Dr Lawrie, Ivermectin video, Short Precis

Ivermectin interview, Precis, Dr. Tess Lawrie

Video 1, the importance of EBP

Synthesised evidence

Video 2, Ivermectin

Heard publicity around Christmas / New Year

Front line covid-19 critical care alliance

Dr. Pierre Kory

Dr. Lawrie has background expertise required for analysis

We / I do not prescribe

Impressed with body of evidence from FLCCC

Several plausible mechanisms of Ivermectin action, antiviral and anti-inflammatory

Prevents viral life cycles and replication

Reduces inflammatory markers

Some studies show Ivermectin reduces viral load

Studies show possible action against yellow fever, dengue, zika and others

Let’s explore with more studies on viral illnesses

Practical empirical evidence

Preventing death and preventing infection

Including RCT and better quality observational studies = 83% reduction in deaths

Appraised each study for risk of bias

Talked to authors

Reviewed manager software

Pooled studies and data

Submitted to Matt Hancock’s office 4th Jan, no response

Publications coming

Researchers have a moral duty to relay information ASAP, so preprint site (2015)

Next, RCT only

Starting from scratch with a review team, 68% fewer deaths

Using very strict criteria

Forest plot

Plotting deaths in treatment group and deaths in placebo group

Out of 1,000 deaths

Ivermectin group, 27 deaths out of 1,000 cases

Placebo group, 82 deaths out of 903 cases

65% reduction

P = 0.002

Findings of RCT was the same as observational studies

Useful in all stages of the disease

88% reductions in infection rates

And mild and moderate disease to reduce viral load, so disease worsening

? Long covid

Possible evidence from Argentina and Peru

Placebo controlled trial for 2 weeks, with options to treat

Placebo controlled treatment trial, not ethical

Reduces symptoms, low certainty, 48%

Safety

Billions of doses have been given over 40 years

WHO, essential medicines list

Third of the world’s population, 4,600 adverse events 16 deaths

(Remdesivir, 417 deaths over past year)

Safe at 10x dose

3, 6, 12 mg tabs

0.2 mg / Kg to 0.4 mg / Kg

Oral tabs

Cost, $168 per KG

WHO, 100, 12mg tabs $2.90

BIRD, recommended for prevention and treatment in UK, and told everyone, WHO, FDA etc.

Helsinki declaration, doctors should give what they know to be effective

Large RCT would have to stop at interim analysis, probably at about 1,000 patients

Protection from infection in workers and contacts

Ivermectin group, 25 out of 1,397 got covid

Control group, 386 out of 833 got covid

Risk reduction 93% reduction in infection rates

Or 87% with the best study taken out

Medical oil tankers

Ivermectin reduces the risk of death from COVID-19 -a rapid review and meta-analysis in support of the recommendation of the Front Line COVID-19 Critical Care Alliance.

Kory P, Meduri GU, Iglesias J, et al. Review of the emerging evidence demonstrating the efficacy of ivermectin in the prophylaxis and treatment of COVID-19. 18 Dec 2020.

World Health Organization. 21st Model List of Essential Medicines. Geneva, Switzerland. 2019.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 Cochrane, 2019.

www.training.cochrane.org/handbook.

The GRADE Working Group. GRADE [website] 2020

www.gradeworkinggroup.org.

Alam MT, Murshed R, Gomes PF, Masud ZM, Saber S, Chaklader MA, Khanam F, Hossain M, Momen ABIM, Yasmin N, Alam RF, Sultana A, Robin RC. Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study