Numerous clinical trials with ivermectin in Covid-19 have shown consistent, large improvements in clinical outcomes. It must be authorised for use in the UK, argues Dr Christine Clark.
Ivermectin has been widely used to treat a variety of human parasites since its introduction in 1981. The drug also has antiviral and anti-inflammatory properties. It is estimated that some 4 billion doses have been taken over the past 40 years and it has a good safety record with minimal toxic effects.
Ivermectin is included in the WHO Model List of Essential Medicines as a 3mg tablet.
A recent independent meta-analysis of 15 randomised controlled trials (RCTs) and observational controlled trials shows that ivermectin is remarkably effective both for prophylaxis and treatment of Covid-19.1
When used prophylactically – for example, taken by healthcare workers or relatives of confirmed cases – it was shown that ivermectin reduces the risk of transmission by 88 per cent compared to control.
When used to treat Covid-19 infection, ivermectin reduces the risk of death by 83 per cent compared to ‘no ivermectin’. It also reduces the risk of deterioration by about 50 per cent. Almost 4,000 patients were included in the trials used in the meta-analysis. The British Ivermectin Recommendation Development (BIRD) Group has now recommended the immediate roll-out of ivermectin for prevention and treatment of Covid-19.
More than 20 countries, including Greece, Bulgaria, Macedonia, Slovakia and the Czech Republic in the EU, have now included ivermectin in their Covid-19 management strategies. Several South American countries have seen Covid-19 infections fall sharply following the introduction of mass treatment with ivermectin.
In the US a group of intensivists – the Front Line Covid-19 Critical Care (FLCCC) Alliance – has called for the rapid introduction of ivermectin to stem the tide of infections.2
In Belgium, a plan has been put forward to eradicate Covid-19 in six weeks by using ivermectin.3 Similar results could be expected in other countries if the same protocol was followed.
Dose regimens vary but prophylactic treatment can be given with two doses of 0.2mg/kg, 48 hours apart, once a month. For early out-patient treatment, a daily dose of 0.2mg/kg for a maximum of five days is recommended.2
Some regulators have said that more trials are needed to determine the drug’s effectiveness. Dr Tess Lawrie, systematic reviewer and director of the Evidence-Based Medicine Consultancy, and other reviewers, argue that all the trials included in meta-analyses show positive results and the only question is exactly how large the positive effect is.
This is hardly a reason to block the use of a life-saving drug. They also point out that several other drugs, such as remdesivir, have been authorised on the basis of far less evidence. In some countries ivermectin can be purchased OTC in pharmacies.
In others ‘Covid treatment kits’ have been issued with instructions to start treatment after contact with an infected person or when symptoms develop. The kits typically contain ivermectin tablets, vitamin C, vitamin D, zinc and sometimes azithromycin or doxycycline.
In the UK, the best way forward would be for the MHRA to authorise use of ivermectin for prophylaxis and treatment of Covid-19 on the basis of the published evidence to date. Next, the drug could be made available through community pharmacies either using a PGD or by making ivermectin a P medicine.
Ivermectin would then help to save lives and reduce suffering until the majority of the population can be vaccinated. Failure to use a cheap, safe drug that reduces the severity and duration of infection as well as the risks of death and transmission seems incomprehensible.
• Video interviews with Tess Lawrie can be found here.
1. Lawrie T. Ivermectin reduces the risk of death from Covid-19 – a rapid review and meta-analysis in support of the recommendation of the Front Line Covid-19 Critical Care Alliance. Available at e-bmc.co.uk
2. Front Line Covid-19 Critical Care Alliance: Prophylaxis and treatment protocols for Covid-19: covid19criticalcare.com
3. Wathelet M. December 2020: linkedin.com/pulse/plan-eradicate-sars-cov-2-from-belgium-emergency-trial-marc-wathelet