How the totality of evidence for ivermectin informs clinical practice

Colleen Aldous, Professor for Medical Research, University of KwaZulu-Natal explains how the evidence supporting the use of ivermectin for covid-19 came together to tell a compelling story.

In 2020 a study from Australia reported that ivermectin kills the virus in a Petri dish (in vitro). Some commentators said that the concentrations of the drug were too high and could not be reached in the body (in vivo), however, the study was not designed to determine doses, notes Professor Aldous.  At that time dosage regimens for scabies were already established and another study showed that high doses were tolerable.

Next came reports of clinical experience from front-line physicians. “I worked with Dr Jackie Stone – we looked at a number of her patients where she was able to show how quickly the oxygen saturations improved as soon as she started her patients on an ivermectin containing regimen. ….  We had the same results from [Dr] Sabine Hazan in Malibu in the [United] States and from Dr Babalola in Nigeria.  So, the results of that study were basically repeated”, explains Professor Aldous.

This confirmed that ivermectin worked in clinical practice and could rapidly restore normal oxygen saturation.  The next step was to find out why this happened. A study by Boschi showed that covid viruses caused haemagglutination (micro-clotting). Adding ivermectin reversed the micro-clotting and pre-treatment of blood with ivermectin prevented micro-clotting. “So how does this explain what happened in Jackie’s clinic? Clearly, if you’ve got red blood cells clumping together they’re not going to be able to carry  the blood around. You’re going to get micro-clots forming, the lungs are not going to be able to work [if] you’ve got all this hemagglutination happening. If you give the patient ivermectin those little clots start to disperse …. the red blood cells can now carry on doing their job”, explains Professor Aldous.

In summary, Professor Aldous says: “So, now what do we have? We have a clinical observational paper, we have a laboratory experiment done right in the beginning, a more sophisticated laboratory experiment much later with more variants, not just the Wuhan variant. Now, finally, we’ve got the Medincell experiment which shows ivermectin definitely does prevent people from getting covid, so, if you look at the totality of evidence, you’re able to come to conclusions that will inform clinical practice.”

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