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Ivermectin for Mild-to-Moderate COVID-19 in Ambulatory Patients

Among 1,591 ambulatory patients with mild-to-moderate COVID-19, the antiparasitic drug ivermectin had no effect on time to recovery, the randomized, placebo-controlled Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV-6) study shows. The results support the findings of the TOGETHER trial from Brazil, which also used randomization of ambulatory patients with symptomatic mild-to-moderate COVID-19 and found no clinical benefit based on disease progression.

Participants were aged 30 years or older, had confirmed COVID-19, and were experiencing 2 or more symptoms of acute infection for 7 days or less. Three days of double-blind placebo or ivermectin 40 mcg/kg produced these effects on time to sustained recovery (3 consecutive days without symptoms): “The hazard ratio (HR) for improvement in time to recovery was 1.07 (95% credible interval [CrI], 0.96-1.17; posterior P value [HR >1] = .91). 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. There were 10 hospitalizations or deaths in the ivermectin group and 9 in the placebo group (1.2% vs 1.2%; HR, 1.1 [95% CrI, 0.4-2.6]). The most common serious adverse events were COVID-19 pneumonia (ivermectin [n = 5]; placebo [n = 7]) and venous thromboembolism (ivermectin [n = 1]; placebo [n = 5]).”

“Although there are numerous published studies reporting on the potential efficacy of ivermectin for the treatment of COVID-19, many are in the inpatient setting and the majority are small, variable in population and dosing, and some have been retracted,” the authors write. “In the outpatient setting, larger well-designed trials such as the current trial are emerging and do not support a clinical benefit of ivermectin when used at a dose of 400 μg/kg daily for 3 days.”

Visual abstract available.

Source: JAMA