Insufficient data to recommend widespread Ivermectin use in Covid patients: Experts

There isn’t enough data to back the widespread use of Ivermectin in Covid patients and it can be recommended only in some mild to moderate cases, experts say as three states go ahead with plans to distribute the anti-parasitic drug as a preventive despite WHO warning against such measures.

The oral drug, used to treat a number of neglected tropical diseases, should be used for Covid-19 patients only in the absence of better treatment options, several scientists and doctors cautioned.

The debate over Ivermectin, widely prescribed by doctors here, has intensified with Karnataka, Uttarakhand and Goa announcing this week that they would distribute it as a preventive against Covid-19, ravaging large parts of the country in a more virulent second wave.

Also read: States turn to Ivermectin to fight Covid-19 against WHO advice

The World Health Organization and others have warned against such measures.

“Safety and efficacy are important when using any drug for a new indication. @WHO recommends against the use of ivermectin for #Covid19 except within clinical trials,” WHO Chief Scientist Soumya Swaminathan said in a tweet on Tuesday.

The effectiveness of Ivermectin is being investigated in a number of clinical trials across the world due to its potential anti-inflammatory properties and in-vitro (performed in a petri-dish or test-tube) activity against Covid-19 virus, said Monica Gulati, senior dean, Faculty of Applied Medical Sciences, Lovely Professional University (LPU), Punjab.

“However, till date, due to the paucity of large clinical trials, the data available is not sufficient enough to recommend the use of Ivermectin for the treatment of Covid-19 emphatically at this point of time," Gulati told PTI.

Well-designed and large clinical trials, she stressed, are needed to provide evidence-based recommendations on the issue.

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It is a drug for treating worm infections and may be recommended in only some cases in the current scenario but not all, warned Rachit Srivastava, consultant, general medicine, at Apollo TeleHealth in Hyderabad.

“For stating it to be an absolute drug of choice we need more trials. In the current pandemic, the pros are much more than cons in selecting Ivermectin for patients with mild to moderate diseases with symptoms, using it to prevent progression and making a better prognosis,” Srivastava told PTI.

In the absence of other effective medicines, there could possibly be some benefits from Ivermectin.

“Just to give the benefit of doubt to the treating abilities of Ivermectin we should continue the use of the drug for mild to moderate cases,” added Srivastava.

He agreed that the USFDA strongly opposes the use of Ivermectin.

“To summarise, we have to keep using it unless and until we get an absolute treatment for Covid or we have surplus amount of Remdesevir to cover all our patients,” he added.

Arup Kumar Banerjee from Siliguri’s North Bengal Medical College and Hospital agreed that the disease severity in many cases appears to be less with Ivermectin.

“Till now since we have not seen major side effects and also because there is no specific treatment available for Covid-19, Ivermectin is used,” Banerjee told PTI.

As Indian scientists weigh the pros and cons, their international counterparts at agencies like the WHO, European Medical Agency (EMA), and USFDA have raised red flags.

Merck, the German manufacturer of the drug, has also said available data does not support using the drug as a treatment for Covid-19.

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According to Gurpreet Sandhu, president of the Council for Healthcare & Pharma in Delhi, contrary to what WHO says, Ivermectin is still listed as an option for possible treatment for mild to moderate Covid-19 patients.

“Recommended by WHO, only for clinical trials, the widespread use of this drug is raising alarm. Many public health experts too are against the usage of the drug and demand removal of this drug from the Covid-19 protocol list until some substantial research is released,” he told PTI.

“Supporting international warnings, we too, disagree with the widespread use of Ivermectin unless monitored closely,” Sandhu added.

Though the pandemic has forced doctors to adopt the unconventional route of treatment, taking an unapproved or under-trial drug can be very dangerous, he warned.

Sandhu said there are side effects associated with the drug as listed by the USFDA. “…if it is not taken under proper medical supervision, the side effects may include nausea, sudden drop in blood pressure, skin rash, vomiting, diarrhoea, stomach pain, facial or limb swelling, neurologic adverse events and liver injury.”