Ivermectin is a broad spectrum anti-parasitic agent, included in WHO essential medicines list for several parasitic diseases. It is used in the treatment of onchocerciasis (river blindness), strongyloidiasis and other diseases caused by soil transmitted helminthiasis. It is also used to treat scabies.
A guideline development group was convened in response to the increased international attention on ivermectin as a potential treatment for COVID-19. This group is an independent, international panel of experts, which includes clinical care experts in multiple specialties and also include an ethicist and patient-partners.
The group reviewed pooled data from 16 randomized controlled trials (total enrolled 2407), including both inpatients and outpatients with COVID-19. They determined that the evidence on whether ivermectin reduces mortality, need for mechanical ventilation, need for hospital admission and time to clinical improvement in COVID-19 patients is of “very low certainty,” due to the small sizes and methodological limitations of available trial data, including small number of events.
The panel did not look at the use of ivermectin to prevent COVID-19, which is outside of scope of the current guidelines.
Note to the editor:
Previous recommendations on the use of therapeutics for COVID-19:
· Strong recommendation for the use systemic corticosteroids for severe or critically ill COVID-19 patients; with a conditional recommendation against their use in patients with mild/moderate COVID-19
· Conditional recommendation against administering remdesivir in addition to usual care.
· Strong recommendation against the use of hydroxychloroquine or chloroquine for treatment of COVID-19 of any severity
· Strong recommendation against administering lopinavir/ritonavir for treatment of COVID-19 of any severity
· Conditional recommendation for the use of low dose anticoagulants in hospitalized patients (this recommendation is part of the clinical management guidelines). We suggest the use of low doseanticoagulants rather than higher doses, unless otherwise indicated.
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