Ivermectin not “miracle drug” against COVID-19 infection
CLAIM:
Ivermectin is an effective and powerful treatment for COVID-19.
CONCLUSION:
This is unproven. Experts say current evidence does not support the use of ivermectin as a treatment for COVID-19. They warn against off-label consumption of the drug to treat the coronavirus, which may lead to poisoning and death.
FULL REPORT
The surge of COVID-19 infections and deaths in Malaysia has prompted calls for the use of ivermectin as a treatment. Ivermectin is a drug used to treat parasite infections in humans and animals.
Based on its usage and limited clinical trials elsewhere, proponents of ivermectin say it could be a “miracle drug” for COVID-19.
Since June, a coalition of medical and consumer groups, calling itself the Malaysian Alliance for Effective Covid Control (MAECC), has joined the calls for health authorities to allow the use of ivermectin to treat the coronavirus.
The group claims the drug has “powerful benefits”.
To clarify the claims of ivermectin’s efficacy against COVID-19, Faqcheck Lab spoke to the following medical experts:
- Dr Steven Lim Chee Loon, an infectious disease expert leading a study by Malaysia’s Ministry of Health to assess the use of ivermectin in treating COVID-19
- Dr Suhazeli Abdullah, a family physician with the Ministry of Health
A miracle drug?
Health authorities are concerned over the groundswell of sentiments desiring a quick fix.
On 28 July 2021, the MAECC published an open letter pushing for the emergency use of ivermectin as a COVID-19 treatment in Malaysia. The letter included a list of what the group described as “scientific facts” supporting its use. This came after politicians argued over it in parliament the day before.
But Dr Lim and Dr Suhazeli urged caution.
“Professional clinicians and researchers who practice evidence-based medicine would never describe a drug as a ‘miracle’,” Dr Lim said. “Simply because no drug is 100% effective or safe.”
While early anecdotal reports on clinical trials elsewhere indicated positive results, he stressed the need for conclusive clinical evidence.
Dr Suhazeli added that research supporting ivermectin’s use for Covid treatment lacks credibility.
On 15 July 2021, The Guardian reported that one of the largest studies in support of ivermectin was pulled from publication “due to ethical concerns” of plagiarism and falsified evidence.
On 28 July 2021, the Cochrane Review conducted a study of 101 ivermectin medical trials. Its key takeaway was:
“We found no evidence to support the use of ivermectin for treating or preventing COVID‐19 infection, but the evidence base is limited.
Evaluation of ivermectin is continuing in 31 ongoing studies, and we will update this review with their results when they become available.”
Dr Suhazeli highlighted three other important conclusions from the Cochrane Review:
- The ivermectin studies have a very low- to low-certainty evidence
- Researchers could not determine the effectiveness and safety of ivermectin use against COVID-19 from the review
- The sample sizes used in the ivermectin trials were too small, and only a handful of studies were of notable quality
Safety concerns: of deaths and doses
Supporters of ivermectin say these clinical trials are unnecessary, in light of the drug’s 40-year history and safety record.
“Ivermectin has indeed been used by billions of people globally for more than 40 years with a good safety profile,” Dr Lim said, “But we need to understand that ivermectin's fantastic track record was specifically in the treatment of parasitic infections.”
He added that using the drug to treat COVID-19 is a “totally different ball game”.
“To illustrate my point, just because Datuk Lee Chong Wei was a world champion in badminton for the past 10 years, we cannot assume he would excel in football and send him into a competitive football match right away. He still needs to undergo the same vigorous training regime as others and be judged based on his on-field performance in football!”
Ivermectin’s recent “off-label” use - a term to describe the unapproved use of an approved drug - has led to deaths in Malaysia. Dr Suhazeli called out those promoting ivermectin for “making up their own protocols”.
“For now, the drug is only authorised for animal use (in Malaysia), but our people are modifying it and using it for human use… and you can easily get it anywhere online,” warned Dr Suhazeli.
The Malaysian Pharmacists Society have found widespread sale of illegal ivermectin pills through unauthorised channels. They warned that self-dosing could lead to poisoning. [FMT, NST, Malaysiakini]
On 14 August 2021, Malaysia’s National Poison Centre confirmed two cases of ivermectin poisoning due to improper self-medication.
“We really need to be careful with this notion that ivermectin is safe in COVID-19 treatment just because it was safe in the past for parasitic infection,” Dr Lim cautioned, “Higher dose and longer exposure to a drug will naturally increase the risk of adverse effects.”
The Food and Drug Administration has warned that the unprescribed use of ivermectin could cause, among other things, “neurological adverse events… sudden drop in blood pressure, severe skin rash potentially requiring hospitalisation and liver injury.”
Ivermectin is also not recommended for patients with a history of:
- Liver or kidney diseases
- Cancer, HIV or AIDs, or conditions that can weaken immune systems
- Pregnant or those planning to become pregnant
International Ivermectin Intrigue
In their open letter, the MAECC claimed ivermectin treatment resulted in the decline of COVID-19 cases in India, among other countries.
“The most glaring example is India when in April 2020 the country had the highest daily infection record in the world with 360,960 cases. Within a month after Ivermectin was mass distributed in the most affected states and cities, the infection rate was swiftly brought below seven thousand cases a day.”
But fact checking portal Health Feedback said there was no available data to link the drop in COVID-19 cases in India and the use of ivermectin. It reported:
India experienced a decrease in the number of COVID-19 cases in May 2021. However, no data is available to support the claim that this is causally associated with the recommendation to use ivermectin. The reduced spread of the disease began before India released official recommendations to use that drug.
In fact, the India government dropped ivermectin from its COVID-19 treatment list altogether in its revised guidelines the following month.
As for the countries MAECC claimed to have benefited from using ivermectin, Malaysian fact checking portal Tech ARP responded with graphs showing that the situation in these countries did not actually improve over time.
Dr Suhazeli noted that other countries such as Australia, Singapore, and Japan have looked at the data and decided not to use ivermectin to treat COVID-19 infections.
He said those who insist otherwise are misleading the public as they have “no concrete or conclusive evidence”.
Responding to anecdotal evidence that ivermectin is effective, Dr Lim said: “Generally, COVID-19 is a self-limiting disease. Majority of COVID-19 patients, especially those young and healthy, or low risk patients will recover without any drug therapy after a certain period of time.”
He added that the real concern is for high-risk patients with medical illnesses and co-morbidities who are more likely to deteriorate from COVID-19 complications.
Dr Lim stressed: “Medicine is not testimony-based, but rather evidence-based. It is irresponsible and frankly dangerous to let personal opinions or testimony influence our treatment decision.”
Moving Forward
The allure of a silver bullet to end the pandemic is tempting, more so when daily COVID-19 cases and deaths surge, adding to the mental strain of multiple lockdowns.
But currently available evidence does not support ivermectin as an effective treatment against COVID-19. In fact, unregulated and off-label consumption of the drug is causing real dangers to the public.
“I won’t say ivermectin is a miracle drug. ‘A potential drug for Covid-19’ would be a more appropriate and responsible phrase to use in my opinion,” Dr Lim said, adding that this would be entirely dependent on reliable clinical trials.
To leave no stone unturned, the Ministry of Health is currently undertaking controlled trials to determine the efficacy of the drug. This includes tests on the dosage and risks involved. Dr Lim and Dr Suhazeli advise Malaysians to await the results of these trials in September.
Understanding the science - why do we caution against using ivermectin to treat COVID-19 when it is safe for treating parasite infection?
“If we read the original product insert of ivermectin, we will find that (a) patient is instructed to take ivermectin with (an) empty stomach. The reason is because fatty food increases the absorption of ivermectin in the gut. For treatment of parasitic infection which is often localised, we do not want ivermectin to get absorbed. As much as possible, we want ivermectin to stay in the bowels where the parasites are. I think that is one of the reasons why at its usual low dose in short duration, and by not being highly absorbed into the bloodstream, ivermectin is relatively safe and rarely causes systemic side effects like organ impairment during treatment of parasitic infection.
Conversely, for (the) treatment of COVID-19, we need ivermectin to get absorbed in the gut to achieve high levels of concentration in the blood and then be transported to the COVID-19 infected lungs. Clinicians who treat COVID-19 patients with ivermectin would usually advise patients to take ivermectin with food or after meals. Therefore, higher doses and higher drug concentration in blood may increase the risk of adverse effects such as liver impairment. This needs to be monitored and reported if occurred.
Again, we really need to be careful with this notion that ivermectin is safe in Covid-19 treatment just because it was safe in the past for parasitic infection.”
- Dr Steven Lim, infectious disease expert
FAQCHECK TEAMS:
University of Nottingham Malaysia: Nur Ain Nabila, Muhammad Farhan Shahmi Abdullah, Joshua Ng, Noor Alia Abrar Bestari Abrar, Tan Zhi Ying & Gayathry Venkiteswaran
Xiamen University Malaysia: Siew Tong En, Liu Zihan, Sean Elijah Tan & Dr Jeyasushma A/P Veeriah
Universiti Kebangsaan Malaysia: Nurul Ain, Seri Haidah, Nur Raihan, Yazlin Yahaya, & Dr Sabariah Mohamed Salleh
University of Malaya: Adlin Norafiqah Mohamed, Amin Idham Razalee, Lee Kai Ci, Aq'sa Sumayya Nor Hazalan, Nur Syahmina Aza Azhar & Dr Rosya Izyanie
SPECIAL THANKS:
Dr Steven Lim Chee Loon (National Specialist Registry), Dr Suhazeli Abdullah (Suhazeli.com), and Zurairi A.R (Malay Mail)
