Ivermectin Together Trial results from NEJM
In this update video, Roger Seheult, MD of MedCram discusses the results from the Together Trial from NEJM on ivermectin. Dr. Seheult reports that since Covid-19 began, there have been many studies trying to determine a low-cost and effective treatment for Covid-19. One trial that showed success included the UK Recovery Trial which touted the benefits of steroids in reducing mortality in Covid-19 and now is a mainstay therapy in the treatment of it.
Many trials have also been done in order to repurpose medications and see if there was any benefit in reducing mortality in Covid-19 infections. One arm of the Together Trial showed a reduction of the risk of hospitalization by 30% for fluvoxamine which is an older antidepressant.
A medication that has received a significant amount of attention is ivermectin. In the Together Trial, a randomized trial in Brazil, they assigned patients to different treatment arms including metformin, ivermectin x 1 d, fluvoxamine, doxazosin, interferon lambda, hydroxychloroquine, and lopinavir-ritonavir. The ivermectin 1-day arm was later switched from 1 day to 3 days as there was concern that 1 day of treatment was not enough time.
Dr. Seheult specifically focuses on the arms with ivermectin x 3 days vs placebo in this video. The study used an adaptive platform with the initial recruitment of 10460 eligible patients. 6900 were excluded and the remaining 3515 patients were left to be randomized. 2100 were assigned to different treatment groups. The authors used an intention to treat analysis. Only the results of the 3-day ivermectin group vs the placebo group were included in the trial and similarly only those in the 3-day placebo groups were included in the trial. The trial results did not show any statistical significance between the two groups of ivermectin x 3 days vs placebo.
A critique of this study was that the placebo group had a fair amount of people who actually were taking ivermectin on their own so you might not see a difference between the ivermectin vs the placebo group. However, the researchers stated they were aware of off-label ivermectin use and they used extensive screening to determine the placebo group had in fact not taken any ivermectin.
MedCram itself has brought an emphasis on life management strategies to mitigate the effects of Covid-19 including hydrotherapy, sleep, lifestyle changes, exercise, and dietary changes. One of the most popular videos at MedCram is on 10 Tips if you get Covid-19, sleep, vitamin d exercise, diet, fasting, and light. MedCram believes in the swiss cheese model. The more slices you have, the better a defense to block the “holes” through which Covid-19 can attack.
LINKS / REFERENCES:
Effect of Early Treatment with Ivermectin among Patients with Covid-19 (NEJM) | https://www.nejm.org/doi/full/10.1056…
Supplementary Appendix (NEJM) | https://www.nejm.org/doi/suppl/10.105…
Brazil’s tragic ivermectin frenzy is a warning to the US, experts say (Business Insider) | https://www.businessinsider.com/brazi…
SARS-CoV-2 seroprevalence and associated factors in Manaus, Brazil (NIH) | https://pubmed.ncbi.nlm.nih.gov/34273…
Hospitalization and mortality associated with SARS-CoV-2 viral clades in COVID-19 (Scientific Reports) | https://www.nature.com/articles/s4159…
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