Ivermectin, a widely available, inexpensive medication used to treat parasitic infections in both humans and animals, was found to have antiviral activity against SARS-CoV-2, prompting study by investigators. The results have been conflicting, leading the National Institutes of Health Covid-19 Treatment Guidelines group not to advise for or against routine use and recommending only further study. Ivermectin, however, is increasingly being tried both in the United States and internationally, with reports of widespread use. On Wednesday, the South African Medicines Control Council approved it for compassionate use.
Which parts of the results have been "conflicting" ?
They could be unconvincing, but not conflicting - this suggests he had only read the NIH press release (which uses that language, but is untenable if you examine the studies they cite for such).
There have been a few failed trials, typically underpowered trials that failed to show statistically significant results. With perhaps 1 or 2 exceptions, ALL of those trials showed effects in the right direction. Ivermectin helped the patients in the trial. The size of the effect wasn't big enough, though, to produce p < .05, because there were so few subjects. In concert with the many studies that did find statsig results, even those "failed" trials support the hypothesis that ivermectin works. IMO.
Stereo, this article might have attracted more attention if you put "Washington Post!" after the (date). Thanks for posting it!
I didn't recall those inconclusive trials to be able to argue those :-)
In my view the most convincing real world trial was the Zagazig Univ Egypt study which gives actionable advice about what the public can do - ie how to limit spread from an index case etc.
And it shows ivermectin performing where it performs best - at 8x levels. Which is where it will have the biggest demographic impact.
It's use in ICU etc is interesting but much more modest - though still useful.
which gives actionable advice about what the public can do
Excellent point! The Argentina trial has a couple defects: (1) it's too good to be true and (2) it used carrageenan.
Re point (1): Tess Lawrie excluded the Argentina trial from her meta-analysis because it seemed too good to be true. In an email she pointed out that given the fact that PCR tests do occasionally yield false positives, the 100% success in that trial looks suspicious. Did Dr Carvallo and team do a second PCR, if someone got a positive test in the treatment group? The paper is pretty vague about the testing they did in the BIG trial, and certainly doesn't mention anything about false positives.
Also Zagazig Univ Egypt is a simple trial - and it measures a macro ie large scale effect (how many progress to symptoms/disease) - this makes its numbers bigger ie are large numbers.
Compare this to when are measuring mortality - since only few percent ever die you need many participants to get double digit deaths.
This is true even more for vaccine trial where you need too many more participants to get enough who randomly get infected, and from those even fewer go to hospital, and fewer die.
So a trial looking for very first stage effects - how many develop symptoms etc will be statistically strong even with fewer total participants.
And even from common sense just looking at the Zagazig Univ Egypt numbers you can see that even if there is some random variation in arm selection of participants, the effects wouldn't be 8x - so there is something there.
So this is the first study I usually mention when talking about ivermectin, because it is such a strong result. And it is believable from the cases I have seen.
As I mentioned I have followed about 40+ people - many from pre-symptomatic to recovery (esp the contacts of index cases) - and the behavior is very different from others I talk to - unlike the talk of asymptomatics bring 80pct and so on which is only a demographic statistic ie is an artifact of how the disease spreads and the impediments to it, generally in families it ravages through the household, perhaps sparing 20pct (this is for household who do not do quick social distancing) - the 80pct who do get symptoms usually are much more severe than the ones I am seeing with ivermectin, Famotidine. And when followed up with steroids at day 8 it is a very mild experience.
This leads me to think that the effects of Ivermectin plus Famotidine are quite significant, and the Zagazig Univ Egypt study is within the ballpark of believability.
[-] stereomatch | 2 points | Jan 29 2021 07:07:09
Ivermectin, a widely available, inexpensive medication used to treat parasitic infections in both humans and animals, was found to have antiviral activity against SARS-CoV-2, prompting study by investigators. The results have been conflicting, leading the National Institutes of Health Covid-19 Treatment Guidelines group not to advise for or against routine use and recommending only further study. Ivermectin, however, is increasingly being tried both in the United States and internationally, with reports of widespread use. On Wednesday, the South African Medicines Control Council approved it for compassionate use.
Which parts of the results have been "conflicting" ?
They could be unconvincing, but not conflicting - this suggests he had only read the NIH press release (which uses that language, but is untenable if you examine the studies they cite for such).
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[-] TrumpLyftAlles | 2 points | Feb 02 2021 05:09:21
There have been a few failed trials, typically underpowered trials that failed to show statistically significant results. With perhaps 1 or 2 exceptions, ALL of those trials showed effects in the right direction. Ivermectin helped the patients in the trial. The size of the effect wasn't big enough, though, to produce p < .05, because there were so few subjects. In concert with the many studies that did find statsig results, even those "failed" trials support the hypothesis that ivermectin works. IMO.
Stereo, this article might have attracted more attention if you put "Washington Post!" after the (date). Thanks for posting it!
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[-] stereomatch | 2 points | Feb 02 2021 05:20:01
Good point about the title.
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[-] TrumpLyftAlles | 1 points | Feb 02 2021 05:23:21
So you don't like my other points? Wanna ARGUE with me? !Kidding!!<
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[-] stereomatch | 2 points | Feb 02 2021 05:29:32
I didn't recall those inconclusive trials to be able to argue those :-)
In my view the most convincing real world trial was the Zagazig Univ Egypt study which gives actionable advice about what the public can do - ie how to limit spread from an index case etc.
And it shows ivermectin performing where it performs best - at 8x levels. Which is where it will have the biggest demographic impact.
It's use in ICU etc is interesting but much more modest - though still useful.
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[-] TrumpLyftAlles | 2 points | Feb 02 2021 06:04:46
which gives actionable advice about what the public can do
Excellent point! The Argentina trial has a couple defects: (1) it's too good to be true and (2) it used carrageenan.
Re point (1): Tess Lawrie excluded the Argentina trial from her meta-analysis because it seemed too good to be true. In an email she pointed out that given the fact that PCR tests do occasionally yield false positives, the 100% success in that trial looks suspicious. Did Dr Carvallo and team do a second PCR, if someone got a positive test in the treatment group? The paper is pretty vague about the testing they did in the BIG trial, and certainly doesn't mention anything about false positives.
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[-] stereomatch | 1 points | Feb 02 2021 07:12:48
Also Zagazig Univ Egypt is a simple trial - and it measures a macro ie large scale effect (how many progress to symptoms/disease) - this makes its numbers bigger ie are large numbers.
Compare this to when are measuring mortality - since only few percent ever die you need many participants to get double digit deaths.
This is true even more for vaccine trial where you need too many more participants to get enough who randomly get infected, and from those even fewer go to hospital, and fewer die.
So a trial looking for very first stage effects - how many develop symptoms etc will be statistically strong even with fewer total participants.
And even from common sense just looking at the Zagazig Univ Egypt numbers you can see that even if there is some random variation in arm selection of participants, the effects wouldn't be 8x - so there is something there.
So this is the first study I usually mention when talking about ivermectin, because it is such a strong result. And it is believable from the cases I have seen.
As I mentioned I have followed about 40+ people - many from pre-symptomatic to recovery (esp the contacts of index cases) - and the behavior is very different from others I talk to - unlike the talk of asymptomatics bring 80pct and so on which is only a demographic statistic ie is an artifact of how the disease spreads and the impediments to it, generally in families it ravages through the household, perhaps sparing 20pct (this is for household who do not do quick social distancing) - the 80pct who do get symptoms usually are much more severe than the ones I am seeing with ivermectin, Famotidine. And when followed up with steroids at day 8 it is a very mild experience.
This leads me to think that the effects of Ivermectin plus Famotidine are quite significant, and the Zagazig Univ Egypt study is within the ballpark of believability.
permalink