The antiparasitic ivermectin has not yet been able to treat COVID-19 another randomized clinical trialbut the drug remains popular amid the pandemic Thanks to republican politics. Those are the findings from two separate studies published Friday in JAMA Internal Medicine.
Taken together, the studies raise even more concerns about the use of ivermectin against the pandemic virus — as well as the rationale for its use, which appears politically motivated.
“Political affiliation should not be a factor in clinical treatment decisions,” concluded the Harvard researchers behind one of the studies. “Our findings raise concerns about public confidence in a bipartisan healthcare system.”
The study began when researchers led by Harvard health policy researcher Michael Barnett noted the sharp rise in ivermectin prescriptions during the pandemic, despite the drug being shown to be ineffective in treating COVID-19. Researchers wanted to investigate whether prescription levels could be linked to county-level political voting patterns in the 2020 US presidential election. For comparison, they also looked at prescribing patterns for another antiparasitic drug called albendazole, as well as the immunosuppressive drug methotrexate.
Barnett and colleagues reviewed the medical records of more than 18.5 million adults from January 2019 to December 2020 to assess prescribing practices in counties across the United States. They then sorted the counties into four groups based on their percentage of Republican votes, with the first quartile having the lowest percentage of Republican votes and the fourth having the highest
Total ivermectin prescriptions increased 964 percent in December 2020 compared to pre-pandemic prescription numbers in 2019. But those December 2020 prescriptions were not evenly distributed; The counties with the highest proportions of Republican votes had the highest prescribing rate of ivermectin. In fact, the higher the percentage of Republican votes in a county, the higher the ivermectin prescription rate.
The authors saw a similar pattern for hydroxychloroquine after the Food and Drug Administration revoked an emergency use authorization for use against COVID-19 in March 2020, with the highest Republican vote percentage. Meanwhile, there have been no such policy-driven trends or changes in prescription amounts for the two control drugs, methotrexate and albendazole.
“Our results are consistent with the hypothesis that U.S. prescribing of hydroxychloroquine and ivermectin during the COVID-19 pandemic may have been influenced by political affiliation,” concluded Barnett and his colleagues. The results add context the further use of ivermectin for COVID-19, even as evidence mounts that the drug is ineffective and potentially dangerous.
Alongside Barnett’s study, researchers in Malaysia reported results from a randomized clinical trial involving 490 high-risk COVID-19 patients. In the study, ivermectin failed to prevent COVID-19 from progressing to severe disease in these high-risk patients. It also showed no statistically significant difference across a variety of COVID-19 outcomes, including time of disease progression, length of hospital stay, need for mechanical ventilation, need for critical care, and death.
In Malaysia, people are required to report cases of COVID-19 to authorities, and people at risk of disease progression are either hospitalized or admitted to a COVID-19 quarantine center. This all made it easier to accurately track study participants. The study enrolled people who were COVID-19 positive, aged 50 years or older, and had at least one underlying medical condition. At the time of admission, the 490 patients were believed to have had mild to moderate infections. From there, 241 were randomly assigned to receive oral ivermectin for five days and 249 were randomly assigned to standard of care.
At the end of the study, 52 of the 241 patients receiving ivermectin (21.6 percent) had progressed to severe disease, while 43 of the 249 patients receiving standard of care (17.3 percent) had progressed to disease. While there were no significant differences in other disease outcomes, the researchers documented more side effects in the ivermectin group.
A total of 44 patients reported side effects, 33 of them in the ivermectin group. Diarrhea was the most common side effect known to be caused by ivermectin. There were also five cases of serious side effects, four of which occurred in the ivermectin group. Two patients in the ivermectin group had heart attacks, one had severe anemia, and one developed hypovolemic shock secondary to severe diarrhea. The only remaining severe reaction in the control group was abdominal bleeding.
Not the first time
While some early clinical work suggested that ivermectin might be effective in treating COVID-19, experts have since established this methodological weaknesses in these studies. In addition, the results of the Malaysia study mirror two other randomized clinical trials, in Colombia and Argentina. These studies also found no benefit for using ivermectin to improve COVID-19 symptoms or reduce hospitalization rates.
Overall, the authors of the Malaysian study conclude that in their “randomized clinical trial of high-risk patients with mild to moderate COVID-19, treatment with ivermectin during early illness did not prevent progression to severe disease. The study results do not support the use of ivermectin in patients with COVID-19.”
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