The sudden outbreak and rapid spread of the novel coronavirus accelerated global research into possible therapies and preventive interventions against the disease. Collaborative efforts by scientists and researchers around the world pointed to Remdesivir as the most effective antiviral treatment for COVID-19. However, Remdesivir, which is the only Food and Drug Administration (FDA)-approved COVID-19 treatment, is barely affordable and its use is only limited to the treatment of hospitalized patients. Also, more recent data suggest that the drug may have no significant benefit for COVID-19, as cases, hospitalizations, and death rates continue to surge despite its use.
Now, researchers are pointing to new evidence indicating that a long-known anti-parasitic drug, Ivermectin, could be a better drug for the treatment of COVID-19. Interestingly, Ivermectin was found in some studies to be effective for both prevention and treatment of COVID-19 - and treatment of all stages of the infection.
Ivermectin is an FDA-approved anti-parasitic drug that has been available for over 40 years. The drug is among the first-line treatments for parasitic roundworm infections, including lymphatic filariasis or elephantiasis, cutaneous larva migrans, trichuriasis, and Onchocerciasis. Ivermectin has been aptly described as a ‘wonder drug’ for its versatility, excellent safety profile, and overall benefit to billions of people worldwide, especially in developing countries — just a single, oral dose could eliminate some of the world’s most devastating infectious diseases.
These enthralling effects of this simple drug on a wide range of parasitic diseases earned Irish-born American parasitologist William Campbell and Japanese microbiologist Omura Satoshi the 2015 Nobel Prize for Physiology or Medicine.
However, its potential role in the treatment of COVID-19 gained global attention in early 2020 when a team of researchers in Australia found that ivermectin inhibited the causative virus (SARS-CoV-2) of COVID-19 in experimental studies. A single treatment of the anti-parasitic drug reduced the virus population in cell culture by more than 5000 folds within 24-48 hours. The study also revealed a nearly 100 percent (98.9 percent) reduction in viral RNA after treatment with Ivermectin.
The researchers explained that ivermectin appeared to bind to the spike protein with which SARS-CoV-2 attaches to human tissue, and interferes with other proteins that are needed for entry and replication of the virus. These mechanisms also explain the antiviral effects of ivermectin on several RNA viruses, including Zika, Human Immunodeficiency virus type 1, Avian influenza A, West Nile, yellow fever, and Venezuelan equine encephalitis viruses.
These compelling results precipitated more groundwork and funding into exploring the role of Ivermectin in treating and preventing COVID-19, and the results have been promising.
In December 2020, the Frontline COVID-19 Critical Care (FLCCC) Alliance released a one-page summary of all the clinical trials available globally that investigated the use of ivermectin in the prevention and treatment of COVID-19. Paul Marik, founder of the alliance and a professor of medicine of the division of pulmonary and critical care medicine at Eastern Virginia Medical School, said that all available clinical trial results on ivermectin in COVID-19 concluded that the drug has significant preventive and therapeutic value for COVID-19 infection.
Marik cited one of the randomized controlled trials in Egypt that found that among healthcare and household contacts of COVID-19 patients, just 2 percent of those who received ivermectin and wore PPE contracted the novel coronavirus, compared with 10 percent of contacts who wore only PPE.
Further, Marik described a randomized controlled trial of hospitalized patients with COVID-19, which was done concurrently with the prophylaxis study. The trial involved 400 patients grouped into four categories based on the severity of their symptoms. Two groups consisted of patients with mild to moderate illness, while the other two consisted of critically-ill patients. Patients with mild to moderate illness received one dose of ivermectin each day in addition to standard care or the recommended dosage of hydroxychloroquine twice daily plus standard care. Severely ill patients were given standard care plus ivermectin or hydroxychloroquine.
The study results revealed that the patients that received ivermectin had a lower disease progression and shorter hospital stay than those who did not receive it (1% vs. 22%). The researchers also found that in patients with severe COVID-19, both disease progression rate and mortality rates were significantly lower than in those who did not receive ivermectin — (4% vs. 30%) and (2% vs 20%) respectively.
Generally, all the studies that have been conducted on ivermectin in COVID-19 patients revealed a remarkable decrease in mortality and hospitalization, promising a new therapeutic intervention that could bring an end to the pandemic.
These remarkable findings, though from a small number of studies, are already disrupting COVID-19 treatment programs in some countries. Late January 2021, South Africa approved the limited use of ivermectin to treat COVID-19. The South African Health Products Regulatory Authority mentioned that although there have been no large studies to confirm these findings, current data shows promise in the prevention and treatment of COVID-19. Further, the country has also commenced further research on the role of ivermectin in COVID-19.
Some countries in Latin America have also authorized its use for the treatment of patients with COVID-19, citing that the few studies have been largely positive.
On the heels of this early adoption of the medicine, experts raised concerns about the new emerging coronavirus strains limiting the drug’s efficacy. In response, Dr. Pierre Kory, lead FLCCC Alliance author of the scientific review cited the drug’s extensively-studied anti-viral properties, which prevent entry and replication of several viruses. Given these effects, Ivermectin is poised to remain a potent antiviral against mutant strains of the virus, according to Kory.
To establish this role of ivermectin in preventing and treating COVID-19, the World Health Organization (WHO) has commissioned an updated meta-analysis on ivermectin that would give more clarity about the drug’s efficacy. The team of independent investigators is expected to report their findings to the WHO in the coming weeks.
While scientists continue to investigate and seek a better understanding of ivermectin and its use in COVID-19, emerging results have been promising. Experts hope that larger studies will corroborate these findings, leading to widespread approval and extensive use. This would mean that this award-winning cheap treatment may bring an end to the pandemic.
