Better ivermectin data is finally on its way


Edward Mills came at last month’s meeting with very good data. An expert in clinical trials at McMaster University, Mills was presenting new results from a trial that examines how well half a dozen different drugs treat Covid-19 – not for people so sick they’re in the emergency room or hospital, but in people whose symptoms don’t show up are not yet aggravated. Sick people at home, in other words.

In his online conference, hosted by the National Institutes of Health, Mills’ slides told the story: A relatively safe, familiar and inexpensive drug reduces the relative risk of worsening a mild Covid by almost 30%. The drug is fluvoxamine, a selective serotonin reuptake inhibitor, an antidepressant. (It’s also an anti-inflammatory, and inflammation and an overreaction of the immune system are hallmarks of a serious Covid infection, which may be why it seems to help.) Get a group of people with Covid and randomly divide them into two groups; 739 receive fluvoxamine and 733 receive placebo. Only 77 of those taking fluvoxamine end up in hospital; 109 of the placebo group do so. that’s exciting.

“Is this the first time that these results have been presented in a public forum?” Asked moderator Adrian Hernandez, director of the Duke Clinical Research Institute.

“Yeah,” Mills replied. “You hear it for the first time.

“Well, quite simply, wow,” Hernandez said. If the data is confirmed, it will only be the second reused drug that will work for outpatient Covid-19. (The other is a steroid called budesonide; other medicines you may have heard of, such as remdesivir or dexamethasone, are for people who are seriously ill and in hospital.) results have not yet been peer reviewed or officially published, but the Together trial, on which Mills is the co-principal investigator, is well-designed and well-respected. Now, to be clear, fluvoxamine is still far from being part of the standard of care for people with Covid-19. Once the results of the Together trial are released, guideline-setting organizations such as the U.S. Food and Drug Administration and the World Health Organization will need to take a look. But the data from the Together trial, if held up, looks positive for the SSRI.

But wait! There is more! In the same presentation, the same trial which showed that this antidepressant could alleviate the symptoms of Covid-19 too has shown the antiparasitic drug Ivermectin – you’ve heard of it, haven’t you? – does not help at all. In the Together trial, this drug, commonly used against things like river blindness and intestinal roundworms, did not prevent people with Covid from being discharged from the hospital better than a placebo. Out of 677 people with Covid who received 400 micrograms per kilogram of weight per day for three days, 86 ended up in the emergency room or hospital; of the 678 people who received a placebo, 95 went. That’s not a significant difference, and Mills’ team pulled it out of the study. (Vaccination, I should add, remains the most effective, safest, cheapest, and easiest way to avoid getting sick.)

Ivermectin had some promising first results against the virus in petri dishes and in smaller, observational studies, but it still has not passed a test. Of two apparent large-scale confirmations of its effects, one (a prepublication by Egyptian researchers) obtained retracted on concerns about plagiarism and fake data. BuzzFeed scientists and journalists have found irregularities in the data of another. A separate and positive review of all ivermectin data was rejected from a newspaper after provisional acceptance for concerns about research integrity and conflicts of interest, while a meta-analysis of all randomized controlled trials of ivermectin against Covid found no positive effects for the drug. FDA said people shouldn’t take it. The American Medical Association and two pharmacy associations have issued a declaration recommending that none of their members prescribe ivermectin for Covid-19 outside of a clinical trial. (Oh, and a doctor from Arkansas gave drugs to detainees without knowing it and without consent, which is usually not the side of the story you want to be in.)



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