When the pandemic first broke out, repurposing broad-spectrum antiviral agents were deemed ‘safe’ through testing on early phase clinical trials for Covid-19. Thereafter, many drugs were put to use availing the emergency authorisation with government agencies. One such drug was Ivermectin which is mainly prescribed for patients with mild to moderate infection. With the second wave raging upon us, there was a huge surge in demand for these drugs.
Recently, WHO issued guidelines saying Ivermectin should only be used on Covid-19 patients in clinical trial settings. The UN health agency said there was a “very low certainty of evidence” on Ivermectin’s effects on mortality, need for hospital admission, and getting rid of the virus from the body. After which, many state governments in India have rejected its use for Covid-19 patients. The mechanism of action has not been explained here; this has caused confusion and worries among patients and providers alike. But let me explain the truth behind it; there is enough evidence that shows the effectiveness of the drug. A study published in the American Journal of Therapeutics clearly mentions a large majority of randomised and observational controlled trials of Ivermectin that reported repeatedly on the large magnitude improvements in clinical outcomes. Numerous prophylaxis trials demonstrate that regular Ivermectin use leads to large reductions in transmission. Moreover, a comprehensive review of the available efficacy data as of 12 December 2020, taken from in-vitro, animal, clinical, and real-world studies. All of these show the above impacts of Ivermectin in Covid-19!
Here are few points worth considering:
• Since 2012, multiple in-vitro studies have demonstrated that Ivermectin inhibits the replication of many viruses, including Influenza, Zika, Dengue, and others
• Ivermectin inhibits SARS-CoV-2 replication and binding to host tissue through several observed and proposed mechanisms
• Ivermectin has anti-inflammatory properties that prevent viral replication
• Clinical studies of the efficacy of Ivermectin in hospitalised patients show favourable outcomes
• Exposure prophylaxis studies that showcase Ivermectin’s ability to prevent transmission of Covid-19
• Ivermectin hastens recovery and prevents deterioration in patients with mild to moderate disease, treated early after symptoms
• The World Health Organization has long included Ivermectin on its “List of Essential Medicines”
• However, some studies suggest the need for controlled studies to better test efficacy in Vexing Syndrome
Having said, that anything used in excess or abused is harmful to health. Providers need to careful while prescribing these drugs as they are still under review. The best way is to be wise and not let panic take precedence over our logical reasoning. Most of these repurposed drugs have their own pros and cons when used for Covid-19, this needs to be explained to the patients while prescribing it. We have to be cautious but wise too. Let us all make an informed choice and ensure that we all come out of this crisis stronger and more empowered.
The writer is Chief Intensivist, Fortis Hiranandani Hospital, Vashi.
