Talk:Ivermectin

Treatments for COVID-19: Current consensus

A note on WP:MEDRS: Per this Wikipedia policy, we must rely on the highest quality secondary sources and the recommendations of professional organizations and government bodies when determining the scientific consensus about medical treatments.

1. Ivermectin: The highest quality sources (1 2 3 4) suggest Ivermectin is not an effective treatment for COVID-19. In all likelihood, ivermectin does not reduce all-cause mortality (moderate certainty) or improve quality of life (high certainty) when used to treat COVID-19 in the outpatient setting (4). Recommendations from relevant organizations can be summarized as: Evidence of efficacy for ivermectin is inconclusive. It should not be used outside of clinical trials. (May 2021, June 2021, June 2021, July 2021, July 2021) (WHO, FDA, IDSA, ASHP, CDC, NIH)
2. Chloroquine & hydroxychloroquine: The highest quality sources (1 2 3 4) demonstrate that neither is effective for treating COVID-19. These analyses accounted for use both alone and in combination with azithromycin. Some data suggest their usage may worsen outcomes. Recommendations from relevant organizations can be summarized: Neither hydroxychloroquine nor chloroquine should be used, either alone or in combination with azithromycin, in inpatient or outpatient settings. (July 2020, Aug 2020, Sep 2020, May 2021) (WHO, FDA, IDSA, ASHP, NIH)
3. Ivmmeta.com, c19ivermectin.com, c19hcq.com, hcqmeta.com, trialsitenews.com, etc: These sites are not reliable. The authors are pseudonymous. The findings have not been subject to peer review. We must rely on expert opinion, which describes these sites as unreliable. From published criticisms (1 2 3 4 5), it is clear that these analyses violate basic methodological norms which are known to cause spurious or false conclusions. These analyses include studies which have very small sample sizes, widely different dosages of treatment, open-label designs, different incompatible outcome measures, poor-quality control groups, and ad-hoc un-published trials which themselves did not undergo peer-review. (Dec 2020, Jan 2021, Feb 2021)

Which pages use this template?

Last updated (diff) on 27 February 2023 by Sumanuil (t · c)

Covid effectiveness

Has the consensus on Ivermectin's effectiveness for covid changed since February, when ToBeFree placed the section at the top? I'm seeing three reviews or literature surveys at PubMed that are now saying it might provide some benefit in certain circumstances. If this holds up, it may require changes to the last paragraph of the lead, which is pretty categorical that there's no indication of any benefit whatever, and these surveys don't seem to fit that kind of language. Mathglot (talk) 11:53, 15 December 2022 (UTC)

The issue was always how claims were being made that were not true, such as it was a cure. Slatersteven (talk) 11:59, 15 December 2022 (UTC)

Which reviews specifically? Bon courage (talk) 12:06, 15 December 2022 (UTC)

Yeah, I get that. The two sentences of the lead that I was referring to, are these:

During the COVID-19 pandemic, misinformation has been widely spread claiming that ivermectin is beneficial for treating and preventing COVID-19. Such claims are not backed by credible scientific evidence.

(edit conflict) I think the first part is undoubtedly accurate (misinformation widely spread); but less sure about the rest. If it's beneficial some of the time, for some of the people, then the second part is too strong, or unbalanced. The way it's written now ("*is* beneficial") would not be supported by the surveys I saw either, but that's a pretty categorical statement, that we generally wouldn't use even for approved drugs that have clear benefits almost all of the time. We talk about the benefit of flu vaccines even in some years when they are 10-20% effective. Maybe time to revisit the wording in that paragraph? Mathglot (talk) 12:10, 15 December 2022 (UTC)

I'll have to respond tomorrow, but it was trivial to find them, just include "survey" or "literature review" with your search terms, or go to Cochrane or Pubmed. Mathglot (talk) 12:12, 15 December 2022 (UTC)

All the reviews I know of are junk (and have been repeatedly discussed). So just wondered if there was anything new. I believe the settled state of knowledge is that ivermectin for COVID is a total fraud, just the province of scammers and cranks these days. It's all covered at Ivermectin during the COVID-19 pandemic. Bon courage (talk) 12:21, 15 December 2022 (UTC)

If all the reviews are junk, that leaves us (as editors) with very little to go on to build an article, because they are the secondary sources. How could we even summarize general reliable opinion, if the reviews themselves do not? That would undermine a lot of things, if that's actually the case. Mathglot (talk) 21:15, 15 December 2022 (UTC)

I meant all the review with positive results wrt ivermectin/COVID, which I assumed you were referring to. Bon courage (talk) 02:08, 16 December 2022 (UTC)

No, by review, I meant things like literature surveys/reviews and meta-analyses. I'm not aware of any literature reviews that are "junk", although I know of two that were questioned, because of inclusion (due to the inclusion criteria in their methodology) of studies that were questionable (one in each, iirc), thus calling into question how to deal with that at the level of a survey or meta-analysis. Mathglot (talk) 07:32, 16 December 2022 (UTC)

I think probably what's been happening is that new trials have come out which show small benefit, but then when integrated into the overall evidence picture, these trials do not end up moving the needle much. The confidence intervals keep getting smaller, but they still overlap 1 for odds ratios, indicating the drug probably has just as much likelihood of harming as it does of helping. (see below). Various trials are always coming out as well that have bad methodologies which render them unsuited to answer the questions, and it doesn't come out until later that there are numerous issues. (e.g. Raoult's trials which are now being investigated for research misconduct [1]). — Shibbolethink ^{(♔ ♕)} 17:46, 15 December 2022 (UTC)

Hi Mathglot, I didn't place the section at the top; I have never edited this page here. My protection of Template:COVID-19 treatments (current consensus) is the template's latest revision, so my name is displayed there. ~ ToBeFree (talk) 17:26, 15 December 2022 (UTC)

Yes, I think that was probably me who added the template. I just updated it slightly to include the 2022 cochrane review, so it should show my name instead — Shibbolethink ^{(♔ ♕)} 17:50, 15 December 2022 (UTC)

Oops, sorry ToBeFree; misread that as a small sig. Mathglot (talk) 21:11, 15 December 2022 (UTC)

This 2022 cochrane review (updated as of 21 June 2022) says:

We found no evidence to support the use of ivermectin for treating COVID-19 or preventing SARS-CoV-2 infection. The evidence base improved slightly in this update, but is still limited. (plain language summary)

and more technically speaking (edited only to trim for space, bolded and underlined to emphasize):

Inpatient data

• We are uncertain whether ivermectin plus standard of care compared to standard of care plus/minus placebo reduces or increases all-cause mortality at 28 days (RR 0.60, 95% CI (0.14 to 2.51); 3 trials, 230 participants; very low-certainty evidence)
• or [affect] clinical worsening at 28 days (RR 0.82, 95% CI 0.33 to 2.04; 2 trials, 118 participants; very low-certainty evidence)
• or [reduce] serious adverse events during the trial period (RR 1.55, 95% CI 0.07 to 35.89; 2 trials, 197 participants; very low-certainty evidence)
• may have little or no effect on ... viral clearance at 7 days (RR 1.12, 95% CI 0.80 to 1.58; 3 trials, 231 participants; low-certainty evidence).

Outpatient data

• probably has little or no effect on all-cause mortality at day 28 (RR 0.77, 95% CI 0.47 to 1.25; 6 trials, 2860 participants; moderate-certainty evidence)
• little or no effect on quality of life (measured with the PROMIS Global-10 scale) (physical component mean difference (MD) 0.00, 95% CI -0.98 to 0.98; and mental component MD 0.00, 95% CI -1.08 to 1.08; 1358 participants; high-certainty evidence).
• may have little or no effect on clinical worsening, assessed by admission to hospital or death within 28 days (RR 1.09, 95% CI 0.20 to 6.02; 2 trials, 590 participants; low-certainty evidence);
• may have little or no effect ... on clinical improvement, assessed by the number of participants with all initial symptoms resolved up to 14 days (RR 0.90, 95% CI 0.60 to
  1.36; 2 trials, 478 participants; low-certainty evidence)
• may have little or no effect ... on serious adverse events (RR 2.27, 95% CI 0.62 to 8.31; 5 trials, 1502 participants; low-certainty evidence)
• may have little or no effect ... on any adverse events during the trial period (RR 1.24, 95% CI 0.87 to 1.76; 5 trials, 1502 participants; low-certainty evidence)
• may have little or no effect ... on viral clearance at day 7 compared to placebo (RR 1.01, 95% CI 0.69 to 1.48; 2 trials, 331 participants; low-certainty evidence)

Overall, I would say the evidence base has not changed much. We can be essentially certain that the drug does not reduce mortality or improve quality of life in the outpatient setting. Basically the only difference between this and the 2021 review is that the confidence intervals on these things got a little smaller, but they still overlap 1 (clinical equipoise) and even include relatively large ranges of "negative effect" in each. There is no reason based on this evidence to conclude that ivermectin improves the clinical picture for patients in either an inpatient or outpatient setting. — Shibbolethink ^{(♔ ♕)} 17:34, 15 December 2022 (UTC)

That looks pretty persuasive; I wonder if my search terms were biased in some way? I'll have to go back and see what it was I was looking at, assuming I can repeat what I did, or find them some other way. Mostly what I remember is Pubmed results, linking mostly to ncbi. I'll post again, if there's anything worth saying. Mathglot (talk) 21:00, 15 December 2022 (UTC)

I guess it is just because the people who write Cochrane reviews understand the subject better than a Google search does, even with the best search terms, and can summarize it better. But maybe I misunderstand what is going on here. --Hob Gadling (talk) 06:40, 16 December 2022 (UTC)

Sources

SAIVE Trial

Shall we mention the results of this trial? https://www.businesswire.com/news/home/20230105005896/en/MedinCell-Announces-Positive-Results-for-the-SAIVE-Clinical-Study-in-Prevention-of-Covid-19-Infection-in-a-Contact-Based-Population Pakbelang (talk) 08:13, 26 January 2023 (UTC)

It's just PR. WP:MEDRS needed. Bon courage (talk) 08:20, 26 January 2023 (UTC)

You've linked to a press release for French pharma company MedinCell. Despite these impressive claims made in the press release, no publication, or even preprint has resulted (that I have been able to find).

At the company's website

https://www.medincell.com/en/portfolio/

potential ivermectin products (mdc-STM for malaria and mdc-TTG for COVID-19) are still shown as PRECLINICAL candidates - which in itself is suspect given the company's press release claims of at least one completed Phase-2 trial.

So no - All you have cited is a press release. 156.96.151.132 (talk) 18:50, 2 November 2023 (UTC)

Too preliminary, as even single phase 2 studies contradict WP:MEDRS.

The study design is strange, I doubt that strong conclusions can be drawn. --Julius Senegal (talk) 18:03, 3 November 2023 (UTC)

Should mention Ivermectin Anti-viral properties

Despite the prevailing narrative that has tried to cover up Ivermectin's antiviral properties, if Wikipedia is to show itself as a reliable, unbiased information source, these valuable and important characteristics must be mentioned clearly in the current information.

Some examples:

Ivermectin is an FDA-approved broad-spectrum antiparasitic agent with demonstrated antiviral activity against a number of DNA and RNA viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite this promise, the antiviral activity of ivermectin has not been consistently proven in vivo. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539925/

There were lower viral loads and less viable cultures in the ivermectin group, which shows its anti-SARS-CoV-2 activity. It could reduce transmission in these patients and encourage further studies with this drug. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262706/

Ivermectin proposes many potential effects to treat a range of diseases with its antimicrobial, antiviral, and anti-cancer properties as a wonder drug. It is highly effective against many microorganisms, including some viruses. https://www.nature.com/articles/s41429-020-0336-z

Ivermectin is an FDA-approved broad spectrum anti-parasitic agent (Gonzalez Canga et al., 2008) that in recent years ,we, along with other groups, have shown to have anti-viral activity against a broad range of viruses (Gotz et al., 2016; Lundberg et al., 2013; Tay et al., 2013; Wagstaff et al., 2012) in vitro. https://www.sciencedirect.com/science/article/pii/S0166354220302011

Stop destroying Wikipedia's already tarnished reputation. Hvalborg (talk) 22:01, 18 May 2023 (UTC)

This was discussed ad nauseum here at the height of the ivermectin craze. In vitro is meaningless.Please read the archives for the full discussion, and stop promoting fringe medicine. Acroterion (talk) 22:34, 18 May 2023 (UTC)

Indeed, and this is covered in more detail at Ivermectin during the COVID-19 pandemic. Bon courage (talk) 04:47, 19 May 2023 (UTC)

Ivermectin, COVID, and Peru

In case anyone tries to add that again: the referenced study was co-authored by a member of the discredited FLCCC and Peru completely removed Ivermectin from their recommended COVID treatments in 2021.   –Skywatcher68 (talk) 16:04, 22 August 2023 (UTC)

References

Ivermectin, COVID and Fifth Circuit

Should(n't) the decision concerning the drug's use be mentioned? Here's an article about it: Fifth Circuit sides with ivermectin-prescribing doctors in their quarrel with the FDA | Courthouse News Service = https://www.courthousenews.com/fifth-circuit-sides-with-ivermectin-prescribing-doctors-in-their-quarrel-with-the-fda . Kdammers (talk) 16:15, 26 September 2023 (UTC)

I thin we can mention a court said they over stepped their authority. Slatersteven (talk) 16:19, 26 September 2023 (UTC)

Crazy old America ah? It only means a court decided doctors can do quackery there, but it's not the FDA's role to push back. Would need some decent secondary sources to make sense of this: it doesn't convey any knowledge about ivermectin. This has already been discussed at Ivermectin during the COVID-19 pandemic. Bon courage (talk) 16:21, 26 September 2023 (UTC)

• Note I have adding something on this to Ivermectin during the COVID-19 pandemic, where is's probably WP:DUE (unlike here). Bon courage (talk) 04:06, 28 September 2023 (UTC)