IVERMECTIN PROPHYLAXIS EVIDENCE LAST UPDATED DECEMBER 18 2020

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This entire document is a quotation. None of this work is mine. Below is a presentation of Dr. Kory and FCCC’s Ivermectin Prophylaxis Evidence document. View their document here: Ivermectin Prophylaxis Dec 8 2020

SECTION 1: IVERMECTIN PROPHYLACTIC INFECTIONS VERSUS CONTROL GROUP INVECTION PERCENTAGES META ANALYSIS

Behera, P., Patro, B.K., Singh, A.K., Chandanshive, P.D., Ravikumar, S., Pradhan, S.K., Pentapati, S.S.K., Batmanabane, G., Padhy, B.M., and Bal, S. (2020). Role of ivermectin in the prevention of COVID-19 infection among healthcare workers in India: A matched case-control study. medRxiv.
Treated with IvermectinNot Treated with Ivermectin
Healthcare Workers91281
Subset Contracted COVID15171
Percentage Contracted COVID17%61%
Carvallo, H.E., Roberto, H., Psaltis, A., and Veronica, C. (2020b). Study of the Efficacy and Safety of Topical Ivermectin+ Iota-Carrageenan in the Prophylaxis against COVID-19 in Health Personnel. Journal of Biomedical Research and Clinical Investigation 2, 1
Treated with IvermectinNot Treated with Ivermectin
Health Personnel788407
Subset Contracted COVID0237
Percentage Contracted COVID0%58%
Alam, M., R, M., Pf, G., Md, M.Z., S, S., and Ma, C. (2020). Ivermectin as Pre-exposure Prophylaxis for COVID 19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka An Observational Study. European Journal of Medical and Health Sciences
Treated with IvermectinNot Treated with Ivermectin
Healthcare Providers5860
Subset Contracted COVID444
Percentage Contracted COVID7%73%
Elgazzar, A., Hany, B., Youssef, S.A., Hafez, M., and Moussa, H. (2020). Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic. Research Square. DOI:10.21203/rs.3.rs100956/v1
Treated with IvermectinNot Treated with Ivermectin
Healthcare Workers & Household Members100100
Subset Contracted COVID210
Percentage Contracted COVID2%10%
Shouman, W. (2020). Use of Ivermectin as a Prophylactic Option in Asymptomatic Family Close Contact for Patient with COVID-19. Clincal Trials.gov
Treated with IvermectinNot Treated with Ivermectin
Infected and Family Members203101
Subset Contracted COVID1559
Percentage Contracted COVID7%58%
Carvallo, H.E., Hirsch, R.R., and Farinella, M.E. (2020a). Safety and Efficacy of the combined use of ivermectin, dexamethasone, enoxaparin and aspirin against COVID-19. medRxiv. doi: https://doi.org/10.1101/2020.09.10.20191619
Treated with IvermectinNot Treated with Ivermectin
Patients in Argentina13198
Subset Contracted COVID011
Percentage Contracted COVID0%11%

SECTION 2: IVERMECTION AS PROPHYLACTIC STUDY OUTCOMES

Elgazzar, A., Hany, B., Youssef, S.A., Hafez, M., and Moussa, H. (2020). Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic. Research Square. DOI:10.21203/rs.3.rs100956/v1
NVariableContracted COVID
Treated with Ivermectin100 0.4mg/kg Ivermection on day 1 and 7, and wore PPE2
Not Treated with ivermectin100 wore PPE10
DISCUSSIONElgazzar and colleagues at Benha University in Egypt randomized 200 health care and households contacts of COVID-19 patients where the intervention group consisted of 100 patients given a high dose of 0.4mg/kg on day 1 and a second dose on day 7 in addition to wearing personal protective equipment (PPE), while the control group of 100 contacts wore PPE only (Elgazzar et al., 2020). They reported a large and statistically significant reduction in contacts testing positive by RTPCR when treated with ivermectin vs. controls, 2% vs 10%, p<.05.
Shouman, W. (2020). Use of Ivermectin as a Prophylactic Option in Asymptomatic Family Close Contact for Patient with COVID-19. Clincal Trials.gov
NVariableContracted COVID
Two weeks later, members of all tested households with COVID symptoms
Treated with Ivermectin228 with family member(s) infected0.25 mg/kg Ivermection 2x in Day 1 and 1x in Day 3.7.4%
Not Treated with ivermectin112 with family member(s) infectednot treated58.4%
DISCUSSIONShouman conducted an RCT at Zagazig University in Egypt, including 340 (228 treated, 112 control) family members of patients positive for SARS-CoV-2 via PCR (Shouman, 2020). Ivermectin, (approximately 0.25mg/kg) was administered twice, on the day of the positive test and 72 hours later. After a two-week follow up, a large and statistically significant decrease in COVID-19 symptoms among household members treated with ivermectin was found, 7.4% vs. 58.4%, p<.001.
Carvallo, H.E., Roberto, H., Psaltis, A., and Veronica, C. (2020b). Study of the Efficacy and Safety of Topical Ivermectin+ Iota-Carrageenan in the Prophylaxis against COVID-19 in Health Personnel. Journal of Biomedical Research and Clinical Investigation 2, 1
NVariableContracted COVID
At 28 days
Treated with Ivermectin131 healthy0.2mg Ivermectin drops 5x/day0%
Not Treated with ivermectin98 healthynot treated11.2%
DISCUSSIONSimilarly, in another RCT conducted by Carvallo et al. in Argentina involving 229 healthy citizens, 131 were randomized to treatment with 0.2mg of ivermectin drops taken by mouth five times per day (Carvallo et al., 2020b). After 28 days, none of those receiving ivermectin prophylaxis group had tested positive for SARS-COV-2 versus 11.2% of patients in the control arm (p<.001).
Carvallo, H.E., Roberto, H., Psaltis, A., and Veronica, C. (2020b). Study of the Efficacy and Safety of Topical Ivermectin+ Iota-Carrageenan in the Prophylaxis against COVID-19 in Health Personnel. Journal of Biomedical Research and Clinical Investigation 2, 1
NVariableContracted COVID
During and at end of 3 months
Treated with Ivermectin788 COVID healthcare workers12 mg Ivermectin 1x/week0
Not Treated with ivermectin407 COVID healthcare workersnot treated236
DISCUSSIONIn a much larger follow-up observational controlled trial by the same group that included 1,195 health care workers, they found that over a 3-month period, there were no infections recorded among the 788 workers that took weekly ivermectin prophylaxis while 58% of the 407 controls had become ill with COVID-19. This study demonstrates that protection against transmission can be achieved among high-risk health care workers by taking 12mg once weekly (Carvallo et al., 2020b).
Behera, P., Patro, B.K., Singh, A.K., Chandanshive, P.D., Ravikumar, S., Pradhan, S.K., Pentapati, S.S.K., Batmanabane, G., Padhy, B.M., and Bal, S. (2020). Role of ivermectin in the prevention of COVID-19 infection among healthcare workers in India: A matched case-control study. medRxiv.
NVariableContracted COVID
Nursing home
Treated with Ivermectin69 residents, 52 staffIvermectin as treatment and prophylaxis of scabies7 (10.1%), average age 90 years, 1 of 7 required oxygen, none died
Not Treated with ivermectinMatched control group of residents from surrounding facilitiesnot treated22.6%, 4.9% of those died
DISCUSSIONData which further illuminates the protective role of ivermectin against COVID-19, comes from a study of nursing home residents in France which found that in a facility that suffered a scabies outbreak where all 69 residents and 52 staff were treated with ivermectin (Behera et al., 2020), they found that during the time period surrounding this event, 7/69 residents fell ill with COVID-19 (10.1%). In this group with an average age of 90 years, only one resident required oxygen support and no resident died. In a matched control group of residents from surrounding facilities, they found 22.6% of residents fell ill and 4.9% died.
Hellwig, M.D., and Maia, A. (2020). A COVID-19 Prophylaxis? Lower incidence associated with prophylactic administration of Ivermectin. Int J Antimicrob Agents, 106248
NVariableContracted COVID
Treated with IvermectinCountries with active Ivermectin mass drug administration program for the prevention of parasite infectionsactive Ivermectin mass drug administrationcounts significantly lower
Not Treated with ivermectinCountries with active Ivermectin mass drug administration program for the prevention of parasitenot treatedcounts significantly higher
DISCUSSIONLikely the most definitive evidence supporting the efficacy of ivermectin as a prophylaxis agent was published recently in the International Journal of Anti-Microbial agents where a group of researchers analyzed data using the prophylactic chemotherapy databank administered by the WHO along with case counts obtained by Worldometers, a public data aggregation site used by among others, the Johns Hopkins University (Hellwig and Maia, 2020). When they compared the data from countries with active ivermectin mass drug administration programs for the prevention of parasite infections, they discovered that the COVID-19 case counts were significantly lower in the countries with recently active programs, to a high degree of statistical significance, p<.001.

SECTION 3: IVERMECTIN PROPHYLAXIS REFERENCES and META REFERENCES

Ivermectin inhibits SARS-CoV-2 replication and binding to host tissue via several observed and proposed mechanisms (Caly et al., 2020b).
Caly, L., Druce, J.D., Catton, M.G., Jans, D.A., and Wagstaff, K.M. (2020b). The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res 178, 104787.
Ivermectin has potent anti-inflammatory properties with in-vitro data demonstrating profound inhibition of both cytokine production and transcription of nuclear factor-κB (NF-κB), the most potent mediator of inflammation (Zhang et al., 2008;Ci et al., 2009;Zhang et al., 2009).
Zhang, X., Song, Y., Ci, X., An, N., Ju, Y., Li, H., Wang, X., Han, C., Cui, J., and Deng, X. (2008). Ivermectin inhibits LPSinduced production of inflammatory cytokines and improves LPS-induced survival in mice. Inflamm Res 57, 524-529.
Ci, X., Li, H., Yu, Q., Zhang, X., Yu, L., Chen, N., Song, Y., and Deng, X. (2009). Avermectin exerts anti-inflammatory effect by downregulating the nuclear transcription factor kappa-B and mitogen-activated protein kinase activation pathway. Fundam Clin Pharmacol 23, 449-455.
Zhang, X., Song, Y., Xiong, H., Ci, X., Li, H., Yu, L., Zhang, L., and Deng, X. (2009). Inhibitory effects of ivermectin on nitric oxide and prostaglandin E2 production in LPS-stimulated RAW 264.7 macrophages. Int Immunopharmacol 9, 354-359
Ivermectin significantly diminishes viral load and protects against organ damage in multiple animal models when infected with SARS-CoV-2 or similar coronaviruses (Arevalo et al., 2020;de Melo et al., 2020)
Arevalo, A.P., Pagotto, R., Porfido, J., Daghero, H., Segovia, M., Yamasaki, K., Varela, B., Hill, M., Verdes, J.M., and Vega, M.D. (2020). Ivermectin reduces coronavirus infection in vivo: a mouse experimental model. bioRxiv.
De Melo, G.D., Lazarini, F., Larrous, F., Feige, L., Kergoat, L., Marchio, A., Pineau, P., Lecuit, M., Lledo, P.-M., Changeux, J.- P., and Bourhy, H. (2020). Anti-COVID-19 efficacy of ivermectin in the golden hamster. bioRxiv, 2020.2011.2021.392639.
Ivermectin prevents transmission and development of COVID-19 disease in those exposed to infected patients (Behera et al., 2020;Bernigaud et al., 2020;Carvallo et al., 2020b;Elgazzar et al., 2020;Hellwig and Maia, 2020;Shouman, 2020).
Behera, P., Patro, B.K., Singh, A.K., Chandanshive, P.D., Ravikumar, S., Pradhan, S.K., Pentapati, S.S.K., Batmanabane, G., Padhy, B.M., and Bal, S. (2020). Role of ivermectin in the prevention of COVID-19 infection among healthcare workers in India: A matched case-control study. medRxiv.
Bernigaud, C., Guillemot, D., Ahmed-Belkacem, A., Grimaldi-Bensouda, L., Lespine, A., Berry, F., Softic, L., Chenost, C., DoPham, G., and Giraudeau, B. (2020). “Bénéfice de l’ivermectine: de la gale à la COVID-19, un exemple de sérendipité”, in: Annales de Dermatologie et de Vénéréologie: Elsevier), A194.
Carvallo, H.E., Roberto, H., Psaltis, A., and Veronica, C. (2020b). Study of the Efficacy and Safety of Topical Ivermectin+ Iota-Carrageenan in the Prophylaxis against COVID-19 in Health Personnel. Journal of Biomedical Research and Clinical Investigation 2, 1
Elgazzar, A., Hany, B., Youssef, S.A., Hafez, M., and Moussa, H. (2020). Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic. Research Square. DOI:10.21203/rs.3.rs100956/v1
Hellwig, M.D., and Maia, A. (2020). A COVID-19 Prophylaxis? Lower incidence associated with prophylactic administration of Ivermectin. Int J Antimicrob Agents, 106248
Shouman, W. (2020). Use of Ivermectin as a Prophylactic Option in Asymptomatic Family Close Contact for Patient with COVID-19. Clincal Trials.gov
Ivermectin hastens recovery and prevents deterioration in patients with mild to moderate disease treated early after symptoms (Carvallo et al., 2020a;Elgazzar et al., 2020;Gorial et al., 2020;Khan et al., 2020;Mahmud, 2020;Morgenstern et al., 2020;Robin et al., 2020).
Carvallo, H.E., Hirsch, R.R., and Farinella, M.E. (2020a). Safety and Efficacy of the combined use of ivermectin, dexamethasone, enoxaparin and aspirin against COVID-19. medRxiv. doi: https://doi.org/10.1101/2020.09.10.20191619
Elgazzar, A., Hany, B., Youssef, S.A., Hafez, M., and Moussa, H. (2020). Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic.Research Square. DOI:10.21203/rs.3.rs100956/v1
Gorial, F.I., Mashhadani, S., Sayaly, H.M., Dakhil, B.D., Almashhadani, M.M., Aljabory, A.M., Abbas, Hassan M, Ghanim, M., and Rasheed, J.I. (2020). Effectiveness of Ivermectin as add-on Therapy in COVID-19 Management (Pilot Trial). medRxiv.
Khan, M.S.I., Khan, M.S.I., Debnath, C.R., Nath, P.N., Mahtab, M.A., Nabeka, H., Matsuda, S., and Akbar, S.M.F. (2020). Ivermectin Treatment May Improve the Prognosis of Patients With COVID-19. Archivos de Bronconeumología.
Mahmud, R. (2020). A Randomized, Double-Blind Placebo Controlled Clinical Trial of Ivermectin plus Doxycycline for the Treatment of Confirmed Covid-19 Infection
Morgenstern, J., Redondo, J.N., De Leon, A., Canela, J.M., Torres, N., Tavares, J., Minaya, M., Lopez, O., Placido, A.M., and Castillo, A. (2020). The use of compassionate Ivermectin in the management of symptomatic outpatients and hospitalized patients with clinical diagnosis of COVID-19 at the Medical Center Bournigal and the Medical Center Punta Cana, Rescue Group, Dominican Republic, from may 1 to august 10, 2020. medRxiv.
Robin, R.C., Alam, R.F., Saber, S., Bhiuyan, E., Murshed, R., and Alam, M.T. (2020). A Case Series of 100 COVID-19 Positive Patients Treated with Combination of Ivermectin and Doxycycline. Journal of Bangladesh College of Physicians and Surgeons, 10-15.
Ivermectin hastens recovery and avoidance of ICU admission and death in hospitalized patients (Elgazzar et al., 2020; Hashim et al., 2020; Khan et al., 2020; Niaee et al., 2020; Portmann-Baracco et al., 2020; Rajter et al., 2020; Spoorthi V, 2020).
Elgazzar, A., Hany, B., Youssef, S.A., Hafez, M., and Moussa, H. (2020). Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic. Research Square. DOI:10.21203/rs.3.rs100956/v1
Hashim, H.A., Maulood, M.F., Rasheed, A.M., Fatak, D.F., Kabah, K.K., and Abdulamir, A.S. (2020). Controlled randomized clinical trial on using Ivermectin with Doxycycline for treating COVID-19 patients in Baghdad, Iraq. medRxiv.
Khan, M.S.I., Khan, M.S.I., Debnath, C.R., Nath, P.N., Mahtab, M.A., Nabeka, H., Matsuda, S., and Akbar, S.M.F. (2020). Ivermectin Treatment May Improve the Prognosis of Patients With COVID-19. Archivos de Bronconeumología.
Niaee, M.S., Gheibi, N., Namdar, P., Allami, A., Zolghadr, L., Javadi, A., Karampour, A., Varnaseri, M., Bizhani, B., and Cheraghi, F. (2020). Ivermectin as an adjunct treatment for hospitalized adult COVID-19 patients: A randomized multi-center clinical trial.
Portmann-Baracco, A., Bryce-Alberti, M., and Accinelli, R.A. (2020). Antiviral and Anti-Inflammatory Properties of Ivermectin and Its Potential Use in Covid-19. Arch Bronconeumol
Rajter, J.C., Sherman, M.S., Fatteh, N., Vogel, F., Sacks, J., and Rajter, J.J. (2020). Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID-19 (ICON study). Chest
Spoorthi V, S.S. (2020). Utility of Ivermectin and Doxycycline combination for the treatment of SARS-CoV2. International Archives of Integrated Medicine 7, 177-182.
Ivermectin reduces mortality in critically ill patients with COVID-19 (Elgazzar et al., 2020;Hashim et al., 2020;Rajter et al., 2020).
Elgazzar, A., Hany, B., Youssef, S.A., Hafez, M., and Moussa, H. (2020). Efficacy and Safety of Ivermectin for Treatment and prophylaxis of COVID-19 Pandemic. Research Square. DOI:10.21203/rs.3.rs100956/v1
Hashim, H.A., Maulood, M.F., Rasheed, A.M., Fatak, D.F., Kabah, K.K., and Abdulamir, A.S. (2020). Controlled randomized clinical trial on using Ivermectin with Doxycycline for treating COVID-19 patients in Baghdad, Iraq. medRxiv.
Rajter, J.C., Sherman, M.S., Fatteh, N., Vogel, F., Sacks, J., and Rajter, J.J. (2020). Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID-19 (ICON study). Chest
Ivermectin leads to striking reductions in case-fatality rates in regions with widespread use (Chamie, 2020).
Chamie-Quintero, J., Hibberd, J., Scheim, DE. (2020). COVID-19 case fatalities and total deaths with and without mass ivermectin treatment in different states of Peru. Open Science Foundation https://osf.io/ydc2p/
The safety, availability, and cost of ivermectin is nearly unparalleled given its near nil drug interactions along with only mild and rare side effects observed in almost 40 years of use and billions of doses administered (Kircik et al., 2016).
Kircik, L.H., Del Rosso, J.Q., Layton, A.M., and Schauber, J. (2016). Over 25 Years of Clinical Experience With Ivermectin: An Overview of Safety for an Increasing Number of Indications. Journal of drugs in dermatology : JDD 15, 325- 332.
The World Health Organization has long included ivermectin on its “List of Essential Medicines”.
Essential Medicines

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