Ivermectin, sold under the brand name Stromectol, is an anti-parasitic medication used to treat parasitic infections in animals along with cases of lice, scabies, and Strongyloidiasis in human beings. It is also effectively used to treat river blindness and lymphatic filariasis in human beings and is recently under the scanner for its role in treating Covid-19 patients.
Ivermectin was first developed in Japan in 1970. Its effectiveness has enabled a Nobel Prize to its discoverers William Campbell and Satoshi Omura. It is usually used as a single dose based on the patient’s weight, with great precautions taken with its consumption and distribution because of its high side effects.
A brief note on Covid 19
Covid-19 or coronavirus disease is an infectious disease caused by the Sars-Covid-19virus. A respiratory virus spreads through droplet infection generated from the infected person’s coughs through droplets of saliva and discharge from the nose. Signs of Covid-19 infection include fever, cough, and shortness of breath, with severe pneumonia and respiratory syndrome presented in the more severe cases.
Medications for Covid are rare and still in the making. Currently, only Remdesivir has been recognized as the FDA-approved antiviral for the treatment of Covid-19. Remdesivir being an anti-parasitic, corticosteroids like dexamethasone, is the second line of treatment for dealing with the lungs inflammation resulting due to Covid. This is where the use of Ivermectin becomes crucial in treatment for Covid-19 patients because of its effectiveness and also because of the lack of better options for fighting against the pandemic.
Ivermectin for Covid 19
Studies have postulated that there might be two ways in which Ivermectin could be used in Covid-19 patients. Firstly, it could prevent the SARS-CoV virus from suppressing the human cell’s natural antiviral response, thus enabling our immune system to fight the virus more effectively. Secondly, it could prevent the spike protein on the surface of the virus from binding to our cell receptors. This ineffective binding could restrict the virus from entering our body through the cell receptors and prevent an outbreak of the virus. Additionally, the inflammatory properties of Ivermectin have been surmised to be effective in dealing with the effects of Covid. But research is still pending regarding a valid conclusion about its effectiveness.
UK based trials for Ivermectin
Oxford University in January 2020 declared testing Ivermectin in UK as a treatment plan for the Covid-19 virus. They named the trial ‘Principle’ and planned its implementation as a Government-backed study. Aiming to help in Covid -19 recoveries in non-hospital settings, it included seven medications, namely antibiotics like Azithromycin and Doxycycline and antivirals like Favipiravir along with anti-parasitic medications like Ivermectin as the 7th study.
The trials for the antibiotics were held on a comparatively large scale consisting of almost 546 volunteers. They proved ineffective for the early stages of Covid-19 and were subsequently ruled out from the list of medications used during Covid -19 treatment. Surprisingly, laboratory tests for Ivermectin showed a reduction in virus replication. The results of a comparatively smaller pilot study showed that early use of the drug could reduce the duration of symptoms in patients with mild Covid symptoms.
Further and larger studies are still in progress, but the fact remains clear, as proved by Oxford University, that Ivermectin has the potential to help in the treatment of Covid -19 cases.
Are the safety parameters being followed?
The EMA or European Medicine Agency, after reviewing the data presented by all the researchers, has not given the green flag for the use of Ivermectin in Covid-19 cases. The EMA has considered the latest published evidence from laboratory studies and optimized trials and concluded that the supplied evidence is not enough to support the use of Ivermectin for Covid patients outside of clinical trials.
According to the EMA, the studies were varied about the results of the trials. While some trials showed a positive outcome, others gave a neutral, if not adverse, reaction to using Ivermectin for the virus. Additionally, the trials did not have set parameters for testing the virus, which made the overall report inconsistent.
Why doesn’t the WHO support the use of Ivermectin for Covid-19 patients?
The main issue of the WHO is with the dose of Ivermectin required for fighting against the virus. According to the WHO, Ivermectin has the potential to block the replication of Sars-covid (the virus responsible for Covid) but at much higher concentrations than the permitted dose. In simple words, a higher dose of Ivermectin is required in the lungs for effective treatment against the virus than is legally permissible. Using it in its required strengths could greatly increase the risk of side effects associated with medication overuse. Even if Ivermectin successfully reduced the replication and symptoms associated with the virus, the body would have to deal with the toxicity effects of the medication that could be worse than the effects of the virus.
While it is true that WHO has included Ivermectin in its ‘Model List of Essential Medicines’, this status applies only to the role of Ivermectin in parasitic infections and not as an antiviral in Covid-19 infections.
Then, why are some countries still using them?
The FLCCC (Front Line Covid-19 Critical Care Alliance) was created in March 2020. They conducted multiple large-scale randomized trials regarding the efficacy of Ivermectin along with other medications like Methylprednisolone, Thiamine, and Ascorbic acid for therapeutic relief in Covid-19 patients. Based on these trials, Ivermectin was included as a prophylaxis and treatment medication in some South-American countries and Belize, Macedonia, and some places of India. The goal of FLCCC is to quickly validate the use of Ivermectin in Covid-19 patients and help decrease the large-scale mortality rate caused due to the virus.
Not just these places, the European countries of Czechia and Slovakia have also temporarily allowed the use of Ivermectin in Covid-19 cases and became among the first European nations to formally approve Ivermectin as both prophylaxis and treatment options for Covid-19 patients.
Conclusion
If we are to look at the scientific evidence regarding Ivermectin use for Covid-19 patients, the evidence comes from inferior quality of studies with a high grade of bias. Even Merck, the manufacturer of Ivermectin, does not recommend its use in Covid-19 patients due to a lack of satisfactory data. But the lack of other viable options and the ineffectiveness of potential antibiotics and antivirals have forced the medical field in various countries to use Ivermectin to reduce the growing rates of mortality among Covid-19 patients.
And the fact that there is a chance of its effectiveness as opposed to its side-effects has made a few countries outweigh its good over its bad and go ahead with using it despite FDA and WHO reservations. The entire process needs substantial research with common sets of parameters to reach a solid conclusion. Until then, Ivermectin needs to be used with caution in trial patients. The WHO needs to conduct more research in discovering viable treatment options for Covid patients with more efficacy than the preceding toxicity.
