Ivermectin for Prevention and Treatment of Covid-19 Infection

The López-Medina trial was one of the biggest RCTs for Ivermectin. Out of the 60 trials for Ivermectin, it was one of the few that didn't show statistical significance.

It was also seriously flawed - a large percentage of the placebo group was self-medicating using Ivermectin, they mixed up the treatment and placebo group, and they switched the primary outcome in the middle of the trial. That trial still showed improvement, but it didn't reach statistical significance.

"[López-Medina] has many issues. The primary outcome was changed mid-trial from clinical deterioration to complete resolution of symptoms including "not hospitalized and no limitation of activities" as a negative outcome. Critically, temporary side effects of a successful treatment may be considered as a negative outcome, which could result in falsely concluding that the treatment is not effective. Such an outcome is also not very meaningful in terms of assessing how treatment affects the incidence of serious outcomes. With the low risk patient population in this study, there is also little room for improvement - 58% recovered within the first 2 days to "not hospitalized and no limitation of activities" or better. There was only one death (in the control arm). This study also gave ivermectin to the control arm for 38 patients and it is unknown if the full extent of the error was identified, or if there were additional undiscovered errors. The side effect data reported in this trial raises major concerns, with more side effects reported in the placebo arm, suggesting that more placebo patients may have received treatment. Ivermectin was widely used in the population and available OTC at the time of the study. The study protocol allows other treatments but does not report on usage. The name of the study drug was concealed by refering to it as "D11AX22". The presentation of this study also appears to be significantly biased. While all outcomes show a benefit for ivermectin, the abstract fails to mention that much larger benefits are seen for serious outcomes, including the original primary outcome, and that the reason for not reaching statistical signficance is the low number of events in a low risk population where most recover quickly without treatment."

https://ivmmeta.com/#exc

This prompted an open letter from over 170 physicians concluding that the study is fatally flawed.

https://jamaletter.com/

This also highlights the risk of only relying on a small number of large RCTs, instead of looking at the totality of evidence.

Who is "selling" anything?

This is just one more facile such comparison in the thread, alongside "injecting bleach," "snake oil," etc. Whether ivermectin is effective or not, to describe the state of the evidence as though it were equivalent to pure quackery is very dishonest.

I read the french research at the time, and it was immediately obvious that it was deeply flawed. Asking around in more expert circles, that did seem to be the uniformly echoed initial reaction even then, from day 1 (not that that means it couldn't have worked, just that the paper that sparked it all was not convincing, at all - but absence of evidence isn't strong evidence of absence in such cases). In retrospect it seems obvious people were looking for some kind of light at the end of the tunnel, and too willing to ignore the warning signs.

The case for ivermectin is not a slam dunk. But it's definitely surpassed the low bar that HCQ set. There is at least quite a lot of suggestive correlation without trivially obvious other explanations, and the data set isn't just "a few people non-randomly selected".

To my non expert opinion the ivermectin case seems at least plausible, whereas HCQ was clearly and obviously nonsense. Still, I'm skeptical, partly precisely because there still hasn't been a slam dunk study and because quite a few proponents seem to have a worryingly conspiratorial view of the world. Stuff like assuming it's not being pushed because it's off patent screams conspiratorial thinking to me, and you hear that quite a lot. And that's a warning sign, because there are quite a lot of interested parties here that really don't care about some pharmaceutical companies profit, and in any case - just because they don't fund it doesn't mean they'll go all Machiavellian and intentionally prolong the pandemic just to sell a future drug, and actually get away with it to boot. At best, the lack of exclusivity might explain why there isn't a specific corporate backer for this research, but it doesn't explain why all of the governments and universities and hospitals etc aren't finding convincing data. So when people see a conspiracy here, I wonder how rationally they're looking at the evidence for Ivermectin, too - and at the end of the day, I'm just a random worried person without the capacity to deeply understand every single relevant bit of data, so I need to be able to find trustworthy sources and research. People that see conspiracies everywhere (without data and without real reason) don't inspire great trust in their analyses.

Still, it's hard to resist the lure of the cheap and affordable silver bullet...

Are ya now? Actually “people like me” don’t believe that random people like you are what you claim to be when posting under an anonymous name on the internet.

So no, we don’t just believe the BS we are being told on the internet.

Thank you.