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Ivermectin Prophylaxis Used for Covid-19 (Peer-Reviewed)

cureus.com

52 points by benpiper 4 years ago · 91 comments (84 loaded)

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anagram666 4 years ago

This is an observational study, not strong enough to make any conclusions; The determination if a patient had taken ivermectin was self-reporting. There is no control of the dosage and how much time the patients took ivermectin before getting covid.

This is at best an indication of the need for better studies about the subject, but considering that Brazil's president is rabid pro-ivermectin and this was made in a medium city in a region favorable at the president, take this with a grain of salt.

  • JohnTHaller 4 years ago

    Additionally, it was done in southern Brazil where worms are endemic. Being infected with worms is a known comorbidity of Covid-19. Treating the worms with Ivermectin has been shown to have a small improvement in chance of death from Covid-19. This doesn't apply to the US, of course.

  • ipspam 4 years ago

    We are two years into a pandemic. There isn't coming an answer to ivermectin. There should have been an answer 18 months ago, but the sycophantic vaccine pushers have done everything they can not to discredit ivermectin, but to simply say there isn't enough evidence to prove its effectiveness. Also, the only way to do this is to claim massive widescale multi-country research fraud.

    I don't have a position on ivermectin, but it's pretty clear that any actual pre-treatmwent repurposing of drugs for any future pandemic should be the tip of the spear, but will be oppressed, underfunded, attacked, false-flagged, strawmanned, degraded, and doctor prescribers attacked.

    This is totally, totally backwards. Even at $100,000,000 a clinical trial, funding 100 drugs with repurpose potential should have been step 1.

    • rsfern 4 years ago

      Ivermectin and hydroxychloroquine were met with cautious optimism by the research community after the first preliminary hits in screening experiments for drug repurposing, exactly as you’re advocating [0]. The tides turned when things didn’t pan out in subsequent clinical studies. Actually, for ivermectin the tide started turning after people realized what an unrealistically massive dose was needed in the first in vitro study [0 again]

      There were a few cases of fraud (most notably one of the biggest ivermectin studies last summer) but it’s not necessary to resort to allegations of ubiquitous fraud to conclude that the research doesn’t really support use of these drugs as effective Covid therapeutics

      0: https://www.science.org/content/blog-post/what-s-ivermectin

      • orwin 4 years ago

        Some studies, especially in the southern hemisphere, were quite sold on ivermectin, but there is a lot of suspicion that the good results are actually due to worms increasing the risk of Covid death.

        So if you're from the US and your aunt from Florida/Louisiana tells you Ivermectin work, you can honestly respond: Yes.

        • dogma1138 4 years ago

          Is there any reason why worms would increase the severe morbidity/death rate?

          The only thing I can think off is that (some) parasites tend to have a suppressive impact on the immune system but it also seem that could also prevent the cytokine storm that initially was reported as a major cause of severe illness and death.

    • anagram666 4 years ago

      Sorry to say, but the vaccine is a better option to prevent covid, even considering this study. You can take ivermectin if you use the normal dosage, it is not harmful and may be helpful. But a lot of people is promoting ivermectin instead of the vaccine or using a higher dosage and this is causing a lot of preventable deaths.

ncmncm 4 years ago

In interpreting this result, one should keep in mind that an active parasite infection produces worse results for respiratory infections of all kinds. Taking ivermectin reduces parasite load.

The size and location of the study suggests that reporting of COVID-19 infections was by presentation, meaning asymptomatic or minimal infections were probably not counted.

tl;dr: These results will probably not translate well to places without pervasive parasite infestation. Wearing an N95 mask has a much larger protective effect than taking ivermectin, in any case, even there.

  • lambdaba 4 years ago

    I've seen other similar results, and I don't share this skepticism. I can't find the exact study, but here's one on hospital staff in Argentina: https://www.cureus.com/articles/64807-prophylactic-role-of-i...

    I just don't see how parasites would explain all these results. I do see how monetary incentives would play into maligning them though.

    • gus_massa 4 years ago

      Note that the original article and the article you posted are not randomized controlled trails. Does the people that accept to take Ivermectin more cautious than the people that don't? Does young people more likely to try? There are too many variables and it's just too hard to know without a RCT.

      Also, the problem with these types of studies is that bad outcomes are sometimes not published. Nobody want to write an article with the title "We used Ivermectin and we killed an additional statistical significant number of coworkers" https://en.wikipedia.org/wiki/Reporting_bias For a RCT it's necessary more paperwork and authorizations and ideally preregistering. So that increase the chance of that they must write the final paper.

      Also, as the PG noted the "peer review" of this site is not the traditional peer review of a normal journal. For example, the title says "Observational Study of 223,128 Subjects" but later it says "a total of 159,561 subjects were included in the analysis". The main part of the difference is that they report in the title the total number of inhabitants, but for the analysis they use only the ones that have more than 18 years old. It's not a smoking gun, but at least it's a small red flag.

      • lambdaba 4 years ago

        I don't know, I just see a pattern here, I know as much as every other person that anecdote != data, and correlation != causation, but... I don't know, I don't think these studies are worthless either

        I found the other study I wanted to reference: https://media.marinomed.com/8b/7a/c7/nota-journal-of-biomedi...

        > No patients of the 788 treated with IVERCAR tested positive for CoVid 19 during the study.

        Again, I don't know, but it smells like SOMETHING

        What I "believe" about this is prophylaxis, I think this is why there are no results once symptoms are really apparent. This might be why the point about Ivermectin being antiviral only at very high doses doesn't hold, maybe it provides protection when there is only a tiny exposure to the virus. Heck, there's even a result circulating that cannabis was protective... Who knows?

        • gus_massa 4 years ago

          Nice study, I don't find any mayor fail. (Some articles are very bad.)

          As they say, it's not a double-blind randomized controlled trial.

          I like more the pilot study because they try to match the age and pupation of the both groups. The problem is that they perhaps involuntary cherry picked the sublets in the experimental group. For example if there are 50 nurses and they want to recruit some of them, they may go first with with the ones that fill all the paperwork so they don't mess with the data for the study, or they skip the one that is drunk every other Monday or the one that is 15 minutes late everyday. Do these involuntary selection affect the result? Perhaps. Did they do this involuntary selection? Perhaps??? How can it be solved...

          Make a double-blind randomized controlled trial. They can involuntary cherry pick and this is fixed by the randomization.

          Also double-blind, because if you are the subject of the study, you don't want to "fail" and you are more careful. Or not. But just in case double-blind.

          In the first study it's not clear how they got the control group. Perhspa go to HR, ask for the complete list, and then choose some randomly.

          The second one is more weird, because

          > A total of 1,195 health care workers were recruited from 4 major hospitals ... 788 participants received IVERCAR and PPEs, while the remaining 407 simply adhered to standard PPEs.

          It's very unclear how they split them.

          Another weird details is that

          > Received date: November 09, 2020; Accepted date: November 16, 2020;

          It's a very short review period. Perhaps it's common in the area, but in many areas the reviewers take like a month or more. I'm not sure if it's a good or bad journal. It's very difficult to know that if you are not in the area.

        • ncmncm 4 years ago

          We have pretty good reasons to believe that CBD, in the absence of THC, is protective for people who have contracted COVID: it keeps them out of ICU.

          Unfortunately almost all retail products that claim to have CBD don't. CBD from the pharmacy, which does, costs more than people usually want to pay.

          • lambdaba 4 years ago

            Are you sure about that? I've bought CBD isolate several times from (decently vetted) online vendors... pretty sure it was pure CBD

            Still, pretty amazing CBD would "block" entry of the virus in cells, or something like that (I only read the headlines, not pretending to understand)... But maybe this is somehow how Ivermectin can have antiviral properties at normal doses too. I suppose CBD once the infection sets in is less effective (though surely harmless).

            • ncmncm 4 years ago

              How did you verify it was pure CBD? Do you have equipment that would enable such verification? Seeming to have the effect you expect from CBD is not reliable.

              CBD's effect on COVID-19 is to suppress the over-reaction of the immune system causing congestion and breathing problems. It does not interfere with the viral life cycle. So, it is useless to prevent COVID-19 infection.

              In vitro analysis suggested that, in principle, ivermectin ought to help block COVID-19 virus in several ways. That generated interest to see if it would help.

              The more reliable each study has been, the less effect it has shown. Something working great in test tubes (and even in mice) and failing when prescribed to actual people is totally unsurprising to anybody who works in medical research. Something promising that actually turns out to work clinically is always astonishing.

              So, discounting promotion by people do lack long experience interpreting medical research results is not corrupt SUPPRESSION OF THE TRUTH. It is simple honest reporting, is doing you a favor, and you should welcome it.

              • lambdaba 4 years ago

                I vaped it. It all evaporated every time. And I've tried multiple vendors, I know how the powder looks like, are you suggesting there's a cutting agent or what? Why would a reputable company do that? It's not a very reasonable position. I'm sure there are fakes out there, but not very many, I would estimate.

                • ncmncm 4 years ago

                  You estimate wrong, then.

                  Typical preparations, most especially those sold for vaping, turn out on examination to have ~2% of the amount of CBD advertised, where they have any. I.e., they have just enough that a crude test of presence shows something present.

                  • dekhn 4 years ago

                    Actually, here's what I see on a typical vaping prep, for THC but not CBD: TOT THC: 80.94%. Tot THC: 809.42mg. Tot CBD: 0.00mg. The CBD ones typically have between 65% and 99% CBD. Each container has a traceability mark and these things are tested in-house with calibrated equipment.

                    That said, I buy from a premium dispensary and I have no idea what's vended in smoke shops.

                  • lambdaba 4 years ago

                    I buy pure cbd isolate, powdered cbd. Not a preparation and not sold for vaping. When you've tasted pure cbd you know how to recognize it.

                    • ncmncm 4 years ago

                      Anyway, in answer to your question on whether I am sure CBD helps: No.

                      I read one good-quality paper that reported an effect, and suggested plausible mechanisms. But the authors cautioned it needed more work before it could be recommended clinically. In particular, there was no hint it might prevent infection, or be useful to treat mild cases. The perhaps surprising bit was that THC interfered with the effect of the CBD.

                      The US NIH says that fluvoxamine is useful to treat serious cases. Any doctor can prescribe that.

    • ncmncm 4 years ago

      Scurrilous accusations violate posting rules.

      • lambdaba 4 years ago

        I'm sorry, I wasn't suggesting YOU had monetary incentives, this is just a tech news forum.

cosmotic 4 years ago

This may look and smell like a peer reviewed study, but I cannot find any reliability rankings for the journal 'Cureus'. Wikipedia article on Cureus is brief and it appears they allow anyone to publish. I would take this article with a few large grains of salt.

rsfern 4 years ago

For context, this journal uses crowd sourced open peer review, which is an interesting concept.

There’s one review, and it’s (IMO) not substantive. I would treat this as a preprint basically (not that you shouldn’t read peer reviewed studies critically either)

  • mullingitover 4 years ago

    > not that you shouldn’t read peer reviewed studies critically either

    Can't emphasize this enough. The MMR autism fraud paper that started the anti-vaccine industry was peer reviewed in the Lancet.

    It's unfortunate that the critical thinking skills needed to know good research from bad aren't drilled into us as part of the core curriculum for every high school student.

JohnTHaller 4 years ago

Parasites are a comorbidity of Covid-19. Ivermectin is an anti-parasitic. You'll slightly improve your chances against Covid-19 by treating the parasites with Ivermectin so your body doesn't have to fight those, too. Parasites are endemic in Brazil in the South where Itajaí is located and Ivermectin is in heavy usage pre-pandemic as a result.

We already knew this. This doesn't apply outside areas with endemic parasites. It doesn't apply here in the US.

SteveEM 4 years ago

These authors have had one article retracted by the Journal of Intensive Care Medicine and another refuted by American Journal of Therapeutics. https://journals.lww.com/americantherapeutics/Fulltext/2022/...

noja 4 years ago

Is this the "if the subject is suffering from worms, then treating the worms allows them to fight the virus" result? (So not relevant in the US)

  • JohnTHaller 4 years ago

    Yes. It took place in a city in southern Brazil where worms are endemic. It's exactly what we already knew and not relevant in the US.

SteveEM 4 years ago

These are the issues that limit ability to draw conclusions in this study: No pre-registration, No randomization, No blinding, No allocation concealment, No idea who did/did not fill prescriptions, Prescription writing was based on "judgement"?!, No uniform follow up, No idea who was followed up or lost to follow up

whiskeyRanger 4 years ago

> SIQ™ is a predictive measure of scientific quality.

> How can I improve my article's SIQ™?

> Telling your friends, colleagues and advisors to review the article on Cureus

> Cureus offers a social media promotional add-on, or boost, for eligible published articles at an additional cost.

So this site is like PubMed but with payola?

rootusrootus 4 years ago

Makes sense in Brazil, but is it applicable to the US or other Western nations?

  • threeseed 4 years ago

    Not when we have extremely safe, highly effective vaccines.

    But in places where they aren't available it could be interesting especially if Omicron is the dominant variant and reducing transmission isn't of much use (which Ivermectin doesn't help with).

    • ncmncm 4 years ago

      People in those places should be treating their parasite infections anyway. We already knew they would be the healthier for it. But they aren't, because they can't afford it.

  • JohnTHaller 4 years ago

    Nope. Worms are not endemic here, so Ivermectin has no impact on Covid-19 outcomes. It has a slight effect in this area of Brazil where worms are endemic.

tinus_hn 4 years ago

Interesting. It’s not double blind and I’m not sure how practical this is but it does cast a lot of doubt on the conclusion that ivermectin doesn’t do anything unless the dose is lethal.

  • ncmncm 4 years ago

    Ivermectin affects parasite load, and parasite load affects outcomes of acute respiratory infection.

    The effect size is smaller than from wearing a good mask.

    • tinus_hn 4 years ago

      This is a completely nonsensical dismissal unless you want to claim the outcome for people who actually get ill is different for those who wore masks versus those who didn’t.

      And be sure to keep in mind that the vast majority of infections occur at home where I sincerely doubt people are wearing masks.

      • ncmncm 4 years ago

        The point is that if you have a parasite infection, treating that is a good idea. If you don't, then treating it will not help you.

        If you want not to die from COVID-19, getting fully vaccinated is the way. If you want not to catch and spread it (vaccinated or no) wear a mask when you might be exposed or expose others. If you can't get vaccinated, anyway do things to be healthy -- treat any parasite infections, eat well, sleep well, eat well, exercise.

        • tinus_hn 4 years ago

          In other news, the sky is blue, but that is not at all what this article is about. And you preaching about how your favorite measure, unquantifiably, is better than this measure, does not add anything meaningful to the article.

          • JohnTHaller 4 years ago

            It's not a "favorite measure" it's the ones proven to work. All this self-reported summary shows is that taking Ivermectin can slightly improve Covid-19 outcomes in areas where worms are endemic. This study was done in an area of Brazil where worms are common and where high Ivermectin usage pre-dates Covid-19. It's something we already know. Parasitic infection results in worse outcomes for respiratory infections. Treat worms if you have them.

            • tinus_hn 4 years ago

              You’re just repeating the same thing. This study shows ivermectin does have an effect. It might be because of parasites or not and it has absolutely nothing to do with masks or vaccines so preaching about how masks and vaccines are better is not helpful.

              People aren’t going to wear masks forever and aren’t going to take boosters forever so we need more solutions. And before you say, they aren’t going to take ivermectin forever either but that doesn’t mean it’s not useful to know if, why and how it works.

              • ncmncm 4 years ago

                If people need something else than vaccination and masks, such a thing will need to be identified. Chasing phantoms does not achieve that. And each person who dies because they tried to use things that don't work instead of what works is blood on the hands of people promoting those.

                • tinus_hn 4 years ago

                  You don’t get to decide what others research. Science doesn’t work by saying others can’t look into subjects you think are stupid. You can insert all the dramatic accusations you want, it’s still anti science.

                  • ncmncm 4 years ago

                    If you can't tell the difference between research and promotion, you cannot be any help to anybody. Then, the best thing you can do is let the people who can go about it, without you getting in the way.

                    • tinus_hn 4 years ago

                      I can tell the difference between people that are promoting the things that already exist and research just fine, thank you.

    • lambdaba 4 years ago

      Could you share a link to such a debunking? I could search, but you probably have one that you find most convincing.

    • supperburg 4 years ago

      Parasites double your chances of getting severe Covid? Shouldn’t people be taking it anyway then, as well as wearing a mask?

      • lambdaba 4 years ago

        Right? Ivermectin is reportedly extremely safe at normal doses, and parasites are an issue everywhere I would think, to an extent. Why not advocate for screening for parasites if getting rid of them has such a dramatic effect?

        • ncmncm 4 years ago

          They do screen for parasites in areas where parasites are a problem, principally the tropics. People who live there live with the parasites because they cannot afford treatment.

Grismar 4 years ago

Science on this is great. However, don't parrot this to your friends until you see it replicated somewhere else (preferably somewhere not governed by ivermectin-peddling populists) and confirmed in a double-blind random-controlled trial (which this doesn't even get close to). After all, no reason to hold this stuff to a lower standard than the anyone want to hold the vaccines to (regardless of whether they realise these standards were already met there).

  • josephcsible 4 years ago

    > no reason to hold this stuff to a lower standard than the anyone want to hold the vaccines to

    There absolutely is such a reason: the standard for things that people are required to take should be way, way higher than the standard for things that people are merely allowed to take.

rajangdavis 4 years ago

Why did this get flagged? It's pretty measured in it's findings:

These results indicate that medical-based optional prescription and citywide covered ivermectin can have a positive impact on the healthcare system. However, the present results do not provide sufficient support for the hypothesis that ivermectin could be an alternative to COVID-19 vaccines

LearnerHerzog 4 years ago

I heard those researchers drank horse refresher (water). Can we really trust people putting horse refresher in their bodies?

b0sk 4 years ago

The supposed “hackers” keep pushing these pseudo scientific garbage in Hacker News for some reason

johng 4 years ago

These seems like a pretty thorough study... is it OK for people to talk about Ivermectin now or are they still going to censor and ban accounts?

  • threeseed 4 years ago

    Many of those that I saw banned were for those recommending taking ivermectin.

    Nobody should take anything without discussing it with their doctor.

  • coding123 4 years ago

    Well, I don't think HN will ban accounts for that. They ban accounts for being mean or starting flamewars. Being republican is NOT a reason for bans here.

    • hunter2_ 4 years ago

      Genuinely curious why alignment with this drug is so republican. Seems like the kind of thing that ought to be bipartisan if it's arguably progressive.

      • dekhn 4 years ago

        the alignment is not "republican", it's "ignorant". my relatives who are well educated doctors ("we voted for trump because taxes") don't believe this; they got vaccinated (and kept their mouths shut about it) like the majority of other well-off republicans.

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