The fact that the authors of a systematic review, “Ivermectin for preventing and treating COVID‐19”1 – published by the prestigious Cochrane Infectious Diseases Group at the end of last month – found no evidence to support the use of ivermectin for treating or preventing COVID-19 infection, should send a strong message those who still believe in its effectiveness.

Presenting to delegates to the virtual SA Medical Association (SAMA) Conference at the weekend, both Prof Salim Abdool Karim (pictured), of CAPRISA, and Prof Marc Mendelson, head of the Division of Infectious Diseases and HIV Medicine at Groote Schuur Hospital, alluded to the Cochrane Review study conclusion which read:

“Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID‐19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials.”

In his presentation, Prof Karim made it clear that having to make difficult decisions and act decisively on a healthcare development never experienced before was made all the more complicated by conspiracy theories on the prevention and treatment of COVID-19 and doctors themselves promoting “miracle cures”.

“In the first wave,” he said, “the call was for hydroxychloroquine and people were wanting to know why it wasn’t available. And then in the second wave it was ivermectin – people wanting a miracle cure and not interested in scientific evidence.”

An article in a recent issue of Nature, he explained, pointed out that the initial Egypt study which reported 90% efficacy of ivermectin was found to have “widespread duplication of patient information and incoherent data” by a University of London masters student. At pre-print it had more than 150000 views – “now withdrawn as a flawed study with strong evidence of scientific fraud”.

The release of the Cochrane Review, Prof Karim concluded, has provided the most compelling data to date “showing the whole world that the use of ivermectin is based on scientific fraud!”

In addition to stressing the points made in the Cochrane study conclusion, Prof Mendelson took the opportunity to remind his audience of the responsibility of medical practitioners and the importance of evidence-based medicine in such situations. This, he indicated, was best described just last week by Parrish et al in an SA Medical Journal (SAMJ) In Practice review, “Meta-analytic magic, ivermectin, and socially responsible reporting”2, in which they advise:

“Clinicians remain responsible for ensuring that guidance they follow is both legitimate and reliable. In the ivermectin debate, EBM principles have largely been ignored under the guise that during a pandemic the ‘rules are different’, probably to the detriment of vulnerable patients and certainly to the detriment of the profession’s image.”

REFERENCES:

1. Popp et al: Ivermectin for preventing and treating COVID‐19; https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full

2. Parrish et al: Meta-analytic magic, ivermectin, and socially responsible reporting; http://www.samj.org.za/index.php/samj/article/view/13373