Ivermectin is ineffective for patients with mild to moderate COVID-19

Reference

Lim SCL, Hor CP, Tay KH, et al, for the I-TECH Study Group. Efficacy of ivermectin treatment on disease progression among adults with mild to moderate COVID-19 and comorbidities: the I-TECH randomized clinical trial. JAMA Intern Med 2022;182(4):426-435.

Synopsis

These investigators enrolled 490 patients, 50 years or older, with confirmed COVID-19 and at least one chronic disease. The patients had mild to moderate illness (World Health Organization Clinical Progression Scale 2–4) and did not require oxygen or have a pulse oximetry oxygenation level of less than 95%. The patients, given the protocol at the time in Malaysia, were either hospitalized or in a quarantine center. The study was conducted from April 2021 through October 2021, which was before some of the subsequent variants were common. The patients were randomized, using concealed allocation, to receive standard care alone or in combination with oral ivermectin 0.4 mg per kg for 5 days. Neither patients nor study personnel were masked to treatment assignment, and there was no placebo control; both of these limitations tend to inflate the perception of benefit of an active treatment. The primary outcome, progression to hypoxia requiring supplemental oxygen of 95% or higher, was similar in both groups: 21.6% in the ivermectin group and 17.3% in the control group (P = .25). The need for mechanical ventilation, intensive care admissions, and the rate of in-hospital death were not statistically different between the 2 groups, The study had 80% power to find a 50% reduction in progression to hypoxemia or a 9% rate difference between intervention and control groups. The low numbers of the secondary outcomes indicate that the study likely did not have sufficient power to find any differences, if any truly exist.