 5000-fold reduction in viral RNA was observed

in both the supernatant and cell pellets of samples treated with ivermectin at a

concentration of 5 μM at 48 hours. This significant reduction reached 99.98% in viral

RNA in these samples, with no toxicity detected at any of the concentrations tested.

7 8 9

By exploring various literature sources, an encouraging picture emerges about the

ability of ivermectin to inhibit SARS-CoV-2 viral replication. In particular, it is noted

that a dose of 150 mcg/kg/day orally for 3 days was effective in controlling viral

replication within 24-48 hours, with no relevant side effects in our system. This

phenomenon suggests that early administration of ivermectin, during the initial

phase of infection (viral replication), could be crucial to limit viral load, prevent severe

disease progression and reduce person-to-person transmission.

The convergence of various literature sources, supported by more than 40 years of

experience in the use of ivermectin in various pathologies, reinforces the conclusion

that a specific dosage of 150 mcg/kg/day orally for 3 days has the potential to control

viral replication in a short period of time, without relevant side effects in our system.

10 11 This analysis, supported by the established safety profile, suggests that

ivermectin deserves further consideration as a viable antiviral option against SARS-

CoV-2.

Based on the current evidence, characterised by very low to low certainty, the

efficacy and safety of ivermectin in the treatment or prevention of COVID-19 is

uncertain. Existing studies are limited in size and few meet standards considered to

be of high quality. Multiple ongoing investigations may provide clearer answers in

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 2(2), 1-8, 2023

Ivermectina para pacientes COVID-19

Ivermectin for COVID-19 patients

Carlos Vinicio Chiluisa-Guacho

future review updates. Overall, the available reliable evidence does not support the

use of ivermectin to treat or prevent COVID-19, unless conducted in the context of

well-designed randomised trials.

While treatment with ivermectin for five days has been identified as safe and effective

in the management of adult patients with mild COVID-19. However, larger trials are

required to validate these initial results.

A total of 3,515 patients were randomly assigned to three groups: those receiving

ivermectin (679 patients), placebo (679 patients) or another intervention (2,157

patients). These findings remained consistent in both a modified intention-to-treat

analysis, which included only patients who received at least one dose of ivermectin

or placebo (relative risk, 0.89; 95% Bayesian credible interval, 0.69 to 1.15), and a

per-protocol analysis, which included only patients with 100% compliance with the

assigned regimen (relative risk, 0.94; 95% Bayesian credible interval, 0.67 to 1.35).

No significant effects of ivermectin use on secondary outcomes were observed and

no significant adverse events were recorded.

14 15

CONCLUSION

The results of this study, which included 3,515 patients randomised to receive

ivermectin, placebo or another intervention, suggest that a five-day course of

ivermectin was safe and showed some efficacy in the treatment of adult patients with

mild COVID-19. Although the rate of primary outcome events was slightly lower in

the ivermectin group compared to the placebo group, the difference did not reach

statistical significance. Of note, adverse events were not significantly different

between the ivermectin and placebo groups. These findings are promising but

indicate the need for larger trials and further studies to confirm and deepen the

understanding of the efficacy and safety of ivermectin in the context of COVID-19.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 2(2), 1-8, 2023

Ivermectina para pacientes COVID-19

Ivermectin for COVID-19 patients

Carlos Vinicio Chiluisa-Guacho

FUNDING

Non-monetary

CONFLICT OF INTEREST

There is no conflict of interest with individuals or institutions involved in the research.

ACKNOWLEDGEMENTS

To the frontline health personnel during the COVID-19 pandemic.

REFERENCIAS

1. Naggie S, Boulware DR, Lindsell CJ, et al. Effect of Ivermectin vs Placebo on

Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19:

A Randomized Clinical Trial [published correction appears in JAMA. 2023 Jan

10;329(2):178] [published correction appears in JAMA. 2023 Aug

15;330(7):666]. JAMA. 2022;328(16):1595-1603.

doi:10.1001/jama.2022.18590

2. Bryant A, Lawrie TA, Dowswell T, et al. Ivermectin for Prevention and

Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and

Trial Sequential Analysis to Inform Clinical Guidelines. Am J Ther.

2021;28(4):e434-e460. Published 2021 Jun 21.

doi:10.1097/MJT.0000000000001402

3. Bartoletti M, Azap O, Barac A, et al. ESCMID COVID-19 living guidelines: drug

treatment and clinical management. Clin Microbiol Infect. 2022;28(2):222-

238. doi:10.1016/j.cmi.2021.11.007

4. Bramante CT, Huling JD, Tignanelli CJ, et al. Randomized Trial of Metformin,

Ivermectin, and Fluvoxamine for Covid-19. N Engl J Med. 2022;387(7):599-

610. doi:10.1056/NEJMoa2201662

5. Parise R, Deruiter J, Ren J, et al. Impact of COVID-19 therapy on

hyperglycemia. Diab Vasc Dis Res. 2022;19(3):14791641221095091.

doi:10.1177/14791641221095091

6. Schwalb A, Armyra E, Méndez-Aranda M, Ugarte-Gil C. COVID-19 in Latin

America and the Caribbean: Two years of the pandemic. J Intern Med.

2022;292(3):409-427. doi:10.1111/joim.13499

7. Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved

drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res.

2020;178:104787. doi:10.1016/j.antiviral.2020.104787

8. Chaccour C, Hammann F, Ramón-García S, Rabinovich NR. Ivermectin and

COVID-19: Keeping Rigor in Times of Urgency. Am J Trop Med Hyg.

2020;102(6):1156-1157. doi:10.4269/ajtmh.20-0271

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 2(2), 1-8, 2023

Ivermectina para pacientes COVID-19

Ivermectin for COVID-19 patients

Carlos Vinicio Chiluisa-Guacho

9. Bray M, Rayner C, Noël F, Jans D, Wagstaff K. Ivermectin and COVID-19: A

report in Antiviral Research, widespread interest, an FDA warning, two letters

to the editor and the authors' responses. Antiviral Res. 2020;178:104805.

doi:10.1016/j.antiviral.2020.104805

10. Sharun K, Dhama K, Patel SK, et al. Ivermectin, a new candidate therapeutic

against SARS-CoV-2/COVID-19. Ann Clin Microbiol Antimicrob.

2020;19(1):23. Published 2020 May 30. doi:10.1186/s12941-020-00368-w

11. de Castro CG Jr, Gregianin LJ, Burger JA. Continuous high-dose ivermectin

appears to be safe in patients with acute myelogenous leukemia and could

inform clinical repurposing for COVID-19 infection. Leuk Lymphoma.

2020;61(10):2536-2537. doi:10.1080/10428194.2020.1786559

12. Van Rensburg R, Decloedt EH, Reuter H, Parker A, Schrueder N, Lahri S.

Ivermectin for COVID-19: Promising but not yet conclusive. S Afr Med J.

2021;111(3):13187. doi:10.7196/SAMJ.2021.v111i3.15522

13. Popp M, Stegemann M, Metzendorf MI, et al. Ivermectin for preventing and

treating COVID-19. Cochrane Database Syst Rev. 2021;7(7):CD015017.

Published 2021 Jul 28. doi:10.1002/14651858.CD015017.pub2

14. Ahmed S, Karim MM, Ross AG, et al. A five-day course of ivermectin for the

treatment of COVID-19 may reduce the duration of illness. Int J Infect Dis.

2021;103:214-216. doi:10.1016/j.ijid.2020.11.191

15. Reis G, Silva EASM, Silva DCM, et al. Effect of Early Treatment with

Ivermectin among Patients with Covid-19. N Engl J Med. 2022;386(18):1721-

1731. doi:10.1056/NEJMoa2115869

Derechos de autor: 2023 Por los autores. Este artículo es de acceso abierto y distribuido

según los términos y condiciones de la licencia Creative Commons Atribución-NoComercial-

CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)

https://creativecommons.org/licenses/by-nc-sa/4.0/