ivermectin is a cheap and widely available drug that is getting a lot of buzz right now
with its potential to prevent and treat covid 19 which i'm cautiously optimistic about
we've seen the hype before with different drugs that ultimately didn't pan out
for ivermectin the bus started when researchers in australia showed that in vitro meaning in a
test tube the sars cov2 replication was reduced about 5 000 fold over a 40 hour time span back in
april i made a video about this and explained how this drug is thought to inhibit viral replication
and it's also widely believed that it has anti-inflammatory properties as well
since april i've come through multiple studies as scientists worldwide have been conducting many
of them and so far 14 have been completed but these studies are not without their flaws there
are retrospective studies which introduces bias and most of the studies have small numbers and
some studies are published as pre-prints before a thorough peer review process can be completed
the benefit of pre-print studies being published is that knowledge can be quickly shared worldwide
and the hope is that prospective randomized studies will follow these observational or
anecdotal studies the drawback is that studies are frequently published and retracted once they are
more critically reviewed for example i was able to find three ivermectin pre-print studies that have
since been retracted but i need to know should i be prescribing ivermectin for covid if so at what
dose and for how long well in this video i'm going to be objectively breaking down these studies
the gold standard for a scientific trial is a prospective study that is double-blinded and
randomized with a treatment and a control group and it should be well matched in as
many variables as possible to reduce the risk that unforeseen factors and not the medication's action
are causing the effect that researchers are studying a prospective study enrolls participants
to evaluate treatment protocol follows them for side effects and evaluates the results
a double-blinded study is one in which neither the investigators nor the treatment recipients
know whether they have received the treatment or placebo amid epidemic decision makers have been
trying to balance the need for evidence-based medicine and good clinical practice with the
urgent need for safe and effective treatments for covid 19 advocates who are on the side of
pushing for more treatment protocols through this process even if it means relying on substandard
clinical evidence they're going to argue that the death rate continues to increase
and will argue that there is not enough time to justify a full prospective study which can take
months they'll also note that the medications that they're choosing to treat covid 19
they've been already fda approved for other uses and therefore are considered safe even if they've
not been tested to verify safety and efficacy for covid 19. ivermectin is sold over the counter
in many countries to treat people for animals and for parasitic worm infections in countries
in latin america such as peru guatemala bolivia it's been in great demand as people believe that
it protects them from covid 19 researchers in latin america point out that the evidence is scant
that ivermectin protects against covid 19. however they have difficulty recruiting participants to
run a clinical trial and test their hypotheses because nearly everyone has already taken the drug
bias can lead to beliefs that become difficult to dislodge and question if
people believe medication will work it can become difficult to get them to challenge this belief
many will justify using unproven remedies by saying that it has a good safety profile
and it's not going to hurt even if it doesn't work a zealous belief that a medication will cure
can lead to users ignoring side effects which is a confirmation bias the maximum recommended
dose for ivermectin is 200 micrograms per kilogram side effects are pretty rare but include fatigue
abdominal pain nausea diarrhea dizziness and skin rashes less common side effects include worsening
of asthma steven's johnson reaction hepatitis and jaundice at high doses from an accidental overdose
it can cause seizures numbness and tingling ataxia meaning difficulty maintaining balance
and then there's the potential for severe drug to drug interactions remember in the beginning
of this video i mentioned that the study that was done in australia where it was shown that it
inhibited viral replication in vitro well this leads to the question what dose of ivermectin
would be needed to achieve the same antiviral effect in a human being so there are big questions
with this like even with the highest reported dose of 1700 micrograms per kilogram which is eight and
a half times the fda approved dose ivermectin's maximum plasma concentration was 0.28 micrograms
93 of ivermectin is bound to plasma proteins which limit its uptake into cells when tissue
concentration of ivermectin was studied in calves it was insufficient to achieve an antiviral effect
so the author's conclusion from this study was that although higher doses of ivermectin are
generally well tolerated the clinical effects of doses in the five micromolar range are unknown and
may be associated with toxicity and this is the big unknown how much ivermectin do people need
to treat covid 19 and will that dose do more harm than good the only way to know is by doing
prospective randomized controlled trials that include different dosing regiments which means
you need a lot of people in these trials to get a concrete answer there are currently 47 clinical
trials registered at clinicaltrials.gov and these trials are to study the effects of ivermectin and covid 19
14 of which have been completed for the sake of organizing these studies for this video
i'll number them and i'll briefly discuss the most significant studies so starting with study number
one it was a randomized double blind trial at dhaka medical college in bangladesh they looked at
400 people with mild covid half of which received ivermectin 6 milligrams along with doxycycline 100
milligrams twice a day and that was for five days the other half they received standard treatment
for covid in the treatment group 61 percentage had early recovery 23 percentage had late recovery in the placebo group
44 percentage had early recovery and 37 percentage had late recovery now in the treatment group nine percent had a severe
outcome meaning the covid progressed to more severe disease and this was in comparison to
18 percent that was in the placebo group so although this was not a huge study the ones
who received ivermectin and doxycycline they did have better outcomes okay the second study was
an observational prospective trial at urinakian hospital in argentina where they enrolled 229
participants who were randomized and placed into two groups 131 people received standard care and
ppe plus topical iota carrageenan on the nasal and buccal mucosa so within the cheek and ivormectin
topical on the oral mucosa and the other received standard prophylactic measures along with the ppe
so participants were followed for one month no participant in the treatment
group tested positive for covid 19 and 11 of the standard prophylactic group tested positive
study number three was a randomized sequential assignment study with no masking
at zaghzig university in egypt and it enrolled 340 patients 228 received prophylactic ivermectin with
a dosage based on weight and control group with no treatment participants were followed for 14 days
7.4 percent of the treatment group and 58.4 of the control group developed symptoms of covid
then there was a randomized controlled trial done in iraq where they enrolled 140 participants
half of which received 200 micrograms per kilogram of ivermectin and they also received
doxycycline the other half received standard care researchers reported that the ivermectin
with doxycycline group reduced the mean time to recovery from 17.9 days to 10.6 days and
the percentage of patients who progressed to more severe disease randomization was done by
days of the week but then limited by the number of enrollees with a subjective level of disease
which may have introduced bias and there's another randomized controlled trial done in
egypt that enrolled 600 patients 400 of which were symptomatic and 200 were healthcare and household
contacts the participants were assigned to six different groups which i'll show you right here
the study's endpoint was clinical improvement two negative pcr tests at least 48 hours apart
and number of hospital days so the study results they were variable this trial did
not have a placebo arm and the authors concluded that ivermectin was more effective in treatment
and prophylaxis than the other group which included hydroxychloroquine with standard care
but no placebo arm so it's really hard to come to a solid conclusion there's another retrospective
observational study that was conducted looking at patients with hospitalized covid from four
different hospitals in florida the charts were reviewed for 280 patients
and 173 of them were treated with at least one ivermectin dose at 200 micrograms per kilogram
and 107 without ivermectin most patients in both groups also received hydroxychloroquine
azithromycin or both the researchers found lower mortality in the ivermectin group with an absolute
risk reduction of 11 and no difference in median length of stay or extubation rate meaning who was
able to come off the ventilator now in the ivermectin group the overall mortality rate
was 15 percent the mortality rate for those who received ivermectin and who had severe
pulmonary involvement was 38.8 percent in the non-ivermectin group the overall mortality was 25
and the mortality with severe pulmonary involvement was 80.7 percent so the authors
stated that their study had several limitations that may have introduced bias including being
in a retrospective study a timing bias and use of other medications like dexamethasone
the authors concluded by saying further studies in appropriately designed randomized trials are
recommended before any conclusions can be made and there's also another study in argentina that has
not been completed yet but it's a double-blinded randomized control trial and enrolled 500 people
and 250 of which in the treatment arm will be receiving avermectin based on weight and the
other half was going to be receiving a placebo the participants will be followed to evaluate
the percentage who require hospitalization time to hospitalization and number of days in the hospital
and the percentage who need icu level of care the national institute of health
the nih on august 27 2020 made a strong recommendation against the use of ivermectin
to treat covid this recommendation was based on expert opinion proponents for using Ivermectin
point out that this recommendation was made before many clinical trials on Ivermectin were completed
and the recommendation needs to be updated now reviewing the clinical trials to date show that
many have laws that make it difficult to draw scientific conclusions for a number of reasons
will ivermectin work for both prevention and treatment of covid 19 maybe i remain hopeful and
i think there's a good chance that it will work as there is some evidence to suggest that it does
but instead of rushing to judgment as we did with hydroxychloroquine convalescent plasma
and remdesivir we need to wait for results of prospective randomized blinded studies with a
placebo group studies must clearly demonstrate a causative relationship between using Ivermecting
and treatment or prevention of covid 19 versus a correlative effect a cheap safe and effective drug
will bring the covid 19 pandemic under control faster than a vaccination will the data calls for
regulatory agencies worldwide to invest in studies to provide definitive evidence one way or another
so for now i'm not going to be prescribing it but i hope that changes soon