UP adds ivermectin to its COVID-19 protocols without evidence that the drug works

A box of the drug ivermectin, made by Biogaran, is pictured on the counter of a pharmacy in Paris, France, on 28 April 2020. Experts have warned against using the drug to control COVID-19 at the population level till clinical trials prove its efficacy. Benoit Tessier / REUTERS
03 September, 2020

 The government of Uttar Pradesh has pushed the use of an antiparasitic drug called ivermectin as both, a treatment for and prophylaxis against COVID-19. However, the recommendation has no scientific basis yet—there have been no trials that prove that it works against the novel coronavirus. In fact, scientists at the World Health Organisation warned against using ivermectin to treat COVID-19 since existing studies on its efficacy “have a high risk of bias, very low certainty of the evidence, and that existing evidence is insufficient to draw a conclusion on benefits and harms.” The US Food and Drug Administration said the drug was not approved for prevention or treatment of COVID-19 and that additional testing was needed. Notably, the union ministry of health and family welfare has neither recommended the drug for treatment of COVID-19 patients, nor issued any advisory against its use. 

But state government-run hospitals in Uttar Pradesh have prescribed the drug as part of their protocol to treat mild and moderate cases of COVID-19. Moreover, rapid response teams—teams of doctors who assess asymptomatic patients—have been charged with distributing the drug to people in home quarantine and primary and secondary contacts of confirmed cases. 

 Researchers at the Kitasato Institute in Japan and the US-based pharmaceutical company Merck and Co first formulated ivermectin in the 1970s. It was deemed an important development in veterinary medicine because it was potent against internal and external parasites and in boosting animal health. The drug was subsequently found to be effective in the treatment of human diseases such as river blindness, lymphatic filariasis, and scabies. “In some countries, the drug has also been formulated for topical treatment in the form of a shampoo against head lice,” Dr Carlos Chaccour, a health researcher with the Barcelona Institute of Global Health, said. “In a few Latin American countries, oral dosage of the drug has been approved to treat head lice as well.” 

Chaccour has studied the drug for more than a decade and warned against its use in treating COVID-19 at a population level. He has also closely monitored the mass misuse of ivermectin in Latin American countries such as Peru, where thousands of people started using veterinary ivermectin when the supply for human-use ivermectin fell. Many reportedly suffered side effects, including stomach ailments, tremors, panic attacks and painful blisters. A recent article, “Serious Ivermectin Toxicity and Human ABCB1 Nonsense Mutations”,  published in The New England Journal of Medicine analysed how a single dose of ivermectin, formulated for human use, caused a 13-year-old boy with an unusual genetic condition to develop encephalopathy and slip into a coma.