Ivermectin therapy is associated with changes in SARS-CoV-2 RNA load in asymptomatic patients: a randomized controlled trial

Mouawia et al., Trials, doi:10.1186/s13063-026-09736-x, ChiCTR2000033627, May 2026
Hospitalization 56% improvement lower risk ← → higher risk Recovery, all sympto.. 31% Recovery, fever 81% Recovery, cough -33% Recovery, sore throat 60% Recovery, dyspnea 26% Recovery, pneumonia 33% Recovery, headache 40% Recovery, anosmia -46% Recovery, myalgia 22% Recovery, loss of taste 48% Recovery, fatigue 47% Recovery, dizziness 43% Viral load 62% Ivermectin  Mouawia et al.  EARLY TREATMENT RCT Is early treatment with ivermectin beneficial for COVID-19? RCT 126 patients in Lebanon (November - December 2021) Improved recovery (p=0.0072) and viral clearance (p<0.0001) c19early.org Mouawia et al., Trials, May 2026 0 0.5 1 1.5 2+ RR
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.
Lower risk for mortality, ventilation, ICU, hospitalization, recovery, cases, and viral clearance.
No treatment is 100% effective. Protocols combine treatments.
6,700+ studies for 220+ treatments. c19early.org
Meta-analysis
RCT of 126 asymptomatic PCR+ patients with high viral load, showing improved recovery and significantly lower viral load with ivermectin treatment. All patients received zind and vitamin C.
The trial selected for patients with high viral load that were still asymptomatic - i.e., patients were treated early before significant progression and had received a high viral load, which may be favorable conditions for the strong viral load improvement seen.
This is the 54th COVID-19 RCT for ivermectin, which collectively show efficacy with p=0.000000027.
This is the 106th COVID-19 controlled study for ivermectin, which collectively show efficacy with p<0.0000000001.
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risk of hospitalization, 55.6% lower, RR 0.44, p = 0.24, treatment 4 of 63 (6.3%), control 9 of 63 (14.3%), NNT 13, day 4.
risk of no recovery, 30.9% lower, RR 0.69, p = 0.007, treatment 63, control 63, all symptoms combined.
risk of no recovery, 81.2% lower, RR 0.19, p = 0.002, treatment 3 of 63 (4.8%), control 16 of 63 (25.4%), NNT 4.8, day 4, fever.
risk of no recovery, 33.3% higher, RR 1.33, p = 0.52, treatment 16 of 63 (25.4%), control 12 of 63 (19.0%), day 4, cough.
risk of no recovery, 60.0% lower, RR 0.40, p = 0.44, treatment 2 of 63 (3.2%), control 5 of 63 (7.9%), NNT 21, day 4, sore throat.
risk of no recovery, 26.3% lower, RR 0.74, p = 0.42, treatment 14 of 63 (22.2%), control 19 of 63 (30.2%), NNT 13, day 4, dyspnea.
risk of no recovery, 33.3% lower, RR 0.67, p = 0.74, treatment 4 of 63 (6.3%), control 6 of 63 (9.5%), NNT 32, day 4, pneumonia.
risk of no recovery, 40.0% lower, RR 0.60, p = 0.02, treatment 21 of 63 (33.3%), control 35 of 63 (55.6%), NNT 4.5, day 4, headache.
risk of no recovery, 46.2% higher, RR 1.46, p = 0.31, treatment 19 of 63 (30.2%), control 13 of 63 (20.6%), day 4, anosmia.
risk of no recovery, 22.2% lower, RR 0.78, p = 0.36, treatment 21 of 63 (33.3%), control 27 of 63 (42.9%), NNT 10, day 4, myalgia.
risk of no recovery, 48.0% lower, RR 0.52, p = 0.03, treatment 13 of 63 (20.6%), control 25 of 63 (39.7%), NNT 5.2, day 4, loss of taste.
risk of no recovery, 46.7% lower, RR 0.53, p = 0.02, treatment 16 of 63 (25.4%), control 30 of 63 (47.6%), NNT 4.5, day 4, fatigue.
risk of no recovery, 42.9% lower, RR 0.57, p = 0.53, treatment 4 of 63 (6.3%), control 7 of 63 (11.1%), NNT 21, day 4, dizziness.
viral load, 61.9% lower, relative load 0.38, p < 0.001, treatment 8.38 [7.56-9.2] n=63, control 3.19 [2.36-4.02] n=63, relative ΔCt, day 4.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mouawia et al., 1 May 2026, Randomized Controlled Trial, Lebanon, peer-reviewed, mean age 40.1, 8 authors, study period November 2021 - December 2021, dosage 12mg single dose, <65kg - 9mg, 65-84kg - 12 mg, ≥85kg - 15 mg, trial ChiCTR2000033627. Contact: raadhoussamrh@gmail.com, houssam.raad@ul.edu.lb, houssein.mouawia@ul.edu.lb.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org September 2026 Lebanon Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines USA Brazil France Italy Canada Pakistan Spain Vietnam Japan Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Morocco Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Bosnia-Herzegovina Dominican Republic Bolivia Côte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia Iceland New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel North Macedonia Hong Kong Qatar Panama Serbia Lebanon favored low-cost treatments.The average efficacy of treatments was moderate.Low-cost treatments improve early treatment, andprovide complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org September 2026 Lebanon Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines USA Brazil France Italy Canada Pakistan Spain Vietnam Japan Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Morocco Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Taiwan Fiji Zambia Dominican Rep. Bolivia Côte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel North Macedonia Hong Kong Qatar Panama Serbia Lebanon favored low-cost treatments.The average efficacy was moderate.Low-cost protocols improve early treatment,and add complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Abstract: Trials https://doi.org/10.1186/s13063-026-09736-x Article in Press Ivermectin therapy is associated with changes in SARS-CoV-2 RNA load in asymptomatic patients: a randomized controlled trial Hussein Mouawia, Hamid Saab, Hassan Ayoub, Abbas Mourad, Najwa Yaghi, Ahmad Saabi, Mohamed El-Seblani & Houssam Raad Received: 02 Jul 2025 Accepted: 14 Apr 2026 Cite this article as: Mouawia, H., Saab, H., Ayoub, H. et al. Ivermectin therapy is associated with changes in SARS-CoV-2 RNA load in asymptomatic patients: a randomized controlled trial. Trials (2026). https://doi.org/10.1186/s1306 3-026-09736-x A E R P S S We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. IN If this paper is publishing under a Transparent Peer Review model then Peer Review reports will publish with the final article. I T R E L C ©The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ ACCEPTED ARTICLE IN MANUSCRIPT PRESS Ivermectin Therapy is Associated with Changes in SARS-CoV-2 RNA Load in Asymptomatic Patients: A Randomized Controlled Trial Hussein Mouawia*1, Hamid Bou Saab1, Hassan Ayoub2,3, Abbas mourad4, Najwa Yaghi3, Ahmad Al Saabi1, Mohamed El-Seblani1, Houssam Raad*1 1. Faculty of Public Health, Lebanese University, Zahle, Lebanon 2. Infectious Disease Unit, Rayak Hospital and Baalbek Government Hospital, Lebanon S S E 3. Clinical Laboratory, Baalbek Government Hospital, Lebanon PR 4. Saint Joseph University, Faculty of Management and Administration, Achrafieh, Lebanon : These authors contributed equally to this work E L C * Corresponding author: I T R Dr. Houssam Raad Faculty of public health Lebanese university IN A Lebanon Email: raadhoussamrh@gmail.com or houssam.raad@ul.edu.lb (H.R.) Dr. Hussein Mouawia Faculty of public health Lebanese university Lebanon Email: houssein.mouawia@ul.edu.lb (H.R.) ACCEPTED ARTICLE IN MANUSCRIPT PRESS ABSTRACT Background: Ivermectin, an antiparasitic agent with reported antiviral properties, has been investigated for repurposing in the treatment of COVID-19. This study aimed to assess the efficacy of a single weight-adjusted oral dose of ivermectin in reducing viral load and improving clinical outcomes in asymptomatic individuals infected with SARS-CoV-2. Methods: A randomized controlled trial was conducted with 126..
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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