Ivermectin in Covid-19: Review of the Current Evidence
Abstract
The COVID‑19 pandemic has gripped the world in fear with more than 109 million cases and more than 2.4 million deaths as of 16th February 2021. After US, India has the second highest number of cases in the world. A pandemic of this scale has clearly become an unmet medical need warranting research on effective pharmaco-therapeutic agents. Given the time constraints, existing drugs have been repurposed to fill in the gap. Ivermectin is an FDA-approved broad spectrum antiparasitic agent. It is enlisted in the core list of WHO Model List of Essential Medicine 2019. Ivermectin is economical, easily available and safe without any major side effects. Recent research has shown that Ivermectin possesses strong anti-viral properties. It can also be safely combined with other repurposed drugs for Covid-19. Here, we review mechanism of action and current scientific evidence of Ivermectin in treatment and prophylaxis of Covid-19. A number of ongoing clinical trials are evaluating the drug further in the treatment and prophylaxis of Covid-19. Based on the current clinical evidence in treatment and prophylaxis, Indian Experts’ consensus and recommendations by multiple Indian state governments, Ivermectin may effectively and safely add to the current armamentarium of Indian clinicians involved in the care and management of Covid-19 patients.
Conflict of Interest: Aditi Phadke, Parthasarathy Murlidharan and Amit Qamra are salaried employees of Macleods
Pharmaceuticals Ltd., Mumbai, India. Other authors declare no conflict of interest.
Source of funding: None
References
2. Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, Hosein Z, Padda I, Mangat J, Altaf M. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020 Jun 25:1-8.
3. Ministry of Health and Family Welfare, Government of India [Internet]. Covid 19 Vaccination Status. [cited 2021 Feb 16]. Available from https://www.mohfw.gov.in/.
4. Financial Express [Internet]. Covid-19 vaccine rollout: India approves Covaxin, Covishield; what next?. 2021Jan 5. [cited 2021 Feb 16]. Available from https://www.financialexpress. com/lifestyle/health/covid-19-vaccine-rollout-indiaapproves- covaxin-covishield-what-next/2164444/
5. Long L, Wu L, Chen L, Zhou D, Wu H, Lu D, et al. (2021) Effect of early oxygen therapy and antiviral treatment on disease progression in patients with COVID-19: A retrospective study of medical charts in China. PLoS Negl Trop Dis 15(1): e0009051.
6. Singh TU, Parida S, Lingaraju MC, Kesavan M, Kumar D, Singh RK. Drug repurposing approach to fight COVID-19. Pharmacol Rep. 2020 Dec;72(6):1479-1508.
7. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020 May 12;323(18):1824- 1836.
8. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. Clinical Management Protocol: COVID-19 [Internet]. Version 5. 2020 July 3 [cited 2020 Oct 20]. Available from https://www.mohfw. gov.in/pdf/UpdatedClinicalManagementProtocolfor COVID19dated03072020.pdf
9. Alanagreh L, Alzoughool F, Atoum M. The Human Coronavirus Disease COVID-19: Its Origin, Characteristics, and Insights into Potential Drugs and Its Mechanisms. Pathogens. 2020 Apr 29;9(5):331.
10. Al-Kuraishy HM, Hussien NR, Al-Naimi MS, Al-Buhadily AK, Al-Gareeb AI, Lungnier C. Is ivermectin–Azithromycin combination the next step for COVID-19?. Biomed Biotechnol Res J 2020;4, Suppl S1:101-3
11. Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein. Cell. 2020 Apr 16;181(2):281-292.e6.
12. Lan J, Ge J, Yu J, Shan S, Zhou H, Fan S, Zhang Q, Shi X, Wang Q, Zhang L, Wang X. Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor. Nature. 2020 May;581(7807):215-20.
13. Banerjee K, Nandy M, Dalai CK, Ahmed SN. The Battle against COVID 19 Pandemic: What we Need to Know Before we “Test Fire” Ivermectin. Drug Res (Stuttg). 2020 Aug;70(8):337-40.
14. Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020 Jun;178:104787.
15. Vora A, Arora VK, Behera D, Tripathy SK. White paper on Ivermectin as a potential therapy for COVID-19. Indian J Tuberc. 2020 Jul;67(3):448-51.
16. Rajter JC, Sherman MS, Fatteh N, Vogel F, Sacks J, Rajter JJ. Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019: The Ivermectin in COVID Nineteen Study. Chest. 2021 Jan;159(1):85-92.
17. Gorial FI, Mashhadani S, Sayaly HM, Dakhil BD, AlMashhadani MM, Aljabory AM, Abbas HM, Ghanim M, Rasheed JI. Effectiveness of Ivermectin as add-on Therapy in COVID-19 Management (Pilot Trial) [Preprint]. medRxiv 2020.07.07.20145979. Available from https://www.medrxiv. org/content/10.1101/2020.07.07.20145979v1
18. Podder S, Chowdhury N, Sina M, Ul Haque W. Outcome of ivermectin treated mild to moderate COVID-19 cases: a single- centre, open-label, randomized controlled study. IMC J Med Sci 2020; 14 (2): 002.
19. Chowdhury ATMM, Shahbaz M, Karim MR, Islam J, Guo D, He S. A Randomized Trial of Ivermectin-Doxycycline and Hydroxychloroquine-Azithromycin therapy on COVID19 patients [preprint]. medRxiv 2020.07.07.20145979. Available from https://www.medrxiv.org/content/10.1101/2020.07.07. 20145979v1
20. Rahman MA, Iqbal S, Islam MA, Niaz MK, Hussain T, Siddiquee T. Comparison of Viral Clearance between Ivermectin with Doxycycline and Hydroxychloroquine with Azithromycin in COVID-19 Patients. Journal of Bangladesh College of Physicians and Surgeons. 2020;38:5-9.
21. Alam MT, Murshed R, Bhiuyan E, Saber S, Alam R, Robin R. A Case Series of 100 COVID-19 Positive Patients Treated with Combination of Ivermectin and Doxycycline. Journal of Bangladesh College of Physicians and Surgeons. 2020;38:10-15.
22. Behera P, Patro BK, Singh AK, Chandanshive PD, S R R, Pradhan SK, Pentapati SSK, Batmanabane G, Mohapatra PR, Padhy BM, Bal SK, Singh SR, Mohanty RR. Role of ivermectin in the prevention of SARS-CoV-2 infection among healthcare workers in India: A matched case-control study. PLoS One. 2021 Feb 16;16(2):e0247163.
23. Directorate of Medical & Health Services, Uttar Pradesh [Internet]. COVID 19 documents. c2021 [cited 2021 Feb 19]. Available from: http://dgmhup.gov.in/
DocumentsCovid19/1621.pdf
