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Pacheco G, Lopes ALF, Oliveira APD, Corrêa WDRM, Lima LDB, Souza MHLPD, Teles AS, Nicolau LAD, Medeiros JVR. Comprehensive analysis of gastrointestinal side effects in COVID-19 patients undergoing combined pharmacological treatment with azithromycin and hydroxychloroquine: a systematic review and network meta-analysis. Crit Rev Toxicol 2024:1-14. [PMID: 38860720 DOI: 10.1080/10408444.2024.2348169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/22/2024] [Indexed: 06/12/2024]
Abstract
During the COVID-19 pandemic, several drugs were repositioned and combined to quickly find a way to mitigate the effects of the infection. However, the adverse effects of these combinations on the gastrointestinal tract are unknown. We aimed investigate whether Hydroxychloroquine (HD), Azithromycin (AZ), and Ivermectin (IV) used in combination for the treatment of COVID-19, can lead to the development of gastrointestinal disorders. This is a systematic review and network meta-analysis conducted using Stata and Revman software, respectively. The protocol was registered with PROSPERO (CRD42023372802). A search of clinical trials in Cochrane Library databases, Embase, Web of Science, Lilacs, PubMed, Scopus and Clinicaltrials.gov conducted on November 26, 2023. The eligibility of the studies was assessed based on PICO criteria, including trials that compared different treatments and control group. The analysis of the quality of the evidence was carried out according to the GRADE. Six trials involving 1,686 COVID-19 patients were included. No trials on the association of HD or AZ with IV met the inclusion criteria, only studies on the association between HD and AZ were included. Nausea, vomiting, diarrhea, abdominal pain and increased transaminases were related. The symptoms of vomiting and nausea were evaluated through a network meta-analysis, while the symptom of abdominal pain was evaluated through a meta-analysis. No significant associations with these symptoms were observed for HD, AZ, or their combination, compared to control. Low heterogeneity and absence of inconsistency in indirect and direct comparisons were noted. Limitations included small sample sizes, varied drug dosages, and potential publication bias during the pandemic peak. This review unveils that there are no associations between gastrointestinal adverse effects and the combined treatment of HD with AZ in the management of COVID-19, as compared to either the use of a control group or the administration of the drugs individually, on the other hand, highlighting the very low or low certainty of evidence for the evaluated outcomes. To accurately conclude the absence of side effects, further high-quality randomized studies are needed.
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Affiliation(s)
- Gabriella Pacheco
- Medicinal Plants Research Center (NPPM), Post-graduation Program in Pharmacology, Federal University of Piauí, Teresina, PI, Brazil
| | - André Luis Fernandes Lopes
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | | | | | - Lucas Daniel Batista Lima
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | | | - Ariel Soares Teles
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
- Federal Institute of Maranhão (IFMA), Araioses, MA, Brazil
| | - Lucas Antonio Duarte Nicolau
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
| | - Jand Venes Rolim Medeiros
- Medicinal Plants Research Center (NPPM), Post-graduation Program in Pharmacology, Federal University of Piauí, Teresina, PI, Brazil
- Biotechnology and Biodiversity Research Center (BIOTEC), Post-graduation Program in Biotechnology, Parnaíba Delta Federal University (UFDPar), Parnaíba, PI, Brazil
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Njuguna AG, Wangombe AW, Walekhwa MN, Kamondo DK. Clinical Course and Factors Associated With Hospital Admission and Mortality among Sars-Cov 2 Patients within Nairobi Metropolitan Area. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24307403. [PMID: 38798388 PMCID: PMC11118643 DOI: 10.1101/2024.05.15.24307403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
This study aims to investigate the clinical course and factors associated with hospital admission and mortality among SARS-CoV-2 patients within the Nairobi Metropolitan Area. The study utilizes a multicenter retrospective cohort design, collecting clinical characteristics and laboratory parameters of hospitalized patients from March 2020 to May 2022. Data analysis includes percentages, frequencies, chi-square tests, Kaplan-Meier analysis, pairwise comparisons, and multivariate regression models. Ethical considerations are observed throughout the research process. The study findings highlight significant associations between comorbidities, such as hypertension, and increased mortality risk due to COVID-19. Symptoms including fever, cough, dyspnea, chest pain, sore throat, and loss of smell/taste are also identified as predictors of mortality. Abnormal laboratory parameters, such as oxygen saturation, procalcitonin, glucose levels, serum creatinine, and gamma-glutamyl transpeptidase, are associated with mortality. However, demographic factors and certain vital signs do not exhibit significant associations. Recommendations based on this study suggest increased monitoring and management of comorbidities, early identification and management of symptoms, regular monitoring of laboratory parameters, continued research and collaboration, and implementation of preventive measures. Overall, a multidisciplinary approach involving healthcare professionals, researchers, policymakers, and the public is crucial to improve COVID-19 outcomes and reduce mortality rates. Adaptation of strategies based on emerging evidence and resource allocation is essential for effective management of the pandemic.
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Jin SL, Kolis J, Parker J, Proctor DA, Prybylski D, Wardle C, Abad N, Brookmeyer KA, Voegeli C, Chiou H. Social histories of public health misinformation and infodemics: case studies of four pandemics. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00105-1. [PMID: 38648811 DOI: 10.1016/s1473-3099(24)00105-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 04/25/2024]
Abstract
Recognition of misinformation as a public health threat and interest in infodemics, defined as an inundation of information accompanying an epidemic or acute health event, have increased worldwide. However, scientists have no consensus on how to best define and identify misinformation and other essential characteristics of infodemics. We conducted a narrative review of secondary historical sources to examine previous infodemics in relation to four infectious diseases associated with pandemics (ie, smallpox, cholera, 1918 influenza, and HIV) and challenge the assumption that misinformation is a new phenomenon associated with increased use of social media or with the COVID-19 pandemic. On the contrary, we found that the spread of health misinformation has always been a public health challenge that has necessitated innovative solutions from medical and public health communities. We suggest expanding beyond the narrow scope of addressing misinformation to manage information ecosystems, defined as how people consume, produce, interact with, and behave around information, which include factors such as trust, stigma, and scientific literacy. Although misinformation can spread on a global scale, this holistic approach advocates for community-level interventions that improve relationships and trust between medical or public health entities and local populations.
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Affiliation(s)
- Sabrina L Jin
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Kolis
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jessica Parker
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Claire Wardle
- School of Public Health, Brown University, Providence, RI, USA
| | - Neetu Abad
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Howard Chiou
- US Centers for Disease Control and Prevention, Atlanta, GA, USA; Commissioned Corps, US Public Health Service, Rockville, MD, USA
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Vanhee C, Jacobs B, Kamugisha A, Canfyn M, Van Der Meersch H, Ceyssens B, Deconinck E, Van Hoorde K, Willocx M. Substandard and falsified ivermectin tablets obtained for self-medication during the COVID-19 pandemic as a source of potential harm. Drug Test Anal 2023. [PMID: 38043940 DOI: 10.1002/dta.3618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Abstract
In 2019, a global viral pandemic, due to the SARS-CoV-2 virus, broke out. Soon after, the search for a vaccine and/or antiviral medicine began. One of the candidate antiviral medicines tested was ivermectin. Although several health authorities warned the public against the use of this medicine outside clinical trials, the drug was widely used at the end of 2020 and in 2021. Simultaneously, several reports started to emerge demonstrating serious adverse effects after self-medicating with ivermectin. It stands to reason that the self-administration of substandard or falsified (SF) medicines bearing harmful quality deficiencies have contributed to this phenomenon. In order to have a better view on the nature of these harmful quality deficiencies, SF ivermectin samples, intercepted in large quantities by the Belgian regulatory agencies during the period 2021-2022, were analyzed in our official medicines control laboratory. None of the samples (n = 19) were compliant to the quality criteria applicable to medicinal products. These SF products either suffered from a systematic underdosing of the active pharmaceutical ingredient or were severely contaminated with bacteria, two of which were contaminated with known pathogens that cause gastrointestinal illness upon oral intake. In addition to the direct risks of self-medicating with such a product, the improper usage and dosage of ivermectin medication might also facilitate ivermectin tolerance or resistance in parasites. This may have detrimental consequences on a global scale, certainly as the number of newly developed active pharmaceutical ingredients that can safely be used to combat parasites is rather scarce.
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Affiliation(s)
- Celine Vanhee
- Service Medicines and Health Products, Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium
| | - Bram Jacobs
- Service of Foodborne Pathogen, Scientific Direction of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Angélique Kamugisha
- Service Medicines and Health Products, Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium
| | - Michael Canfyn
- Service Medicines and Health Products, Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium
| | | | - Bart Ceyssens
- Federal Agency for Medicine and Health Care Products, Brussels, Belgium
| | - Eric Deconinck
- Service Medicines and Health Products, Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium
| | - Koenraad Van Hoorde
- Service of Foodborne Pathogen, Scientific Direction of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Marie Willocx
- Service Medicines and Health Products, Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium
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Movahedi Nia Z, Bragazzi NL, Ahamadi A, Asgary A, Mellado B, Orbinski J, Seyyed-Kalantari L, Woldegerima WA, Wu J, Kong JD. Off-label drug use during the COVID-19 pandemic in Africa: topic modelling and sentiment analysis of ivermectin in South Africa and Nigeria as a case study. J R Soc Interface 2023; 20:20230200. [PMID: 37700708 PMCID: PMC10498353 DOI: 10.1098/rsif.2023.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/18/2023] [Indexed: 09/14/2023] Open
Abstract
Although rejected by the World Health Organization, the human and even veterinary formulation of ivermectin has widely been used for prevention and treatment of COVID-19. In this work we leverage Twitter to understand the reasons for the drug use from ivermectin supporters, their source of information, their emotions, their gender demographics, and location information, in Nigeria and South Africa. Topic modelling is performed on a Twitter dataset gathered using keywords 'ivermectin' and 'ivm'. A model is fine-tuned on RoBERTa to find the stance of the tweets. Statistical analysis is performed to compare the stance and emotions. Most ivermectin supporters either redistribute conspiracy theories posted by influencers, or refer to flawed studies confirming ivermectin efficacy in vitro. Three emotions have the highest intensity, optimism, joy and disgust. The number of anti-ivermectin tweets has a significant positive correlation with vaccination rate. All the provinces in South Africa and most of the provinces of Nigeria are pro-ivermectin and have higher disgust polarity. This work makes the effort to understand public discussions regarding ivermectin during the COVID-19 pandemic to help policy-makers understand the rationale behind its popularity, and inform more targeted policies to discourage self-administration of ivermectin. Moreover, it is a lesson to future outbreaks.
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Affiliation(s)
- Z. Movahedi Nia
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - N. L. Bragazzi
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - A. Ahamadi
- Advanced Disaster, Emergency and Rapid-response Simulation (ADERSIM), York University, Toronto, Ontario, Canada
- Faculty of Computer Engineering, K.N. Toosi University, Tehran, Iran
| | - A. Asgary
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Advanced Disaster, Emergency and Rapid-response Simulation (ADERSIM), York University, Toronto, Ontario, Canada
| | - B. Mellado
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- School of Physics, Institute for Collider Particle Physics, University of the Witwatersrand, Johannesburg, South Africa
| | - J. Orbinski
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Ontario, Canada
| | - L. Seyyed-Kalantari
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Department of Electrical Engineering and Computer Science, York University, Toronto, Ontario, Canada
| | - W. A. Woldegerima
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - J. Wu
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - J. D. Kong
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
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Williams AH, Zhan CG. Staying Ahead of the Game: How SARS-CoV-2 has Accelerated the Application of Machine Learning in Pandemic Management. BioDrugs 2023; 37:649-674. [PMID: 37464099 DOI: 10.1007/s40259-023-00611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 07/20/2023]
Abstract
In recent years, machine learning (ML) techniques have garnered considerable interest for their potential use in accelerating the rate of drug discovery. With the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the utilization of ML has become even more crucial in the search for effective antiviral medications. The pandemic has presented the scientific community with a unique challenge, and the rapid identification of potential treatments has become an urgent priority. Researchers have been able to accelerate the process of identifying drug candidates, repurposing existing drugs, and designing new compounds with desirable properties using machine learning in drug discovery. To train predictive models, ML techniques in drug discovery rely on the analysis of large datasets, including both experimental and clinical data. These models can be used to predict the biological activities, potential side effects, and interactions with specific target proteins of drug candidates. This strategy has proven to be an effective method for identifying potential coronavirus disease 2019 (COVID-19) and other disease treatments. This paper offers a thorough analysis of the various ML techniques implemented to combat COVID-19, including supervised and unsupervised learning, deep learning, and natural language processing. The paper discusses the impact of these techniques on pandemic drug development, including the identification of potential treatments, the understanding of the disease mechanism, and the creation of effective and safe therapeutics. The lessons learned can be applied to future outbreaks and drug discovery initiatives.
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Affiliation(s)
- Alexander H Williams
- Molecular Modeling and Biopharmaceutical Center, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
- GSK Upper Providence, 1250 S. Collegeville Road, Collegeville, PA, 19426, USA
| | - Chang-Guo Zhan
- Molecular Modeling and Biopharmaceutical Center, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA.
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA.
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Perlis RH, Lunz Trujillo K, Green J, Safarpour A, Druckman JN, Santillana M, Ognyanova K, Lazer D. Misinformation, Trust, and Use of Ivermectin and Hydroxychloroquine for COVID-19. JAMA HEALTH FORUM 2023; 4:e233257. [PMID: 37773507 PMCID: PMC10542734 DOI: 10.1001/jamahealthforum.2023.3257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/24/2023] [Indexed: 10/01/2023] Open
Abstract
Importance The COVID-19 pandemic has been notable for the widespread dissemination of misinformation regarding the virus and appropriate treatment. Objective To quantify the prevalence of non-evidence-based treatment for COVID-19 in the US and the association between such treatment and endorsement of misinformation as well as lack of trust in physicians and scientists. Design, Setting, and Participants This single-wave, population-based, nonprobability internet survey study was conducted between December 22, 2022, and January 16, 2023, in US residents 18 years or older who reported prior COVID-19 infection. Main Outcome and Measure Self-reported use of ivermectin or hydroxychloroquine, endorsing false statements related to COVID-19 vaccination, self-reported trust in various institutions, conspiratorial thinking measured by the American Conspiracy Thinking Scale, and news sources. Results A total of 13 438 individuals (mean [SD] age, 42.7 [16.1] years; 9150 [68.1%] female and 4288 [31.9%] male) who reported prior COVID-19 infection were included in this study. In this cohort, 799 (5.9%) reported prior use of hydroxychloroquine (527 [3.9%]) or ivermectin (440 [3.3%]). In regression models including sociodemographic features as well as political affiliation, those who endorsed at least 1 item of COVID-19 vaccine misinformation were more likely to receive non-evidence-based medication (adjusted odds ratio [OR], 2.86; 95% CI, 2.28-3.58). Those reporting trust in physicians and hospitals (adjusted OR, 0.74; 95% CI, 0.56-0.98) and in scientists (adjusted OR, 0.63; 95% CI, 0.51-0.79) were less likely to receive non-evidence-based medication. Respondents reporting trust in social media (adjusted OR, 2.39; 95% CI, 2.00-2.87) and in Donald Trump (adjusted OR, 2.97; 95% CI, 2.34-3.78) were more likely to have taken non-evidence-based medication. Individuals with greater scores on the American Conspiracy Thinking Scale were more likely to have received non-evidence-based medications (unadjusted OR, 1.09; 95% CI, 1.06-1.11; adjusted OR, 1.10; 95% CI, 1.07-1.13). Conclusions and Relevance In this survey study of US adults, endorsement of misinformation about the COVID-19 pandemic, lack of trust in physicians or scientists, conspiracy-mindedness, and the nature of news sources were associated with receiving non-evidence-based treatment for COVID-19. These results suggest that the potential harms of misinformation may extend to the use of ineffective and potentially toxic treatments in addition to avoidance of health-promoting behaviors.
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Affiliation(s)
- Roy H. Perlis
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Associate Editor, JAMA Network Open
| | - Kristin Lunz Trujillo
- Department of Political Science, Northeastern University, Boston, Massachusetts
- John F. Kennedy School of Government and Department of Government, Harvard University, Cambridge, Massachusetts
| | - Jon Green
- Department of Political Science, Northeastern University, Boston, Massachusetts
| | - Alauna Safarpour
- Department of Political Science, Northeastern University, Boston, Massachusetts
- John F. Kennedy School of Government and Department of Government, Harvard University, Cambridge, Massachusetts
| | - James N. Druckman
- Department of Political Science, Northwestern University, Evanston, Illinois
| | - Mauricio Santillana
- Department of Political Science, Northeastern University, Boston, Massachusetts
| | - Katherine Ognyanova
- Department of Communication, School of Communication and Information, Rutgers University, New Brunswick, New Jersey
| | - David Lazer
- Department of Political Science, Northeastern University, Boston, Massachusetts
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Sheng AY, Gottlieb M, Bautista JR, Trueger NS, Westafer LM, Gisondi MA. The role of emergency physicians in the fight against health misinformation: Implications for resident training. AEM EDUCATION AND TRAINING 2023; 7:S48-S57. [PMID: 37383831 PMCID: PMC10294217 DOI: 10.1002/aet2.10877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 06/30/2023]
Abstract
Emergency physicians on the frontlines of the COVID-19 pandemic are first-hand witnesses to the direct impact of health misinformation and disinformation on individual patients, communities, and public health at large. Therefore, emergency physicians naturally have a crucial role to play to steward factual information and combat health misinformation. Unfortunately, most physicians lack the communications and social media training needed to address health misinformation with patients and online, highlighting an obvious gap in emergency medicine training. We convened an expert panel of academic emergency physicians who have taught and conducted research about health misinformation at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in New Orleans, LA, on May 13, 2022. The panelists represented geographically diverse institutions including Baystate Medical Center/Tufts University, Boston Medical Center, Northwestern University, Rush Medical College, and Stanford University. In this article, we describe the scope and impact of health misinformation, introduce methods for addressing misinformation in the clinical environment and online, acknowledge the challenges of tackling misinformation from our physician colleagues, demonstrate strategies for debunking and prebunking, and highlight implications for education and training in emergency medicine. Finally, we discuss several actionable interventions that define the role of the emergency physician in the management of health misinformation.
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Affiliation(s)
- Alexander Y. Sheng
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
- School of Medicine, Boston UniversityBostonMassachusettsUSA
- Department of Emergency MedicineAlpert Medical School at Brown UniversityRhode IslandProvidenceUSA
| | - Michael Gottlieb
- Emergency Ultrasound Division, Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | | | - N. Seth Trueger
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Lauren M. Westafer
- Department of Emergency Medicine, Department of Healthcare Delivery and Population ScienceUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMassachusettsUSA
| | - Michael A. Gisondi
- The Precision Education and Assessment Research Lab, Department of Emergency MedicineStanford UniversityPalo AltoCaliforniaUSA
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Llenas-García J, Del Pozo A, Talaya A, Roig-Sánchez N, Poveda Ruiz N, Devesa García C, Borrajo Brunete E, González Cuello I, Lucas Dato A, Navarro M, Wikman-Jorgensen P. Ivermectin Effect on In-Hospital Mortality and Need for Respiratory Support in COVID-19 Pneumonia: Propensity Score-Matched Retrospective Study. Viruses 2023; 15:v15051138. [PMID: 37243224 DOI: 10.3390/v15051138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION There is negligible evidence on the efficacy of ivermectin for treating COVID-19 pneumonia. This study aimed to assess the efficacy of ivermectin for pre-emptively treating Strongyloides stercoralis hyperinfection syndrome in order to reduce mortality and the need for respiratory support in patients hospitalized for COVID-19. METHODS This single-center, observational, retrospective study included patients admitted with COVID-19 pneumonia at Hospital Vega Baja from 23 February 2020 to 14 March 2021. Because strongyloidiasis is endemic to our area, medical criteria support empiric administration of a single, 200 μg/kg dose of ivermectin to prevent Strongyloides hyperinfection syndrome. The outcome was a composite of all-cause in-hospital mortality and the need for respiratory support. RESULTS Of 1167 patients in the cohort, 96 received ivermectin. After propensity score matching, we included 192 patients. The composite outcome of in-hospital mortality or need for respiratory support occurred in 41.7% of the control group (40/96) and 34.4% (33/96) of the ivermectin group. Ivermectin was not associated with the outcome of interest (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.35, 1.69; p = 0.52). The factors independently associated with this endpoint were oxygen saturation (aOR 0.78, 95% CI 0.68, 0.89, p < 0.001) and C-reactive protein at admission (aOR: 1.09, 95% CI 1.03, 1.16, p < 0.001). CONCLUSIONS In hospitalized patients with COVID-19 pneumonia, ivermectin at a single dose for pre-emptively treating Strongyloides stercoralis is not effective in reducing mortality or the need for respiratory support measures.
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Affiliation(s)
- Jara Llenas-García
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
- Clinical Medicine Department, Miguel Hernández University, 03202 Elche, Spain
| | - Alfonso Del Pozo
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | - Alberto Talaya
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | - Nuria Roig-Sánchez
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | | | | | | | - Inmaculada González Cuello
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | - Ana Lucas Dato
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | - Miriam Navarro
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
- Epidemiology Unit, Public Health Centre, 03202 Elche, Spain
| | - Philip Wikman-Jorgensen
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
- Internal Medicine Service, Elda General University Hospital, 03600 Elda, Spain
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Catalani V, Townshend HD, Prilutskaya M, Roman-Urrestarazu A, van Kessel R, Chilcott RP, Banayoti H, McSweeney T, Corazza O. Profiling the vendors of COVID-19 related product on the Darknet: An observational study. EMERGING TRENDS IN DRUGS, ADDICTIONS, AND HEALTH 2023; 3:100051. [PMID: 37020522 PMCID: PMC10030259 DOI: 10.1016/j.etdah.2023.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND In a time of unprecedented global change, the COVID-19 pandemic has led to a surge in demand of COVID-19 vaccines and related certifications. Mainly due to supply shortages, counterfeit vaccines, fake documentation, and alleged cures to illegal portfolios, have been offered on darkweb marketplaces (DWMs) with important public health consequences. We aimed to profile key DWMs and vendors by presenting some in-depth case studies. METHODS A non-systematic search for COVID-19 products was performed across 118 DWMs. Levels of activity, credibility, content, COVID-19 product listings, privacy protocols were among the features retrieved. Open web fora and other open web sources were also considered for further analysis of both functional and non functional DWMs. Collected data refers to the period between January 2020 and October 2021. RESULTS A total of 42 relevant listings sold by 24 vendors across eight DWMs were identified. Four of these markets were active and well-established at the time of the study with good levels of credibility. COVID-19 products were listed alongside other marketplace content. Vendors had a trusted profile, communicated in English language and accepted payments in cryptocurrencies (Monero or Bitcoin). Their geographical location included the USA, Asia and Europe. While COVID-19 related goods were mostly available for regional supply, other listings were also shipped worldwide. INTERPRETATION Findings emerging from this study rise important questions about the health safety of certain DWMs activities and encourage the development of targeted interventions to overcome such new and rapidly expanding public health threats. FUNDING CovSaf, National Research centre on Privacy, Harm Reduction and Adversarial Influence Online (REPHRAIN), Commonwealth Fund.
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Affiliation(s)
- Valeria Catalani
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Honor D Townshend
- School of Law, University of Hertfordshire, Hatfield, United Kingdom
| | - Mariya Prilutskaya
- Department of Personalised Medicine, Pavlodar Branch of Semey Medical University, Pavlodar, Kazakhstan
| | - Andres Roman-Urrestarazu
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA
| | - Robin van Kessel
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Robert P Chilcott
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | | | - Tim McSweeney
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Ornella Corazza
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
- Department of Psychology and Cognitive Science, University of Trento, Italy
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11
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Glen AK, Ma C, Mendoza L, Womack F, Wood EC, Sinha M, Acevedo L, Kvarfordt LG, Peene RC, Liu S, Hoffman AS, Roach JC, Deutsch EW, Ramsey SA, Koslicki D. ARAX: a graph-based modular reasoning tool for translational biomedicine. Bioinformatics 2023; 39:7031241. [PMID: 36752514 PMCID: PMC10027432 DOI: 10.1093/bioinformatics/btad082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/17/2022] [Accepted: 02/07/2023] [Indexed: 04/12/2023] Open
Abstract
MOTIVATION With the rapidly growing volume of knowledge and data in biomedical databases, improved methods for knowledge-graph-based computational reasoning are needed in order to answer translational questions. Previous efforts to solve such challenging computational reasoning problems have contributed tools and approaches, but progress has been hindered by the lack of an expressive analysis workflow language for translational reasoning and by the lack of a reasoning engine-supporting that language-that federates semantically integrated knowledge-bases. RESULTS We introduce ARAX, a new reasoning system for translational biomedicine that provides a web browser user interface and an application programming interface (API). ARAX enables users to encode translational biomedical questions and to integrate knowledge across sources to answer the user's query and facilitate exploration of results. For ARAX, we developed new approaches to query planning, knowledge-gathering, reasoning and result ranking and dynamically integrate knowledge providers for answering biomedical questions. To illustrate ARAX's application and utility in specific disease contexts, we present several use-case examples. AVAILABILITY AND IMPLEMENTATION The source code and technical documentation for building the ARAX server-side software and its built-in knowledge database are freely available online (https://github.com/RTXteam/RTX). We provide a hosted ARAX service with a web browser interface at arax.rtx.ai and a web API endpoint at arax.rtx.ai/api/arax/v1.3/ui/. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
| | | | - Luis Mendoza
- Institute for Systems Biology, Seattle, WA 98109, USA
| | - Finn Womack
- Huck Institutes of the Life Sciences, Pennsylvania State University, State College, PA 16802, USA
| | - E C Wood
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, OR 97331, USA
| | - Meghamala Sinha
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, OR 97331, USA
| | - Liliana Acevedo
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, OR 97331, USA
| | - Lindsey G Kvarfordt
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, OR 97331, USA
| | - Ross C Peene
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, OR 97331, USA
| | - Shaopeng Liu
- Huck Institutes of the Life Sciences, Pennsylvania State University, State College, PA 16802, USA
| | - Andrew S Hoffman
- Interdisciplinary Hub for Digitalization and Society, Radboud University, Nijmegen 6500GL, The Netherlands
| | - Jared C Roach
- Institute for Systems Biology, Seattle, WA 98109, USA
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12
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Löscher W. Is the antiparasitic drug ivermectin a suitable candidate for the treatment of epilepsy? Epilepsia 2023; 64:553-566. [PMID: 36645121 DOI: 10.1111/epi.17511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
There are only a few drugs that can seriously lay claim to the title of "wonder drug," and ivermectin, the world's first endectocide and forerunner of a completely new class of antiparasitic agents, is among them. Ivermectin, a mixture of two macrolytic lactone derivatives (avermectin B1a and B1b in a ratio of 80:20), exerts its highly potent antiparasitic effect by activating the glutamate-gated chloride channel, which is absent in vertebrate species. However, in mammals, ivermectin activates several other Cys-loop receptors, including the inhibitory γ-aminobutyric acid type A and glycine receptors and the excitatory nicotinic acetylcholine receptor of brain neurons. Based on these effects on vertebrate receptors, ivermectin has recently been proposed to constitute a multifaceted wonder drug for various novel neurological indications, including alcohol use disorders, motor neuron diseases, and epilepsy. This review critically discusses the preclinical and clinical evidence of antiseizure effects of ivermectin and provides several arguments supporting that ivermectin is not a suitable candidate drug for the treatment of epilepsy. First, ivermectin penetrates the mammalian brain poorly, so it does not exert any pharmacological effects via mammalian ligand-gated ion channels in the brain unless it is used at high, potentially toxic doses or the blood-brain barrier is functionally impaired. Second, ivermectin is not selective but activates numerous inhibitory and excitatory receptors. Third, the preclinical evidence for antiseizure effects of ivermectin is equivocal, and at least in part, median effective doses in seizure models are in the range of the median lethal dose. Fourth, the only robust clinical evidence of antiseizure effects stems from the treatment of patients with onchocerciasis, in which the reduction of seizures is due to a reduction in microfilaria densities but not a direct antiseizure effect of ivermectin. We hope that this critical analysis of available data will avert the unjustified hype associated with the recent use of ivermectin to control COVID-19 from recurring in neurological diseases such as epilepsy.
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Affiliation(s)
- Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
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13
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Abstract
SARS-CoV-2 is the viral agent of COVID-19, a pandemic that surfaced in 2019. Although predominantly a respiratory ailment, patients with COVID-19 can have gastrointestinal (GI) and hepatobiliary manifestations. These manifestations are often mild and transient, but they can be severe and consequential. In the GI tract, ischemic enterocolitis is the most common and significant consequence of COVID-19. In the liver, the reported pathologic findings may often be related to consequences of severe systemic viral infection, but reports of hepatitis presumed to be due to SARS-CoV-2 suggest that direct viral infection of the liver may be a rare complication of COVID-19. In both the GI tract and liver, lingering symptoms of GI or hepatic injury after resolution of pulmonary infection may be part of the evolving spectrum of long COVID.
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Affiliation(s)
- Angela R Shih
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Joseph Misdraji
- Department of Pathology, Yale New Haven Hospital, Yale University, New Haven, CT, 06510, USA.
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14
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An Unforeseen Adverse Effect of Ivermectin—Is It a Safe Choice in COVID-19 Patients? INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Chary MA, Barbuto AF, Izadmehr S, Tarsillo M, Fleischer E, Burns MM. COVID-19 Therapeutics: Use, Mechanism of Action, and Toxicity (Xenobiotics). J Med Toxicol 2023; 19:26-36. [PMID: 36525217 PMCID: PMC9756926 DOI: 10.1007/s13181-022-00918-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 emerged in 2019 and led to the COVID-19 pandemic. Efforts to develop therapeutics against SARS-Cov-2 led to both new treatments and attempts to repurpose existing medications. Here, we provide a narrative review of the xenobiotics and alternative remedies used or proposed to treat COVID-19. Most repositioned xenobiotics have had neither the feared toxicity nor the anticipated efficacy. Repurposed viral replication inhibitors are not efficacious and frequently associated with nausea, vomiting, and diarrhea. Antiviral medications designed specifically against SARS-CoV-2 may prevent progression to severe disease in at-risk individuals and appear to have a wide therapeutic index. Colloidal silver, zinc, and ivermectin have no demonstrated efficacy. Ivermectin has a wide therapeutic index but is not efficacious and acquiring it from veterinary sources poses additional danger. Chloroquine has a narrow therapeutic index and no efficacy. A companion review covers vaccines, monoclonal antibodies, and immunotherapies. Together, these two reviews form an update to our 2020 review.
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Affiliation(s)
- Michael A. Chary
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children’s Hospital, Boston, MA USA ,Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA USA ,Division of Medical Toxicology, Department of Emergency Medicine, Weill Cornell Medical College, New York, NY USA
| | - Alexander F. Barbuto
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children’s Hospital, Boston, MA USA ,Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA USA ,Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX USA
| | - Sudeh Izadmehr
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Marc Tarsillo
- Division of Medical Toxicology, Department of Emergency Medicine, Weill Cornell Medical College, New York, NY USA
| | - Eduardo Fleischer
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Michele M. Burns
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children’s Hospital, Boston, MA USA ,Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA USA ,Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
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16
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Furlan L. Ivermectin Treatment for Covid-19. N Engl J Med 2022; 387:e66. [PMID: 36516102 DOI: 10.1056/nejmc2207995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Hoang R, Temple C, Correia MS, Clemons J, Hendrickson RG. Characteristics of ivermectin toxicity in patients taking veterinary and human formulations for the prevention and treatment of COVID-19. Clin Toxicol (Phila) 2022; 60:1350-1355. [PMID: 36374218 DOI: 10.1080/15563650.2022.2134788] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND US poison control centers reported increased cases of ivermectin toxicity during the COVID-19 pandemic. Previous descriptions of ivermectin toxicity have evaluated heterogeneous groups with a variety of ivermectin sources and dosage patterns. We sought to compare the clinical effects of ivermectin toxicity in patients taking human- vs. veterinary-formulations and acute- vs. chronic-ingestion patterns. METHODS We performed a retrospective analysis of cases from the Oregon Poison Center of ivermectin exposures for the prevention or treatment of COVID-19 that resulted in a healthcare visit over a 24-week period (14 August 2021 - 31 January 2022). RESULTS We identified 37 cases of ivermectin toxicity. The median age of patients was 64 years, and most patients were male. The majority of patients were hospitalized (21) or treated in an emergency department (13). A minority were treated in an outpatient setting (3) and one patient died. Seventeen ingested veterinary formulations and fifteen ingested prescription tablets. Patients reported taking ivermectin for treatment (23) and prevention (14) of COVID-19. Clinical effects included neurotoxicity (30), gastrointestinal symptoms (14), and musculoskeletal complaints (7). Patients taking veterinary products took higher doses of ivermectin and had higher rates of altered mental status than those taking prescription tablets. Patients taking ivermectin chronically took smaller doses (daily dose of 13.5 mg) over a prolonged period (median 3.8 weeks) and developed toxicity that was milder than those with acute ingestions. CONCLUSION Ivermectin toxicity developed in predominantly male patients >60 years old who ingested higher than recommended doses and developed neurologic symptoms. Patients who took a veterinary formulation of ivermectin ingested large single doses or large daily doses for several days and developed rapid onset of neurotoxicity. Patients with chronic toxicity developed milder symptoms and tended to take typical therapeutic doses, but continued therapy for weeks rather than days.
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Affiliation(s)
- Ruby Hoang
- Department of Emergency Medicine, Division of Medical Toxicology, Oregon Health and Science University, Portland, OR, USA.,Oregon Poison Center, Oregon Health and Science University, Portland, OR, USA
| | - Courtney Temple
- Department of Emergency Medicine, Division of Medical Toxicology, Oregon Health and Science University, Portland, OR, USA.,Oregon Poison Center, Oregon Health and Science University, Portland, OR, USA
| | - Matthew S Correia
- Department of Emergency Medicine, Division of Medical Toxicology, Oregon Health and Science University, Portland, OR, USA.,Oregon Poison Center, Oregon Health and Science University, Portland, OR, USA
| | - Joseph Clemons
- Department of Emergency Medicine, Division of Medical Toxicology, Oregon Health and Science University, Portland, OR, USA.,Oregon Poison Center, Oregon Health and Science University, Portland, OR, USA
| | - Robert G Hendrickson
- Department of Emergency Medicine, Division of Medical Toxicology, Oregon Health and Science University, Portland, OR, USA.,Oregon Poison Center, Oregon Health and Science University, Portland, OR, USA
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18
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Taibe NS, Kord MA, Badawy MA, Shytaj IL, Elhefnawi MM. Progress, pitfalls, and path forward of drug repurposing for COVID-19 treatment. Ther Adv Respir Dis 2022; 16:17534666221132736. [PMID: 36282077 PMCID: PMC9597285 DOI: 10.1177/17534666221132736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
On 30 January 2020, the World Health Organization (WHO) declared the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic a public health emergency of international concern. The viral outbreak led in turn to an exponential growth of coronavirus disease 2019 (COVID-19) cases, that is, a multiorgan disease that has led to more than 6.3 million deaths worldwide, as of June 2022. There are currently few effective drugs approved for treatment of SARS-CoV-2/COVID-19 patients. Many of the compounds tested so far have been selected through a drug repurposing approach, that is, by identifying novel indications for drugs already approved for other conditions. We here present an up-to-date review of the main Food and Drug Administration (FDA)-approved drugs repurposed against SARS-CoV-2 infection, discussing their mechanism of action and their most important preclinical and clinical results. Reviewed compounds were chosen to privilege those that have been approved for use in SARS-CoV-2 patients or that have completed phase III clinical trials. Moreover, we also summarize the evidence on some novel and promising repurposed drugs in the pipeline. Finally, we discuss the current stage and possible steps toward the development of broadly effective drug combinations to suppress the onset or progression of COVID-19.
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Affiliation(s)
- Noha Samir Taibe
- Biotechnology-Biomolecular Chemistry Program, Chemistry Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Maimona A. Kord
- Department of Botany, Faculty of Science, Cairo University, Giza, Egypt
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19
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Alfaidi M, Zhang H, Oliveira SD. Fostering New Scientific Networks in the COVID Era and Beyond. Arterioscler Thromb Vasc Biol 2022; 42:1113-1120. [PMID: 35861068 PMCID: PMC9420830 DOI: 10.1161/atvbaha.122.317452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the last 2 years, the COVID-19 pandemic has stimulated the scientific community by starting a race to develop new vaccines and therapeutic approaches to fight this life-threatening illness. At the same time, the pandemic also evoked an urge for innovative communication strategies to maintain scientific networking and data sharing among investigators. Communication through audiovisual platforms has quickly become a unique tool to sustain scientific interaction, whereas social media has turned into an unmistakable pivotal environment for sharing scientific data and combating misinformation around SARS-CoV-2 infection, prevention, and therapy. Amid this challenging scenario, the scientific community organically established new roles, such as a social media ambassador, a conference-associated role to virtually promote breakthrough science while reconnecting investigators and forging new scientific networks via social media. Moreover, in response to the COVID-19 pandemic, it also became clear the critical need for the scientific community to support efforts to empower flexibility, creativity, and the inclusion of new forms of communication to advance science. Thus, the goal of this brief article is to provide a structured follow-up on the importance for researchers to occupy the internet to promote scientific findings and events, to combat science mistrust by stimulating communication among nonscientists to scientists, and to provide essential strategies for young and senior investigators on how to virtually expand their professional networks within and across research and clinical areas of the cardiovascular field.
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Affiliation(s)
- Mabruka Alfaidi
- Department of Internal Medicine, Division of Cardiology, Center for Cardiovascular Diseases and Sciences, LSU Health - Shreveport, LA (M.A.)
| | - Hanrui Zhang
- Cardiometabolic Genomics Program, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York (H.Z.)
| | - Suellen D Oliveira
- College of Medicine, Department of Anesthesiology, University of Illinois at Chicago (S.D.O.)
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20
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Grant JM, Chan J, Lother SA, Barrett L, Bonnar PE, Findlater AR, Kassim SS, Lam JC, Vinh DC. AMMI Canada Practice Point: Treatments for adults with COVID-19 in 2021-2022. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:163-169. [PMID: 36337603 PMCID: PMC9629725 DOI: 10.3138/jammi-2022-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer M Grant
- Division of Medical Microbiology and Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Chan
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States
| | - Sylvain A Lother
- Divisions of Critical Care and Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Barrett
- Division of Infectious Diseases, Department of Medicine, Department of Microbiology and Immunology, Queen Elizabeth II Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul E Bonnar
- Division of Infectious Diseases, Queen Elizabeth II Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Aidan R Findlater
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sameer S Kassim
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba
| | - John C Lam
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donald C Vinh
- Division of Infectious Diseases, Department of Medicine; Division of Medical Microbiology, Department of Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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21
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Awad H, Hassan B, Dweek S, Aboelata Y, Rawas-Qalaji M, Ahmed IS. Repurposing Potential of the Antiparasitic Agent Ivermectin for the Treatment and/or Prophylaxis of COVID-19. Pharmaceuticals (Basel) 2022; 15:ph15091068. [PMID: 36145289 PMCID: PMC9506580 DOI: 10.3390/ph15091068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Due to the rapid, vast, and emerging global spread of the Coronavirus Disease 2019 (COVID-19) pandemic, many drugs were quickly repurposed in a desperate attempt to unveil a miracle drug. Ivermectin (IVM), an antiparasitic macrocyclic lactone, was tested and confirmed for its in vitro antiviral activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in early 2020. Along with its potential antiviral activity, the affordability and availability of IVM resulted in a wide public interest. Across the world, trials have put IVM to test for both the treatment and prophylaxis of COVID-19, as well as its potential role in combination therapy. Additionally, the targeted delivery of IVM was studied in animals and COVID-19 patients. Through this conducted literature review, the potential value and effectiveness of the repurposed antiparasitic agent in the ongoing global emergency were summarized. The reviewed trials suggested a value of IVM as a treatment in mild COVID-19 cases, though the benefit was not extensive. On the other hand, IVM efficacy as a prophylactic agent was more evident and widely reported. In the most recent trials, novel nasal formulations of IVM were explored with the hope of an improved optimized effect.
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Affiliation(s)
- Hoda Awad
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Basmala Hassan
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Sara Dweek
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Yasmeen Aboelata
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Mutasem Rawas-Qalaji
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Iman Saad Ahmed
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Correspondence: ; Tel.: +971-65057403
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22
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Mathur P, Kottilil S. Immunomodulatory therapies for COVID-19. Front Med (Lausanne) 2022; 9:921452. [PMID: 35991665 PMCID: PMC9381694 DOI: 10.3389/fmed.2022.921452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose As COVID-19 disease progresses, the host inflammatory response contributes to hypoxemia and severe and critical illness. In these latter stages of disease, patients may benefit from immunomodulatory therapies to control the aberrant host inflammatory response. In this review, we provide an overview of these therapies and provide summaries of the studies that led to issuance of FDA Emergency Use Authorization or recommendation by the Infectious Diseases Society of America (IDSA). Materials and methods We reviewed English-language studies, Emergency Use Authorizations (EUAs), and guidelines from March 2020 to present. Conclusion and relevance There are several therapies with proposed benefit in severe and critical COVID-19 disease. Few have been issued FDA EUA or recommendation by the Infectious Diseases Society of America (IDSA). Physicians should be familiar with the evidence supporting use of these therapies and the patient populations most likely to benefit from each.
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23
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Hentschke-Lopes M, Botton MR, Borges P, Freitas M, Mancuso ACB, Matte U. Sales of "COVID kit" drugs and adverse drug reactions reported by the Brazilian Health Regulatory Agency. CAD SAUDE PUBLICA 2022; 38:e00001022. [PMID: 35894360 DOI: 10.1590/0102-311xen001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Off-label use of azithromycin, hydroxychloroquine, and ivermectin (the "COVID kit") has been suggested for COVID-19 treatment in Brazil without clinical or scientific evidence of efficacy. These drugs have known adverse drug reactions (ADR). This study aimed to analyze if the sales of drugs in the "COVID kit" are correlated to the reported number of ADR after the COVID-19 pandemic began. Data was obtained from the Brazilian Health Regulatory Agency (Anvisa) website on reported sales and ADRs for azithromycin, hydroxychloroquine, and ivermectin for all Brazilian states. The period from March 2019 to February 2020 (before the pandemic) was compared to that from March 2020 to February 2021 (during the pandemic). Trend adjustment was performed for time series data and cross-correlation analysis to investigate correlation between sales and ADR within the same month (lag 0) and in the following months (lag 1 and lag 2). Spearman's correlation coefficient was used to assess the magnitude of the correlations. After the pandemic onset, sales of all investigated drugs increased significantly (69.75% for azithromycin, 10,856,481.39% for hydroxychloroquine, and 12,291,129.32% for ivermectin). ADR levels of all medications but azithromycin were zero before the pandemic, but increased after its onset. Cross-correlation analysis was significant in lag 1 for all drugs nationwide. Spearman's correlation was moderate for azithromycin and hydroxychloroquine but absent for ivermectin. Data must be interpreted cautiously since no active search for ADR was performed. Our results show that the increased and indiscriminate use of "COVID kit" during the pandemic correlates to an increased occurrence of ADRs.
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Affiliation(s)
- Marina Hentschke-Lopes
- Laboratório de Células, Tecidos e Genes, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil.,Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Mariana R Botton
- Laboratório de Células, Tecidos e Genes, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | - Pâmella Borges
- Laboratório de Células, Tecidos e Genes, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | - Martiela Freitas
- Laboratório de Células, Tecidos e Genes, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil.,Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | - Ursula Matte
- Laboratório de Células, Tecidos e Genes, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil.,Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Marcolino MS, Meira KC, Guimarães NS, Motta PP, Chagas VS, Kelles SMB, de Sá LC, Valacio RA, Ziegelmann PK. Systematic review and meta-analysis of ivermectin for treatment of COVID-19: evidence beyond the hype. BMC Infect Dis 2022; 22:639. [PMID: 35870876 PMCID: PMC9308124 DOI: 10.1186/s12879-022-07589-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/05/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The role of ivermectin in the treatment of COVID-19 is still under debate, yet the drug has been widely used in some parts of the world, as shown by impressive market data. The available body of evidence may have changed over the last months, as studies have been retracted and "standards of care" (SOC) used in control groups have changed with rapidly evolving knowledge on COVID-19. This review aims to summarize and critically appraise the evidence of randomized controlled trials (RCTs) of ivermectin, assessing clinical outcomes in COVID-19 patients. METHODS RCTs evaluating the effects of ivermectin in adult patients with COVID-19 were searched through June 22, 2022, in four databases, L.OVE platform, clinical trial registries and pre-prints platforms. Primary endpoints included all-cause mortality and invasive ventilation requirement. Secondary endpoint was the occurrence of adverse events. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Meta-analysis included only studies which compared ivermectin to placebo or SOC. Random-effects were used to pool the risk ratios (RRs) of individual trials. The quality of evidence was evaluated using GRADE. The protocol was register in PROSPERO (CRD42021257471). RESULTS Twenty-five RCTs fulfilled inclusion criteria (n = 6310). Of those, 14 compared ivermectin with placebo, in night ivermectin associated with SOC was compared to SOC and two studies compared ivermectin to an active comparator. Most RCTs had some concerns or high risk of bias, mostly due to lack of concealment of the randomization sequence and allocation, lack of blinding and high number of missing cases. Ivermectin did not show an effect in reducing mortality (RR = 0.76; 95%CI: 0.52-1.11) or mechanical ventilation (RR = 0.74; 95%CI: 0.48-1.16). This effect was consistent when comparing ivermectin vs. placebo, and ivermectin associated with SOC vs. SOC, as well as in sensitivity analysis. Additionally, there was very low quality of evidence regarding adverse effects (RR = 1.07; 95%CI: 0.84-1.35). CONCLUSIONS The evidence suggests that ivermectin does not reduce mortality risk and the risk of mechanical ventilation requirement. Although we did not observe an increase in the risk of adverse effects, the evidence is very uncertain regarding this endpoint.
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Affiliation(s)
- Milena Soriano Marcolino
- Department of Internal Medicine, Medical School and Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, sala 246, Belo Horizonte, 30130-100 Brazil
- Institute for Health Technology Assessment (IATS/CNPq), Rua Ramiro Barcelos, 2359, Prédio 21|Sala 507, Porto Alegre, Brazil
| | - Karina Cardoso Meira
- Health School, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, s/n-Lagoa Nova, Natal, Rio Grande do Norte, Brazil
| | - Nathalia Sernizon Guimarães
- Instituto de Saúde Coletiva da Universidade Federal da Bahia, R. Basílio da Gama, s/n-Canela, Salvador, Brazil
| | - Paula Perdigão Motta
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, R. Prof. Moacir Gomes de Freitas S/N-Pampulha, Belo Horizonte, Minas Gerais Brazil
| | - Victor Schulthais Chagas
- Department of Internal Medicine, Medical School and Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, sala 246, Belo Horizonte, 30130-100 Brazil
- Department of Medicine and Nursing, Universidade Federal de Viçosa, Av. Peter Henry Rolfs, University Campus, Viçosa, Brazil
| | - Silvana Márcia Bruschi Kelles
- Pontifícia Universidade Católica de Minas Gerais, R. do Rosário, 1.081 Bairro Angola, Betim, Brazil
- Unimed-BH, Belo Horizonte, MG Brazil
| | - Laura Caetano de Sá
- Department of Internal Medicine, Medical School and Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, sala 246, Belo Horizonte, 30130-100 Brazil
- Faculdade Ciências Médicas de Minas Gerais-FCMMG, Alameda Ezequiel Dias, Belo Horizonte, 275 Brazil
| | | | - Patrícia Klarmann Ziegelmann
- Institute for Health Technology Assessment (IATS/CNPq), Rua Ramiro Barcelos, 2359, Prédio 21|Sala 507, Porto Alegre, Brazil
- Epidemiology e Statistics Department, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, Porto Alegre, RS 2400 Brazil
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25
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Popp M, Reis S, Schießer S, Hausinger RI, Stegemann M, Metzendorf MI, Kranke P, Meybohm P, Skoetz N, Weibel S. Ivermectin for preventing and treating COVID-19. Cochrane Database Syst Rev 2022; 6:CD015017. [PMID: 35726131 PMCID: PMC9215332 DOI: 10.1002/14651858.cd015017.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Ivermectin, an antiparasitic agent, inhibits the replication of viruses in vitro. The molecular hypothesis of ivermectin's antiviral mode of action suggests an inhibitory effect on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in early stages of infection. Currently, evidence on ivermectin for prevention of SARS-CoV-2 infection and COVID-19 treatment is conflicting. OBJECTIVES To assess the efficacy and safety of ivermectin plus standard of care compared to standard of care plus/minus placebo, or any other proven intervention for people with COVID-19 receiving treatment as inpatients or outpatients, and for prevention of an infection with SARS-CoV-2 (postexposure prophylaxis). SEARCH METHODS We searched the Cochrane COVID-19 Study Register, Web of Science (Emerging Citation Index and Science Citation Index), WHO COVID-19 Global literature on coronavirus disease, and HTA database weekly to identify completed and ongoing trials without language restrictions to 16 December 2021. Additionally, we included trials with > 1000 participants up to April 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing ivermectin to standard of care, placebo, or another proven intervention for treatment of people with confirmed COVID-19 diagnosis, irrespective of disease severity or treatment setting, and for prevention of SARS-CoV-2 infection. Co-interventions had to be the same in both study arms. For this review update, we reappraised eligible trials for research integrity: only RCTs prospectively registered in a trial registry according to WHO guidelines for clinical trial registration were eligible for inclusion. DATA COLLECTION AND ANALYSIS We assessed RCTs for bias, using the Cochrane RoB 2 tool. We used GRADE to rate the certainty of evidence for outcomes in the following settings and populations: 1) to treat inpatients with moderate-to-severe COVID-19, 2) to treat outpatients with mild COVID-19 (outcomes: mortality, clinical worsening or improvement, (serious) adverse events, quality of life, and viral clearance), and 3) to prevent SARS-CoV-2 infection (outcomes: SARS-CoV-2 infection, development of COVID-19 symptoms, admission to hospital, mortality, adverse events and quality of life). MAIN RESULTS We excluded seven of the 14 trials included in the previous review version; six were not prospectively registered and one was non-randomized. This updated review includes 11 trials with 3409 participants investigating ivermectin plus standard of care compared to standard of care plus/minus placebo. No trial investigated ivermectin for prevention of infection or compared ivermectin to an intervention with proven efficacy. Five trials treated participants with moderate COVID-19 (inpatient settings); six treated mild COVID-19 (outpatient settings). Eight trials were double-blind and placebo-controlled, and three were open-label. We assessed around 50% of the trial results as low risk of bias. We identified 31 ongoing trials. In addition, there are 28 potentially eligible trials without publication of results, or with disparities in the reporting of the methods and results, held in 'awaiting classification' until the trial authors clarify questions upon request. Ivermectin for treating COVID-19 in inpatient settings with moderate-to-severe disease We are uncertain whether ivermectin plus standard of care compared to standard of care plus/minus placebo reduces or increases all-cause mortality at 28 days (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.14 to 2.51; 3 trials, 230 participants; very low-certainty evidence); or clinical worsening, assessed by participants with new need for invasive mechanical ventilation or death at day 28 (RR 0.82, 95% CI 0.33 to 2.04; 2 trials, 118 participants; very low-certainty evidence); or serious adverse events during the trial period (RR 1.55, 95% CI 0.07 to 35.89; 2 trials, 197 participants; very low-certainty evidence). Ivermectin plus standard of care compared to standard of care plus placebo may have little or no effect on clinical improvement, assessed by the number of participants discharged alive at day 28 (RR 1.03, 95% CI 0.78 to 1.35; 1 trial, 73 participants; low-certainty evidence); on any adverse events during the trial period (RR 1.04, 95% CI 0.61 to 1.79; 3 trials, 228 participants; low-certainty evidence); and on viral clearance at 7 days (RR 1.12, 95% CI 0.80 to 1.58; 3 trials, 231 participants; low-certainty evidence). No trial investigated quality of life at any time point. Ivermectin for treating COVID-19 in outpatient settings with asymptomatic or mild disease Ivermectin plus standard of care compared to standard of care plus/minus placebo probably has little or no effect on all-cause mortality at day 28 (RR 0.77, 95% CI 0.47 to 1.25; 6 trials, 2860 participants; moderate-certainty evidence) and little or no effect on quality of life, measured with the PROMIS Global-10 scale (physical component mean difference (MD) 0.00, 95% CI -0.98 to 0.98; and mental component MD 0.00, 95% CI -1.08 to 1.08; 1358 participants; high-certainty evidence). Ivermectin may have little or no effect on clinical worsening, assessed by admission to hospital or death within 28 days (RR 1.09, 95% CI 0.20 to 6.02; 2 trials, 590 participants; low-certainty evidence); on clinical improvement, assessed by the number of participants with all initial symptoms resolved up to 14 days (RR 0.90, 95% CI 0.60 to 1.36; 2 trials, 478 participants; low-certainty evidence); on serious adverse events (RR 2.27, 95% CI 0.62 to 8.31; 5 trials, 1502 participants; low-certainty evidence); on any adverse events during the trial period (RR 1.24, 95% CI 0.87 to 1.76; 5 trials, 1502 participants; low-certainty evidence); and on viral clearance at day 7 compared to placebo (RR 1.01, 95% CI 0.69 to 1.48; 2 trials, 331 participants; low-certainty evidence). None of the trials reporting duration of symptoms were eligible for meta-analysis. AUTHORS' CONCLUSIONS For outpatients, there is currently low- to high-certainty evidence that ivermectin has no beneficial effect for people with COVID-19. Based on the very low-certainty evidence for inpatients, we are still uncertain whether ivermectin prevents death or clinical worsening or increases serious adverse events, while there is low-certainty evidence that it has no beneficial effect regarding clinical improvement, viral clearance and adverse events. No evidence is available on ivermectin to prevent SARS-CoV-2 infection. In this update, certainty of evidence increased through higher quality trials including more participants. According to this review's living approach, we will continually update our search.
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Affiliation(s)
- Maria Popp
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Stefanie Reis
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Selina Schießer
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Renate Ilona Hausinger
- Department of Nephrology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Miriam Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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Yang S, Shen S, Hou N. Is Ivermectin Effective in Treating COVID-19? Front Pharmacol 2022; 13:858693. [PMID: 35800451 PMCID: PMC9253511 DOI: 10.3389/fphar.2022.858693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 was first discovered in December 2019 and subsequently became a global pandemic with serious political, economic, and social implications worldwide. We urgently need to find drugs that can be effective against COVID-19. Among the many observational studies, ivermectin has attracted the attention of many countries. Ivermectin is a broad-spectrum antiparasitic drug that also has some antiviral effects. We reviewed studies related to ivermectin for the treatment of COVID-19 over the last 2 years (2019.12–2022.03) via search engines such as PubMed, Web of Science, and EBSCOhost. Seven studies showed a lower mortality rate in the ivermectin group than in the control group, six studies found that the ivermectin group had a significantly fewer length of hospitalization than the control group, and eight studies showed better negative RT-PCR responses in the IVM group than in the control group. Our systematic review indicated that ivermectin may be effective for mildly to moderately ill patients. There is no clear evidence or guidelines to recommend ivermectin as a therapeutic agent for COVID-19, so physicians should use it with caution in the absence of better alternatives in the clinical setting, and self-medication is not recommended for patients.
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Affiliation(s)
- Shuangshuang Yang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Graduate Department, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
| | - Shan Shen
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ning Hou
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Ning Hou,
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Rezai MS, Ahangarkani F, Hill A, Ellis L, Mirchandani M, Davoudi A, Eslami G, Roozbeh F, Babamahmoodi F, Rouhani N, Alikhani A, Najafi N, Ghasemian R, Mehravaran H, Hajialibeig A, Navaeifar MR, Shahbaznejad L, Rahimzadeh G, Saeedi M, Alizadeh-Navai R, Moosazadeh M, Saeedi S, Razavi-Amoli SK, Rezai S, Rostami-Maskopaee F, Hosseinzadeh F, Movahedi FS, Markowitz JS, Valadan R. Non-effectiveness of Ivermectin on Inpatients and Outpatients With COVID-19; Results of Two Randomized, Double-Blinded, Placebo-Controlled Clinical Trials. Front Med (Lausanne) 2022; 9:919708. [PMID: 35783616 PMCID: PMC9244711 DOI: 10.3389/fmed.2022.919708] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/30/2022] [Indexed: 01/04/2023] Open
Abstract
Background Ivermectin which was widely considered as a potential treatment for COVID-19, showed uncertain clinical benefit in many clinical trials. Performing large-scale clinical trials to evaluate the effectiveness of this drug in the midst of the pandemic, while difficult, has been urgently needed. Methods We performed two large multicenter randomized, double-blind, placebo-controlled clinical trials evaluating the effectiveness of ivermectin in treating inpatients and outpatients with COVID-19 infection. The intervention group received ivermectin, 0.4mg/kg of body weight per day for 3 days. In the control group, placebo tablets were used for 3 days. Results Data for 609 inpatients and 549 outpatients were analyzed. In hospitalized patients, complete recovery was significantly higher in the ivermectin group (37%) compared to placebo group (28%; RR, 1.32 [95% CI, 1.04–1.66]; p-value = 0.02). On the other hand, the length of hospital stay was significantly longer in the ivermectin group with a mean of 7.98 ± 4.4 days compared to the placebo receiving group with a mean of 7.16 ± 3.2 days (RR, 0.80 [95% CI, 0.15–1.45]; p-value = 0.02). In outpatients, the mean duration of fever was significantly shorter (2.02 ± 0.11 days) in the ivermectin group versus (2.41 ± 0.13 days) placebo group with p value = 0.020. On the day seventh of treatment, fever (p-value = 0.040), cough (p-value = 0.019), and weakness (p-value = 0.002) were significantly higher in the placebo group compared to the ivermectin group. Among all outpatients, 7% in ivermectin group and 5% in placebo group needed to be hospitalized (RR, 1.36 [95% CI, 0.65–2.84]; p-value = 0.41). Also, the result of RT-PCR on day five after treatment was negative for 26% of patients in the ivermectin group versus 32% in the placebo group (RR, 0.81 [95% CI, 0.60–1.09]; p-value = 0.16). Conclusion Our data showed, ivermectin, compared with placebo, did not have a significant potential effect on clinical improvement, reduced admission in ICU, need for invasive ventilation, and death in hospitalized patients; likewise, no evidence was found to support the prescription of ivermectin on recovery, reduced hospitalization and increased negative RT-PCR assay for SARS-CoV-2 5 days after treatment in outpatients. Our findings do not support the use of ivermectin to treat mild to severe forms of COVID-19. Clinical Trial Registration www.irct.ir IRCT20111224008507N5 and IRCT20111224008507N4.
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Affiliation(s)
- Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- *Correspondence: Mohammad Sadegh Rezai,
| | - Fatemeh Ahangarkani
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, Liverpool University, Liverpool, United Kingdom
| | - Leah Ellis
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Manya Mirchandani
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Alireza Davoudi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Gohar Eslami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Roozbeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farhang Babamahmoodi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nima Rouhani
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Alikhani
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narges Najafi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mehravaran
- Department of Internal Medicine, Pulmonary and Critical Care Division, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Azin Hajialibeig
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Reza Navaeifar
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Shahbaznejad
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Golnar Rahimzadeh
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navai
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahab Saeedi
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Shaghayegh Rezai
- Department of Microbiology and Virology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Rostami-Maskopaee
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Hosseinzadeh
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - John S. Markowitz
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, United States
| | - Reza Valadan
- Department of Immunology and Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Shafiee A, Teymouri Athar MM, Kohandel Gargari O, Jafarabady K, Siahvoshi S, Mozhgani SH. Ivermectin under scrutiny: a systematic review and meta-analysis of efficacy and possible sources of controversies in COVID-19 patients. Virol J 2022; 19:102. [PMID: 35698151 PMCID: PMC9191543 DOI: 10.1186/s12985-022-01829-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/02/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to evaluate the efficacy of ivermectin for COVID-19 patients based on current peer-reviewed RCTs and to address disputes over the existing evidence. METHODS MEDLINE (Pubmed), Scopus, Web of Science, Cochrane library, Google scholar and Clinicaltrials.gov were searched for RCTs assessing the efficacy of Ivermectin up to 20 February 2022. A systematic review and meta-analysis of studies was performed based on the PRISMA 2020 statement criteria. RESULTS 19 and 17 studies were included in this systematic review and meta-analysis, respectively. There was no significant difference in progression to severe disease (log OR - 0.27 [95% CI - 0.61 to 0.08], I2 = 42.29%), negative RT-PCR (log OR 0.25 [95% CI - 0.18-0.68], I2 = 58.73%), recovery (log OR 0.11 [95% CI - 0.22-0.45], I2 = 13.84%), duration of hospitalization (SMD - 0.40 [95% CI - 0.85-0.06], I2 = 88.90%), time to negative RT-PCR (SMD - 0.36 [95% CI - 0.89-0.17], I2 = 46.2%), and viral load (SMD -0.17 [95% CI -0.45 to 0.12], I^2 = 0%). It is worth noting that, based on low-certainty evidence, ivermectin may possibly reduce mortality (log OR - 0.67 [95% CI - 1.20 to - 0.13], I2 = 28.96%). However, studies with a higher risk of bias were more likely to indicate positive effects on the efficacy of this drug, according to our subgroup analyses based on study quality. CONCLUSION Ivermectin did not have any significant effect on outcomes of COVID-19 patients and as WHO recommends, use of ivermectin should be limited to clinical trials.
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Affiliation(s)
- Arman Shafiee
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Kyana Jafarabady
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Sepehr Siahvoshi
- Dental Materials Research Center, Dental School, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Sayed-Hamidreza Mozhgani
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
- Non-Communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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Desantis J, Felicetti T, Cannalire R. An overview on small molecules acting as broad spectrum-agents for yellow fever infection. Expert Opin Drug Discov 2022; 17:755-773. [PMID: 35638299 DOI: 10.1080/17460441.2022.2084529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Yellow Fever virus (YFV) is a mosquito-borne flavivirus, endemic in 47 countries in Africa and South America, which causes febrile symptoms that can evolve in 15% of the patients to serious haemorrhagic conditions, liver injury, and multiorgan failure. Although a highly effective vaccine (YF-17D vaccine) is available, to date, no antiviral drugs have been approved for the prevention and treatment of YFV infections. AREAS COVERED This review article focuses on the description of viral targets that have been considered within YFV and flavivirus drug discovery studies and on the most relevant candidates reported so far that elicit broad-spectrum inhibition against relevant strains and mutants of YFV. EXPERT OPINION Considering the growing interest on (re)emerging vector-borne viral infections, it is expected that flavivirus drug discovery will quickly deliver potential candidates for clinical evaluation. Due to similarity among flaviviral targets, several candidates identified against different flaviviruses have shown broad-spectrum activity, thus exhibiting anti-YFV activity, as well. In this regard, it would be desirable to routinely include the assessment of antiviral activity against different YFV strains. On the other hand, the development of host targeting agents are still at an initial stage and deserve further focused efforts.
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Affiliation(s)
- Jenny Desantis
- Department of Chemistry, Biology, and Biotechnology, University of Perugia, Via Elce di Sotto 8, 06123, Perugia, Italy
| | - Tommaso Felicetti
- Department of Pharmaceutical Sciences, University of Perugia, Via del Liceo 1, 06123, Perugia, Italy
| | - Rolando Cannalire
- Department of Pharmacy, University of Napoli "Federico II", Via D. Montesano 49, 80131, Napoli, Italy
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Farah R, Kazzi Z, Brent J, Burkhart K, Wax P, Aldy K. Ivermectin associated adverse events in the treatment and prevention of COVID-19 reported to the FACT pharmacovigilance project. Clin Toxicol (Phila) 2022; 60:942-946. [PMID: 35535587 DOI: 10.1080/15563650.2022.2070187] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In August 2021, the Centers for Disease Control and Prevention (CDC) released a health alert following the rapid increase in ivermectin prescriptions and reports of severe illness associated with use of products containing ivermectin for the prevention or treatment of COVID-19 infections. The United States Food and Drug Administration (FDA) and the CDC have explicitly discouraged the use of ivermectin in the prevention or treatment of COVID-19 outside of clinical trials. The study aims to describe the adverse events (AEs) related to ivermectin use for the prevention or treatment of COVID-19. METHODS This is a prospective case series of adverse events related to therapeutics used in the prevention or treatment of COVID-19 submitted to the FDA ACMT COVID-19 ToxIC (FACT) Pharmacovigilance Project sub-registry between October 2020 and December 2021. This is an ongoing toxico-surveillance system at 15 major academic medical centers in 12 states. Data collected included sociodemographics, exposure related information including dose, frequency, route, duration, and reason for taking ivermectin as well as a clinical description of the adverse event and the outcome. RESULTS A total of 40 patients who developed AEs following ivermectin use were reported to FACT over 15 months. Self-medication with veterinary formulations were reported in 18/40 patients Thirty-three patients presented to emergency departments and nineteen patients were admitted to the hospital. Patients reported using ivermectin for prevention (24/40), treatment of symptoms (19/40), and for treatment of documented COVID-19 (8/40). Neurological toxicity was the most frequent finding. Fifteen patients had minor symptoms while 25 developed severe toxicity. CONCLUSIONS Ivermectin use for the attempted treatment of COVID-19 has potential adverse health effects primarily related to neurological function. This is especially true when patients are self-treating with this medication and when they are using formulations intended for non-human use.
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Affiliation(s)
- Rita Farah
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA.,Georgia Poison Center, Atlanta, GA, USA
| | - Ziad Kazzi
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA.,Georgia Poison Center, Atlanta, GA, USA
| | - Jeffrey Brent
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Keith Burkhart
- United States Food and Drug Administration, Rockville, MD, USA
| | - Paul Wax
- American College of Medical Toxicology, Phoenix, AZ, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kim Aldy
- American College of Medical Toxicology, Phoenix, AZ, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
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- American College of Medical Toxicology, Phoenix, AZ, USA
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Zhang Y, Sun T, Li M, Lin Y, Liu Y, Tang S, Dai C. Ivermectin-Induced Apoptotic Cell Death in Human SH-SY5Y Cells Involves the Activation of Oxidative Stress and Mitochondrial Pathway and Akt/mTOR-Pathway-Mediated Autophagy. Antioxidants (Basel) 2022; 11:antiox11050908. [PMID: 35624772 PMCID: PMC9137967 DOI: 10.3390/antiox11050908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 12/19/2022] Open
Abstract
Ivermectin (IVM) could cause potential neurotoxicity; however, the precise molecular mechanisms remain unclear. This study explores the cytotoxicity of IVM in human neuroblastoma (SH-SY5Y) cells and the underlying molecular mechanisms. The results show that IVM treatment (2.5–15 μM) for 24 h could induce dose-dependent cell death in SH-SY5Y cells. Compared to the control, IVM treatment significantly promoted the production of ROS, mitochondrial dysfunction, and cell apoptosis. IVM treatment also promoted mitophagy and autophagy, which were charactered by the decreased expression of phosphorylation (p)-Akt and p-mTOR proteins, increased expression of LC3II, Beclin1, ATG5, PINK, and Pakin1 proteins and autophagosome formation. N-acetylcysteine treatment significantly inhibited the IVM-induced production of ROS and cell death in SH-SY5Y cells. Autophagy inhibitor (e.g., 3-methyladenine) treatment significantly inhibited IVM-induced autophagy, oxidative stress, and cell apoptosis. Taken together, our results reveal that IVM could induce autophagy and apoptotic cell death in SH-SY5Y cells, which involved the production of ROS, activation of mitochondrial pathway, and inhibition of Akt/mTOR pathway. Autophagy inhibition improved IVM-induced oxidative stress and apoptotic cell death in SH-SY5Y cells. This current study provides new insights into understanding the molecular mechanism of IVM-induced neurotoxicity and facilitates the discovery of potential neuroprotective agents.
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Affiliation(s)
- Yuan Zhang
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China; (Y.Z.); (T.S.); (M.L.); (Y.L.); (Y.L.)
| | - Tun Sun
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China; (Y.Z.); (T.S.); (M.L.); (Y.L.); (Y.L.)
| | - Meng Li
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China; (Y.Z.); (T.S.); (M.L.); (Y.L.); (Y.L.)
| | - Yanling Lin
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China; (Y.Z.); (T.S.); (M.L.); (Y.L.); (Y.L.)
| | - Yue Liu
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China; (Y.Z.); (T.S.); (M.L.); (Y.L.); (Y.L.)
| | - Shusheng Tang
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China; (Y.Z.); (T.S.); (M.L.); (Y.L.); (Y.L.)
- Beijing Key Laboratory of Detection Technology for Animal-Derived Food Safety, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
- Correspondence: (S.T.); (C.D.)
| | - Chongshan Dai
- College of Veterinary Medicine, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing 100193, China; (Y.Z.); (T.S.); (M.L.); (Y.L.); (Y.L.)
- Beijing Key Laboratory of Detection Technology for Animal-Derived Food Safety, College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
- Key Biology Laboratory of Chinese Veterinary Medicine, Ministry of Agriculture and Rural Affairs, Beijing 100193, China
- Correspondence: (S.T.); (C.D.)
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32
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Bomze D, Sprecher E, Geller S. Severe cutaneous adverse reactions associated with systemic ivermectin: A pharmacovigilance analysis. J Dermatol 2022; 49:769-774. [PMID: 35475524 PMCID: PMC9111106 DOI: 10.1111/1346-8138.16398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
Despite poor evidence, the antiparasitic ivermectin has been advocated as a potential COVID-19 therapy. This has led to a rise in calls to poison-control centers by people self-medicating with ivermectin, which is sold over the counter for veterinary uses. We aimed to investigate the association between severe cutaneous adverse reactions (SCARs) and ivermectin. Postmarketing data from the FDA Adverse Event Reporting System (FAERS), gathered between 2014 and 2021, was employed to detect disproportional signals of SCARs following systemic ivermectin therapy. The reporting odds ratio (ROR) was used to quantify the strength of association, while adjusting for age, sex, and region. The search yielded 517 reports of systemic ivermectin (median age 54 years, 46.8% female), of which 25 (4.8%), 81 (15.7%), and 411 (79.5%) were classified as SCARs, nonsevere cutaneous adverse events (AEs), or noncutaneous AEs, respectively. The regional distribution differed between SCAR reports (32.0% from Africa and 12.0% from North America) compared with other AEs, which originated from North America in over half of cases. The most common SCARs were toxic epidermal necrolysis (seven cases), Stevens-Johnson syndrome (seven cases), and drug reaction with eosinophilia and systemic symptoms (four cases). Five SCAR cases (20.0%) resulted in death and 12 (48.0%) lead to hospitalization. There was a strong safety signal for any SCAR (adjusted ROR 3.34, 95% confidence interval [CI] 2.17-5.12) and toxidermias (adjusted ROR 7.08, 95% CI 4.23-11.84). This study suggests that ivermectin is associated with SCARs on rare occasions. Dermatologists should be aware of this given the increase in ivermectin misuse.
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Affiliation(s)
- David Bomze
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Shamir Geller
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
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Drug Repurposing for COVID-19: A Review and a Novel Strategy to Identify New Targets and Potential Drug Candidates. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27092723. [PMID: 35566073 PMCID: PMC9099573 DOI: 10.3390/molecules27092723] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 02/01/2023]
Abstract
In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) was first identified in the province of Wuhan, China. Since then, there have been over 400 million confirmed cases and 5.8 million deaths by COVID-19 reported worldwide. The urgent need for therapies against SARS-CoV-2 led researchers to use drug repurposing approaches. This strategy allows the reduction in risks, time, and costs associated with drug development. In many cases, a repurposed drug can enter directly to preclinical testing and clinical trials, thus accelerating the whole drug discovery process. In this work, we will give a general overview of the main developments in COVID-19 treatment, focusing on the contribution of the drug repurposing paradigm to find effective drugs against this disease. Finally, we will present our findings using a new drug repurposing strategy that identified 11 compounds that may be potentially effective against COVID-19. To our knowledge, seven of these drugs have never been tested against SARS-CoV-2 and are potential candidates for in vitro and in vivo studies to evaluate their effectiveness in COVID-19 treatment.
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García-Lledó A, Gómez-Pavón J, González Del Castillo J, Hernández-Sampelayo T, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, Bouza E. Pharmacological treatment of COVID-19: an opinion paper. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:115-130. [PMID: 34894208 PMCID: PMC8972693 DOI: 10.37201/req/158.2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Deng J, Heybati K, Hou W, Zuo QK. Safety cannot justify the use of ivermectin for the management of COVID-19. QJM 2022; 115:194-195. [PMID: 35080630 DOI: 10.1093/qjmed/hcac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Deng
- From the Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - K Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - W Hou
- From the Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Q K Zuo
- Department of Anesthesiology, Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC H3A 0G5, Canada
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Abstract
Introduction: Avermectins are common antiparasitic drugs, derived from Streptomyces bacteria that exhibit activity against arthropods and nematodes. Ivermectin, an avermectin derivative, is used as a treatment for parasitic infections in humans and domesticated animals.Discussion: Ivermectin's mechanism of action involves binding to ligand-gated ion channel receptors including glutamate, GABA, and glycine, resulting in parasitic paralysis and death. Due to varying expression of these ion channel receptors in vertebrate species, ivermectin toxicity is rarely reported in mammals. Ivermectin is also a substrate for P-glycoprotein, which limits its neurological toxicity in humans. Genetic polymorphisms in P-glycoprotein or coadministration of P-glycoprotein inhibitors may increase the neurotoxicity of ivermectin. Other toxic effects of ivermectin after therapeutic oral use include edema, rash, headache, and ocular complaints. Most of these effects are mild and short in duration. Ivermectin exhibits antiviral effects in-vitro at very high concentrations. This has led to suggestions of ivermectin as a potential treatment for SARS-CoV-2 (COVID-19) infection, although the drug's pharmacokinetic parameters reduce the likelihood that high concentrations of the drug can be achieved in-vivo.Conclusion: Due to concern for adverse events, specifically neurotoxicity, as well as a paucity of supporting evidence, the use of ivermectin as a routine treatment or preventive measure for COVID-19 infection is not recommended at this time.
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Affiliation(s)
- Kelly Johnson-Arbor
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.,National Capital Poison Center, Washington, DC, USA
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Kountouras J, Gialamprinou D, Kotronis G, Papaefthymiou A, Economidou E, Soteriades ES, Vardaka E, Chatzopoulos D, Tzitiridou-Chatzopoulou M, Papazoglou DD, Doulberis M. Ofeleein i mi Vlaptin-Volume II: Immunity Following Infection or mRNA Vaccination, Drug Therapies and Non-Pharmacological Management at Post-Two Years SARS-CoV-2 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:309. [PMID: 35208631 PMCID: PMC8874934 DOI: 10.3390/medicina58020309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/06/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022]
Abstract
The persistence of the coronavirus disease 2019 (COVID-19) pandemic has triggered research into limiting transmission, morbidity and mortality, thus warranting a comprehensive approach to guide balanced healthcare policies with respect to people's physical and mental health. The mainstay priority during COVID-19 is to achieve widespread immunity, which could be established through natural contact or vaccination. Deep knowledge of the immune response combined with recent specific data indicates the potential inferiority of induced immunity against infection. Moreover, the prevention of transmission has been founded on general non-pharmacological measures of protection, albeit debate exists considering their efficacy and, among other issues, their socio-psychological burden. The second line of defense is engaged after infection and is supported by a plethora of studied agents, such as antibiotics, steroids and non-steroid anti-inflammatory drugs, antiviral medications and other biological agents that have been proposed, though variability in terms of benefits and adverse events has not allowed distinct solutions, albeit certain treatments might have a role in prevention and/or treatment of the disease. This narrative review summarizes the existing literature on the advantages and weaknesses of current COVID-19 management measures, thus underlining the necessity of acting based on the classical principle of "ofeleein i mi vlaptin", that is, to help or not to harm.
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Affiliation(s)
- Jannis Kountouras
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
| | - Dimitra Gialamprinou
- Second Neonatal Department and NICU, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Central Macedonia, Greece;
| | - Georgios Kotronis
- Department of Internal Medicine, General Hospital Aghios Pavlos of Thessaloniki, 55134 Thessaloniki, Central Macedonia, Greece;
| | - Apostolis Papaefthymiou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Department of Gastroenterology, University Hospital of Larisa, Mezourlo, 41110 Larisa, Thessaly, Greece
| | - Eleftheria Economidou
- School of Economics and Management, Healthcare Management Program, Open University of Cyprus, Nicosia 12794, Cyprus; (E.E.); (E.S.S.)
| | - Elpidoforos S. Soteriades
- School of Economics and Management, Healthcare Management Program, Open University of Cyprus, Nicosia 12794, Cyprus; (E.E.); (E.S.S.)
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA 02115, USA
| | - Elisabeth Vardaka
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Central Macedonia, Greece
| | - Dimitrios Chatzopoulos
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
| | - Maria Tzitiridou-Chatzopoulou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Midwifery Department, School of Healthcare Sciences, University of West Macedonia, Koila, 50100 Kozani, Central Macedonia, Greece
| | - Dimitrios David Papazoglou
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Michael Doulberis
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
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High dose ivermectin for the early treatment of COVID-19 (COVER study): a randomised, double-blind, multicentre, phase II, dose-finding, proof of concept clinical trial. Int J Antimicrob Agents 2022; 59:106516. [PMID: 34999239 PMCID: PMC8734085 DOI: 10.1016/j.ijantimicag.2021.106516] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 12/01/2022]
Abstract
High concentrations of ivermectin demonstrated antiviral activity against SARS-CoV-2 in vitro. The aim of this study was to assess the safety and efficacy of high-dose ivermectin in reducing viral load in individuals with early SARS-CoV-2 infection. This was a randomised, double-blind, multicentre, phase II, dose-finding, proof-of-concept clinical trial. Participants were adults recently diagnosed with asymptomatic/oligosymptomatic SARS-CoV-2 infection. Exclusion criteria were: pregnant or lactating women; CNS disease; dialysis; severe medical condition with prognosis <6 months; warfarin treatment; and antiviral/chloroquine phosphate/hydroxychloroquine treatment. Participants were assigned (ratio 1:1:1) according to a randomised permuted block procedure to one of the following arms: placebo (arm A); single-dose ivermectin 600 μg/kg plus placebo for 5 days (arm B); and single-dose ivermectin 1200 μg/kg for 5 days (arm C). Primary outcomes were serious adverse drug reactions (SADRs) and change in viral load at Day 7. From 31 July 2020 to 26 May 2021, 32 participants were randomised to arm A, 29 to arm B and 32 to arm C. Recruitment was stopped on 10 June because of a dramatic drop in cases. The safety analysis included 89 participants and the change in viral load was calculated in 87 participants. No SADRs were registered. Mean (S.D.) log10 viral load reduction was 2.9 (1.6) in arm C, 2.5 (2.2) in arm B and 2.0 (2.1) in arm A, with no significant differences (P = 0.099 and 0.122 for C vs. A and B vs. A, respectively). High-dose ivermectin was safe but did not show efficacy to reduce viral load.
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Rothrock SG, Weber KD, Giordano PA, Barneck MD. Meta-Analyses Do Not Establish Improved Mortality With Ivermectin Use in COVID-19. Am J Ther 2022; 29:e87-e94. [DOI: 10.1097/mjt.0000000000001461] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Campillo JT, Faillie JL. Adverse drug reactions associated with ivermectin use for COVID-19 reported in the World Health Organization's pharmacovigilance database. Therapie 2022; 77:747-749. [PMID: 35606189 PMCID: PMC9020491 DOI: 10.1016/j.therap.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/31/2022] [Accepted: 03/14/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Jeremy T Campillo
- Department of medical pharmacology and toxicology, CHU Montpellier, 34000 Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France.
| | - Jean-Luc Faillie
- Department of medical pharmacology and toxicology, CHU Montpellier, 34000 Montpellier, France; IDESP-UMR UA11 Inserm, université de Montpellier, 34000 Montpellier, France
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Re: “Commentary” by Rothrock et al. “Meta-Analyses Did Not Establish Improved Mortality With Ivermectin Use in COVID-19”. Am J Ther 2021; 29:e233-e237. [DOI: 10.1097/mjt.0000000000001465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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