Ivermectin was found to decrease the duration of viral shedding in patients with mild to moderate COVID-19 infection, suggesting its value as an anti-SARS-CoV-2 agent and potential to decrease COVID-19 transmission. These study findings were published in the International Journal of Infectious Diseases.
In this randomized, placebo-controlled, double-blinded trial, researchers enrolled adult patients with mild to moderate COVID-19 infection at hotels designated as isolation facilities in Israel between May 2020 and January 2021. Patients (N=95) were randomly assigned in a 1:1 fashion to receive daily treatment with either weight-based ivermectin (n=50) or placebo (n=45) for 3 days. Patients were contacted by telephone daily and asked about treatment adherence and symptoms. The primary endpoint was viral clearance at day 6, defined as a cycle threshold (Ct) value of less than 30 assessed via reverse transcription polymerase chain reaction testing.
Among patients in the ivermectin and placebo groups, 77.6% and 80.0% were men, the median age was 35 (IQR, 29-46) and 37 (IQR, 27-51) years, 78.0% and 84.4% were symptomatic, 16% and 11.1% were at increased risk for severe disease, and the median time between symptom onset and treatment initiation was 4 (IQR, 3-5) and 4 (IQR, 3-5) days, respectively.
At baseline, the mean Ct value was 24.2 and 22.4 among patients in the ivermectin and placebo groups included in the per protocol analysis (n=89), respectively. With the exception of significantly different mean Ct values between patients in the ivermectin vs placebo groups at days 2 (28.8 vs 23.9; P =.02) and 14 (37.6 vs 33.1; P =.02), no other significant group differences in mean Ct values were noted between baseline and day 14.
Although more patients who received ivermectin tested negative for SARS-CoV-2 infection at days 4 through 10 compared with those who received placebo, this increase was significant only at days 6 (odds ratio [OR], 2.62; 95% CI, 1.09-6.31; P =.03) and 8 (OR, 3.32; 95% CI, 1.25-8.82; P =.01).
Similar results were noted in the multivariable logistic regression analysis. At day 8 only, a significantly increased odds of testing negative for SARS-CoV-2 infection was observed among patients in the ivermectin vs placebo groups (adjusted OR, 3.70; 95%, 1.19-11.49; P =.02).
This study was limited by its small sample size and its predominantly male population. In addition, treatment adherence among patients who received ivermectin was not confirmed by the researchers.
According to the researchers, “[this] study supports the notion that ivermectin has anti-SARS-CoV-2 activity.” They concluded, “if used at the early stage of disease onset, it may shorten the isolation time and reduce [COVID-19] transmission.”
Biber A Harmelin G, Lev D, et al. The effect of ivermectin on the viral load and culture viability in early treatment of nonhospitalized patients with mild COVID-19 – a double-blind, randomized placebo-controlled trial. Int J Infect Dis. 2022;122:733-740. doi:10.1016/j.ijid.2022.07.003