Ivermectin. Again.
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@jolly said in Ivermectin. Again.:
Don't like restrictions on off-label use. That's a doc decision, especially if it's as cheap as Ivermectin.
The stakeholders expand beyond patient and doc once insurance is involved — the insurance company, and whoever pays for insurance (maybe the employers who pays some of the premium, maybe the state or national government if you’re talking about Medicare/Medicaid) come into play.
@axtremus said in Ivermectin. Again.:
@jolly said in Ivermectin. Again.:
Don't like restrictions on off-label use. That's a doc decision, especially if it's as cheap as Ivermectin.
The stakeholders expand beyond patient and doc once insurance is involved — the insurance company, and whoever pays for insurance (maybe the employers who pays some of the premium, maybe the state or national government if you’re talking about Medicare/Medicaid) come into play.
If you don't like how a doctor practices medicine, go be one.
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Abstract
Importance Ivermectin, an inexpensive and widely available antiparasitic drug, is prescribed to treat COVID-19. Evidence-based data to recommend either for or against the use of ivermectin are needed.Objective To determine the efficacy of ivermectin in preventing progression to severe disease among high-risk patients with COVID-19.
Design, Setting, and Participants The Ivermectin Treatment Efficacy in COVID-19 High-Risk Patients (I-TECH) study was an open-label randomized clinical trial conducted at 20 public hospitals and a COVID-19 quarantine center in Malaysia between May 31 and October 25, 2021. Within the first week of patients’ symptom onset, the study enrolled patients 50 years and older with laboratory-confirmed COVID-19, comorbidities, and mild to moderate disease.
Interventions Patients were randomized in a 1:1 ratio to receive either oral ivermectin, 0.4 mg/kg body weight daily for 5 days, plus standard of care (n = 241) or standard of care alone (n = 249). The standard of care consisted of symptomatic therapy and monitoring for signs of early deterioration based on clinical findings, laboratory test results, and chest imaging.
Main Outcomes and Measures The primary outcome was the proportion of patients who progressed to severe disease, defined as the hypoxic stage requiring supplemental oxygen to maintain pulse oximetry oxygen saturation of 95% or higher. Secondary outcomes of the trial included the rates of mechanical ventilation, intensive care unit admission, 28-day in-hospital mortality, and adverse events.
Results Among 490 patients included in the primary analysis (mean [SD] age, 62.5 [8.7] years; 267 women [54.5%]), 52 of 241 patients (21.6%) in the ivermectin group and 43 of 249 patients (17.3%) in the control group progressed to severe disease (relative risk [RR], 1.25; 95% CI, 0.87-1.80; P = .25). For all prespecified secondary outcomes, there were no significant differences between groups. Mechanical ventilation occurred in 4 (1.7%) vs 10 (4.0%) (RR, 0.41; 95% CI, 0.13-1.30; P = .17), intensive care unit admission in 6 (2.4%) vs 8 (3.2%) (RR, 0.78; 95% CI, 0.27-2.20; P = .79), and 28-day in-hospital death in 3 (1.2%) vs 10 (4.0%) (RR, 0.31; 95% CI, 0.09-1.11; P = .09). The most common adverse event reported was diarrhea (14 [5.8%] in the ivermectin group and 4 [1.6%] in the control group).
Conclusions and Relevance In this randomized clinical trial of high-risk patients with mild to moderate COVID-19, ivermectin treatment during early illness did not prevent progression to severe disease. The study findings do not support the use of ivermectin for patients with COVID-19.
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On the positive side, Group B was completely free of worms
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On the positive side, Group B was completely free of worms
@Doctor-Phibes said in Ivermectin. Again.:
On the positive side, Group B was completely free of worms
You kid - but I hear that could be why some of the trials in areas with parasites can show benefits to using ivermectin for Covid.
Basically - fighting off parasites + covid at the same time is harder than fighting off covid.
Just a hypothesis though.
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@Doctor-Phibes said in Ivermectin. Again.:
On the positive side, Group B was completely free of worms
You kid - but I hear that could be why some of the trials in areas with parasites can show benefits to using ivermectin for Covid.
Basically - fighting off parasites + covid at the same time is harder than fighting off covid.
Just a hypothesis though.
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@Doctor-Phibes said in Ivermectin. Again.:
On the positive side, Group B was completely free of worms
You kid - but I hear that could be why some of the trials in areas with parasites can show benefits to using ivermectin for Covid.
Basically - fighting off parasites + covid at the same time is harder than fighting off covid.
Just a hypothesis though.
@xenon said in Ivermectin. Again.:
@Doctor-Phibes said in Ivermectin. Again.:
On the positive side, Group B was completely free of worms
You kid - but I hear that could be why some of the trials in areas with parasites can show benefits to using ivermectin for Covid.
Basically - fighting off parasites + covid at the same time is harder than fighting off covid.
Just a hypothesis though.
Might be a pretty good one.
In my career, I've only seen one patient with seven intestinal parasites. She was direct from rural Vietnam.
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@Doctor-Phibes said in Ivermectin. Again.:
On the positive side, Group B was completely free of worms
You kid - but I hear that could be why some of the trials in areas with parasites can show benefits to using ivermectin for Covid.
Basically - fighting off parasites + covid at the same time is harder than fighting off covid.
Just a hypothesis though.
@xenon said in Ivermectin. Again.:
Basically - fighting off parasites + covid at the same time is harder than fighting off covid.
I doubt that a significant cohort of the COVID population is concurrently infected with any kind of worm. But, your point might be valid.
What I noticed, early on in all of these debates about other drugs, is that, for the most part, were in vitro - showing that a Petri dish infused with a virus and the drug showed inhibition of the virus.
What happens in vivo is a whole 'nother thing.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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@xenon said in Ivermectin. Again.:
Basically - fighting off parasites + covid at the same time is harder than fighting off covid.
I doubt that a significant cohort of the COVID population is concurrently infected with any kind of worm. But, your point might be valid.
What I noticed, early on in all of these debates about other drugs, is that, for the most part, were in vitro - showing that a Petri dish infused with a virus and the drug showed inhibition of the virus.
What happens in vivo is a whole 'nother thing.
@George-K said in Ivermectin. Again.:
What I noticed, early on in all of these debates about other drugs, is that, for the most part, were in vitro - showing that a Petri dish infused with a virus and the drug showed inhibition of the virus.
The infamous bleach would probably work that way, too
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@George-K said in Ivermectin. Again.:
What I noticed, early on in all of these debates about other drugs, is that, for the most part, were in vitro - showing that a Petri dish infused with a virus and the drug showed inhibition of the virus.
The infamous bleach would probably work that way, too
@Doctor-Phibes said in Ivermectin. Again.:
@George-K said in Ivermectin. Again.:
What I noticed, early on in all of these debates about other drugs, is that, for the most part, were in vitro - showing that a Petri dish infused with a virus and the drug showed inhibition of the virus.
The infamous bleach would probably work that way, too
There actually was research years ago about dilute hypochlorite solutions as a virocide.
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@Doctor-Phibes said in Ivermectin. Again.:
@George-K said in Ivermectin. Again.:
What I noticed, early on in all of these debates about other drugs, is that, for the most part, were in vitro - showing that a Petri dish infused with a virus and the drug showed inhibition of the virus.
The infamous bleach would probably work that way, too
There actually was research years ago about dilute hypochlorite solutions as a virocide.
@Jolly said in Ivermectin. Again.:
@Doctor-Phibes said in Ivermectin. Again.:
@George-K said in Ivermectin. Again.:
What I noticed, early on in all of these debates about other drugs, is that, for the most part, were in vitro - showing that a Petri dish infused with a virus and the drug showed inhibition of the virus.
The infamous bleach would probably work that way, too
There actually was research years ago about dilute hypochlorite solutions as a virocide.
Some thru hikers use diluted bleach to sanitize their water, the idea being that they wouldn't be doing it long enough for permanent kidney damage.
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https://www.washingtonpost.com/nation/2022/02/25/new-hampshire-hospital-threats-qanon/
... Calls were flooding into the [hospital's] switchboard, and senior staff members were receiving a flurry of voice messages and emails to their work accounts. The callers were impassioned and vehement, demanding that the hospital begin treating a covid patient in its care with ivermectin, an anti-parasitic drug. As the day went on, the volume of calls grew so large that the hospital shut down its main number.
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That morning was only the beginning. The calls and emails — mobilized by a group calling itself the Truth Seekers 88 — continued for more than a week. The hospital limited access to one entrance, and local police posted a cruiser there 24 hours a day. Several of the communications were threatening, Caple said, including a voice mail in which a caller warned of a “military extraction” of the patient from the hospital. Nine days after the calls and emails began, she said, the hospital received a bomb threat for the first time in its history.
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https://www.nejm.org/doi/full/10.1056/NEJMoa2115869#.YkUKwiDgnz8.twitter
BACKGROUND
The efficacy of ivermectin in preventing hospitalization or extended observation in an emergency setting among outpatients with acutely symptomatic coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is unclear.METHODS
We conducted a double-blind, randomized, placebo-controlled, adaptive platform trial involving symptomatic SARS-CoV-2–positive adults recruited from 12 public health clinics in Brazil. Patients who had had symptoms of Covid-19 for up to 7 days and had at least one risk factor for disease progression were randomly assigned to receive ivermectin (400 μg per kilogram of body weight) once daily for 3 days or placebo. (The trial also involved other interventions that are not reported here.) The primary composite outcome was hospitalization due to Covid-19 within 28 days after randomization or an emergency department visit due to clinical worsening of Covid-19 (defined as the participant remaining under observation for >6 hours) within 28 days after randomization.RESULTS
A total of 3515 patients were randomly assigned to receive ivermectin (679 patients), placebo (679), or another intervention (2157). Overall, 100 patients (14.7%) in the ivermectin group had a primary-outcome event, as compared with 111 (16.3%) in the placebo group (relative risk, 0.90; 95% Bayesian credible interval, 0.70 to 1.16). Of the 211 primary-outcome events, 171 (81.0%) were hospital admissions. Findings were similar to the primary analysis in a modified intention-to-treat analysis that included only patients who received at least one dose of ivermectin or placebo (relative risk, 0.89; 95% Bayesian credible interval, 0.69 to 1.15) and in a per-protocol analysis that included only patients who reported 100% adherence to the assigned regimen (relative risk, 0.94; 95% Bayesian credible interval, 0.67 to 1.35). There were no significant effects of ivermectin use on secondary outcomes or adverse events.CONCLUSIONS
Treatment with ivermectin did not result in a lower incidence of medical admission to a hospital due to progression of Covid-19 or of prolonged emergency department observation among outpatients with an early diagnosis of Covid-19."Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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I saw an amazing meta analysis on Ivermectin studies and it makes a strong case that it helps in parts of the world precisely because it kills worms.
The worm infections make it harder to fight Covid. Also corticosteroid based Covid treatments cause the worms to multiple dramatically. That’s why the tests with the strongest results for ivermectin come from places that are teeming with worms, eg Bangladesh, East India, Colombia, etc whereas studies in the developed world show no significant effect.
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https://www.nejm.org/doi/full/10.1056/NEJMoa2115869#.YkUKwiDgnz8.twitter
BACKGROUND
The efficacy of ivermectin in preventing hospitalization or extended observation in an emergency setting among outpatients with acutely symptomatic coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is unclear.METHODS
We conducted a double-blind, randomized, placebo-controlled, adaptive platform trial involving symptomatic SARS-CoV-2–positive adults recruited from 12 public health clinics in Brazil. Patients who had had symptoms of Covid-19 for up to 7 days and had at least one risk factor for disease progression were randomly assigned to receive ivermectin (400 μg per kilogram of body weight) once daily for 3 days or placebo. (The trial also involved other interventions that are not reported here.) The primary composite outcome was hospitalization due to Covid-19 within 28 days after randomization or an emergency department visit due to clinical worsening of Covid-19 (defined as the participant remaining under observation for >6 hours) within 28 days after randomization.RESULTS
A total of 3515 patients were randomly assigned to receive ivermectin (679 patients), placebo (679), or another intervention (2157). Overall, 100 patients (14.7%) in the ivermectin group had a primary-outcome event, as compared with 111 (16.3%) in the placebo group (relative risk, 0.90; 95% Bayesian credible interval, 0.70 to 1.16). Of the 211 primary-outcome events, 171 (81.0%) were hospital admissions. Findings were similar to the primary analysis in a modified intention-to-treat analysis that included only patients who received at least one dose of ivermectin or placebo (relative risk, 0.89; 95% Bayesian credible interval, 0.69 to 1.15) and in a per-protocol analysis that included only patients who reported 100% adherence to the assigned regimen (relative risk, 0.94; 95% Bayesian credible interval, 0.67 to 1.35). There were no significant effects of ivermectin use on secondary outcomes or adverse events.CONCLUSIONS
Treatment with ivermectin did not result in a lower incidence of medical admission to a hospital due to progression of Covid-19 or of prolonged emergency department observation among outpatients with an early diagnosis of Covid-19.@George-K said in Ivermectin. Again.:
https://www.nejm.org/doi/full/10.1056/NEJMoa2115869#.YkUKwiDgnz8.twitter
BACKGROUND
The efficacy of ivermectin in preventing hospitalization or extended observation in an emergency setting among outpatients with acutely symptomatic coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is unclear.METHODS
We conducted a double-blind, randomized, placebo-controlled, adaptive platform trial involving symptomatic SARS-CoV-2–positive adults recruited from 12 public health clinics in Brazil. Patients who had had symptoms of Covid-19 for up to 7 days and had at least one risk factor for disease progression were randomly assigned to receive ivermectin (400 μg per kilogram of body weight) once daily for 3 days or placebo. (The trial also involved other interventions that are not reported here.) The primary composite outcome was hospitalization due to Covid-19 within 28 days after randomization or an emergency department visit due to clinical worsening of Covid-19 (defined as the participant remaining under observation for >6 hours) within 28 days after randomization.RESULTS
A total of 3515 patients were randomly assigned to receive ivermectin (679 patients), placebo (679), or another intervention (2157). Overall, 100 patients (14.7%) in the ivermectin group had a primary-outcome event, as compared with 111 (16.3%) in the placebo group (relative risk, 0.90; 95% Bayesian credible interval, 0.70 to 1.16). Of the 211 primary-outcome events, 171 (81.0%) were hospital admissions. Findings were similar to the primary analysis in a modified intention-to-treat analysis that included only patients who received at least one dose of ivermectin or placebo (relative risk, 0.89; 95% Bayesian credible interval, 0.69 to 1.15) and in a per-protocol analysis that included only patients who reported 100% adherence to the assigned regimen (relative risk, 0.94; 95% Bayesian credible interval, 0.67 to 1.35). There were no significant effects of ivermectin use on secondary outcomes or adverse events.CONCLUSIONS
Treatment with ivermectin did not result in a lower incidence of medical admission to a hospital due to progression of Covid-19 or of prolonged emergency department observation among outpatients with an early diagnosis of Covid-19.Don't doubt it. Proponents of Ivermectin have never claimed it worked well in acute cases. They've advocated taking it prophylactically or at the first onset of symptoms. I'd like to see a good study of where that was done.
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