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Ivermectin, a controversial antiparasitic drug that has been touted as a potential treatment for Covid-19, does not speed recovery in people with mild cases of the disease, according to a randomized controlled trial published Thursday in the journal JAMA.
Ivermectin is typically used to treat parasitic worms in humans and animals, but the scientific evidence for its effectiveness against the coronavirus is poor. Some studies have indicated that the drug can prevent several different viruses from replicating in cells. And last year, Australian researchers found that high doses of ivermectin suppressed SARS-CoV-2, the virus responsible for Covid-19, in cell cultures.
Such findings have boosted the use of the Covid-19 drug, especially in Latin America.
“Ivermectin is currently widely used,” said Dr Eduardo López-Medina, a doctor and researcher at the Center for Pediatric Infectious Diseases in Cali, Colombia, who led the new trial. “In many countries in the Americas and other parts of the world, this is part of the national guidelines for treating Covid.”
But drugs have also proved divisive. While some scientists see potential, others suspect that effective inhibition of the coronavirus may require extremely high and potentially dangerous doses. Health officials are also concerned that people desperate for coronavirus treatments may take versions of the drug that have been formulated for pets. (It is commonly used to prevent heartworm in dogs.)
“There have been a lot of conflicting views on this, sometimes extremely conflicting views,” said Dr Carlos Chaccour, a researcher at the Barcelona Institute for Global Health who was not involved in the new study. “I think it’s become another hydroxychloroquine.”
But neither supporters nor critics have had much hard data to back up their views. There are few well-controlled trials of the drug’s effectiveness against Covid-19, although more are expected in the coming months. And treatment guidelines from the National Institutes of Health note that there is not enough evidence “to recommend or against” the use of the drug in patients with Covid-19.
In the new study, Dr López-Medina and his colleagues randomly assigned more than 400 people who had recently developed mild symptoms of Covid-19 to receive a five-day course of ivermectin or a placebo. They found that symptoms of Covid-19 lasted about 10 days, on average, in people who received the drug, compared to 12 days in those who received the placebo, a statistically insignificant difference.
The new trial adds vital clinical data to the debate over the drug’s use to treat Covid-19, said Dr Regina Rabinovich, a global health researcher at the TH Chan School of Public Health at Harvard, who was not involved. in the study.
But she noted that the trial was relatively small and did not answer the most pressing clinical question – whether ivermectin can prevent serious illness or death. “Symptom duration may not be the most important clinical or public health parameter to look at,” she said.
The researchers found that seven patients in the placebo group deteriorated after enrolling in the trial, compared to four in the ivermectin group, but the numbers were too small to draw a meaningful conclusion.
“There was a little signal there, and it would be interesting to see if this signal that we saw is real or not,” said Dr López-Medina. “But that would have to be answered in a larger trial.”
Dr López-Medina also pointed out that the study population was relatively young and healthy, with an average age of 37 and few underlying conditions that can make Covid-19 more dangerous.
Larger trials, currently underway, may provide more definitive answers, said Dr Rabinovich, who noted that she was “completely neutral” on the potential usefulness of ivermectin. “I just want data because there is such chaos in the field.”
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