8 ms·

Study findings do not support the use of ivermectin for patients with Covid-19

75 points by barbazoo 5y ago

evilpotatoes 5y ago
They also didn’t start treatment until 7 days post symptoms.
deleted 5y ago
[deleted]
roenxi 5y ago
It is good that people are doing studies, but at this point adding one more study isn't really headline news so I'm not sure what the up-voters think this will show. There isn't really a need for more evidence as far as I'm aware. What is far more interesting and useful is explanations of why there are a bunch of studies showing great COVID outcomes when patients are paired with Ivermectin (eg, https://ivmmeta.com/ https://ivmmeta.com/). The best answer I've heard is the geographic distribution of successful studies lines up with parasite-prone countries, so they are actually an interesting example of the base-rate effect.
- ggm 5y ago
  So in laymans terms, enough people had untreated and undiagnosed parasitic infections that "they got better" was curing an undiagnosed comorbidity to a positive C19 and since the parasite causes high risk problems eg with kidneys or pulmonary risk or breathing, it helped them survive. Is that it?
  - jasonhansel 5y ago
    It's also that treatment with dexamethasone may be dangerous in patients with preexisting Strongyloides infections. Astral Codex Ten has an (admittedly rather speculative) take on this: https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted?utm_source=url https://astralcodexten.substack.com/p/ivermectin-much-more-t...
  - inter_netuser 5y ago
    I'd also say covid case/severity reporting is probably of questionable quality in those regions as well, as they struggle economically and probably don't have resources to do that well.
- arn 5y ago
  Many of the early studies weren’t high quality studies. And as I recall a couple were outright fabricated. It takes time to run randomized prospective studies and those are coming out now.
  - roenxi 5y ago
    If we have lots of low quality studies that show Ivermectin works well in populations which probably have high parasite incidence, and not much obvious effect of anything in populations where there aren't many parasites (insert puns here about lawyers and politicians)... What is the high quality study here to prove? I don't see why the problem is evidence. AFAIK there seems to just be a shortage of people repeating "the helpful effect is geographically correlated" over and over again. Unless there is evidence of a positive effect that I'm not aware of?
- ayngg 5y ago
  I think the difference is that in places where ivermectin had efficacy (India, Sub Saharan Africa, South America), parasitic infection was a significant comorbidity. In much of the developed world, the most significant comorbidities are things like obesity and age (with all of its associated pulmonary and respiratory risks).
- raphlinus 5y ago
  A lot of it is just straight-up fraud. Gideon Meyerowitz-Katz has documented this in some detail. Also, ivnmeta itself is just weird. It can only be characterized as a propaganda site. It's well done, but scientifically invalid. They're far, far better at science communication than, say, the CDC (low bar, I know). We don't know who they are or who funds them, though there are certainly correlations with other, generally right-wing or libertarian, flavored groups. Given the number of times it's posted unironically here, it looks like a large number of people have been taken in by it.
  - RickHull 5y ago
    > A lot of it is just straight-up fraud. Gideon Meyerowitz-Katz has documented this in some detail. Alexandros Marinos provides a counterpoint [1] > Reading the article, I was surprised (but not really) by the central role Gideon Meyerowitz-Katz (henceforth GidMK as is his much shorter Twitter handle) had played in the analysis. The man has a way to apparate wherever a person of influence takes a position on ivermectin. This is at least the third time I’ve observed the same sequence of events. > ... > I wanted to avoid focusing on GidMK himself, but the way the analysis comes out, this won’t be possible. I’ll try to keep things as dispassionate as possible without being fake, but I beseech the reader to understand that this isn’t your standard “Ad Hominem” argument. If Scott’s analysis depends on his trust on GidMK, it is paramount that I demonstrate that GidMK’s track record is not one deserving of that trust. > ... > I have to also note that GidMK is highly conscious of his feed, and is probably applying some automated means of blocking anyone supporting opposing views to his. Not only has he blocked me on Twitter, he seems to have blocked a double-digit percentage of my followers, many of which were not aware of the block until I asked them to check. My best hypothesis is that anyone “liking” anything I posted opposing his positions would automatically get blocked. There is more I could excerpt, but probably better to read the whole thing. 1. https://doyourownresearch.substack.com/p/a-conflict-of-blurred-visions https://doyourownresearch.substack.com/p/a-conflict-of-blurr...
    - _djo_ 5y ago
      This is not a counter-point, this is an ad hominem attack (despite its protestation to the contrary) that doesn’t address any of the serious problems that Meyerowitz-Katz found with those studies. Problems severe enough to force retractions from the relevant journals. The credibility of Meyerowitz-Katz (and others like him) rests on the quality of his claims and analyses, not on whether he blocks people on Twitter.
phlipski 5y ago
I look forward to the study confirming that Yes - the Earth is still round...
smm11 5y ago
More than two years, and still ...
sinyug 5y ago
Does any study ever suggest that a $0.10 drug with expired patents is better than the new and patented $30 alternative? If so which benevolent pharmaceutical company funds such studies? Between doctors prescribing specific medicine "brands" when generic alternatives are available, insurance companies denying perfectly valid claims and forcing you to challenge their decisions in tribunals and similar venues, and pharmaceutical companies engaging in questionable behavior,[1] I am very reluctant to trust anything championed by this unholy nexus. [1] There is a multivitamin product from Bayer called Supradyn that I have been using for years. Last year, the company changed the formulation and halved the doses of most of the ingredients while increasing the price by 50% resulting in an effective price increase of 300%.
- wombatpm 5y ago
  Aspirin regimen for cardiovascular event prevention as an example of a cheap drug studied extensively.
  - sinyug 5y ago
    > Aspirin Good example. It would be a pleasant surprise to find out that these studies were funded by pharma companies.
- barbazoo 5y ago
  > Does any study ever suggest that a $0.10 drug with expired patents is better than the new and patented $30 alternative? If so which benevolent pharmaceutical company funds such studies? I hear this a lot to explain the lack of studies. What about this one here though? Isn't this finally a conclusive study debunking all the claims saying Ivermectin alone is a good prevention/treatment for COVID-19?
  - vkou 5y ago
    > Isn't this finally a conclusive study debunking all the claims saying Ivermectin alone is a good prevention/treatment for COVID-19? No, because they didn't <administer some particular dosage>/<administer it at the right times>/<administer it when the moon was in the right phase/when Mercury was in retrograde>. A true believer can always keep shifting the goalposts.
JackOfCrows 5y ago
ggrothendieck 5y ago
If we look at the secondary endpoints note that 3x as many died in the control group, 2.5x as many needed mechanical ventilation and one third more need to go to the ICU. Ivermectin Control n 247 249 Mech vent 4 10 ICU 6 8 Died 3 10 These may not have been primary endpoints and may not have been statistically significant but it does raise the question of whether they would have been significant had a larger sample size been used.
- PragmaticPulp 5y ago
  Once you start dealing with small numbers (e.g. 2% versus 3%) then you would need far, far more patients to reach statistical significance. It's tempting to look at things like 8 people visiting the ICU in one group but only 6 people in the other group and see that 6 < 8, but the problem is that it's too small of a sample size to decide if it's significant. The article covers that: > There were no significant differences between ivermectin and control groups for all the prespecified secondary outcomes The only one that almost comes close is death rate: > The 28-day in-hospital mortality rate was similar for the ivermectin and control groups (3 [1.2%] vs 10 [4.0%]; RR, 0.31; 95% CI, 0.09 to 1.11; P = .09) If this was the only Ivermectin study out there, it would be worth following up on. But it's not, and when this is added to the rest of the (not-retracted) studies it doesn't really change the picture. At this point it matters less and less anyway. Countries that already tried Ivermectin at scale are starting to abandon the approach. Legitimately effective COVID drugs like Paxlovid with highly significant differences are becoming readily available. It's time to stop grasping at straws and accept that it doesn't work.
  - msandford 5y ago
    So on the one hand I completely agree with you on the necessity of having enough people to dodge the problem of random chance. "the law of large numbers" on Wikipedia is good. On the other hand you have three different categories where the numbers from one group are smaller than the numbers from the other group. Could it all be random chance? Sure! But that does kind of hint that there might be something there.
prohobo 5y ago
I don't understand why Japan, India, most of latin america and Brazil are using ivermectin to treat covid then. Are they just hoping for the best?
- PragmaticPulp 5y ago
  They're not using it. Those are Ivermectin conspiracy talking points that are spreading around the internet, but they're either not true or heavily distorted. Japan is not using Ivermectin. It's a myth that is spreading in the Ivermectin conspiracy circles, but it's not true: https://www.reuters.com/article/factcheck-japan-ivermectinandmandate/fact-check-japan-has-not-authorized-ivermectin-to-treat-covid-19-or-revoked-a-vaccine-mandate-idUSL1N2TX1GK https://www.reuters.com/article/factcheck-japan-ivermectinan... India stopped recommending Ivermectin a long time ago, after not seeing positive results: https://www.thehindu.com/news/national/icmr-stops-use-of-ivermectin-hcq-for-covid-19-treatment/article36651890.ece https://www.thehindu.com/news/national/icmr-stops-use-of-ive... Brazil's relationship with Ivermectin is mixed at best, but the famed "COVID Kit" that included Ivermectin (among other things) wasn't as official as some try to make it sound: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00085-5/fulltext https://www.thelancet.com/journals/lanam/article/PIIS2667-19... I'm still stunned by how these rumors continue to circulate as facts despite being so easily disproven. On the other hand, some of the top Google results I found while looking those up quickly were obvious conspiracy websites with false information. I suppose the misinformation is just flooding the internet so fast that the truth is getting diluted away.
  - gambler 5y ago
    > Japan is not using Ivermectin. https://www.nikkei.com/article/DGXZQOFD31A0C0R30C22A1000000/ https://www.nikkei.com/article/DGXZQOFD31A0C0R30C22A1000000/ 2022/1/31 興和（名古屋市）は31日、寄生虫病薬「イベルメクチン」が新型コロナウイルスの変異型「オミクロン型」の治療薬として効果があることを確認したと発表した。北里大学との非臨床試験をもとに、抗ウイルス効果があるとした Bing translation: "Kowa (Nagoya City) announced today that it has confirmed that the parasitic drug "Ivermectin" is effective as a treatment for the mutant "Omicron type" of the novel coronavirus. Based on the non-clinical trial with Kitasato University, it was said that it had an antiviral effect."
nu11ptr 5y ago
The study says they were given treatment "within 7 days" of onset. The proponents of IVM have always said "early treatment" was required for it to work. Serious question: Does "within 7 days" meet the definition of "early treatment"? My guess would be "no", but curious what others think. NOTE: To be clear, I have no opinion here. Just like discussion and curious on thoughts.
- dundarious 5y ago
  In the vast majority of the anecdotes I know where the person developed serious symptoms, they first had quite mild symptoms for about a week or two, sometimes longer. Given how many people develop no serious symptoms at all, I think "within 7 days" is ambiguously but defensibly in the "early" category.
  - s1artibartfast 5y ago
    It is still a relevant point given recently approved medications like Paxlovid ran their trials with a even tighter window of <5 days and 50% of the trail was <3 days.
  - s1artibartfast 5y ago
    >In the vast majority of the anecdotes I know where the person developed serious symptoms, they first had quite mild symptoms for about a week or two, sometimes longer. Serious symptoms arent usually caused by the virus, which peaks 3-5 days after symtoms, then dies out. If you want to treat in the viral stage, early action is incredibly important. If you want to treat the after effects, it is less critical.

75 points by barbazoo 5y ago

evilpotatoes 5y ago

They also didn’t start treatment until 7 days post symptoms.

deleted 5y ago

[deleted]

roenxi 5y ago

It is good that people are doing studies, but at this point adding one more study isn't really headline news so I'm not sure what the up-voters think this will show. There isn't really a need for more evidence as far as I'm aware. What is far more interesting and useful is explanations of why there are a bunch of studies showing great COVID outcomes when patients are paired with Ivermectin (eg, https://ivmmeta.com/ https://ivmmeta.com/). The best answer I've heard is the geographic distribution of successful studies lines up with parasite-prone countries, so they are actually an interesting example of the base-rate effect.

ggm 5y ago
So in laymans terms, enough people had untreated and undiagnosed parasitic infections that "they got better" was curing an undiagnosed comorbidity to a positive C19 and since the parasite causes high risk problems eg with kidneys or pulmonary risk or breathing, it helped them survive. Is that it?
- jasonhansel 5y ago
  It's also that treatment with dexamethasone may be dangerous in patients with preexisting Strongyloides infections. Astral Codex Ten has an (admittedly rather speculative) take on this: https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted?utm_source=url https://astralcodexten.substack.com/p/ivermectin-much-more-t...
- inter_netuser 5y ago
  I'd also say covid case/severity reporting is probably of questionable quality in those regions as well, as they struggle economically and probably don't have resources to do that well.
arn 5y ago
Many of the early studies weren’t high quality studies. And as I recall a couple were outright fabricated. It takes time to run randomized prospective studies and those are coming out now.
- roenxi 5y ago
  If we have lots of low quality studies that show Ivermectin works well in populations which probably have high parasite incidence, and not much obvious effect of anything in populations where there aren't many parasites (insert puns here about lawyers and politicians)... What is the high quality study here to prove? I don't see why the problem is evidence. AFAIK there seems to just be a shortage of people repeating "the helpful effect is geographically correlated" over and over again. Unless there is evidence of a positive effect that I'm not aware of?
ayngg 5y ago
I think the difference is that in places where ivermectin had efficacy (India, Sub Saharan Africa, South America), parasitic infection was a significant comorbidity. In much of the developed world, the most significant comorbidities are things like obesity and age (with all of its associated pulmonary and respiratory risks).
raphlinus 5y ago
A lot of it is just straight-up fraud. Gideon Meyerowitz-Katz has documented this in some detail. Also, ivnmeta itself is just weird. It can only be characterized as a propaganda site. It's well done, but scientifically invalid. They're far, far better at science communication than, say, the CDC (low bar, I know). We don't know who they are or who funds them, though there are certainly correlations with other, generally right-wing or libertarian, flavored groups. Given the number of times it's posted unironically here, it looks like a large number of people have been taken in by it.
- RickHull 5y ago
  > A lot of it is just straight-up fraud. Gideon Meyerowitz-Katz has documented this in some detail. Alexandros Marinos provides a counterpoint [1] > Reading the article, I was surprised (but not really) by the central role Gideon Meyerowitz-Katz (henceforth GidMK as is his much shorter Twitter handle) had played in the analysis. The man has a way to apparate wherever a person of influence takes a position on ivermectin. This is at least the third time I’ve observed the same sequence of events. > ... > I wanted to avoid focusing on GidMK himself, but the way the analysis comes out, this won’t be possible. I’ll try to keep things as dispassionate as possible without being fake, but I beseech the reader to understand that this isn’t your standard “Ad Hominem” argument. If Scott’s analysis depends on his trust on GidMK, it is paramount that I demonstrate that GidMK’s track record is not one deserving of that trust. > ... > I have to also note that GidMK is highly conscious of his feed, and is probably applying some automated means of blocking anyone supporting opposing views to his. Not only has he blocked me on Twitter, he seems to have blocked a double-digit percentage of my followers, many of which were not aware of the block until I asked them to check. My best hypothesis is that anyone “liking” anything I posted opposing his positions would automatically get blocked. There is more I could excerpt, but probably better to read the whole thing. 1. https://doyourownresearch.substack.com/p/a-conflict-of-blurred-visions https://doyourownresearch.substack.com/p/a-conflict-of-blurr...
  - _djo_ 5y ago
    This is not a counter-point, this is an ad hominem attack (despite its protestation to the contrary) that doesn’t address any of the serious problems that Meyerowitz-Katz found with those studies. Problems severe enough to force retractions from the relevant journals. The credibility of Meyerowitz-Katz (and others like him) rests on the quality of his claims and analyses, not on whether he blocks people on Twitter.

phlipski 5y ago

I look forward to the study confirming that Yes - the Earth is still round...

smm11 5y ago

More than two years, and still ...

sinyug 5y ago

Does any study ever suggest that a $0.10 drug with expired patents is better than the new and patented $30 alternative? If so which benevolent pharmaceutical company funds such studies? Between doctors prescribing specific medicine "brands" when generic alternatives are available, insurance companies denying perfectly valid claims and forcing you to challenge their decisions in tribunals and similar venues, and pharmaceutical companies engaging in questionable behavior,[1] I am very reluctant to trust anything championed by this unholy nexus. [1] There is a multivitamin product from Bayer called Supradyn that I have been using for years. Last year, the company changed the formulation and halved the doses of most of the ingredients while increasing the price by 50% resulting in an effective price increase of 300%.

wombatpm 5y ago
Aspirin regimen for cardiovascular event prevention as an example of a cheap drug studied extensively.
- sinyug 5y ago
  > Aspirin Good example. It would be a pleasant surprise to find out that these studies were funded by pharma companies.
barbazoo 5y ago
> Does any study ever suggest that a $0.10 drug with expired patents is better than the new and patented $30 alternative? If so which benevolent pharmaceutical company funds such studies? I hear this a lot to explain the lack of studies. What about this one here though? Isn't this finally a conclusive study debunking all the claims saying Ivermectin alone is a good prevention/treatment for COVID-19?
- vkou 5y ago
  > Isn't this finally a conclusive study debunking all the claims saying Ivermectin alone is a good prevention/treatment for COVID-19? No, because they didn't <administer some particular dosage>/<administer it at the right times>/<administer it when the moon was in the right phase/when Mercury was in retrograde>. A true believer can always keep shifting the goalposts.

JackOfCrows 5y ago

ggrothendieck 5y ago

If we look at the secondary endpoints note that 3x as many died in the control group, 2.5x as many needed mechanical ventilation and one third more need to go to the ICU. Ivermectin Control n 247 249 Mech vent 4 10 ICU 6 8 Died 3 10 These may not have been primary endpoints and may not have been statistically significant but it does raise the question of whether they would have been significant had a larger sample size been used.

PragmaticPulp 5y ago
Once you start dealing with small numbers (e.g. 2% versus 3%) then you would need far, far more patients to reach statistical significance. It's tempting to look at things like 8 people visiting the ICU in one group but only 6 people in the other group and see that 6 < 8, but the problem is that it's too small of a sample size to decide if it's significant. The article covers that: > There were no significant differences between ivermectin and control groups for all the prespecified secondary outcomes The only one that almost comes close is death rate: > The 28-day in-hospital mortality rate was similar for the ivermectin and control groups (3 [1.2%] vs 10 [4.0%]; RR, 0.31; 95% CI, 0.09 to 1.11; P = .09) If this was the only Ivermectin study out there, it would be worth following up on. But it's not, and when this is added to the rest of the (not-retracted) studies it doesn't really change the picture. At this point it matters less and less anyway. Countries that already tried Ivermectin at scale are starting to abandon the approach. Legitimately effective COVID drugs like Paxlovid with highly significant differences are becoming readily available. It's time to stop grasping at straws and accept that it doesn't work.
- msandford 5y ago
  So on the one hand I completely agree with you on the necessity of having enough people to dodge the problem of random chance. "the law of large numbers" on Wikipedia is good. On the other hand you have three different categories where the numbers from one group are smaller than the numbers from the other group. Could it all be random chance? Sure! But that does kind of hint that there might be something there.

prohobo 5y ago

I don't understand why Japan, India, most of latin america and Brazil are using ivermectin to treat covid then. Are they just hoping for the best?

PragmaticPulp 5y ago
They're not using it. Those are Ivermectin conspiracy talking points that are spreading around the internet, but they're either not true or heavily distorted. Japan is not using Ivermectin. It's a myth that is spreading in the Ivermectin conspiracy circles, but it's not true: https://www.reuters.com/article/factcheck-japan-ivermectinandmandate/fact-check-japan-has-not-authorized-ivermectin-to-treat-covid-19-or-revoked-a-vaccine-mandate-idUSL1N2TX1GK https://www.reuters.com/article/factcheck-japan-ivermectinan... India stopped recommending Ivermectin a long time ago, after not seeing positive results: https://www.thehindu.com/news/national/icmr-stops-use-of-ivermectin-hcq-for-covid-19-treatment/article36651890.ece https://www.thehindu.com/news/national/icmr-stops-use-of-ive... Brazil's relationship with Ivermectin is mixed at best, but the famed "COVID Kit" that included Ivermectin (among other things) wasn't as official as some try to make it sound: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00085-5/fulltext https://www.thelancet.com/journals/lanam/article/PIIS2667-19... I'm still stunned by how these rumors continue to circulate as facts despite being so easily disproven. On the other hand, some of the top Google results I found while looking those up quickly were obvious conspiracy websites with false information. I suppose the misinformation is just flooding the internet so fast that the truth is getting diluted away.
- gambler 5y ago
  > Japan is not using Ivermectin. https://www.nikkei.com/article/DGXZQOFD31A0C0R30C22A1000000/ https://www.nikkei.com/article/DGXZQOFD31A0C0R30C22A1000000/ 2022/1/31 興和（名古屋市）は31日、寄生虫病薬「イベルメクチン」が新型コロナウイルスの変異型「オミクロン型」の治療薬として効果があることを確認したと発表した。北里大学との非臨床試験をもとに、抗ウイルス効果があるとした Bing translation: "Kowa (Nagoya City) announced today that it has confirmed that the parasitic drug "Ivermectin" is effective as a treatment for the mutant "Omicron type" of the novel coronavirus. Based on the non-clinical trial with Kitasato University, it was said that it had an antiviral effect."

nu11ptr 5y ago

The study says they were given treatment "within 7 days" of onset. The proponents of IVM have always said "early treatment" was required for it to work. Serious question: Does "within 7 days" meet the definition of "early treatment"? My guess would be "no", but curious what others think. NOTE: To be clear, I have no opinion here. Just like discussion and curious on thoughts.

dundarious 5y ago
In the vast majority of the anecdotes I know where the person developed serious symptoms, they first had quite mild symptoms for about a week or two, sometimes longer. Given how many people develop no serious symptoms at all, I think "within 7 days" is ambiguously but defensibly in the "early" category.
- s1artibartfast 5y ago
  It is still a relevant point given recently approved medications like Paxlovid ran their trials with a even tighter window of <5 days and 50% of the trail was <3 days.
- s1artibartfast 5y ago
  >In the vast majority of the anecdotes I know where the person developed serious symptoms, they first had quite mild symptoms for about a week or two, sometimes longer. Serious symptoms arent usually caused by the virus, which peaks 3-5 days after symtoms, then dies out. If you want to treat in the viral stage, early action is incredibly important. If you want to treat the after effects, it is less critical.