TrumpLyftAlles | 15 points
ICON (Ivermectin in COvid Nineteen) Study: Use of Ivermectin Is Associated with Lower Mortality in Hospitalized Patients with COVID-19 (2020-08-21) Trial results in LancetPatients in the ivermectin group received at least one oral dose of ivermectin at 200 micrograms/kilogram in addition to usual clinical care. A second dose could be given at the discretion of the treating physician at day 7 of treatment.
[-] TrumpLyftAlles | 1 points
Lancet! At last, some visibility for ivermectin!
Lede: Fatalities among patients sick enough to require 02 supplementation were 52% lower with ivermectin.
The lead investigators are working on another trial, presumably one with random assignment of patients to the treatment and control arms, instead of this study's "Treatment decisions were at the discretion of the treating physicians."
Background: No therapy to date has been shown to improve survival for patients infected with SARS-CoV-2. Ivermectin has been shown to inhibit replication of SARS-CoV-2 in-vitro, which has led to off-label use, but clinical in-vivo efficacy has not been previously described.
This is a retrospective cohort study of consecutive patients hospitalized at four Broward Health hospitals in South Florida with confirmed SARS-CoV-2 between March 15, 2020 through May 11, 2020. 280 patients with confirmed SARS-CoV-2 infection, of whom 173 were treated with ivermectin and 107 with usual care, were reviewed. Treatment decisions were at the discretion of the treating physicians. Severe pulmonary involvement at baseline was defined as need for either FiO2 ≥50%, noninvasive ventilation, or invasive mechanical ventilation. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included subgroup mortality in patients with severe pulmonary involvement, extubation rates for patients requiring invasive ventilation, and length of hospital stay. Logistic regression and propensity score matching were used to adjust for confounders.
Univariate analysis showed lower mortality in the ivermectin group (15·0% versus 25·2%, OR 0·52, CI 0·29-0·96, P=0·03). Mortality was also lower among patients with severe pulmonary involvement treated with ivermectin (38·8% vs 80·7%, OR 0·15, CI 0·05-0·47, p=0·001), but there were no significant differences in successful extubation rates (36·1% vs 15·4%, OR 3·11 (0·88-11·00), p=0·07) or length of stay. After multivariate adjustment for confounders and mortality risks, the mortality difference remained significant (OR 0·27, CI 0·09-0·85, p=0·03). 194 patients were included in the propensity-matched cohort; mortality was again significantly lower in the ivermectin group (12.4% vs 25.8%, OR 0·41, CI 0·19-0·87, p=0·02).
Ivermectin treatment was associated with lower mortality during treatment of COVID-19, especially in patients who required higher inspired oxygen or ventilatory support. These findings should be further evaluated with randomized controlled trials.
I started reading this sub recently, so, I would like to ask you guys that have been following this more closely for some time.
- Is there any published study for ivermectin on COVID-19 that does not find evidence that it works?
- Should we expect scientists/doctors to publish bad results for a drug if they have done a trial that is not a "gold-standard" RCT ? I kinda of feel like if a group is running a trial on a drug and find that it doesn't help, they would probably say "Well, we don't have the best trial design and we didn't get promising results, so, we should probably end the trial and don't bother to publish it because no one will care". If this sort of behavior is expected, I believe we should take into account a huge survival bias in results coming from small, non-gold standard RCTs.
But, I know nothing about medicine research, so, I would like to hear other people's opinion
[-] movethroughit | 2 points
I dunno. I think we need a pared down process that makes it easier to run trials in times such as these. Might it, for instance, be quicker to look at a big improvement in FiO2 requirements within 48 hours compared to matched patients that didn't get the medication?
Honestly, the lack of coordination in the scientific community and the amount of time needed to get results of CTs really surprised me negatively during this pandemic. I really expected coordinated efforts around the world and lots of collaborations between institutions, but it seems to be the opposite.
[-] movethroughit | 3 points
I think there has also been a heaping helping of confusion thrown into the frey. But we could sure do with some tempering of the automatic "Hear no anecdotal, see no anecdotal, speak no anecdotal." stance. If we don't have anything better that addresses the urgency of the situation, there really needs to be a protocol in place that cuts to the chase.
[-] TrumpLyftAlles | 3 points | Sep 04 2020 19:44:00
This study was posted to the sub 2 months ago. I had heard that they had trouble getting the paper accepted. Getting Lancet to take is a huge coup. I think that makes it re-post worthy.
I'll take a look at it later to see if any relevant details have changed (probably not).
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[-] movethroughit | 2 points | Sep 04 2020 22:50:18
"Lede: Fatalities among patients sick enough to require 02 supplementation were 52% lower with ivermectin."
I think that was patients with severe pulmonary disease:
"Severe pulmonary involvement at baseline was defined as need for either FiO2 ≥50%, noninvasive ventilation, or invasive mechanical ventilation."
So you could have someone walk in with SPo2 in the low 80's getting treatment with Ivermectin and getting oxygen via a nasal cannula, but not requiring 50% FiO2.
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[-] TrumpLyftAlles | 2 points | Sep 05 2020 00:12:43
Do you want to post your correction to the article's post on /r/covid19?
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[-] movethroughit | 1 points | Sep 05 2020 06:04:20
Done.
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[-] TrumpLyftAlles | 1 points | Sep 05 2020 00:07:28
I stand semi-corrected. ;)
No, you're right, thanks.
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[-] movethroughit | 2 points | Sep 05 2020 04:42:53
Double check it, it appears to be preprint still, just preprint at Lancet instead.
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[-] TrumpLyftAlles | 2 points | Sep 05 2020 04:45:11
Someone on /r/covid19 pointed that out too.
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