Articles
Related articles in EMJ
Letter to the Editor
Ivermectin Treatment for COVID-19 ENG
Department of Internal Medicine, JCHO Hokkaido Hospital, Sapporo, Japan
Correspondence to:This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ewha Med J 2021; 44(4): 146-147
Published October 31, 2021 https://doi.org/10.12771/emj.2021.44.4.146
Copyright © Ewha Womans University School of Medicine.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak that originated in late 2019 has become a serious global threat to human health. Presently, there are no drugs approved to combat the disease (coronavirus disease 2019, COVID-19). Therefore, it is important to find effective drugs against COVID-19 and to conduct clinical trials of these drugs. Drug repurposing is a well-known strategy applied to redeploy existing licensed drugs for newer indications, thereby providing the quickest possible transition from bench to bedside for meeting therapeutic needs. At present, several existing licensed drugs such as tetracycline (e.g., doxycycline), macrolide antibiotics (e.g., azithromycin), corticosteroids (e.g., prednisolone and dexamethasone), and IL-6 inhibitor (e.g., tocilizumab), have been used because of their potential efficacy in inhibiting COVID-19. Recently, the anti-SARS-CoV-2 effects of macrolide antiparasitics (e.g., ivermectin, IVM) have attracted considerable attention.
IVM is also an inhibitor of SARS-CoV-2, with a single treatment causing approximately 5,000-fold reduction in the virus at 48 hours in cell culture [1]. The mechanism by which IVM inhibits SARS-CoV-2 is thought to be via the inhibition of the nuclear import of viral and host proteins. Importin
Regarding IVM treatment for mild and moderate COVID-19, Ahmed et al. [4] reported that a 5-day course of IVM (12 mg daily) for COVID-19 reduced the duration of the illness. Prasad [5] reported a case of COVID-19 with pulmonary lesion successfully treated with the early administration of IVM (6 mg twice daily for 3 days), azithromycin (500 mg daily for 5 days), doxycycline (100 mg twice daily for 5 days), and prednisolone (50 mg daily for 5 days) followed by dexamethasone (6 mg daily).
COVID-19 is characterized by early exponential viral replication, cytokine-associated organ damage, and thrombosis. Severe COVID-19 involves this cytokine-associated organ damage, including acute respiratory distress syndrome (ARDS). Elevated levels of blood IL-6, IL-8, IL-10, and TNF-α were noted in COVID-19–induced ARDS [6]. COVID-19–induced ARDS was reported to be effectively treated with cytokine suppression, using a combination of IVM (12 mg single dose) and tocilizumab (240 mg single dose) [7]. Rajter et al. [8] reported that additional IVM (200
Taken together, treatment with IVM alone or in combination with other drugs may show efficacy in COVID-19 in mild to severe stages and may be beneficial throughout the course of COVID-19.
In any case, clinical trials need to be conducted to better assess the optimal doses and durations as well as the efficacy and tolerability of these treatments before they can be adopted on a wider basis.
References
- Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2
in vitro .Antiviral Res 2020;178:104787. - Lehrer S, Rheinstein PH. Ivermectin docks to the SARS-CoV-2 spike receptor-binding domain attached to ACE2.
In Vivo 2020;34:3023-3026. - Zhang X, Song Y, Ci X, An N, Ju Y, Li H, et al. Ivermectin inhibits LPS-induced production of inflammatory cytokines and improves LPS-induced survival in mice.
Inflamm Res 2008;57:524-529. - Ahmed S, Karim MM, Ross AG, Hossain MS, Clemens JD, Sumiya MK, et al. A five-day course of ivermectin for the treatment of COVID-19 may reduce the duration of illness.
Int J Infect Dis 2021;103:214-216. - Prasad A. Early administration of ivermectin, azithromycin & doxycycline along with I.V. prednisolone in a case of COVID-19 disease may lead to early recovery?
Int J Pharm Chem Anal 2020;7:149-150. - Wang J, Yang X, Li Y, Huang JA, Jiang J, Su N. Specific cytokines in the inflammatory cytokine storm of patients with COVID-19-associated acute respiratory distress syndrome and extrapulmonary multiple-organ dysfunction.
Virol J 2021;18:117. - Chuang TY, Tsai MH, Wu LM, Ho SJ, Yeh PS, Liu YL, et al. Successful treatment of tocilizumab and ivermectin for a patient with ARDS due to COVID-19.
J Microbiol Immunol Infect 2021;54:147-148. - Rajter JC, Sherman MS, Fatteh N, Vogel F, Sacks J, Rajter JJ. Use of ivermectin is associated with lower mortality in hospitalized patients with coronavirus disease 2019: the ivermectin in COVID nineteen study.
Chest 2021;159:85-92. - Hashim HA, Maulood MF, Ali CL, Rasheed AM, Fatak DF, Kabah KK, et al. Controlled randomized clinical trial on using ivermectin with doxycycline for treating COVID-19 patients in Baghdad, Iraq.
Iraqi JMS 2021;19:107-115.