Ivermectin meta-analysis – the implications
Dr Tess Lawrie, Director of the Evidence-based Medicine Consultancy Ltd, describes the implications of her recently-published meta-analysis of ivermectin trials for covid-19.
Dr Lawrie is now trying to make an appointment with the Secretary of State for Health, Matt Hancock in order to share her findings so that ivermectin can be made available for British citizens as soon as possible.
There are many different ways that ivermectin use could be implemented. “I think firstly we need to get it to our health care workers and other frontline workers – they should be prioritised – and the other vulnerable people”, says Dr Lawrie. One way would be to have packs that contain ivermectin tablets, and sufficient vitamin, vitamin D and zinc for seven days’ treatment. Such packs could be posted to people to be kept at home until required, she suggests. When people develop symptoms of covid-19 or they are exposed to someone else who has the disease then they could start taking the medicines. Such approaches have already been used successfully in other countries such as India. Dr Lawrie’s message to GPs was simply that “ivermectin works” and she reminded them that doctors are entitled to prescribe the medicine that they regards as best for their patients.
Considering the types of trials that are needed for ivermectin now, Dr Lawrie suggested that trials to determine the optimum frequency of prophylactic doses would be helpful as would trials to compare different doses of ivermectin for covid treatment. It would also be useful to determine whether to give ivermectin alone or in combination with doxycycline or with other therapies such as vitamins D and C and zinc. There are comparative studies that can be done – but just not with a placebo, she emphasised. “In this instance, where there’s such a massive effect and it is so consistent, doing a big trial is not going to come up with something different in the opposite direction”, she says.
Clinical practice guidelines, the Government, that National Institute for Health and Care Excellence (NICE) and the World Health Organisation (WHO) have always relied on Cochrane reviews as the foundation for recommendations. For this reason Dr Lawrie has joined forces with Dr Andrew Hill in Liverpool to undertake a rapid Cochrane review of ivermectin for covid-19. They plan to complete the review in three weeks. “Hopefully, that will settle the question once and for all”, she says.