Use of Ivermectin, a broad-spectrum anti-parasitic agent, included in WHO essential medicines list for several parasitic diseases has already fuelled debate over its efficacy in the management of covid-19
Following Goa government’s prescription of ivermectin to all persons above 18 years of age as a prophylactic treatment of covid-19, the World Health Organization (WHO) waved out a caution flag against the drug.
“Safety and efficacy are important when using any drug for a new indication. @WHO recommends against the use of ivermectin for #COVID19 except within clinical trials," Soumya Swaminathan, Chief Scientist at WHO tweeted.
Use of Ivermectin, a broad-spectrum anti-parasitic agent, included in WHO essential medicines list for several parasitic diseases has already fuelled debate over its efficacy in the management of covid-19. Ivermectin is used in the treatment of onchocerciasis (river blindness), strongyloidiasis and other diseases caused by soil-transmitted helminthiasis. It is also used to treat scabies.
The WHO earlier in March had said that the current evidence on the use of ivermectin to treat covid-19 patients is inconclusive. Until more data is available, WHO recommended that the drug only be used within clinical trials. The U.S. Food and Drug Administration (FDA) has also recommended it not be used for covid-19.
Even as the WHO has been cautioning against the drug, the union health ministry in its revised guidelines on home isolation has recommended Ivermectin in cases of mild or asymptomatic infection, in case of a fever not settling with paracetamol. “Consider Tab Ivermectin (200 mcg/kg once a day, to be taken empty stomach) for 3 to 5 days", the revised guidelines of the union health ministry state.
Merck, an Ivermectin manufacturer in the US, also in February came out with a statement on the use of drug during the pandemic saying that Company scientists continue to carefully examine the findings of all available and emerging studies of ivermectin for the treatment of covid-19 for evidence of efficacy and safety. “It is important to note that, to-date, our analysis has identified--no scientific basis for a potential therapeutic effect against covid-19 from pre-clinical studies; no meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and; a concerning lack of safety data in the majority of studies," the company said in a statement.
Several public health experts too are against the usage of the drug. “There is apparently no role of Ivermectin in management of covid-19. Both should be removed from all guidelines till robust evidence is generated. Ivermectin maker (Merck) and WHO both have strongly advised against it. It can be individually or universally given for scabies, O. volvulus, strongyloidiasis and filariasis," said Dr Anoop Misra, chairman, Fortis-C-DOC.
In a stark contrast of the voices against Ivermectin, a latest peer-reviewed research published last week has said that immediate global ivermectin use will end the covid-19 pandemic. Peer reviewed by medical experts that included three U.S. government senior scientists and published in the American Journal of Therapeutics, the research is a comprehensive review of the available data taken from clinical, in vitro, animal, and real-world studies.
Led by the Front Line covid-19 Critical Care Alliance (FLCCC), a group of medical and scientific experts reviewed published peer-reviewed studies, manuscripts, expert meta-analyses, and epidemiological analyses of regions with ivermectin distribution efforts all showing that ivermectin is an effective prophylaxis and treatment for covid-19.
"We applied the gold standard to qualify the data reviewed before concluding that ivermectin can end this pandemic," said Pierre Kory, president and chief medical officer of the FLCCC. A focus of the manuscript was on the 27 controlled trials available in January 2021, 15 of which were randomized controlled trials (RCT's), the preferred trial of the WHO, U.S. National Institutes of Health, and the European Medicines Agency. Consistent with numerous meta-analyses of ivermectin RCT's since published by expert panels from the UK, Italy, Spain, and Japan, they found large, statistically significant reduction in mortality, time to recovery and viral clearance in covid-19 patients treated with ivermectin.
To evaluate the efficacy of ivermectin in preventing covid-19, 3 RCT's and 5 observational controlled trial's including almost 2,500 patients all reported that ivermectin significantly reduces the risk of contracting covid-19 when used regularly, the scientists said.
South Africa, Zimbabwe, Slovakia, Czech Republic, Mexico, and now, India, have approved the drug for use by medical professionals. “The results as seen in this latest study demonstrate that the ivermectin distribution campaigns repeatedly led to "rapid population-wide decreases in morbidity and mortality," the scientists said.
"Our latest research shows, once again, that when the totality of the evidence is examined, there is no doubt that ivermectin is highly effective as a safe prophylaxis and treatment for covid-19," said Paul E. Marik, founding member of the FLCCC and Chief, Pulmonary and Critical Care Medicine at Eastern Virginia Medical School. "We can no longer rely on many of the larger health authorities to make an honest examination of the medical and scientific evidence. So, we are calling on regional public health authorities and medical professionals around the world to demand that ivermectin be included in their standard of care right away so we can end this pandemic once and for all," Marik said.
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