Should I Prescribe Ivermectin for COVID 19?

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Should I Prescribe Ivermectin for COVID 19?

Ivermectin is a cheap and widely available drug that is getting many buzzes 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 did not pan out. For Ivermectin, the buzz started when researchers in Australia showed that in vitro, meaning in a test tube, SARS-CoV-2 replication was reduced about ~5000-fold over a 48 h time span.
In April, I made a video about this, and I explained how this drug is thought to inhibit viral replication. And is also widely believed to have anti-inflammatory properties.

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Since April, I’ve combed thru multiple studies, as scientists worldwide have been looking at ivermectin, and so far, 14 studies 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 preprints 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. 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 For example, I was able to find 3 ivermectin pre-print studies that have since been retracted.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 objectively break these studies down.

The gold standard for a scientific trial is a prospective study that is double-blind and randomized with a treatment and 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 a treatment protocol, follows them for side effects, and evaluates the results. A double-blind study is one in which neither the investigators nor the treatment recipients know whether they have received the treatment or a placebo. Amid a pandemic, 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 more treatment protocols through this process, even if it ming on sub-standard clinical evidence, will 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 also note that the medications they are choosing to treat COVID 19 with have been FDA approved for other uses and therefore are considered safe, even if they have not been tested to verify safety and efficacy for COVID 19.
Ivermectin is sold over-the-counter in many countries to treat people and animals for parasitic worm infections. In countries in Latin America such as Peru, Guatemala, and Bolivia, its been in great demand as people believe that it protects them from COVID 19. Researchers in Latin America points 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 hypothesis 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 will not hurt even if it does not work. A zealous belief that medication will cure can lead to users ignoring side effects, a confirmation bias.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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