[HN Gopher] Study findings do not support the use of ivermectin ...
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       Study findings do not support the use of ivermectin for patients
       with Covid-19
        
       Author : barbazoo
       Score  : 59 points
       Date   : 2022-02-18 20:47 UTC (2 hours ago)
        
 (HTM) web link (jamanetwork.com)
 (TXT) w3m dump (jamanetwork.com)
        
       | phlipski wrote:
       | I look forward to the study confirming that Yes - the Earth is
       | still round...
        
       | JackOfCrows wrote:
        
       | [deleted]
        
       | roenxi wrote:
       | It is good that people are doing studies, but at this point
       | adding one more study isn't really headline news so I'm not sure
       | what the up-voters think this will show. There isn't really a
       | need for more evidence as far as I'm aware.
       | 
       | What is far more interesting and useful is explanations of _why_
       | there are a bunch of studies showing great COVID outcomes when
       | patients are paired with Ivermectin (eg, https://ivmmeta.com/).
       | The best answer I've heard is the geographic distribution of
       | successful studies lines up with parasite-prone countries, so
       | they are actually an interesting example of the base-rate effect.
        
         | arn wrote:
         | Many of the early studies weren't high quality studies. And as
         | I recall a couple were outright fabricated. It takes time to
         | run randomized prospective studies and those are coming out
         | now.
        
         | ayngg wrote:
         | I think the difference is that in places where ivermectin had
         | efficacy (India, Sub Saharan Africa, South America), parasitic
         | infection was a significant comorbidity. In much of the
         | developed world, the most significant comorbidities are things
         | like obesity and age (with all of its associated pulmonary and
         | respiratory risks).
        
         | ggm wrote:
         | So in laymans terms, enough people had untreated and
         | undiagnosed parasitic infections that "they got better" was
         | curing an undiagnosed comorbidity to a positive C19 and since
         | the parasite causes high risk problems eg with kidneys or
         | pulmonary risk or breathing, it helped them survive.
         | 
         | Is that it?
        
           | jasonhansel wrote:
           | It's also that treatment with dexamethasone may be dangerous
           | in patients with preexisting Strongyloides infections. Astral
           | Codex Ten has an (admittedly rather speculative) take on
           | this: https://astralcodexten.substack.com/p/ivermectin-much-
           | more-t...
        
       | smm11 wrote:
       | More than two years, and still ...
        
       | evilpotatoes wrote:
       | They also didn't start treatment until 7 days post symptoms.
        
       | ggrothendieck wrote:
       | If we look at the secondary endpoints note that 3x as many died
       | in the control group, 2.5x as many needed mechanical ventilation
       | and one third more need to go to the ICU.
       | Ivermectin   Control       n         247          249       Mech
       | vent   4           10       ICU         6            8       Died
       | 3           10
       | 
       | These may not have been primary endpoints and may not have been
       | statistically significant but it does raise the question of
       | whether they would have been significant had a larger sample size
       | been used.
        
         | PragmaticPulp wrote:
         | Once you start dealing with small numbers (e.g. 2% versus 3%)
         | then you would need far, far more patients to reach statistical
         | significance.
         | 
         | It's tempting to look at things like 8 people visiting the ICU
         | in one group but only 6 people in the other group and see that
         | 6 < 8, but the problem is that it's too small of a sample size
         | to decide if it's significant. The article covers that:
         | 
         | > There were no significant differences between ivermectin and
         | control groups for all the prespecified secondary outcomes
         | 
         | The only one that _almost_ comes close is death rate:
         | 
         | > The 28-day in-hospital mortality rate was similar for the
         | ivermectin and control groups (3 [1.2%] vs 10 [4.0%]; RR, 0.31;
         | 95% CI, 0.09 to 1.11; P = .09)
         | 
         | If this was the only Ivermectin study out there, it would be
         | worth following up on. But it's not, and when this is added to
         | the rest of the (not-retracted) studies it doesn't really
         | change the picture.
         | 
         | At this point it matters less and less anyway. Countries that
         | already tried Ivermectin at scale are starting to abandon the
         | approach. Legitimately effective COVID drugs like Paxlovid with
         | highly significant differences are becoming readily available.
         | It's time to stop grasping at straws and accept that it doesn't
         | work.
        
       | sinyug wrote:
       | Does any study ever suggest that a $0.10 drug with expired
       | patents is better than the new and patented $30 alternative? If
       | so which benevolent pharmaceutical company funds such studies?
       | 
       | Between doctors prescribing specific medicine "brands" when
       | generic alternatives are available, insurance companies denying
       | perfectly valid claims and forcing you to challenge their
       | decisions in tribunals and similar venues, and pharmaceutical
       | companies engaging in questionable behavior,[1] I am very
       | reluctant to trust anything championed by this unholy nexus.
       | 
       | [1] There is a multivitamin product from Bayer called Supradyn
       | that I have been using for years. Last year, the company changed
       | the formulation and halved the doses of most of the ingredients
       | while increasing the price by 50% resulting in an effective price
       | increase of 300%.
        
         | wombatpm wrote:
         | Aspirin regimen for cardiovascular event prevention as an
         | example of a cheap drug studied extensively.
        
           | sinyug wrote:
           | > Aspirin
           | 
           | Good example. It would be a pleasant surprise to find out
           | that these studies were funded by pharma companies.
        
         | danielmg wrote:
         | If it worked, they'd study it to find out what the interaction
         | was or if it was a metabolite that carried the action. Then
         | they'd develop a targetted version of that drug, patent it, and
         | cash in _.
         | 
         | It doesn't work. So they haven't.
         | 
         | _A good example is major clinical depression and ketamine.
        
         | barbazoo wrote:
         | > Does any study ever suggest that a $0.10 drug with expired
         | patents is better than the new and patented $30 alternative? If
         | so which benevolent pharmaceutical company funds such studies?
         | 
         | I hear this a lot to explain the lack of studies. What about
         | this one here though? Isn't this finally a conclusive study
         | debunking all the claims saying Ivermectin alone is a good
         | prevention/treatment for COVID-19?
        
         | armchair_ wrote:
         | Better than an alternative? Probably not. Worth using at all?
         | Sure, if the data supports that conclusion. In particular, a
         | lot of labs have been trying a wide variety of drugs to see if
         | any have efficacy against covid. Ivermectin... just doesn't.
         | 
         | Here are three meta-analyses indicating that an SSRI with an
         | expired patent (fluvoxamine) is potentially effective at
         | reducing hospitalization rates for covid:
         | 
         | https://www.thelancet.com/journals/langlo/article/PIIS2214-1...
         | https://www.medrxiv.org/content/10.1101/2021.12.17.21268008v...
         | https://pubmed.ncbi.nlm.nih.gov/35118917/
        
         | robbiep wrote:
         | Not all investigations like this are funded by drug companies.
         | 
         | For example, and as a perfectly balanced counterpoint to the
         | one you are trying to make about ivermectin, dexamethasone was
         | rapidly identified as a cheap, easily available, out of patent
         | medication that significantly reduces morbidity and mortality
         | in covid hospitalised patients early in the pandemic by NHS
         | doctors
        
       | prohobo wrote:
       | I don't understand why Japan, India, and parts of Brazil are
       | using ivermectin to treat covid then. Are they just hoping for
       | the best?
        
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       (page generated 2022-02-18 23:01 UTC)