Recently, the Malaysian Alliance for Effective Covid Control claimed that the use of Ivermectin as an early intervention tactic could help reduce the strain on Malaysia’s health system and put the country on the fast track to recovery.
Despite this, health director-general Dr Noor Hisham Abdullah said the ministry had not approved the use of Ivermectin to prevent or treat Covid-19 because there were no scientific studies to prove it was effective.
Speaking to FMT, World Health Organization (WHO) local representative Dr Jacqueline Lo shed light on WHO’s stand on Ivermectin.
What is Ivermectin?
According to Lo, Ivermectin is a broad-spectrum anti-parasitic agent, included in WHO’s essential medicines list for several parasitic diseases.
It is used in the treatment of onchocerciasis (river blindness), strongyloidiasis and other neglected tropical diseases, including those caused by soil-transmitted helminthiasis as well as to treat scabies.
Is it effective in treating Covid-19?
In April 2020, Lo said, researchers using laboratory methods found that Ivermectin could inhibit the in vitro replication of SARS-CoV-2, the novel virus that causes Covid-19.
She said although Ivermectin might have some anti-viral and anti-inflammatory effects, the evidence remained inconclusive.
“The effects of ivermectin on mortality, mechanical ventilation, hospital admission, duration of hospitalisation and viral clearance remains uncertain because of very low certainty of evidence addressing each of these outcomes,” she said.
What is WHO’s stand on Ivermectin?
WHO does not recommend the use of Ivermectin for patients with Covid-19 except in the context of a clinical trial in which patients are monitored closely by experienced clinicians and researchers for safety and efficacy.
This recommendation applies to patients with any disease severity and any duration of symptoms. There is an ongoing need for adequately powered, well-designed, and well-conducted clinical trials for evidence-based guidance on the role of Ivermectin in the treatment of Covid-19.
How far along is the research?
A guideline development group by WHO was convened in response to the increased international attention on Ivermectin as a potential treatment for Covid-19. This group is an independent, international panel of experts, which includes clinical care experts in multiple specialties and an ethicist and patient-partners.
The group reviewed pooled data from 16 randomised controlled trials (total enrolled 2,407), including both inpatients and outpatients with Covid-19.
They determined that the evidence on whether Ivermectin reduces mortality, the need for mechanical ventilation, need for hospital admission and time for clinical improvement in Covid-19 patients is of “very low certainty”, due to the small sizes and methodological limitations of the available trial data.
Currently, clinical trials in Malaysia for the use of the drug are under way, with these involving the drug’s application in high-risk, late-stage patients.
Lo said the health ministry and the Institute for Clinical Research (ICR) had initiated a randomised clinical trial to repurpose Ivermectin and evaluate its efficacy and safety in high-risk Covid-19 patients.
The study will enrol 500 subjects from high-risk groups, those who are 50 years old and above, who have been admitted to public hospitals with mild to moderate Covid-19 symptoms.
She said the ICR had also set up a data monitoring board, consisting of independent physicians, clinical trial pharmacists and methodological experts, to safeguard the trial patients based on the safety and efficacy of the investigation product set by the National Pharmaceutical Regulatory Agency (NPRA).
What are the potential side effects?
The US Food and Drug Administration (FDA) said Ivermectin could cause nausea, vomiting, diarrhoea, hypotension (low blood pressure), allergic reactions (itching and hives), dizziness, ataxia (problems with balance), seizures, coma and even death if taken in large doses.
Which countries have approved the use of Ivermectin?
According to Forbes magazine, many countries around the world, particularly in Latin America and South Africa as well as the Philippines and India, have approved Ivermectin for use against Covid-19.
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