In hospitalised patients with COVID-19, Ivermectin was associated with lower mortality compared to treatment without the antiparasitic drug, a US hospital study has found.
Researchers at Broward Health Medical Centre, Fort Lauderdale, reviewed charts of 280 consecutive patients who were hospitalised at 4 hospitals in Florida with confirmed COVID-19 between March 15 and May 11, 2020. A total of 173 patients in this cohort were treated with ivermectin vs 107 who were not treated with ivermectin. Dosing of ivermectin was per treating physician’s discretion. The majority of patients in both groups received hydroxychloroquine (92.9%) and azithromycin (86.7%).
The primary outcome of the study was all-cause in-hospital mortality. Secondary outcomes included mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, and hospital length of stay (LOS). The investigators defined severe pulmonary involvement as the need for 50% or more of fraction of inspired oxygen (FiO2), high-flow nasal oxygen, non-invasive ventilation, or intubation and mechanical ventilation at study entry.
In the multivariable-adjusted analysis, mortality was significantly lower in patients treated with ivermectin compared with those not treated with the drug (odds ratio [OR], 0.27; 95% CI, 0.09-0.80; P =.03). Of the 196 patients in the propensity-matched cohort, mortality remained significantly lower in patients treated with ivermectin (13.3% vs 24.5%; OR, 0.47; 95% CI, 0.22-0.99; P =.045).
Mortality rates were significantly lower in a subgroup of patients with pulmonary involvement who were treated with ivermectin compared with similar patients not treated with the drug (38.8% vs 80.7%, respectively; OR, 0.15; 95% CI, 0.05-0.47; P =.001). No differences were found in the unmatched and matched cohorts with regard to the median hospital LOS and extubation rates.
A limitation of this study included its retrospective design. Additionally, the inclusion of a large proportion of patients who were also receiving concomitant medications, such as hydroxychloroquine and azithromycin, may have limited the ability to determine whether ivermectin itself was responsible for the observed mortality benefits.
The investigators concluded that “further studies in appropriately designed randomised trials are recommended before any conclusions can be made,” including appropriate dosing for hospitalized patients with COVID-19.
Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019: The ICON Study
Juliana Cepelowicz Rajter, Michael S Sherman, NaazFatteh, FabioVogel, Jamie Sacks, Jean-JacquesRajter
Published in Chest on 9 October 2020
Ivermectin was shown to inhibit severe acute respiratory syndrome coronavirus 2 replication in vitro, which has led to off-label use, but clinical efficacy has not been described previously.
Does ivermectin benefit hospitalized coronavirus disease 2019 (COVID-19) patients?
Study Design and Methods
Charts of consecutive patients hospitalized at four Broward Health hospitals in Florida with confirmed COVID-19 between March 15 and May 11, 2020, treated with or without ivermectin were reviewed. Hospital ivermectin dosing guidelines were provided, but treatment decisions were at the treating physician’s discretion. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, and length of stay. Severe pulmonary involvement was defined as need for FIO2 ≥ 50%, noninvasive ventilation, or invasive ventilation at study entry. Logistic regression and propensity score matching were used to adjust for confounders.
Two hundred eighty patients, 173 treated with ivermectin and 107 without ivermectin, were reviewed. Most patients in both groups also received hydroxychloroquine, azithromycin, or both. Univariate analysis showed lower mortality in the ivermectin group (15.0% vs 25.2%; OR, 0.52; 95% CI, 0.29-0.96; P = .03). Mortality also was lower among ivermectin-treated patients with severe pulmonary involvement (38.8% vs 80.7%; OR, 0.15; 95% CI, 0.05-0.47; P = .001). No significant differences were found in extubation rates (36.1% vs 15.4%; OR, 3.11; 95% CI, 0.88-11.00; P = .07) or length of stay. After multivariate adjustment for confounders and mortality risks, the mortality difference remained significant (OR, 0.27; 95% CI, 0.09-0.80; P = .03). One hundred ninety-six patients were included in the propensity-matched cohort. Mortality was significantly lower in the ivermectin group (13.3% vs 24.5%; OR, 0.47; 95% CI, 0.22-0.99; P < .05), an 11.2% (95% CI, 0.38%-22.1%) absolute risk reduction, with a number needed to treat of 8.9 (95% CI, 4.5-263).
Ivermectin treatment was associated with lower mortality during treatment of COVID-19, especially in patients with severe pulmonary involvement. Randomized controlled trials are needed to confirm these findings.
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