Does the anti-parasitic Ivermectin work in actual human studies versus the Petri dish in vitro studies, when treating coronavirus COVID-19 infection? And if so, is it safe in humans?
An in vitro study was done.
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This in-vitro study reveals exciting data regarding Ivermectin, which is typically used for treatment of scabies.
I was unable to find any clinical data to support use of Ivermectin for COVID-19. But this study definitely supports starting a clinical trial given the widespread availability of Ivermectin. Overall ivermectin is well-tolerated in both children and adults, with rash being one of the most common side effects. It may have fewer severe adverse effects than hydroxychloroquine, which can cause fatal arrhythmias like Torsades de Pointes(though this is more with chronic use; https://www.ncbi.nlm.nih.gov/pubmed/16615675). This supports ivermectin as a good candidate drug to study.
It is important to note, however, that many drugs that have shown to be effective in-vitro will fail to produce any clinical benefit when given to animals or humans. For instance, for ebola virus, chloroquine was effective in-vitro but not in guinea pigs (https://www.ncbi.nlm.nih.gov/pubmed/26459826). There are many factors that could contribute to these discrepancies, including issues with bioavailability, distribution to the appropriate tissues, entrance into cells, and breakdown of the drug by cellular or viral mechanisms.
I think that the ivermectin is unlikely to be an effective antiviral vs. SARS-CoV-2 at recommended dosing.
I think the key points are as follows;
These questions follow naturally from the preprint/paper above.
Of course, the most strong evidence is reliable clinical. However, as far as I am aware, there are no result of valid clinical studies as of November 1, 2020.
It seems that one data analysis company published a preprint saying that ivermectin was beneficial based on analysis of real world data, but it was later retracted. According to this article, it seems to have pointed out many unnatural aspects of the data.
In September 2020, Japan's Kitasato University appears to have begun a physician-led clinical trial for COVID-19. Kitasato University is where Satoshi Omura, one of the discoverers of ivermectin, is affiliated.
They will administer the Ivermectin Tablets, sold under the brand name STROMECTOL, orally. According to a Japanese newspaper article (written in Japanese), the trial is expected to be completed in March 2021. (Completion = LPI?)