As we reluctantly complete two years in a pandemic-ridden world and with the new variant already knocked on our door, it is difficult to say if this testing time would ever come to an end. As we progress into the forthcoming year, it is vital we take a stance against ignorance and misinformation.
Since the number of people infected or diagnosed with Covid-19 increases, the need to consume over-the-counter medicines is also on the rise. Many such OTC drugs are not FDA or WHO approved for COVID-19 but are otherwise prescribed for the treatment of different diseases. The consumption of such drugs could lead to various side effects and secondary infections.
One such notable drug that is in the news for wrongful consumption is Ivermectin. Ivermectin is a broad-spectrum anti-parasitic drug on the WHO’s list of essential medications for various parasitic disorders. River blindness (Onchocerciasis), Scabies, strongyloidiasis, and other such disorders caused by soil-transmitted helminthiasis are treated with the help of Ivermectin.
It’s also being tested for its ability to lessen the incidence of malaria transmission by eliminating mosquitoes that feed on people and cattle who have been treated. Incidentally enough, the FDA has not approved Ivermectin for use in the treatment of any viral illness.
Ivermectin is also used widely as an anti-parasitic drug for animals.
Although recently, the use of Ivermectin in Australia has been adopted by many people, especially those who are anti-vaccine activists or disbelievers of vaccination.
This now leads us to the question, how did such a drug gain traction as a potential cure for COVID-19? According to reports, some preliminary research carried out by a research group in Australia established that Ivermectin had medicinal applications that could kill the virus, only under laboratory settings. Despite these limitations, the popularization and mainstream usage of Ivermectin are still continuing and has dreadful implications.
Why The Use of Existing Drugs to Cure COVID-19 Was Advocated?
Considering developing new pharmaceuticals takes years, recognizing existing drugs that can be repurposed against COVID-19 and have a proven safety profile based on decades of usage could be essential in slowing or possibly stopping the SARS-CoV-2 pandemic. Because many of the world’s population, particularly in LMIC nations, may wait months, if not years, to get vaccinated, using repurposed drugs may be especially crucial. However, in the current scenario where vaccinations are easily available for most, such OTC drugs are questionable.
Ivermectin Usage in Animals as Opposed to Humans
To begin with, animal medications are sometimes extremely concentrated because they are intended for huge animals such as horses and cows, which weigh a tonne or more than humans. Thus, such highly concentrated doses can be extremely hazardous in humans and cause several other severe complications. Furthermore, the FDA examines medications for both the active and inactive ingredients’ safety and effectiveness. Many inactive substances included in animal products have not been tested for use in humans. Alternatively, they are present in far higher quantities than those seen in people. We don’t know how such inactive substances will affect Ivermectin absorption in the human body in some circumstances.
What is the Mechanism of action of Ivermectin?
IVM’s efficacy in treating a wide range of parasite diseases and other viruses and bacteria is well documented, but the mechanism of action is less clear. IVM’s antiviral strategy against the RNA virus SARS-CoV-2 involves preventing viral proteins from being imported into the nucleus via the IMP/ß1 pathway.
Importins are soluble transport receptors that play a role in the nucleo-cytoplasmic transport of different substrates. IMP/ß1 attaches to the coronavirus cargo protein in the cytoplasm and transports it into the nucleus via the nuclear pore complex (NPC), where the complex disintegrates, and the viral cargo reduces the host cell’s antiviral response, allowing for increased infection. IVM attaches to the IMP/ß1 heterodimer and destabilizes it, preventing IMP/ß1 from attaching to the viral protein and so preventing entry into the nucleus. As a result, antiviral responses are less inhibited, resulting in a more normal and efficient antiviral response. On the basis of this hypothesis and published in vitro investigations, it can be assumed that IVM has a role in the elimination of SARS-CoV-2.
Several randomized trials and retrospective cohort studies of Ivermectin used in COVID-19 patients have been published or made accessible as articles awaiting peer review. Some clinical studies found no benefits or worsening of the disease after Ivermectin treatment, while others found that patients who received Ivermectin had a faster time to resolution of COVID-19-related symptoms, a greater reduction in inflammatory marker levels, a faster time to viral clearance, or a lower mortality rate than patients who received comparator drugs or placebo.
Recent Clinical Trials Data
In both observational and randomized studies, Ivermectin has been studied as a treatment and as prophylactic for COVID-19 infection since the commencement of the SARS-CoV-2 pandemic. The Front Line COVID-19 Critical Care Alliance reviewed 27 research on the impact of Ivermectin for the prevention and treatment of COVID-19 infection and concluded that ivermectin “demonstrates a strong signal of therapeutic efficacy” against COVID-19. Ivermectin was reported to lower fatalities by 75% in a recent study.
Despite these findings, the US National Institutes of Health opined, “Insufficient data exist to suggest either for or against the use of Ivermectin for the treatment of COVID-19,” and the World Health Organization advised against using it outside of clinical trials.
The Ivermectin trial (I-TECH) outcomes in 500 hospitalized patients with Stage 2 or 3 COVID-19 were released by the National Institutes of Health’s Institute for Clinical Research (ICR). This multi-center open-label randomized controlled trial compared a 5-day course of Ivermectin (0.4mg/kg/day) plus standard of care (IVM group) to standard of care (SOC group) for COVID-19 patients at 20 government hospitals and the MAEPS 2.0 Quarantine and COVID-19 Treatment Centre according to Ministry of Health Malaysia (MOH) guidelines (PKRC).
The trial was carried out in partnership with the Institute for Clinical Research (ICR), National Institute of Health, by infectious disease physicians and clinicians who were actively involved in COVID-19 treatment (NIH). The major goal of the I-TECH research was to explore if Ivermectin given during the first week of sickness may prevent hospitalized patients aged 50 and above with at least one comorbidity from deteriorating to severe COVID-19 Stage 4 or 5.
According to Dr. Steven Lim Chee Loon, Infectious Disease Specialist at Hospital Raja PermaisuriBainun, Ipoh, there were no significant differences between the two groups in terms of ICU admission, mechanical ventilation, symptom recovery, blood parameters, and chest x-ray resolution. Between the IVM and SOC groups, the probabilities of complete symptom resolution by Day 5 of enrolment were extremely similar and not statistically significant.
Ivermectin cannot be recommended for inclusion in current COVID-19 treatment guidelines based on the findings of the I-TECH research since it does not lessen the risk of serious illness from COVID-19. Ivermectin should only be used in research trials with close monitoring, according to the Ministry of Health. Other recent major trials, such as IVERCOR-COVID19 from Argentina and TOGETHER from Brazil, show that Ivermectin should not be used routinely in clinical practice. The I-TECH study team intends to publish the findings in a peer-reviewed journal, which will provide further research data for ivermectin investigations, including meta-analysis.
Why Should You Not Consume Ivermectin For COVID-19 Treatment?
Research and data suggest that Ivermectin does not significantly affect patients diagnosed with COVID-19, and its consumption may not have any relative or visible cure. Furthermore, consumption of Ivermectin can have adverse side effects and overdose problems.
Due to the increase in the purchase and consumption of Ivermectin by humans as an easier and cheaper alternative to other treatments, there has been slide inaccessibility or even availability of these medicines for veterinary use. This has led to an unnecessary demand for the drug.
Even amounts of Ivermectin permitted for human use, according to the FDA, can interfere with other drugs, such as blood thinners. Ivermectin overdose can lead to nausea, vomiting, diarrhea, hypotension, allergic reactions, dizziness, balance issues, seizures, coma, and even death.
Alternative drug recommendations
WHO suggests other drugs that can be used for the treatment of COVID-19, such as:
- Strong recommendation for systemic corticosteroids in severe or critically ill COVID-19 patients, with a conditional recommendation against their use in mild/moderate COVID-19 patients.
- Conditional advice against using remdesivir in addition to standard therapy in mild/moderate COVID-19 patients.
It also strictly condemns:
- The use of hydroxychloroquine or chloroquine for the treatment of COVID-19 of any severity is strongly discouraged.
- It is strongly advised against using lopinavir/ritonavir to treat COVID-19 of any severity.
Any decrease in COVID-19 infection rates after Ivermectin was recommended could be attributable to herd immunity, lockdown, or immunizations. These cases do not provide conclusive evidence of Ivermectin’s efficacy as a preventative strategy. Ivermectin does not have any direct or proven effect on treating COVID-19, and consumption of randomized drugs may lead to unnecessary side effects and complications.
WHO suggests the usage of Ivermectin only under intro conditions and for clinical trials. This information is important given the excess consumption of drugs for immediate treatment. The treatment currently available for COVID-19 is proper vaccination, and FDA-approved drugs, and staying safe with our surroundings.