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EBM opinion and debate
Misleading clinical evidence and systematic reviews on ivermectin for COVID-19
  1. Luis Ignacio Garegnani1,
  2. Eva Madrid2,
  3. Nicolás Meza2
  1. 1 Research Department. Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  2. 2 Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Cochrane Chile Associate Centre, Viña del Mar, Chile
  1. Correspondence to Nicolás Meza, CIESAL, Universidad de Valparaiso, Viña del Mar, Chile; nicolas.meza{at}uv.cl

https://doi.org/10.1136/bmjebm-2021-111678

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    Since WHO declared the COVID-19 as a pandemic,1 2 healthcare systems all over the world have focused their efforts on limiting the spread of SARS-CoV-2, and despite the ceaseless development of strategies to struggle with the impact of COVID-19, there is no sign of let-up. And the stress and overburden elicited by the pandemic—especially in vulnerable or marginalised populations—remain unstoppable, while the possibility of massive vaccination gives hope for a respite.3 4 Beyond public health interventions, several drugs have been considered for the treatment of SARS-CoV-2 infection,5 which triggers severe respiratory symptoms and critical illness in approximately 5%–20% of patients, with intensive care requirements and high mortality.6–10 In this article, we appraise and debate about the available evidence regarding the role of ivermectin for COVID-19.

    Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial results have had a critical role establishing the most useful pharmacological interventions in COVID-19 critical care, such as dexamethasone.11 However, despite the development of new therapies and the attempts for implementing repurposed drugs (because of their potential immunomodulator or antiviral effects), no reliable specific therapy has been identified yet. Azithromycin, chloroquine and hydroxychloroquine are some of those drugs, whose adverse effects and/or concerns about efficacy on COVID-19 treatment12 have determined its deimplementation by different agencies and regulatory authorities.13–15 And despite the wide dissemination of these recommendations, paradoxically, its adherence in both high-income, and middle-income and low-income countries has been hindered not only by the COVID-19 social media infodemic, but also by authorities.16

    Ivermectin is a broad-spectrum antiparasitic agent approved by the Food and Drug Administration (FDA) of the USA proved to be safe at the conventional dose of ≤200 µg/kg, although severe …

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    Footnotes

    • Twitter @nicolasmezac

    • Correction notice This article has been corrected since it appeared Online First. In the fifth paragraph, "…rationale is the 0.5 µM required concentration…", concentration has been corrected to 5 µM.

    • Contributors All authors contributed equally in the manuscript development. LIG wrote the first draft of the manuscript. NM and EM revised the first draft of the manuscript and wrote part of the introduction and the appraisal of the available evidence.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.