Abstract
Abstract Importance: No therapy to date has been shown to
improve survival for patients infected with SARS-CoV-2. Ivermectin has
been shown to inhibit the replication of SARS-CoV-2 in vitro but
clinical response has not been previously evaluated. Objective: To
determine whether Ivermectin is associated with lower mortality rate in
patients hospitalized with COVID-19. Design and Setting: Retrospective
cohort study of consecutive patients hospitalized at four Broward Health
hospitals in South Florida with confirmed SARS-CoV-2. Enrollment dates
were March 15, 2020 through May 11, 2020. Follow up data for all
outcomes was May 19, 2020. Participants: 280 patients with confirmed
SARS-CoV-2 infection (mean age 59.6 years [standard deviation 17.9],
45.4% female), of whom 173 were treated with ivermectin and 107 were
usual care were reviewed. 27 identified patients were not reviewed due
to multiple admissions, lack of confirmed COVID results during
hospitalization, age less than 18, pregnancy, or incarceration.
Exposure: Patients were categorized into two treatment groups based on
whether they received at least one dose of ivermectin at any time during
the hospitalization. Treatment decisions were at the discretion of the
treating physicians. Severe pulmonary involvement at study entry was
characterized as need for either FiO2 ≥50%, or noninvasive or invasive
mechanical ventilation. Main Outcomes and Measures: The primary outcome
was all-cause in-hospital mortality. Secondary outcomes included
subgroup mortality in patients with severe pulmonary involvement and
extubation rates for patients requiring invasive ventilation. Results:
Univariate analysis showed lower mortality in the ivermectin group
(25.2% versus 15.0%, OR 0.52, 95% CI 0.29-0.96, P=.03). Mortality was
also lower among 75 patients with severe pulmonary disease treated with
ivermectin (38.8% vs 80.7%, OR 0.15, CI 0.05-0.47, P=.001), but there
was no significant difference in successful extubation rates (36.1% vs
15.4%, OR 3.11 (0.88-11.00), p=.07). After adjustment for between-group
differences and mortality risks, the mortality difference remained
significant for the entire cohort (OR 0.27, CI 0.09-0.85, p=.03; HR
0.37, CI 0.19-0.71, p=.03). Conclusions and Relevance: Ivermectin was
associated with lower mortality during treatment of COVID-19, especially
in patients who required higher inspired oxygen or ventilatory support.
These findings should be further evaluated with randomized controlled
trials.
Competing Interest Statement
The authors have declared no competing interest.
Clinical Trial
n/a
Funding Statement
No funding.
Author Declarations
I confirm all relevant ethical guidelines have been
followed, and any necessary IRB and/or ethics committee approvals have
been obtained.
Yes
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https://www.medrxiv.org/content/10.1101/2020.06.06.20124461v2
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