Dr. Kingsley Amibor is a consultant clinical pharmacist and chairman of Association of Hospital and Administrative Pharmacists of Nigeria. In this interview with ADEBAYO FOLORUNSH FRANCIS, he says the use of Ivermectin in the management of COVID-19 should not be completely disregarded, as the world struggles with COVID-19 vaccination programmes.
The US National Institute of Health said that it has left the use of Ivermectin to the discretion of physicians managing COVID-19 cases. What’s your position on it?
I believe that patients who are already down with the infection stand a chance of benefiting from Ivermectin use. There shouldn’t be any hard and fast rule about it. Those doing well on hydroxychloroquine and azithromycin should be allowed to continue with them and be discharged to go home once they get well. But those not responding well to the two drugs could be put on Ivermectin and discharged once they are okay.
Is the use of Ivermectin evidence-based?
Some studies have highlighted the significance of Ivermectin in COVID-19; however, it requires evidence from more randomised controlled trials and dose-response studies to support its use.
Ivermectin has shown efficacy against SARS-CoV-2 in-vitro. Some other studies retrospectively reviewed severe COVID-19 patients receiving standard doses of Ivermectin and compared clinical and microbiological outcomes with a similar group of patients not receiving Ivermectin. No differences were found between the groups. The authors recommended the evaluation of high doses of Ivermectin in randomised trials against SARS-CoV-2.
However, the safety of Ivermectin at higher doses in children less than 15 kg and pregnant women has insufficient evidence and hence is not recommended in these population groups.
Are there studies that have shown evidence of lower mortality in the treatment of patients with mild to moderate COVID-19 disease?
In a retrospective study of 280 patients with SARS-CoV-2 infection treated with Ivermectin (n = 173) or standard of care (n = 107), the authors found lower mortality in the Ivermectin group. The authors also reported lower mortality among patients with severe pulmonary disease (n = 75) treated with Ivermectin.
What should be done in treatment centres where Ivermectin fails to yield the desired result?
That is why I said earlier that there is no hard and fast rule with the use of Ivermectin.If it is being used in a particular centre and the clinicians are getting positive outcomes in terms of resolution of symptoms and overall cure, then it is advisable to continue with Ivermectin; after all, there is no permanent cure yet.
And where they use Ivermectin and the clinicians are not getting the desired outcomes, they should not hesitate to switch to some other treatment protocol that gives positive outcome for their patients
What about the emergence of new variants of COVID-19?
As regards the issue of new variants or mutations of SARS-CoV-2, for one, we are not sure if it has reached Nigeria yet. But even then, some treatment centres like mine are still registering satisfactory results with Ivermectin. I believe it is rational and logical to continue with a medication that gives you good or fair enough results, rather than folding one’s hands and lamenting about the absence of a permanent cure.
How does Ivermectin rank, when compared with the once touted use of dexamethasone and hydroxychloroquine for treatment of the disease?
Dexamethasone is for severe cases. As stated earlier, Ivermectin is being positioned for mild to moderate cases. Hydroxychloroquine is not known to be effective in all cases of COVID-19 and is associated with some adverse effects. So, for those that can tolerate it, the clinicians can go ahead with it.
Therefore, for those for whom hydroxychloroquine is not effective, other treatment protocols, including Ivermectin, could be tried.
If Ivermectin and dexamethasone are still effective, why is the world still struggling with vaccination programmes?
Vaccination is largely preventive. As they say, prevention is better than cure. If you take the vaccine, you are not likely to come down with the infection – even though we have received reports of people who had issues with the vaccine, including developing allergic reactions in some cases.
Ivermectin is for those who have already contracted the infection and are experiencing symptoms. It is not for prophylaxis.
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