The
creators of Ivermectin won a Nobel prize in 2015 for the drugs role as an effective
anti-parasitic agent. In 2020, Caly et al., published a study that found ivermectin
has antiviral properties and if effective at controlling SARS-CoV-2 in vitro
through the suspected route of inhibiting IMPα/β1-mediated nuclear importation.
It is important to note that although this one of the hypothesized mechanisms,
the exact mechanism of how ivermectin is yet to be fully elucidated. Other
systemic reviews that performed meta-analysis of ivermectin efficacy as treatment
of COVID-19, reported that although no significant differences were observed in
factors like progression, severity, recovery, or duration of hospitalization were
found, findings suggested that there might be a reduced mortality rate amongst
those treated with ivermectin (Shafiee et al, 2022). In support of this claim,
it is hypothesized that the increased use of ivermectin in sub-Saharan Africa
to combat high rates of parasitic infection, may have contributed to the continent
of Africa having the lowest COVID-19 mortality rate out of any other continent
(Marques et al., 2022). In Brazil, it was found that administering ivermectin
as a prophylactic in treatment against COVID-19, that there was a significant reduction
infection, hospitalization, and mortality rates (Kerr et al., 2022).
I
think this is a topic that touches on the biomedical ethical principles of
beneficence, non-malfeasance, autonomy, and justice. In the early days of the
COVID-19 pandemic healthcare workers were forced to make do with what they had
and what worked. Perhaps an argument could be made that the beneficent thing to
do was to allow healthcare providers to take an evidence-based approach and
treat their patients with ivermectin while a vaccine was still being developed.
An argument for non-malfeasance could similarly be made that it was important
to first know how the drug worked before administering it. I feel that autonomy
and justice go hand in hand for this example. Joe Rogan made headline news for talking
about how he was prescribed ivermectin as part of his COVID-19 protocol from a
doctor that Rogan claimed did for other celebrities and professional athletes. As
one might expect, there was outrage and blowback to Rogan’s claims. Certain news networks smeared ivermectin as a horse de-wormer and minimized the drugs important applications against human disease,
while average citizens wondered why they were being denied a treatment they
wanted and a treatment the more privileged may have been given access to and taken in secret.
Despite
all this research and evidence indicating the potential of a reduced mortality rate, there is
still more to be done to verify the efficacy of ivermectin as a treatment against
COVID-19. Unfortunately, ivermectin will likely remain a polarizing topic for
years to come. As of the writing of this I am uncertain if the stigma against
ivermectin is based in caution due to a lack of large-scale double-blind
studies, lingering political biases, or fears of the anecdotal cases were
someone could not get ahold of the medicine they wanted from a physician and
instead obtained animal versions of the drug. Now that there are studies
supporting the evidence that ivermectin usage might be associated with lower
mortality rates, is it fair to still be writing it off? Do were merely follow the accepted science rather than just science? Is it time to reevaluate our biases
and focus on what is helping the patient, because isn’t that who we are all
doing this for? Is this how we ought to
live?
Leon Caly,
Julian D. Druce, Mike G. Catton, David A. Jans, Kylie M. Wagstaff, The
FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro, Antiviral
Research, Volume 178, 2020, 104787, ISSN 0166-3542, https://doi.org/10.1016/j.antiviral.2020.104787.
https://www.sciencedirect.com/science/article/pii/S0166354220302011
Shafiee A, Teymouri Athar MM, Kohandel Gargari O, Jafarabady
K, Siahvoshi S, Mozhgani SH. Ivermectin under scrutiny: a systematic review and
meta-analysis of efficacy and possible sources of controversies in COVID-19
patients. Virol J. 2022 Jun 13;19(1):102. doi: 10.1186/s12985-022-01829-8.
PMID: 35698151; PMCID: PMC9191543.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9191543/
Marques
LLM, Beneti SC, Pinzon C, Cardoso FAR. Ivermectin as a possible treatment for
COVID-19: a review of the 2022 protocols. Braz J Biol. 2022 May 20;84:e258325.
doi: 10.1590/1519-6984.258325. PMID: 35584459.
https://www.scielo.br/j/bjb/a/kHSWtq7BpNVhz8psKz4VDmw/?lang=en
Kerr L,
Cadegiani FA, Baldi F, Lobo RB, Assagra WLO, Proença FC, Kory P, Hibberd JA,
Chamie-Quintero JJ. Ivermectin Prophylaxis Used for COVID-19: A Citywide,
Prospective, Observational Study of 223,128 Subjects Using Propensity Score
Matching. Cureus. 2022 Jan 15;14(1):e21272. doi: 10.7759/cureus.21272. Erratum
in: Cureus. 2022 Mar 24;14(3):c61. PMID: 35070575; PMCID: PMC8765582.
https://pubmed.ncbi.nlm.nih.gov/35070575/
I do not like politicization of Ivermectin as well as other treatments such as hydroxychloroquine at all. The more research you do, especially first-hand research, speaking to healthcare professionals and physicians who directly treated hundreds, even thousands, of COVID patients, you realize that something is not adding up. It is especially concerning when you realize that open conversation and discourse is immediately vilified or shut down. Most studies on Ivermectin were either dismissed or discouraged based on known Ivermectin mechanisms before it could get a proper trial. Despite all this, sometimes people's personal experiences are more important than published scientific literature, especially paper published by researchers who do not actually treat COVID patients on a daily basis. I have first-hand accounts and experience that is probably beyond the scope of this blog, so I have included scientific literature sources instead. The first linked reference is a paper that not only verified Ivermectin's effect on decreasing COVID's mortality and hospitalization rate, but also a decreased risk of contracting COVID while taking Ivermectin. This paper utilized multiple studies with information and evidence from thousands of COVID patients. The second and third articles are reviews on the mechanisms of action for both Ivermectin and Paxlovid, Pfizer's anti-viral COVID medication. Ivermectin has 20 outlined levels of action, including 3 direct levels of action on the SARS-CoV-2 virus. One of these direct levels of actions is also utilized by Paxlovid; however, Paxlovid has been described as a promising treatment for "non-hospitalized" patients. People are free to do their own research and come to their own conclusions regarding Pfizer, the FDA, the CDC, and the WHO's motivations during the COVID pandemic. I do not personally believe that patient safety, mortality, and accessibility to treatment are uncompromising criteria for any of these organizations especially in the presence of political or financial gain.
ReplyDeleteKory, P., Meduri, G. U., Varon, J., Iglesias, J., & Marik, P. E. (2021). Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. American journal of therapeutics, 28(3), e299–e318. https://doi.org/10.1097/MJT.0000000000001377
Zaidi, A.K., Dehgani-Mobaraki, P. The mechanisms of action of ivermectin against SARS-CoV-2—an extensive review. J Antibiot 75, 60–71 (2022). https://doi.org/10.1038/s41429-021-00491-6
ReplyDeleteMahrokh Marzi, Mohammad Kazem Vakil, Maryam Bahmanyar, Elham Zarenezhad, "Paxlovid: Mechanism of Action, Synthesis, and In Silico Study", BioMed Research International, vol. 2022, Article ID 7341493, 16 pages, 2022. https://doi.org/10.1155/2022/7341493