Retrospective 230 hospitalized patients in Brazil showing no significant difference with ivermectin treatment. Authors note that the treatments were more likely to be offered to sicker patients. Authors note that they do not know if treatment was started before or after ICU admission and intubation.
Baseline total chest CT opacities were higher for ivermectin (20% vs. 15%). 25% of control patients were admitted within 3 days, compared to 5 days for ivermectin. Only 38% of patients in the ivermectin arm were treated within 7 days, compared to 61% for HCQ. These are consistent with ivermectin being used for more severe patients. Dosage is unknown.
49 studies are RCTs, which show efficacy with
p=0.00000038.
This study is excluded in the after exclusion results of meta
analysis:
unadjusted results with no group details; substantial unadjusted
confounding by indication likely.
Study covers
HCQ and ivermectin.
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risk of death, 5.0% higher, RR 1.05, p = 1.00, treatment 3 of 21 (14.3%), control 11 of 81 (13.6%).
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risk of death/intubation, 54.3% higher, RR 1.54, p = 0.37, treatment 6 of 21 (28.6%), control 15 of 81 (18.5%).
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risk of death/intubation/ICU, 62.4% higher, RR 1.62, p = 0.27, treatment 8 of 21 (38.1%), control 19 of 81 (23.5%).
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Ferreira et al., 26 Nov 2021, retrospective, Brazil, peer-reviewed, 5 authors, study period 12 March, 2020 - 8 July, 2020, average treatment delay 7.0 days, dosage not specified.
Outcomes associated with Hydroxychloroquine and Ivermectin in hospitalized patients with COVID-19: a single-center experience
Roberto Muniz Ferreira, Renata Wanderley Beranger, Pedro Paulo Noguères Sampaio, João Mansur Filho, Ricardo Antônio Correia Lima
Revista da Associação Médica Brasileira, doi:10.1590/1806-9282.20210661
OBJECTIVE: Hydroxychloroquine and Ivermectin are advocated as potential treatments for coronavirus disease 2019 (COVID-19) despite the lack of supportive clinical evidence. In this study, outcomes associated with Hydroxychloroquine and/or Ivermectin were determined in a series of patients with confirmed COVID-19 from a single institution in Brazil. METHODS: Consecutive patients admitted between March and July 2020 were retrospectively analyzed and divided into four treatment categories: no treatment (Group 0), Ivermectin only (Group I), Hydroxychloroquine only (Group II), and Hydroxychloroquine and Ivermectin (Group III). Intensive care unit admission, mechanical ventilation, and death were compared between the Groups. RESULTS: A total of 230 patients were included, with the following treatment distribution: 35.2% (0), 9.1% (I), 48.3% (II), and 7.4% (III). Groups I, II, and III had the higher rates of Intensive care unit admission, mechanical ventilation, or death (0: 23.5% versus I: 38.1% versus II: 37.8% versus III: 70.6%, p=0.002), and the greatest mortality was found in Group III (0 versus III: 13.6% versus 35.3%, p=0.03). In the multivariate analysis, Hydroxychloroquine remained significantly associated with death (OR 3.3, 95%CI 1.1-9.6, p=0.03).
CONCLUSION: In a series of consecutive hospitalized patients with COVID-19, Ivermectin was not associated with improved outcomes and Hydroxychloroquine may have resulted in a harmful effect.
AUTHORS' CONTRIBUTIONS RMF
References
Alanagreh, Alzoughool, Atoum, Risk of using hydroxychloroquine as a treatment of COVID-19, Int J Risk Saf Med,
doi:10.3233/JRS-200024Axfors, Schmitt, Janiaud, Van't Hooft, Abd-Elsalam et al., Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials, Nat Commun,
doi:10.1038/s41467-021-22446-zBhimraj, Morgan, Shumaker, Lavergne, Baden et al., IDSA guidelines on the treatment and management of patients with COVID-19
Cardoso, Fernandes, Santos, What happens in Brazil? A pandemic of misinformation that culminates in an endless disease burden, Rev Soc Bras Med Trop,
doi:10.1590/0037-8682-0713-2020Gupta, Sahoo, Singh, Ivermectin: potential candidate for the treatment of Covid 19, Braz J Infect Dis
López-Medina, López, Hurtado, Dávalos, Ramirez et al., Effect of Ivermectin on time to resolution of symptoms among adults with mild COVID-19, JAMA,
doi:10.1001/jama.2021.3071Mccullough, Kelly, Ruocco, Lerma, Tumlin et al., Pathophysiological basis and rationale for early outpatient treatment of SARS-CoV-2 (COVID-19) infection, Am J Med,
doi:10.1016/j.amjmed.2020.07.003Reis, Silva, Silva, Thabane, Singh et al., Effect of early treatment with Hydroxychloroquine or Lopinavir and Ritonavir on risk of hospitalization among patients with COVID-19, JAMA Netw Open,
doi:10.1001/jamanetworkopen.2021.6468Réa-Neto, Bernardelli, Câmara, Reese, Queiroga et al., An open-label randomized controlled trial evaluating the efficacy of chloroquine/hydroxychloroquine in severe COVID-19 patients, Sci Rep,
doi:10.1038/s41598-021-88509-9Virgínia, Infectious diseases society of America
