Ivermectin: balance of evidence shows no benefit against Covid-19

hellfire

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Full article: https://www.groundup.org.za/article/ivermectin-flops-largest-trial-yet/

While it’s too soon to say that the drug is useless, it has clearly been overhyped​

Ivermectin has been touted as the wonder drug solution to the Covid-19 crisis. Several trials have suggested it may have some benefit. But the largest trial yet comparing ivermectin to placebo was published on Friday. It found no statistically significant benefit from ivermectin but possible harm from the drug.

Yet even this trial is too small to definitively settle questions about ivermectin’s safety and efficacy. Nevertheless, even if some future trial does find benefit, there is now little doubt that this is not a wonder drug; whatever benefits it may have are at most modest.

This latest trial was conducted in Argentina by Julio Vallejos and colleagues. The results were published in BMC Infectious Diseases on 2 July. It’s main outcome was to see if ivermectin reduced hospitalisation in people with Covid-19.

The trial included 501 volunteers, 250 randomly assigned to take ivermectin and the remaining 251 were assigned to a placebo arm. The trial used quite a complicated dosing regimen that depended on patient weight.

Incredibly it was extremely hard to find patients for the trial. Why? Too many Argentinians it seems were already taking ivermectin. Of 15,968 people who tested positive for Covid and were excluded from taking part in the trial, 12,356 could not participate because they were already taking ivermectin. (We are also hearing anecdotal reports of South Africans using ivermectin.)

Fourteen people on the ivermectin arm were hospitalised versus 21 on the placebo arm. Besides this not being a statistically significant difference, there were more people with diabetes, perhaps the most serious risk factor for serious Covid, in the placebo arm; there were also more people with hypertension in the placebo arm (weight and age were well matched between the arms). Quite clearly ivermectin was not shown to be beneficial in this trial.

There was one statistically significant difference in outcomes. Four people on the ivermectin arm needed to be put on ventilators versus three in the placebo arm, but the ivermectin patients needed to be ventilated five days after they joined the study versus ten days for the placebo arm. This doesn’t mean ivermectin is unsafe, but it definitely doesn’t bode well for a drug that some have promoted so hard.
ivermectin-flops-largest-trial-yet


This study confirms the results of a Columbian one published in March in the Journal of the American Medical Association, which also found no statisticially significant benefit from ivermectin versus placebo. That study had 476 participants.

One other clinical trial, as far as we can tell, has had more ivermectin participants (400), but it had no placebo participants; instead the control arm took hydroxychloroquine, another overhyped drug that is ineffective against Covid-19 and possibly harmful. That study was conducted in Egypt and had several serious ethical and methodological problems; for example the study was completed before it was registered (this is very bad for reasons that would require another article to explain).

The Egyptian study is not the only ethically questionable ivermectin one. The open access science journal, Frontiers, in a scathing editorial, rejected a widely circulated article by Pierre Kory that has been used by ivermectin advocates.

The Frontier editor, Frederick Fenter, wrote: “t was revealed that the article made a series of strong, unsupported claims based on studies with insufficient statistical significance, and at times, without the use of control groups. Further, the authors promoted their own specific ivermectin-based treatment which is inappropriate for a review article and against our editorial policies.”
 

rvZA

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The trial included 501 volunteers, 250 randomly assigned to take ivermectin and the remaining 251 were assigned to a placebo arm. The trial used quite a complicated dosing regimen that depended on patient weight.

Oh, okay, the 'experts' decided 501 people is enough to come to this conclusion. Well done.

Over and above this, I will not be paying too much attention to anything posted in Groundup nor any 'scientific' evidence coming from Argentina.
 

Sinbad

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Oh, okay, the 'experts' decided 501 people is enough to come to this conclusion. Well done.

Over and above this, I will not be paying too much attention to anything posted in Groundup nor any 'scientific' evidence coming from Argentina.
Hide your dunning Kruger.

A sample size of 500 gives something like a 95% confidence level.
 

Sollie

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So which is the best? The Honda or the Kawasaki?
 

Temujin

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This study has several limitations. Firstly, the percentage of events in relation to the primary outcome was below the estimate, so this trial was under powered.

Secondly, the mean dose of ivermectin was 192.37 μg/kg/day (SD ± 24.56), which is below the doses proposed as probably effective [20, 33]. Thirdly, a middle-aged population was included which, in accordance with the first point raised in this section, had hospitalization events below the 10% set at the time of calculating the sample size. On the other hand, including a population with these characteristics increases the external validity of the study. Consideration could be given to analyzing the efficacy of ivermectin in a population at high risk of hospitalization in future trials. Fourth, blood ivermectin levels were not measured, so we cannot know the bioavailability of the drug in these patients or the blood ivermectin levels that were reached. Lastly, we did not include any scale to determine the severity of the patients who were enrolled. At the time of inclusion in IVERCORCOVID19, the patients did not have hospitalization criteria, therefore, we cannot determine if the population included was mostly with a mild or moderate condition or if there was a similar distribution between both groups.
So then why did you bother?
 

surface

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Hide your dunning Kruger.

A sample size of 500 gives something like a 95% confidence level.
I am pretty sure the poster is a PP who relies on minority judgement to do a victory lap. 5% - yay - look, these people agreed with us. WE WON.
 

Temujin

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Where did you find this commentary please?
Oh sorry, link to study in article(bottom of 'study' - second last paragraph)
 

Nicodeamus

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This is a clear case where we love to draw the conclusions that we want from the data that we like.

"The mean age was 42 years (SD ± 15.5) and the median time since symptom onset to the inclusion was 4 days [interquartile range 3–6]. The primary outcome of hospitalization was met in 14/250 (5.6%) individuals in ivermectin group and 21/251 (8.4%) in placebo group (odds ratio 0.65; 95% confidence interval, 0.32–1.31; p = 0.227). Time to hospitalization was not statistically different between groups."


The results aren't statistically insignificant yet clinically valid, you cannot infer from the statement that ivermectin isn't showing a signal, because the treated group had a better outcome.

That doesn't even go into the issue of low dosage and odd time of treatment. All that this shows me is that even a badly designed Ivermectin trial can show a good signal.





The Daily Maverick is cherry picking the results that they want, the current evidence around Ivermectin suggests a clinical improvement, the uncertainty lies within the range.
 

Temujin

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This is a clear case where we love to draw the conclusions that we want from the data that we like.




The results aren't statistically insignificant yet clinically valid, you cannot infer from the statement that ivermectin isn't showing a signal, because the treated group had a better outcome.

That doesn't even go into the issue of low dosage and odd time of treatment. All that this shows me is that even a badly designed Ivermectin trial can show a good signal.





The Daily Maverick is cherry picking the results that they want, the current evidence around Ivermectin suggests a clinical improvement, the uncertainty lies within the range.
My bigger issue is that the authors basically state in their own paper they knowingly underdosed and didn't bother with blood and data... just publish for media to lap up 'it doesn't work'
 

Geoff.D

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My bigger issue is that the authors basically state in their own paper they knowingly underdosed and didn't bother with blood and data... just publish for media to lap up 'it doesn't work'
There is plenty more wrong with that study. Just like the one in Colombia. Both proved nothing except the obvious.
 

The Darkness

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These doses are minute. Last year when I had covid I was really ill, lost my smell and taste and took weeks to recover properly. Recently I caught the new strain, even before the test results I was on a proper dose of Ivermectin. By day 3 the symptoms were gone. It can't be disputed, and all of the doctors and pharmacists I've spoken to who are on the front line swear by it.
 

Geoff.D

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These doses are minute. Last year when I had covid I was really ill, lost my smell and taste and took weeks to recover properly. Recently I caught the new strain, even before the test results I was on a proper dose of Ivermectin. By day 3 the symptoms were gone. It can't be disputed, and all of the doctors and pharmacists I've spoken to who are on the front line swear by it.
What was your dosage? Was it prescribed by a doctor?

Have you had any urges to bleat like Zuma and Dali yet?
The above is about the worst side effect you might experience and the good news is it will wear off quite quickly.
 
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Cosmik Debris

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These doses are minute. Last year when I had covid I was really ill, lost my smell and taste and took weeks to recover properly. Recently I caught the new strain, even before the test results I was on a proper dose of Ivermectin. By day 3 the symptoms were gone. It can't be disputed, and all of the doctors and pharmacists I've spoken to who are on the front line swear by it.

Could that be due to your immunity that built up from the last time or soley due to the Ivermectin?
 
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