Better Data on Ivermectin Is Finally on Its Way

Yet ivermectin is still a big deal in the US. Prescriptions spiked to nearly 100,000 in August, 20 times their pre-pandemic level. Talk show hosts, right-wing propagandists, and some physicians are still claiming that the drug is miraculously effective. Shortages and lack of access to prescriptions have led some people to turn to the more readily available veterinary formulations of the drug—horse and cow deworming agents. That’s dangerous, to be sure, though perhaps not enough people actually did it to warrant an unusual amount of snark from a federal agency warning against interspecies self-medication.

All this confusion and misinformation filled what has been an information vacuum. No one had rock-solid data on cheap, workhorse drugs to fight “mild” outpatient Covid. The need for them became apparent early in the pandemic, and it hasn’t gone away. Vaccines are powerful armor against the virus, but money, policy, and logistics mean most of the world can’t get them, and pockets of political opposition and structural obstacles remain in wealthier countries like the United States. Combine that real need with snake-oil grifterism and political opportunism and you get crazes like this one for ivermectin or last year’s for hydroxychloroquine (which mostly faded when big randomized trials like Recovery in England and another at the University of Minnesota found that it had no effect , and doctors stopped prescribing it). Maybe hydroxychloroquine’s journey will be a template. “There was noise on both sides in terms of, is it a cure-all or does it have safety issues? But when the Recovery trial came out with a rigorous, definitive answer of ‘No, it doesn’t work,’ everything quieted down,” says Hernandez. “That’s the crisis. We haven’t had a national system that can rigorously evaluate these in a rapid fashion. That’s kind of what we need now to address the ivermectin question, a definitive answer to ‘does it work or not?’”In North America, trials to get those answers have begun. The Together trial is an adaptive, multi-arm trial —which means it enrolls people on an ongoing basis and uses statistical techniques to swap drugs in and out as they either succeed or fail. Besides helping dispatch hydroxychloroquine, the Together trial has now similarly shown that the antidiabetes (and sometimes anti-aging) drug metformin doesn’t make much of a difference, either.But political activists didn’t turn metformin into a rhetorical tool; ivermectin has stans so aggressive they make Gamergaters seem chill. Mills says he and his colleagues have been abused and threatened by ivermectin adherents; the trial designers even went through the rigorous process of changing the dosage administered to comport better to the fans’ preferred regimen of three days instead of just one. “We tested, what, seven other drugs? Nobody abuses us about the other drugs. We even showed one of them worked,” Mills tells me. His team touted positive results for fluvoxamine, “and that crowd doesn’t seem to care. If you ask them, ‘Why do you feel so strongly about ivermectin?’ they will say, ‘Because we feel there should be a cheap, effective drug that can be used by poor people.’ OK, well, we have that. We have it with fluvoxamine, and with inhaled budesonide. Why do they not care about those drugs? They don’t have an answer. They just want to talk about ivermectin.”I’ve written about this problem before . Since the pandemic began, physicians and researchers have launched hundreds of trials for Covid-19 drugs, involving thousands of volunteer participants. But drug trials are complicated and expensive. Taken individually, few of those trials had the rigorous design or statistical power to give results robust enough to change the standard of care. A few did, of course. The drug remdesivir—in a trial partially supported by a pharma company—showed some success. Expensive monoclonal antibodies (touted by Florida governor Ron DeSantis as an alternative to vaccines or masks) were hits, too. But a health care worker has to administer them. “There was this notion of a 1,000 flowers blooming, all these individual sites doing local trials. But there was no integration of those, so you couldn’t generate answers that would change guidelines,” Hernandez says.