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Doing my best to stay off social media since there are way too many experts on pharmacotherapy (yet they barely passed high school; discussion for another time I suppose).... anyways I wanted to start a thread to discuss some of the therapy options and the evidence supporting their use or not supporting their use.
-ASHP has a fantastic evidence table and it seems to be updated very regularly (8/19/21 most recently):
-This website is.... interesting. Not sure how credible.
c19early.com
1. Thoughts on ivermectin? I see a lot of anecdotal junk... but the only randomized, double-blind, placebo-controlled studies per ASHP table don't have favorable data for it. Am I missing something? The general public thinks it's a miracle drug... but again they're a few fries (or many) short of a happy meal.
"Randomized, double-blind, placebocontrolled trial in hospitalized adults (Ahmed et al): A total of 72 adults with COVID-19 were randomized to receive ivermectin (12 mg orally once daily for 5 days), ivermectin (single 12-mg oral dose) with doxycycline (200 mg orally on day 1, then 100 mg every 12 hours for 4 days), or placebo. The primary end points were time required for virologic clearance (i.e., negative RT-PCR on nasopharyngeal swab) and remission of fever and cough within 7 days. The mean time to viral clearance was 9.7 days in the 5-day ivermectin group, 11.5 days in the ivermectin with doxycycline group, and 12.7 days in the placebo group. There was no significant difference between groups in remission of fever and cough. 14"
"Randomized, double-blind, placebocontrolled trial in adults with mild COVID19 (López-Medina et al; NCT04405843): A total of 476 adults (hospitalized or outpatients) with mild disease and symptom onset within the previous 7 days were randomized 1:1 to receive a 5-day regimen of ivermectin (300 mcg/kg daily as an oral solution) or placebo. The primary outcome was the time from randomization to complete resolution of symptoms within the 21 -day follow-up. The primary efficacy analysis population included 398 pts (200 received ivermectin and 198 received placebo). Baseline demographic and disease characteristics were well balanced between groups. Ivermectin treatment did not significantly improve time to resolution of symptoms in pts with mild COVID-19 (median of 10 or 12 days in the ivermectin or placebo group, respectively). At day 21, 82 or 79% of the ivermectin or placebo group, respectively, had complete resolution of symptoms. 21"
"Randomized, double-blind, placebocontrolled pilot study to evaluate ivermectin for reduction of SARS-CoV-2 transmission (Chaccour et al): Twelve adults with nonsevere COVID-19 who had no risk factors and symptom onset within the last 72 hours were randomized 1:1 to receive ivermectin (single dose of 400 mcg/kg) or placebo. The primary outcome measure was the proportion of patients with detectable SARS-CoV-2 RNA by PCR from nasopharyngeal swab at day 7. Results indicated no difference in the proportion of PCR-positive patients between the ivermectin group and placebo group at day 7 (100% of pts in both groups still had positive PCR). 15"
Discuss, pharmacy friends.
-ASHP has a fantastic evidence table and it seems to be updated very regularly (8/19/21 most recently):
-This website is.... interesting. Not sure how credible.
COVID-19 early treatment: real-time analysis of 3,679 studies
COVID-19 early treatment: real-time analysis of 3,679 studies
c19early.com
1. Thoughts on ivermectin? I see a lot of anecdotal junk... but the only randomized, double-blind, placebo-controlled studies per ASHP table don't have favorable data for it. Am I missing something? The general public thinks it's a miracle drug... but again they're a few fries (or many) short of a happy meal.
"Randomized, double-blind, placebocontrolled trial in hospitalized adults (Ahmed et al): A total of 72 adults with COVID-19 were randomized to receive ivermectin (12 mg orally once daily for 5 days), ivermectin (single 12-mg oral dose) with doxycycline (200 mg orally on day 1, then 100 mg every 12 hours for 4 days), or placebo. The primary end points were time required for virologic clearance (i.e., negative RT-PCR on nasopharyngeal swab) and remission of fever and cough within 7 days. The mean time to viral clearance was 9.7 days in the 5-day ivermectin group, 11.5 days in the ivermectin with doxycycline group, and 12.7 days in the placebo group. There was no significant difference between groups in remission of fever and cough. 14"
"Randomized, double-blind, placebocontrolled trial in adults with mild COVID19 (López-Medina et al; NCT04405843): A total of 476 adults (hospitalized or outpatients) with mild disease and symptom onset within the previous 7 days were randomized 1:1 to receive a 5-day regimen of ivermectin (300 mcg/kg daily as an oral solution) or placebo. The primary outcome was the time from randomization to complete resolution of symptoms within the 21 -day follow-up. The primary efficacy analysis population included 398 pts (200 received ivermectin and 198 received placebo). Baseline demographic and disease characteristics were well balanced between groups. Ivermectin treatment did not significantly improve time to resolution of symptoms in pts with mild COVID-19 (median of 10 or 12 days in the ivermectin or placebo group, respectively). At day 21, 82 or 79% of the ivermectin or placebo group, respectively, had complete resolution of symptoms. 21"
"Randomized, double-blind, placebocontrolled pilot study to evaluate ivermectin for reduction of SARS-CoV-2 transmission (Chaccour et al): Twelve adults with nonsevere COVID-19 who had no risk factors and symptom onset within the last 72 hours were randomized 1:1 to receive ivermectin (single dose of 400 mcg/kg) or placebo. The primary outcome measure was the proportion of patients with detectable SARS-CoV-2 RNA by PCR from nasopharyngeal swab at day 7. Results indicated no difference in the proportion of PCR-positive patients between the ivermectin group and placebo group at day 7 (100% of pts in both groups still had positive PCR). 15"
Discuss, pharmacy friends.
