The Research Is Clear: Ivermectin Is a Safe, Effective Treatment for COVID. So Why Isn’t It Being...

MAJ Dale E. Wilson, Ph.D. From the WHO: Benefits and harms
The effects of ivermectin on mortality, mechanical ventilation, hospital admission, duration of hospitalization and viral clearance remain uncertain because of very low certainty of evidence addressing each of these outcomes. Ivermectin may have little or no effect on time to clinical improvement (low certainty evidence). Ivermectin may increase the risk of SAEs leading to drug discontinuation (low certainty evidence).

Subgroup analyses indicated no effect modification based on dose. We were unable to examine subgroups based on patient age or severity of illness due to insufficent trial data (see section text). Therefore, we assumed similar effects in all subgroups. This recommendation applies to patients with any disease severity and any duration of symptoms.

Certainty of the Evidence
For most key outcomes, including mortality, mechanical ventilation, hospital admission, duration of hospitalization and viral clearance, the GDG considered the evidence of very low certainty. Evidence was rated as very low certainty primarily because of very serious imprecision for most outcomes: the aggregate data had wide confidence intervals and/or very few events. There were also serious concerns related to risk of bias for some outcomes, specifically lack of blinding, lack of trial pre-registration, and lack of outcome reporting for one trial that did not report mechanical ventilation despite pre-specifying it in their protocol (publication bias).

For more details, see the Justification section for this recommendation. For other outcomes, including SAEs and time to clinical improvement, the certainty of the evidence was low.

Preference and values
Applying the agreed values and preferences (see Section 5), the GDG inferred that almost all well-informed patients would want to receive ivermectin only in the context of a randomized trial, given that the evidence left a very high degree of uncertainty in effect on mortality, need for mechanical ventilation, need for hospitalization and other critical outcomes of interest and there was a possibility of harms, such as treatment-associated SAEs. The panel anticipated little variation in values and preferences between patients when it came to this intervention.

Resources and other considerations
Ivermectin is a relatively inexpensive drug and is widely available, including in low-income settings. The low cost and wide availability do not, in the GDG's view, mandate the use of a drug in which any benefit remains very uncertain and ongoing concerns regarding harms remain. Although the cost may be low per patient, the GDG raised concerns about diverting attention and resources away from care likely to provide a benefit such as corticosteroids in patients with severe COVID-19 and other supportive care interventions. Also, use of ivermectin for COVID-19 would divert drug supply away from pathologies for which it is clearly indicated, potentially contributing to drug shortages, especially for helminth control and elimination programmes. Other endemic infections that may worsen with corticosteroids should be considered. If steroids are used in the treatment of COVID-19, empiric treatment with ivermectin may still be considered in Strongyloidiasis endemic areas, at the discretion of clinicians overseeing treatment, albeit not for treatment of COVID-19 itself.

My last trip to the feed store, last week, there was a sign on the drive through window that the store was sold out out of Ivermectin. I had to chuckle.

Whatever works.