{"id":9947,"date":"2021-01-04T11:15:07","date_gmt":"2021-01-04T16:15:07","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9947"},"modified":"2021-01-08T11:49:01","modified_gmt":"2021-01-08T16:49:01","slug":"ivermectin-for-covid-19-breakthrough-treatment-or-hydroxychloroquine-redux","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/ivermectin-for-covid-19-breakthrough-treatment-or-hydroxychloroquine-redux\/2021\/01\/04\/","title":{"rendered":"Ivermectin for COVID-19 — Breakthrough Treatment or Hydroxychloroquine Redux?"},"content":{"rendered":"
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Sulphur-crested Cockatoo. Anonymous, ca. 1600.<\/p><\/div>\n

It’s an indisputable fact that we need better treatments for COVID-19.<\/p>\n

This is particularly true in the outpatient setting. Let’s count how many we have today, hmm, this shouldn’t take long. That would be zero<\/em> — the same number we had over a year ago, when the disease first emerged in China.<\/p>\n

Something safe, easy to take as a pill, and inexpensive. Something that isn’t a costly bioengineered molecule<\/a> that requires lengthy infusions, given within a short time after diagnosis, to a highly contagious person.<\/p>\n

Enter ivermectin — and let the controversy begin.<\/p>\n

Yes, ivermectin — the drug licensed for use against strongyloides and other parasites, and probably best known to primary providers for its off-label use for scabies and head lice, and for pet owners as a common de-worming agent.<\/p>\n

Of course upon hearing about this “repurposed” antiparasitic drug, many will develop a weary feeling of deja vu.<\/p>\n

Didn’t we make this mistake with hydroxychloroquine? Wasn’t excess enthusiasm for this treatment a dismal chapter in our clinical and research approach to this new disease? Enthusiasm that led to wasteful, duplicative clinical trials, flawed observational studies, and irrational prescribing with arguably more harm than benefit? Harms that included not just side effects, but also drug shortages and pointless stockpiling?<\/p>\n

Yes to all of the above.<\/p>\n

Note that the harm done by the hydroxychloroquine controversy continues to this day. I know investigators who led well-done, fully powered clinical trials with negative results who were, and continue to be, viciously attacked in emails and on social media. Accusations typically charge that they succumbed to pressure from big pharma, or obscured favorable study results based on political agendas, or both.<\/p>\n

Believe me, they wanted<\/em> hydroxychloroquine to work. We all did! It’s relatively safe,<\/a> inexpensive, widely available — but oh well, the clinical trials showed us it didn’t do much of anything.<\/p>\n

Now — back to ivermectin. Where do we stand today? Unlike in the spring, when hydroxychloroquine use was rampant pretty much everywhere (and even appeared in some institutions’ treatment guidelines), this poll suggests<\/em> that ivermectin use now is much more restrained:<\/p>\n

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Hey #IDTwitter<\/a> and other clinicians who care for people with #COVID19<\/a>. Have you prescribed (or recommended) ivermectin for this disease? Please vote and comment. Thank you!<\/p>\n

— Paul Sax (@PaulSaxMD) January 3, 2021<\/a><\/p><\/blockquote>\n