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Ivermectin - A useful treatment for COVID-19 coronavirus? Some discussion and studies...

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  • #16
    NIH

    Ivermectin



    Last Updated: February 11, 2021

    Ivermectin is a Food and Drug Administration (FDA)-approved antiparasitic drug that is used to treat several neglected tropical diseases, including onchocerciasis, helminthiases, and scabies.1 It is also being evaluated for its potential to reduce the rate of malaria transmission by killing mosquitoes that feed on treated humans and livestock.2 For these indications, ivermectin has been widely used and is generally well tolerated.1,3 Ivermectin is not approved by the FDA for the treatment of any viral infection.

    Proposed Mechanism of Action and Rationale for Use in Patients With COVID-19

    Reports from in vitro studies suggest that ivermectin acts by inhibiting the host importin alpha/beta-1 nuclear transport proteins, which are part of a key intracellular transport process that viruses hijack to enhance infection by suppressing the host’s antiviral response.4,5 In addition, ivermectin docking may interfere with the attachment of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein to the human cell membrane.6 Ivermectin is thought to be a host-directed agent, which may be the basis for its broad-spectrum activity in vitro against the viruses that cause dengue, Zika, HIV, and yellow fever.4,7-9 Despite this in vitro activity, no clinical trials have reported a clinical benefit for ivermectin in patients with these viruses. Some studies of ivermectin have also reported potential anti-inflammatory properties, which have been postulated to be beneficial in people with COVID-19.10-12

    Some observational cohorts and clinical trials have evaluated the use of ivermectin for the prevention and treatment of COVID-19. Data from some of these studies can be found in Table 2c.

    Recommendation
    • There are insufficient data for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19.

    READ MORE
    COVID-19 treatment and research information from the US federal government.
    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

    Comment


    • #17
      I noticed some posters on a cancer forum were getting prescriptions for Ivermectin to have on hand. Even if they are getting vaccinated, they are worried about strains that might escape the vaccine. They felt like this drug would be safer than HCQ and probably more effective, but were worred about politics getting this one blacklisted, too.
      _____________________________________________

      Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

      i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

      "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

      (My posts are not intended as advice or professional assessments of any kind.)
      Never forget Excalibur.

      Comment


      • Vibrant62
        Vibrant62 commented
        Editing a comment
        one would hope that the penny is dropping that the vaccines are not 'THE answer' but part of a broad spectrum approach that is necessary to combat Covid. The time for politics and vested interests to dominate is well past IMHO. I hope the media starts asking the right questions such as, 'why haven't the necessary trials to verify ivermectin's usefulness been executed and reported on by now?' and 'why isn't the data currently available sufficient to allow more widespread use?' There are some fairly substantial RCTs published.

    • #18
      Some South African medics are going to court to seek permission to prescribe Ivermectin to Covid patients.


      The drug Ivermectin, which has been touted by some as an effective coronavirus treatment even though it is clinically unproven, is at the centre of a legal battle in South Africa as some medics want it licensed for human use, as Pumza Fihlani reports.

      Many South Africans are desperate for something that could ease the impact of a predicted third wave of coronavirus infections.

      With a vaccination programme that has not yet covered all the most vulnerable, there are concerns that the continent's worst-hit country could suffer more as the temperature cools down with the approaching winter.
      "The only security we have is our ability to adapt."

      Comment


      • #19
        If you are interested in Ivermectin I would recommend listening to https://www.microbe.tv/twiv/twiv-599/ the problem is with it is dosage. Tests finding efficacy were based on concentrations over 1000 times above those on which the FDA authorisation as an anti-parasitc are based. When tested at the allowable concentrations it had no effect. Also it was found to have killed some dogs which had a particular mutation in their genome despite there not having problems otherwise. If a similar mutation is found in some humans it may end up killing them too at the dosage levels that would be needed to be of any use.

        Comment


        • #20
          C'est le premier m?dicament qui en v?t?rinaire a montr? chez le chien, les bovins, les tortues qu'avec certaines particularit?s g?n?tiques, cela pouvait tuer. Le rapport b?n?fice risque a fait son usage en v?t?rinaire. Je ne pense pas que la dose soit importante, puisque ces particularit?s permettent le passage de la barri?re h?mato-m?nig?e, ou non . Cela concerne des anti-canc?reux aussi , il me semble .

          Cette audio montre que des personnes peuvent communiquer avec courtoisie . Vu les publications d?j? sur ce sujet et les usages fait en grand en Inde

          :


          10 avril 2020 La FDA ordonne de ne pas utiliser l'ivermectine dans le traitement du Covid-19. [ 61 ] ?

          Le 6 mai 2020, le minist?re p?ruvien de la Sant? a approuv? l'utilisation de l'ivermectine dans le traitement du Covid-19.
          [72] Le

          12 mai 2020, le minist?re bolivien de la Sant? a ?mis une approbation similaire.

          https://bn.wikipedia.org/wiki/%E0%A6...A6%BF%E0%A6%A8


          On ne peut donc qu??tre surpris de la position du laboratoire Merck alors que des chercheurs ind?pendants, des pays ont d?ores et d?j? donn? une approbation ? l?usage de l?ivermectine et l?inde a vu sa courbe de mortalit? fortement baisser depuis le d?but de l?utilisation de cette mol?cule en 2020.

          Dans un communiqué de presse paru ce 4 février 2021, le géant pharmaceutique Merck, qui a annoncé plus tôt dans la semaine arrêter son vaccin contre la Covid, fait une déclaration sur l’utilisation de l’ivermectine comme traitement contre la Covid-19.


          C'est donc un dossier qui permet d'entrevoir que les d?cisions locales sont diverses... De plus, lorsque l'on admet que cet "ange mal?fique" ne provoque de vrais probl?mes que pour une infime partie de la population et vu la non description correcte des populations test?es , il est possible que l'?pid?miologie descriptive soit plus pertinente , que la fondamentale .

          Pour ?clairer , ce dernier point , je souhaiterai que les personnes dans cette vid?o expliquent les pourquoi des r?sultats des chinois?

          Les publications mises en ligne, en ce lieu, chinoises, n'ont jamais d?crit les traitements de m?decine chinoise , lors des publications sur des traitements potentiels. C'est de la science ?

          Dit, en clair, sur des populations , avec des parasites, connus comme sensible , ? cette mol?cule , son usage ne peut-il changer la donne vis ? vis de la covid ?





          Comment


          • bertrand789
            bertrand789 commented
            Editing a comment
            j'accepte ces propos. Pour moi , nous ne sommes d?finitivement pas face ? une ?pid?mie , mais une synd?mie . Il me semble que la position de ceux qui veulent aborder une synd?mie avec des mol?cules class?es comme m?dicament et pour lesquels le fabricant indique que m?me ? 10 fois la dose ne sont pas dangereuses, peuvent ?tre en usage dans x populations choisies pour cela .

            Dans ce dossier , on ne connait pas le taux de vitamine D des populations, on sait quel est le parasitisme en x lieux ?

            C'est la quatri?me critique que je fais ? l'encontre de Monsieur : ne pas avoir incit? l'O.M.S ? d?crire d'une mani?re ?pid?miologique et scientifique a tu? et va tuer ...

            Nommer correctement , c'est pour moi, le premier des traitements ...

          • Emily
            Emily commented
            Editing a comment
            If it is helping COVID patients, (I have no opinion on this), maybe it acts as an immune modulator somehow. I hope they don't do a toxic trial like someone did for HCQ. I think that one was a mistake in dosing, rather than a highest possible dose test. They should also do the trial in a region where doctors are claiming it works. Could be regional exposures to other pathogens priming the locals' immune systems. It might work in one place, an area in need of a cheap medicine, but be of no value elsewhere.

          • bertrand789
            bertrand789 commented
            Editing a comment
            Emily , je suis d'accord. Si l'on admet que nous sommes face ? une synd?mie, il a ?t? d?montr? que les ?pid?miologistes n'ont pas ?t? bon, mais les autres l'ont ?t? aussi?

            Le pr?alable c'est , nous sommes face ? une synd?mie , ensuite en chaque lieu, on fait en fonction du su ( vitamine, parasite , etc )

        • #21
          A very interesting discussion was held between Dr Jon Campbell and Dr. Pierre Kory on Ivermectin.

          See https://www.youtube.com/watch?v=19DPijOoVKE

          Part 1 is also worth listening to.

          Dr. Kory has been a mainstream part of the medical science establishment for years with a large number of peer reviewed studies to his name, and he raises some very interesting (but concerning) points at the end of this interview that are worth discussion. He states he has become cynical in the last year, but if what he says is correct, then our regulatory and science funding system (especially during an emergency) is very broken and needs urgently reforming to allow space for cheap interventions as well as the massive investments needed under Emergency Use Authorisations, especially when so many lives are at stake.

          Expert review report on Ivermectin safety can be downloaded here https://www.medincell.com/ivermectin

          Ivermectin pre-print review can be found here:
          Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19


          YouTube have taken down his webinar medical lecture (for medics) on the grounds it violates their terms of service. I watched this before it was taken down and it was pure science and data analysis. This stinks. Something is really very wrong here, and we all should be really very concerned indeed. The science MUST be allowed to speak for itself, especially as we see things unfold in India (and likely other places).

          Comment


          • #22
            bump this

            Comment


            • #23
              Further discussion of forthcoming meta-analysis paper on Ivermectin by Dr Tess Lawrie here with Dr John Campbell, and worth listening to.


              I believe that this research gate publication contains some of the data they are referring to but I am uncertain that it is the full paper, as in the above interview (7th April) Dr Lawrie says that it has not yet been published but will be shortly, so it may be that this was an early analysis.



              Comment


              • #24
                Tetano posted this. Treatment was HCQ, but it shows that doctors in Iran have more freedom than US doctors have.

                https://flutrackers.com/forum/forum/...-a-case-report
                We report a case of COVID-19 infection in a middle aged Iranian man without underlying disease who presented with bizarre behavior. Results of brain imaging were normal, but COVID-19 pneumonia was detected on chest computed tomography scan. Given the respiratory problem and positive polymerase chain reaction (PCR) test for COVID-19, treatment with hydroxychloroquine was administered, and after 2 days all of the symptoms resolved.
                _____________________________________________

                Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

                i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

                "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

                (My posts are not intended as advice or professional assessments of any kind.)
                Never forget Excalibur.

                Comment


                • Vibrant62
                  Vibrant62 commented
                  Editing a comment
                  Indeed - and this is why all the RCTs on ivermectin for example have been coming out of countries that are not in the West, and where its use has been permitted. In general, HCQ has been found to have potent activity against the ACE2 cellular method of entry, but does not have means of blocking viral entry via TMPRSS2 - which partially explains the mixed results from studies into this compound. Used alone its unlikely to be that effective as an antiviral as SARS Cov 2 simply switches to the other method/s of cellular entry. The situation may be different when used as part of a combination of drugs, especially if other drugs target the TMPRSS2 pathway. The situation with ivermectin is very different.

              • #25
                I hope the hospital is sued for any damages the patient suffered while they ignored the court order.


                COVID-19 patient shows 'improvement' after receiving ivermectin following legal battle with hospital

                By Anthony Ponce
                Published 1 day ago
                Coronavirus in Chicago
                FOX 32 Chicago
                COVID-19 patient shows ?improvement? after receiving ivermectin following court order

                After a short but tense legal battle, Edward-Elmhurst Hospital has agreed to allow an outside doctor to administer ivermectin to one of its COVID-19 patients.
                ELMHURST - After a short but tense legal battle, Edward-Elmhurst Hospital has agreed to allow an outside doctor to administer ivermectin to one of its COVID-19 patients.

                "She looks calm, relaxed, she looks comfortable, so this is all I can tell right now," said Desi Fype, who has been fighting for her mother, 68-year-old Nurije Fype, to receive ivermectin -- an anti-parasitic drug which has not been FDA-approved to treat COVID.

                Since Nurije was placed on a ventilator April 28th, and with her condition not improving, Desi has been fighting for Edward-Elmhurst Hospital to allow the drug to be used.

                "At the point of me having nothing else to lose, and seeing that no other treatment in the hospital was making her any better, I wanted to try something different. Why not try to save her life instead of seeing her decline?" Desi said.

                While ivermectin isn't FDA-approved, some doctors say it's proved to be effective against COVID. Despite a judge's orders, the hospital had been refusing to administer the drug until Monday night, when it agreed to let an outside doctor give Nurije her first dose....
                _____________________________________________

                Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

                i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

                "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

                (My posts are not intended as advice or professional assessments of any kind.)
                Never forget Excalibur.

                Comment


                • #26
                  A study from AIIMS - a very established research authority in India (and used by big Pharma frequently to conduct studies) has looked at ivermectin prophylaxis in healthcare workers. I dont think anyone is proposing that ivermectin could replace vaccines - it can't, but used alongside vaccines as an adjunctive therapy for high risk individuals and in areas with variants of concern could be a good idea?

                  The study is pre-print but can be found here https://www.researchsquare.com/article/rs-208785/v1

                  Study conclusion:
                  Conclusion and relevance Two-doses of oral ivermectin (300 ?g/kg given 72 hours apart) as chemoprophylaxis among HCWs reduces the risk of COVID-19 infection by 83% in the following month. Safe, effective, and low-cost chemoprophylaxis have relevance in the containment of pandemic alongside vaccine.
                  More on AIIMS here https://www.aiims.edu/en.html

                  Comment


                  • #27
                    Here is an interesting podcast from Dark Horse titled Vaccine "Emergency Use Authorization" & ivermectin. Clip with scientists and evolutional biologists Bret Weinstein and Heather Heying.



                    They discuss the efficacy of Ivermectin and the suppression of effective treatments which would have jeopardize the emergency use authorization for the vaccines. They raise some very interesting issues.


                    References: FDA’s Emergency Use Authorization Guidelines: https://www.fda.gov/media/97321/download Bannister, A. 2021. Don’t mention Ivermectin; it’ll upset the vaccine rollout. BizNews, May 12, 2021: https://www.biznews.com/thought-leade... Merck Statement on Ivermectin use During the COVID-19 Pandemic, February 4, 2021: https://www.merck.com/news/merck-stat... No evidence ivermectin is a miracle drug against COVID-19 – fact-checking by the AP on December 11, 2020: https://apnews.com/article/fact-check... Dr. Pierre Kory testifies before the Senate, December 15, 2020: https://www.youtube.com/watch?v=28YV8... Clip taken from DarkHorse Podcast Livestream #80 (originally streamed live on May 15, 2021): https://youtu.be/vxTODvTNHlw Q&A: https://youtu.be/N9ZXBsSkYLE


                    Comment


                    • #28
                      Source: https://journals.lww.com/americanthe...ing_the.4.aspx



                      Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19

                      Kory, Pierre MD1,*; Meduri, Gianfranco Umberto MD2; Varon, Joseph MD3; Iglesias, Jose DO4; Marik, Paul E. MD5
                      Author Information
                      American Journal of Therapeutics: May/June 2021 - Volume 28 - Issue 3 - p e299-e318

                      doi: 10.1097/MJT.0000000000001377


                      Abstract


                      Background:

                      After COVID-19 emerged on U.S shores, providers began reviewing the emerging basic science, translational, and clinical data to identify potentially effective treatment options. In addition, a multitude of both novel and repurposed therapeutic agents were used empirically and studied within clinical trials.
                      Areas of Uncertainty:

                      The majority of trialed agents have failed to provide reproducible, definitive proof of efficacy in reducing the mortality of COVID-19 with the exception of corticosteroids in moderate to severe disease. Recently, evidence has emerged that the oral antiparasitic agent ivermectin exhibits numerous antiviral and anti-inflammatory mechanisms with trial results reporting significant outcome benefits. Given some have not passed peer review, several expert groups including Unitaid/World Health Organization have undertaken a systematic global effort to contact all active trial investigators to rapidly gather the data needed to grade and perform meta-analyses.

                      Data Sources:

                      Data were sourced from published peer-reviewed studies, manuscripts posted to preprint servers, expert meta-analyses, and numerous epidemiological analyses of regions with ivermectin distribution campaigns.

                      Therapeutic Advances:

                      A large majority of randomized and observational controlled trials of ivermectin are reporting repeated, large magnitude improvements in clinical outcomes. Numerous prophylaxis trials demonstrate that regular ivermectin use leads to large reductions in transmission. Multiple, large “natural experiments” occurred in regions that initiated “ivermectin distribution” campaigns followed by tight, reproducible, temporally associated decreases in case counts and case fatality rates compared with nearby regions without such campaigns.

                      Conclusions:

                      Meta-analyses based on 18 randomized controlled treatment trials of ivermectin in COVID-19 have found large, statistically significant reductions in mortality, time to clinical recovery, and time to viral clearance. Furthermore, results from numerous controlled prophylaxis trials report significantly reduced risks of contracting COVID-19 with the regular use of ivermectin. Finally, the many examples of ivermectin distribution campaigns leading to rapid population-wide decreases in morbidity and mortality indicate that an oral agent effective in all phases of COVID-19 has been identified.



                      Comment


                      • #29
                        On this very special live broadcast of the DarkHorse podcast, Dr. Bret Weinstein (Ph.D) and Dr. Pierre Kory (M.D.) will discuss the ongoing pandemic, the care of COVID-19 patients, and the incredible story of Ivermectin: https://www.youtube.com/watch?v=Tn_b4NRTB6k

                        Comment


                        • GardenSpider
                          GardenSpider commented
                          Editing a comment
                          Dark Horse also discussed the censorship of this site by Big Tech. https://www.youtube.com/watch?v=COyQVUhtMDQ
                          due to its advocacy for Ivermectin.

                          Front Line COVID-19 Critical Care Alliance
                          Prevention & Treatment Protocols for COVID-19. See treatment protocols for hospital, home care, as well as prevention. There is also a section on recent studies and clinical trials.

                          Keep the insights and the conversation going Connect without fear of censorship in FLCCC FORUMS! Anyone can register in the PUBLIC Forum. Start today! Join the new FLCCC Forums FLCCC CANCER STUDY We are proud to announce our observational cancer study aimed at learning more about the power of


                          Recent studies and clinical trials on ivermectin

                          Favorable outcome on viral load and culture viability using Ivermectin in early treatment of non-hospitalized patients with mild COVID-19 – A double-blind, randomized placebo-controlled trial can be found at the following link: https://www.medrxiv.org/content/10.1....31.21258081v1

                          For an up-to-date overview of all published studies on ivermectin in the treatment and prevention of COVID-19 we recommend visiting c19ivermectin.com; in addition, a meta-analysis of all studies can be found at ivmmeta.com (constantly updated).

                          A majority of the studies (until January 12, 2021) were included in our comprehensive Review of the Emerging Evidence Supporting the Use of Ivermectin in the Prophylaxis and Treatment of COVID-19, and a brief summary of the studies at that time can be found in the accompanying One-page summary of the scientific review on ivermectin.

                        • Shiloh
                          Shiloh commented
                          Editing a comment
                          The discussion between Dr. Weinstein and Dr Kory has been censored by Youtube. To view the discussion go to: https://www.bitchute.com/video/qHjNQIynVb5O/

                        • Vibrant62
                          Vibrant62 commented
                          Editing a comment
                          The censorship going on is horrifying. Since when is it OK to censor discussion of science, even if one does not agree with the viewpoints or interpretations of the data expressed? The science should be followed to wherever it leads - surely that is THE founding principle of science and especially in the field of medical science.

                          Youtube also have removed another very interesting DarkHorse discussion (even if one of the panel is highly irritating IMHO, but passionate and has been funding trials) that needs airing. Its long, but for those interested discusses the problems that repurposed drugs have getting authorised or used in the US (I think the same problems exist everywhere however) as well as covering some of the genuine concerns and issues with current Covid vaccines.

                          Dr. Robert Malone is the inventor of mRNA Vaccine technology.
                          Mr. Steve Kirsch is a serial entrepreneur who has been researching adverse reactions to COVID vaccines and funding trial work into repurposed drugs in an effort to get these used to counter this pandemic..

                          A back up of the interview can be found here https://www.bitchute.com/video/TH2HAmTp40xq/

                          This censorship goes way beyond YouTube, and it is terrifying. It is also censorship of science itself and the universal burying of interventions that are low cost or off patent that could help people in third world countries as well as the developed world. This is allowing people to die who do not need to.

                          I am not sure what can be done about it, but the issues go way beyond the pandemic and the current crisis; it seems to me that the pandemic is being perpetuated unnecessarily, at great cost to individuals, countries and society as a whole.

                          There is also a real and serious risk that SARS-Cov-2 could recombine in either non-human hosts, or even in humans e.g. MERS and/or the host of other coronaviruses that exist in companion and farmed livestock. We (as in the world and society) cannot afford to have this situation continue, where viable 'adjunctive' treatments are being buried DESPITE Gold Standard meta-analyses and RCTs showing clear benefits. No pharmaceutical company will ever support these drugs UNLESS they are in patent. They will not fund the necessary trial work. The WHO should be taking the lead here funded by governments, but it seems our health institutions - both national and global - are terminally sick and irreversibly bound to the Pharma sector and their interests.

                          It also should be noted that no country - not even those in the developed western world - can possibly afford to solely use 'new' and highly expensive drugs to treat all the manifestations of long covid, or covid itself if and when escape variants or novel viruses arise. Vaccination is 'a' tool in the armoury, and for those at risk, the risks outweigh the benefits in my opinion - but it cannot be the 'one size fits all' panacea. We need to throw everything at the problem of Covid and Long Covid. Vaccination alone wont work, as the evolution of novel variants on a near daily basis shows. And the risk (and probability) of further novel evolutions with high mortality and morbidity are very high. We also know that vaccination does not necessarily protect against infection; we also know that even mild or asymptomatic infection can lead to Long Covid, and that this arises in between 10-30% of those infected, and predominantly occurs in younger (economically active) age groups. In other words, vaccination probably does not protect people from development of long covid. What country can afford to lose that amount of economically active adults - possibly permanently? Never mind the treatment costs - no country's healthcare system can possibly cope with the sheer numbers of long covid sufferers that have already been generated, and we still do not understand wholly what is occurring here, much less what on earth we can do about it.

                          I really hope and pray that the media start asking the right questions of the powers that be, and that Governments' and national health organisations - the CDC, the WHO, the European equivalents etc etc start looking beyond the immediate strategy and face up to the clear issues we have going forward. The Pharma sector is already doing very well out of this, and will continue to do so, even with the addition of repurposed drugs such as Ivermectin.

                      • #30
                        Am. J of Therapeutics - Ivermectin for Prevention and Treatment of COVID-19 Infection: a Systematic Review and Meta-analysis

                        https://assets.researchsquare.com/fi...6cc8f79d54.pdf

                        Abstract

                        Background
                        Re-purposed medicines may have role in combating the SARS-CoV-2 virus. The antiparasitic medicine ivermectin, which has anti-viral and anti-inammatory properties, has been tested in numerous clinical trials with promising results.

                        Methods
                        We assessed the ecacy of ivermectin treatment and/or prophylaxis among people with, or at high risk of covid-19 infection. We searched bibliographic databases up to February 2021 and two review authors sifted for studies, extracted data and assessed risk of bias. Meta-analyses were conducted and certainty of the evidence was assessed using GRADE approach.

                        Findings
                        Twenty-one RCTs involving 2741 participants met review inclusion. Meta-analysis of 13 trials found ivermectin reduced risk of death compared with no ivermectin (average Risk Ratio 0.32, 95% condence interval (CI) 0.14 to 0.72; n=1892; I2=57%; low to moderate-certainty evidence. Low-certainty evidence found ivermectin prophylaxis reduced covid-19 infection by an average 86% (95% CI 79% to 91%). Secondary outcomes provided very-low or low certainty evidence. Low certainty evidence suggests that that there may be no benet with ivermectin for ‘need for mechanical ventilation’, whereas effect estimates for ‘improvement’ and ‘deterioration’ favoured ivermectin use. Severe adverse events were rare and evidence of no difference was assessed as low to very lowcertainty. Evidence on other secondary outcomes was very low certainty.

                        Interpretation
                        Low to moderate-certainty evidence suggests reductions in covid-19 deaths and infections may be possible by using ivermectin. Employing ivermectin early on may reduce the number of people progressing to severe disease. The apparent safety and low cost suggest that ivermectin could have an impact on the SARS-CoV-2 pandemic globally.
                        ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                        Richard Horton, Editor-in-Chief The Lancet

                        ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                        Comment

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