Effect of Ivermectin vs Placebo on Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19: A Randomized Clinical Trial

Naggie et al., JAMA, doi:10.1001/jama.2022.18590, Oct 2022

Ivermectin for COVID-19

4th treatment shown to reduce risk in August 2020, now with p < 0.0000000001 from 106 studies, recognized in 24 countries.

No treatment is 100% effective.
Protocols combine treatments.

DOI record: { "DOI": "10.1001/jama.2022.18590", "ISSN": [ "0098-7484" ], "URL": "http://dx.doi.org/10.1001/jama.2022.18590", "abstract": "<jats:sec><jats:title>Importance</jats:title><jats:p>The effectiveness of ivermectin to shorten symptom duration or prevent hospitalization among outpatients in the US with mild to moderate symptomatic COVID-19 is unknown.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the efficacy of ivermectin, 400 μg/kg, daily for 3 days compared with placebo for the treatment of early mild to moderate COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Participants</jats:title><jats:p>ACTIV-6, an ongoing, decentralized, double-blind, randomized, placebo-controlled platform trial, was designed to evaluate repurposed therapies in outpatients with mild to moderate COVID-19. A total of 1591 participants aged 30 years and older with confirmed COVID-19, experiencing 2 or more symptoms of acute infection for 7 days or less, were enrolled from June 23, 2021, through February 4, 2022, with follow-up data through May 31, 2022, at 91 sites in the US.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Participants were randomized to receive ivermectin, 400 μg/kg (n = 817), daily for 3 days or placebo (n = 774).</jats:p></jats:sec><jats:sec><jats:title>Main Outcomes and Measures</jats:title><jats:p>Time to sustained recovery, defined as at least 3 consecutive days without symptoms. There were 7 secondary outcomes, including a composite of hospitalization or death by day 28.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 1800 participants who were randomized (mean [SD] age, 48 [12] years; 932 women [58.6%]; 753 [47.3%] reported receiving at least 2 doses of a SARS-CoV-2 vaccine), 1591 completed the trial. The hazard ratio (HR) for improvement in time to recovery was 1.07 (95% credible interval [CrI], 0.96-1.17; posterior <jats:italic>P</jats:italic> value [HR &amp;amp;gt;1] = .91). The median time to recovery was 12 days (IQR, 11-13) in the ivermectin group and 13 days (IQR, 12-14) in the placebo group. There were 10 hospitalizations or deaths in the ivermectin group and 9 in the placebo group (1.2% vs 1.2%; HR, 1.1 [95% CrI, 0.4-2.6]). The most common serious adverse events were COVID-19 pneumonia (ivermectin [n = 5]; placebo [n = 7]) and venous thromboembolism (ivermectin [n = 1]; placebo [n = 5]).</jats:p></jats:sec><jats:sec><jats:title>Conclusions and Relevance</jats:title><jats:p>Among outpatients with mild to moderate COVID-19, treatment with ivermectin, compared with placebo, did not significantly improve time to recovery. These findings do not support the use of ivermectin in patients with mild to moderate COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Trial Registration</jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/ct2/show/NCT04885530\">NCT04885530</jats:ext-link></jats:p></jats:sec>", "author": [ { "affiliation": [ { "name": "Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina" }, { "name": "Department of Medicine, Duke University School of Medicine, Durham, North Carolina" } ], "family": "Naggie", "given": "Susanna", "sequence": "first" }, { "affiliation": [ { "name": "Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis" } ], "family": "Boulware", "given": "David R.", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee" } ], "family": "Lindsell", "given": "Christopher J.", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee" } ], "family": "Stewart", "given": "Thomas G.", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania" } ], "family": "Gentile", "given": "Nina", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee" } ], "family": "Collins", "given": "Sean", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medicine, Weill Cornell Medicine, New York, New York" } ], "family": "McCarthy", "given": "Matthew William", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida" } ], "family": "Jayaweera", "given": "Dushyantha", "sequence": "additional" }, { "affiliation": [ { "name": "Division of Pulmonary, Critical Care and Sleep Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Kansas" } ], "family": "Castro", "given": "Mario", "sequence": "additional" }, { "affiliation": [ { "name": "Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland" } ], "family": "Sulkowski", "given": "Mark", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania" } ], "family": "McTigue", "given": "Kathleen", "sequence": "additional" }, { "affiliation": [ { "name": "Stakeholder Advisory Committee, Pittsburgh, Pennsylvania" } ], "family": "Thicklin", "given": "Florence", "sequence": "additional" }, { "affiliation": [ { "name": "Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina" }, { "name": "Department of Medicine, Duke University School of Medicine, Durham, North Carolina" } ], "family": "Felker", "given": "G. 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Carolina, Charleston" } ], "family": "Lenert", "given": "Leslie A.", "sequence": "additional" }, { "affiliation": [ { "name": "National Center for Advancing Translational Sciences, Bethesda, Maryland" } ], "family": "Dunsmore", "given": "Sarah E.", "sequence": "additional" }, { "affiliation": [ { "name": "Foundation for the National Institutes of Health, Bethesda, Maryland" } ], "family": "Adam", "given": "Stacey J.", "sequence": "additional" }, { "affiliation": [ { "name": "Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina" } ], "family": "DeLong", "given": "Allison", "sequence": "additional" }, { "affiliation": [ { "name": "Biomedical Advanced Research and Development Authority, Washington, DC" } ], "family": "Hanna", "given": "George", "sequence": "additional" }, { "affiliation": [ { "name": "Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina" } ], "family": "Remaly", "given": "April", "sequence": 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