Summary: study compared outcomes for those who got Remdesivir (but not Ivermectin) vs. Ivermectin (but not Remdesivir) - after doing propensity score matching.

While the study did propensity score matching to account for the patient populations in the two groups (Remdesivir vs. Ivermectin) to remove other biases, there may be certain biases which may hard to remove - if they are intrinsically tied to the use of Ivermectin/Remdesivir.

 

A secondary implication

Would you prefer being treated by a physician:

• who is aware and willing to prescribe Ivermectin

• or a physician who is ignorant of it (and who says "there is no early treatment - go home and come back when you are hypoxic") and who when faced with a hypoxic patient is unwilling to escalate steroids beyond 6mg Dexamethasone (capped) + Remdesivir - and is willing to watch as the patient stagnates and then winds up on ventilator

Which doctor do you think would have a lower mortality rate?

The doctor who prescribes Ivermectin.

Which should not be a surprise - since we know early treatment doctors are able to achieve near zero death rate and near zero long haulers.

Meanwhile hospitals which turn patients away - only for them to return next week with hypoxia - achieve a 22-25% overall mortality rate, and an 80% mortality rate for ICUs.

And countrywide mortality rates vary from 1.3% to 2% - and higher - which is then affected by those atrocious death rates in such large hospitals that are hamstrung by rigid protocols.

So early treatment doctors having near zero deaths and near zero long haulers is significant.

 

Ivermectin as a proxy for superior treatment

If Ivermectin is a proxy for superior treatment, it is no surprise that Ivermectin arm did much better.

 

Ivermectin may be superior to Remdesivir - or those who prescribe Ivermectin may provide better treatment

So Ivermectin arm doing better may be because Ivermectin outperforms Remdesivir.

But it may also be because those who receive Ivermectin from a doctor, may get better, more responsive care from those doctors as well (compared to doctors who don't change protocols in response to what they have seen).

 

Paper:

https://www.sciencedirect.com/science/article/pii/S1201971221009887

International Journal of Infectious Diseases

March 2022

Treatment with Ivermectin Is Associated with Decreased Mortality in COVID-19 Patients: Analysis of a National Federated Database

I.Efimenko 1, S.Nackeeran 2, S.Jabori 3, J.A. GonzalezZamora 4, S.Danker 3, D.Singh 1

1 University of Miami, Plastic Surgery, Miami, United States

2 University of Miami, Urology, Miami, United States

3 University of Miami, Plastic Surgery, Miami, United States

4 University of Miami, Infectious Diseases, Miami, United States

28 February 2022

https://doi.org/10.1016/j.ijid.2021.12.096

 

Purpose

To evaluate the difference in mortality of patients treated with ivermectin vs patients treated with remdesivir with COVID-19 in United States using TriNetX Research network, a federated EMR network of over 44 healthcare organizations and 68 million patients from US, from 2009-2021.

Methods & Materials

We retrospectively identified adults (≥18 years) with a recorded COVID-19 infection between January 1, 2020 and July 11, 2021. We compared those with recorded use of ivermectin, but not remdesivir, against those with recorded use of remdesivir, but not ivermectin. We controlled for the following demographics, comorbidities, and treatments that may affect COVID-19 survival outcomes: age, gender, race, ethnicity, nicotine use diabetes mellitus, obesity, chronic lower respiratory disease, ischemic heart diseases, tocilizumab, glucocorticoids, or ventilator use. We measured association with mortality as the primary outcome, with significance assessed at p<0.05.

Results

There were a total of 1,761,060 possible COVID-19 patients based on ICD-10 diagnostic terms and confirmatory lab results. Prior to controlling, our analysis yielded 41,608 patients who had COVID-19 resulting in two unique cohorts that were treated with either ivermectin (1,072) or remdesivir (40,536). Within the ivermectin cohort, average age was 51.9 + 17.8 years, 43% were male, 60% had glucocorticoids and 1% required ventilator support. In the remdesivir cohort, average age was 62.0 + 16.0 years, 54% were male, 64% had glucocorticoids and 2% required ventilator support. After using propensity score matching and adjusting for potential confounders, ivermectin was associated with reduced mortality vs remdesivir (OR 0.308, 95% CI (0.198,0.479)),Risk Difference -5.224%, CI (-7.079%,-3.369%), p <0.0001.

Conclusion

Ivermectin use was associated with decreased mortality in patients with COVID-19 compared to remdesivir. To our knowledge, this is the largest association study of patients with COVID-19, mortality and ivermectin. Further double-blinded placebo-controlled RCTs with large samples are required for definite conclusion. In the future, if more publications are published with the similar result to the current analyses, the certainty of evidence will increase.