MohiuddinXJTU | 6 points
"A comparative observational study on Ivermectin- Doxycycline and Hydroxychloroquine-Azithromycin therapy on COVID19 patients" -Research Gate Preprint[-] MohiuddinXJTU | 1 points
Coronavirus disease 2019 (COVID19) is a WHO declared a global pandemic. From the time of origin to till many antiviral and other drugs are on desperate use to find a cure. We decided to investigate the efficacy of Ivermectin (200mcg/kg single dose)-Doxycycline combination therapy and compare it to the standard HCQ-Azithromycin therapy among the mild to moderate cases of COVID19 patients in Bangladesh. According to this study both the Ivermectin-Doxycycline and HCQ-Azithromycin treatment regimens were found to be effective against SARS-CoV-2 infection. But concerning the treatment outcome, adverse effect, and safety Ivermectin-Doxycycline combination is superior to HCQ-Azithromycin therapy for mild to moderate degree of COVID19 patients in Bangladesh. We strongly believe by rescheduling and increasing the duration of Ivermectin to 3days will certainly decrease the recovery period further than that of our study. This will also prevent disease progression and morbidity to COVID19 patients.
[-] TrumpLyftAlles | 1 points
Did you delete your post about this study, and repost? My comments are lost?! :(
[-] TrumpLyftAlles | 1 points
Please repost with (Bangladesh 2020-06-10) after the title. The naming conventions are at the top of the sub! :)
[-] fyodor32768 | 1 points
This basically shows no benefit to Ivermectin or at least no significant effect. Maybe there's some confounding variable or whatnot but a pretty disappointing result.
[-] TrumpLyftAlles | 1 points
100% recovery, shorter time to recovery, fewer side-effects: How is that not a great result?
Please explain your viewpoint because I really don't get it.
Well, I get this: It would have been better if the HCQ+AZT arm had a much higher fatality rate, like it was 100% vs 60% instead of 100% vs 96.36%. Wait, you don't have those numbers. They're in the PDF, which I briefly wrote up, then my post disappeared or something. I'll repost.
[-] fyodor32768 | 1 points
"Results: Group-A recovery rate was 100%, the mean symptomatic recovery duration was 5.93days and negative PCR was on 8.93days; in Group-B this was 96.36%, 6.99days, and 9.33days respectively. 55.10% of patients in Group-A gained symptomatic recovery on the 5th day."
Unless I'm misreading this a very small difference. A day earlier for symptomatic recovery and .6 days for viral negative. This seems pretty underwhelming. I guess that 100 percent is better than 97 percent but especially given that its a retrospective analysis with imperfect cohort matching, it's hard to see much evidence that Ivermectin is making any difference, let alone a big difference. The report itself said that the results weren't statistically significant.
[-] TrumpLyftAlles | 1 points
Thanks for your careful reading! I was barely functioning at 1:30 AM when I looked at the PDF. Got my facts wrong!
it's hard to see much evidence that Ivermectin is making any difference, let alone a big difference.
Only if your premise is that HCQ+AZT doesn't work even a little, so the study says ivermectin works barely better than nothing. Is that plausible? I haven't followed the HCQ studies.
[-] fyodor32768 | 2 points
No evidence that HCQ is doing anything from several huge studies. My understanding is that it's not even getting used anymore.
[-] TrumpLyftAlles | 1 points
This review found that 5 of 7 HCQ studies showed positive outcomes for HCQ, 2 studies that showed no change compared to the controls.
[-] fyodor32768 | 2 points
I'm not being dismissive but I'm not going to get a into a hydroxyqualiqine argument. The FDA dropped its emergency use authorization because it didn't work. The biggest RCTs showed no benefit. This, one of the largest trials stopped the hydroxychloroquine arm because they were seeing no benefit.
https://www.cnn.com/2020/06/05/health/hydroxychloroquine-uk-recovery-trial-bn/index.html
[-] TrumpLyftAlles | 1 points
Some specifics from the PDF:
I'll write up the PDF sometime today. If you want to go look, you download it from OP's article.
I agree with the other commenter that this is a bit underwhelming of a result. But i think there also some variables missing. For example, we know that the actual mortality rate of covid is between 0.4-3% more or less depending on age group and comorbidities. The numbers of recovered in both groups maybe could have recovered nevertheless the treatment. Unlike the ICON study, this one doesn't specify severity, which i think would have been more useful and made the results clearer.
Those people might have not died anyway, but in what state did they finish the treatmentment? Did they kept getting worse or stayed mild? How many of them were already in a severe state?
If i checked correctly, they only state symptomatic and asymptomatic, and the Ivermectin group 85% symptomatic vs HCQ 75%, but they didn't state how many of the asymptomatic progressed to sumotomatic in of the groups, which would have been interesting.
The most remarkable difference (imo) is that they noted more people recovered in the 5th day with ivermectin (55%) vs HCQ (23%). For the 7th day , 84.06 % had already recovered in the Ivermectin group Vs 64.63% in the HCQ group.
With ivermectin, the last 2% to recover did so on the 10th day vs last 2% with HCQ did so on the 12th day, ( and then 3.64% didn't ).
Without further details on severity and symptoms (and what is being considered recovery exactly. Zero symptoms and a negative test or just going back to stable and out an about but with discomforts, or anything in between? What happened to the asymptomatic people, how do they count their recovieries?) My uneducated (and probably biased) take on this is that most of these people might have recovered on their own, more or less, but ivermectin indeed boosted the speed of recovery and took care of the small % that wouldn't have recovered on their own.
[-] TrumpLyftAlles | 1 points
This is a turned-to-text version of the PDF version of this study. I intended to post this to /r/covid19 but I find myself banned for 3 days! (Don't know why.)
By
Abu Taiub Mohammed Mohiuddin Chowdhury^1; Mohammad Shahbaz^2; Md. Rezaul Karim^3; Jahirul Islam^4; Guo Dan^1; He Shuixiang^1
^1 Department of Gastroenterology, First affiliated hospital of Xi’an Jiaotong University, Xi’an . China
^2 Chakaria Upazilla Health Complaex, Cox’s Bazar. Bangladesh.
^3 Biomedical Research Institute of Hubei University of Medicine, Shiyan, China.
^4 Department of Epidemiology and Healh Statistics; Xi’an Jiaotong University. China.
Corresponding author:
He shuixiang
Email: dyyyjxk@xjtu.edu.cn
Professor and Head, Department of Gastroenterology
First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, P.R. china
#Abstract:
Background: The COVID-19 pandemic in Bangladesh is part of the worldwide pandemic caused by a newly discovered Coronavirus. The treatment methods for COVID-19 are emerging and rapidly evolving because of ongoing researches being done worldwide by a record number of investigators. Researchers have investigated existing drugs, including Ivermectin as well as Hydroxychloroquine in addition to other existing drugs. In this research, we investigated and compared the outcome of Ivermectin-Doxycycline and Hydroxychloroquine-Azithromycin combination therapy on mild to moderate degree of COVID19 patients.
Methods: Following exclusion, 116 patients tested positive by RT PCR for SARS-CoV-2 infection were included in this study. Patients were divided into two groups. Ivermectin 200µgm/kg single dose + Doxycycline 100mg BID for 10d and Hydroxychloroquine 400mg 1st day then 200mg BID for 9days + Azithromycin 500mg daily for 5Days was given to the GroupA and group-B respectively. Treatment outcomes were evaluated on the 5th day in case of asymptomatic patients and the 2nd non-symptomatic day onward from the first day of the drug intake by PCR study.
My short-hand:
I read this as:
For the asymptomatic patients, the PCR test was given 5 days after they were first dosed with IVMDX or HCQAZT. For symptomatic patients, we tested them with the PCR test on the second day that they were no longer symptomatic.
Results: Group-A recovery rate was 100%. The mean recovery duration was 8.93 days. A mild degree of adverse effect was noted by 31.67% of patients; lethargy in 14 (23.3%), nausea in 11 (18.3%), and occasional vertigo in 7 (11.66%) of patients. In group-B recovery rate was 96.36%. The mean duration of recovery was 9.33 days. 46.43% had experienced some degree of adverse effects; 13 (23.21%) mild type of blurring of vision and headache; 22 (39.2%) increased lethargy and dizziness, 10 (17.85%) occasional palpitation, and 9 (16.07%) experienced nausea and vomiting.
Both drug regimens had outstanding success; less success for both would have been more persuasive IMO.
IVMDX was somewhat more successful:
These differences seem pretty tiny, to me.
Conclusion: Concerning the treatment outcome, adverse effect, and safety, IvermectinDoxycycline combination is a better alternative to Hydroxychloroquine-Azithromycin therapy in the case of mild to moderate degree of COVID19 patients. Though, both the treatment regimens were found to be effective in this study.
IMO, IVMDX is slightly better.
Keywords: Ivermectin; Doxycycline; Hydroxychloroquine; Azithromycin; COVID19, Bangladesh
#Background:
Coronavirus disease 2019 (COVID19) is a WHO declared a global pandemic. Till now around eight million people have been infected by severe acute respiratory syndrome‐coronavirus‐2 (SARS-CoV-2) and billions are affected by socioeconomic measures. As SARS-CoV-2 is a novel virus, definite treatment options against it are yet to discover. From the time of origin to till many antiviral and other drugs are on desperate use to find a cure. Lopinavir/ritonavir was the initial therapeutic management. Currently, antiviral agents like favipiravir and remdesivir are in wide use in the case of moderate to severe COVID19 patients. However, with such limited antiviral option chloroquine and Hydroxychloroquine (HCQ) are showing an emerging hope and currently underused in many affected regions. Chloroquine was proven as a potential suppressor of SARS-CoV-2 in a vitro study. [1] Though many trials have shown a good outcome in mild to moderate cases, the toxicity of chloroquine is an important concern. [2] Later the less toxic derivatives hydroxychloroquine was found to be effective. [3]
I haven't followed the CH/HCQ studies closely. This seems to be a more positive take on their effectiveness than I would have guessed.
Very recently Ivermectin an antiparasitic drug has been described highly effective in an in-vitro study against SARS-CoV-2.
The Monash 48 hours study was released as a preprint on April 5! Not so recently!
[4] Besides the efficacy of HCQ-Azithromycin combination therapy was proven as an effective combination therapy in the treatment of SARS-CoV-2. [5, 6] These two studies reported 100% and 83% recovery in the 6th and 7th day with a reduced hospital stay. Very recently, few unofficial studies were done in Bangladesh by a combination of Ivermectin and Doxycyclin among the COVID19 patients with an encouraging result. But no study has been reported about the efficacy of Ivermectin in COVID19 till now. Ivermectin is well-tolerated, also has less toxicity and adverse effect compare to the HCQ. Due to drug complications, recent discouraging statements by WHO about HCQ treatment it is important to find an effective, safe, and economic alternative of HCQ. Therefore we decided to investigate the efficacy of Ivermectin-Doxycycline combination therapy and compare it to the standard HCQ-Azithromycin therapy among the mild to moderate cases of COVID19 patients in Bangladesh.
You could try posting on r/Wuhan_Flu.
[-] TrumpLyftAlles | 1 points
Never been in that sub before! It looks pretty political. I'm trying hard to stay away from that stuff.
If you want to copy the content to your own post to the sub, feel free.
They were quarantined by reddit for going against the established narrative. They dared to say the virus likely leaked from a lab in Wuhan.
[-] TrumpLyftAlles | 1 points
I know nothing about that and don't want to learn about it. Please don't bring that stuff to this sub.
If you want to bring information about ivermectin to anywhere, that's great!
Sorry about that. I just saw that you got a 3day ban from another sub and weren't sure why. Reddit has taken a very strong stance on maintaining a singular narrative.
[-] TrumpLyftAlles | 1 points
In that case it was writing about how I self-dose vitamin D. No practicing medicine in /r/covid19.
[-] TrumpLyftAlles | 1 points
This study was done from May 2nd to June 5th, 2020. In this study we included 181 patients who were tested positive for SARS-CoV-2 infection by RT PCR presented and a sample collected at Chokoria Upazila Health Complex, Cox’s Bazar; Bangladesh. The PCR analysis of the collected sample was done in Cox’s Bazar Medical College. Each of the patients was examined carefully to find out the details of the disease symptoms, history, comorbid condition, and associated complaints. Patients with severe comorbid conditions like severe Bronchial asthma, COPD, severe ischemic heart disease, uncontrolled diabetes mellitus, advanced renal and hepatic disease, carcinoma, hospitalized and Immuno-compromised patients were not included in this study. 42 patients had comorbid conditions (some required hospitalization) that might affect the recovery time; 14 patients were unwilling to participate in the study and 9 patients did not show-up (3 from group A and 6 from group B) for follow up sample collection so these were excluded. Following exclusion 116 patients were included with mild to moderate degree of illness with normal or near-normal chest radiograph and Oxygen Saturation more than 95%. All the patients enrolled in the study were treated as an outpatient.
For the study purpose the patients were divided into two groups as follows:
Group A (n=60): Ivermectin 200µgm/kg single dose + Doxycycline 100mg BID for 10days
Group B (n=56): Hydroxychloroquine 400mg 1st day then 200mg BID for 9days + Azithromycin
500mg daily for 5Days.
Besides the above, symptomatic treatment for fever, headache, cough, myalgia, etc were given accordingly. Patients were advised for self-isolation, proper nutrition, hydration, and a sanitary environment. Treatment outcomes were evaluated on every 2days starting from the 5th day (Asymptomatic patients) or the 2nd non-symptomatic day from the first day of the drug intake by PCR study of nasopharyngeal and throat swab in each group. Regular contacts were maintained to find out the adverse or side effects of the therapy. A negative PCR was counted as treatment success. The duration from the first-day drug intake to the negative PCR was counted as a recovery period. Informed written consent was obtained in every case. Statistical analysis was done by Graph pad Prism software. T-test was done to see the significance between the values.
Table 1: The total number of patients was 116; male 84 and female 26, age 16 to 80years, mean age 33.94years (±14.12years). Group-A (Ivermectin + Doxycyclin): male 43 (71.67%), female 17 (28.33%), age 35.72 ± 15.1 years; males 37 years and female 32.88 years. Group-B (Hydroxychloroquine + Azithromycin): male 47 (83.93%), female 9(16.07%), age 31.91years; male 31.35, and female 34.5 years. [Figure 1 A & B] Out of the total, 91 (78.45%) were symptomatic and 25 (21.55%) were asymptomatic patients with contact history. This is 49(81.67%) and 11(18.33%) in the case of Group-A; 42 (75%) and 14 (25%) in the case of Group-B.
In Group-A recovery rate was 100% (60/60). The mean recovery duration was 8.93days (8 to 13days). 41 (63.3%) patients had no new complaints other than the symptoms. A mild degree of drug adverse effect was noted; lethargy in 14(23.3%), nausea in 11(18.3%), and occasional vertigo in 7(11.66%) of patients. [Figure 1 D]
In group-B out of 56 patients, two male patients were referred to a tertiary hospital. The recovery rate was 96.36% (54/56). The mean duration of recovery was 9.33 days (5 to 15 days). During the HCQ intake, no severe adverse effect was noted. 30 (53.57%) of the patient had no additional complaint other than the previous symptoms. 13(23.21%) complained of a mild type of blurring of vision and headache; 22 (39.2%) experienced increased lethargy and dizziness, 10 (17.85%) complained of a mild degree of occasional palpitation, and 9 (16.07%) experienced nausea and vomiting. [Figure 1 E]
The difference between the recovery duration of the Group-A and Group-B is not statistically significant in unpaired t-test, P=0.2314. [Figure 1 C] Subgroup analysis of the recovery duration: Male 9.18±1.90 days and female 8.92±1.32 days, P=0.515; in Group-A male 8.907±1.342 days and female 9±1.173 days, P=0.44, Group-B male 9.18±1.90 days and female 8.92±1.32 days, P=0.407. The T-test between the recovery duration of both group male and both group female individually were not significant P = 0.18 and 0.69 respectively.
[-] TrumpLyftAlles | 1 points
The COVID-19 pandemic in Bangladesh is part of the worldwide pandemic of Coronavirus disease 2019 (COVID-19) caused by a newly discovered Coronavirus. Initially, it was called the novel coronavirus and later named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to its similar characteristics with severe acute respiratory syndrome Coronavirus 1 (SARS-CoV-1). [7-9] The treatment methods for COVID-19 are emerging and rapidly evolving because of ongoing researches being done worldwide by a record number of investigators. Due to the uniqueness of each medical and research facility, approach to the care of patients with COVID-19 is also being made differently using existing drugs, including Ivermectin as well as hydroxychloroquine (HCQ) in addition to other existing drugs by multiple investigators. Both of these drugs were found effective to a certain extent in patients with COVID-19 in multiple studies worldwide. [10, 20] Thus, a comparative therapeutic analysis can achieve shorter recovery time and better tolerability among these drugs.
HCQ is a less toxic derivative of chloroquine, is an antimalarial drug, and has decades of treatment used as an immunomodulator. [10] At present, it has been the topic of discussion concerning its potential treatment in patients with COVID-19. [11] It is thought that the effect of HCQ on antigen cross-presentation may occur, in which a dendritic cell presents the antigen to CD8+Tcells. Thus, improving their priming followed by the activation of CD8+Tcells through antigen recognition, which in turn results in the induction of selective killing of the infected cells, therefore, it may accelerate viral clearance in COVID-19. [13] Some studies show that severe deterioration in some patients with COVID-19 has been closely associated with dysregulated and excessive cytokine release termed “cytokine storm”. [14, 15] HCQ was found effective in inhibiting SARS-CoV-2 infection in vitro and can significantly decrease the production of cytokines and especially the pro-inflammatory cytokines. [16]
On the other hand, Azithromycin is a macrolide group of antibiotic drugs used in the treatment of several bacterial infections, including pneumonia. It is known to reversibly bind to the 50S ribosomal subunit of the 70S ribosome to inhibit the translocation step of protein synthesis, but whether it has an antiviral effect or not is not yet known. It has been studied as part of the possible treatment of COVID-19 in combination with HCQ and reported added benefit. [17, 18] However, a recent report failed to establish whether it has any antiviral activity or any synergistic activity with HCQ in the treatment of COVID-19. [19] Therefore, a further comparative study can enhance the significance of the combination therapy of HCQ and Azithromycin.
Ivermectin is a relatively safe and well-tolerated anti-parasitic drug for head lice, scabies, onchocerciasis, and strongyloidiasis that acts by inhibiting nuclear transport activity. [20] Invitro studies have shown its function against human immunodeficiency virus (HIV), dengue, influenza, and most recently, against SARS-CoV-2. This effectiveness against SARS-CoV-2 infection is due to its critical interaction of RNA viruses responsible for integrase protein nuclear import. [21, 22] A recent report suggests that Ivermectin reduces mortality rates in hospitalized patients with COVID-19. [23] However, the antiviral levels are might not attainable or ideal with known dosing regimens in the case of Ivermectin therapy in patients with COVID-19. [24, 25] Thus, it is vital to investigate the dose regimens of Ivermectin for the COVID-19 treatment or appropriate synergism using combination therapy with another drug. Doxycycline, on the other hand, is a tetracycline class of antibiotics that acts via the inhibition of bacterial ribosomes. It is a well-tolerated bacteriostatic drug that has a long history of clinical use. [26] The efficacy and tolerability of Ivermectin and Doxycycline were established in combination with an earlier study for the treatment of onchocerciasis. [27] Besides, few recent studies suggested a therapeutic role of Doxycycline against COVID-19. [28, 29]
In this comparative observational study, we used two different combinations of drugs Ivermectin-Doxycycline (Group-A) and Hydroxychloroquine-Azithromycin (Group-B) for the therapy of patients with COVID-19 in Bangladesh. The presenting symptoms of the COVID19 patients were fever, cough, sore throat, weakness, chest discomfort, breathing difficulty, diarrhoea, myalgia, and abdominal pain. To avoid the influence in the recovery duration we solely selected the cases devoid of any severe comorbidity and mild to moderate disease that fits in OPD treatment protocol only. HCQ dosing was decided as per “National guideline for COVID19 management 4.0”. In our observation, the difference in recovery duration was not significant (P=0.231) among the two groups, but the mean duration of recovery is shorter 8.933days in the case of Ivermectin-Doxycycline (Group A) than that of Hydroxychloroquine-Azithromycin (Group B) 9.33 days. [Figure 1 C] Although the minimum recovery duration is less, 5days in the case of HCQ group, and 8 days in the case of the Ivermectin group. Besides, we have also noticed that the Ivermectin group has better patient compliance and less adverse effect as compared to the HCQ group 31.67% and 46.42% respectively. [Figure 1 D & E] Also Ivermectin has a better outcome ratio of 100% (60/60) than that of HCQ 96.36% (54/56). The adverse effects of HCQ group in our study are similar to others. [30] The adverse effect of Group-A were lethargy, nausea, and occasional vertigo. But in the case of Group-B 39.2% of patients complained of lethargy-dizziness; this is 23.3% in the case of the Ivermectin group. Mild degree blurring of vision and occasional palpitation were noted by 23.21% and 17.85% patients in the HCQ group. In case of Group-A both male and female have the almost same duration of recovery (8.9 and 9 days) but in Group-B (9.45 and 8.78 days) and average male patients has a longer duration of recovery than the females (9.18 days and 8.92 days). [Figure 1 F]
According to this study both the Ivermectin-Doxycycline and HCQ-Azithromycin treatment regimens were found to be effective against SARS-CoV-2 infection. But concerning the treatment outcome, adverse effect, and safety Ivermectin-Doxycycline combination is superior to HCQ-Azithromycin therapy for mild to moderate degree of COVID19 patients in Bangladesh. We strongly believe by rescheduling and increasing the duration of Ivermectin to 3days will certainly decrease the recovery period further than that of our study. This will also prevent disease progression and morbidity to COVID19 patients.
Studies have suggested different drug combination therapies for the treatment of patients with COVID-19. In the context of Bangladesh, Ivermectin-Doxycyclin and HydroxychloroquineAzithromycin both combination therapies were found useful in treating COVID-19 patients. Although Ivermectin based therapy has a relatively short recovery duration and better patient compliance. Also considering the adverse effect experienced by the Hydroxychloroquine group and the recovery rate according to this study, Ivermectin is a better choice for the treatment of mild to moderate degree of COVID19 patients. Our study has limitations, namely the small sample size and the dose of Ivermectin is a major concern. Despite this, we tried to select our study group patients without any major comorbidity as far as possible to avoid differences in treatment outcomes among the groups. Further study is required on a larger scale with an increase in the duration of Ivermectin treatment.
[-] TrumpLyftAlles | 1 points
So confusing. This is the same study, reported here as a study done in China.
[-] Sokrjrk12 | 2 points | Jun 21 2020 14:53:10
My take on this: this is a good start! This study design is still not as strong as a randomized controlled trial (I am surprised they had no placebo group here although given intent-to-treat I could understand why they elected not to do so).
Also not a huge fan of how they selected patients- notice how they didn't include those with significant comorbidities. Would have been really valuable to see this in more people with a broader range of variables to compare.
Bottom line: this is certainly the outcome we wanted to see, and is probably as good as a result as we could get given this study's design. I am excited for the results of subsequent studies! The efficacy of HCQ is still a hot point of discussion/debate, so I would love to see ivermectin be compared to different treatment regimens as well!
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