Ivermectin interview, Precis, Dr. Tess Lawrie Video 1, the importance of EBP
Synthesised evidence
Video 2, Ivermectin
Heard publicity around Christmas / New Year
Front line covid-19 critical care alliance
Dr. Pierre Kory
Dr. Lawrie has background expertise required for analysis
We / I do not prescribe
Impressed with body of evidence from FLCCC
Several plausible mechanisms of Ivermectin action, antiviral and anti-inflammatory
Prevents viral life cycles and replication
Reduces inflammatory markers
Some studies show Ivermectin reduces viral load
Studies show possible action against yellow fever, dengue, zika and others
Let’s explore with more studies on viral illnesses
Practical empirical evidence
Preventing death and preventing infection
Including RCT and better quality observational studies = 83% reduction in deaths
Appraised each study for risk of bias
Talked to authors
Reviewed manager software
Pooled studies and data
Submitted to Matt Hancock’s office 4th Jan, no response
Publications coming
Researchers have a moral duty to relay information ASAP, so preprint site (2015)
Next, RCT only
Starting from scratch with a review team, 68% fewer deaths
Using very strict criteria
Forest plot
Plotting deaths in treatment group and deaths in placebo group
Out of 1,000 deaths
Ivermectin group, 27 deaths out of 1,000 cases
Placebo group, 82 deaths out of 903 cases
65% reduction
P = 0.002
Findings of RCT was the same as observational studies
Useful in all stages of the disease
88% reductions in infection rates
And mild and moderate disease to reduce viral load, so disease worsening
? Long covid
Possible evidence from Argentina and Peru
Placebo controlled trial for 2 weeks, with options to treat
Placebo controlled treatment trial, not ethical
Reduces symptoms, low certainty, 48%
Safety
Billions of doses have been given over 40 years
WHO, essential medicines list
Third of the world’s population, 4,600 adverse events 16 deaths
(Remdesivir, 417 deaths over past year)
Safe at 10x dose
3, 6, 12 mg tabs
0.2 mg / Kg to 0.4 mg / Kg
Oral tabs
Cost, $168 per KG
WHO, 100, 12mg tabs $2.90
BIRD, recommended for prevention and treatment in UK, and told everyone, WHO, FDA etc.
Helsinki declaration, doctors should give what they know to be effective
Large RCT would have to stop at interim analysis, probably at about 1,000 patients
Protection from infection in workers and contacts
Ivermectin group, 25 out of 1,397 got covid
Control group, 386 out of 833 got covid
Risk reduction 93% reduction in infection rates
Or 87% with the best study taken out
Medical oil tankers
Ivermectin reduces the risk of death from COVID-19 -a rapid review and meta-analysis in support of the recommendation of the Front Line COVID-19 Critical Care Alliance.
Kory P, Meduri GU, Iglesias J, et al. Review of the emerging evidence demonstrating the efficacy of ivermectin in the prophylaxis and treatment of COVID-19. 18 Dec 2020.
World Health Organization. 21st Model List of Essential Medicines. Geneva, Switzerland. 2019.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 Cochrane, 2019.
www.training.cochrane.org/handbook.
The GRADE Working Group. GRADE [website] 2020
www.gradeworkinggroup.org.
Alam MT, Murshed R, Gomes PF, Masud ZM, Saber S, Chaklader MA, Khanam F, Hossain M, Momen ABIM, Yasmin N, Alam RF, Sultana A, Robin RC. Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study
0 Comments