This study aims to evaluate the efficacy, safety and tolerability of Ivermectin in patients with mild SARS-CoV-2 infection, in the rate of progression to severe 2019 novel coronavirus disease (COVID-19). The primary efficacy endpoint is the proportion of participants with a disease control status defined as no progression of severe disease Hypothesis (H0): There is no difference between group A (ivermectin + paracetamol) and group B (ivermectin + paracetamol) in terms of the primary endpoint on day 14.
In late 2019, an unidentified viral pneumonia was detected in Wuhan, China. Later, it was
declared that it was pneumonia due to a new coronavirus. The World Health Organization (WHO)
officially called it COVID-19 disease (Xie and Chen 2020).
Ivermectin is a broad-spectrum antiparasitic agent, developed to combat parasitic worms in
veterinary use and in human medicine. This compound has been used orally in humans to treat
filariasis, but is also effective against other worm-associated infections, as well as
parasitic skin diseases and insect infections. It is approved for human use in several
countries, to treat onchocerciasis, lymphatic filariasis, strongyloidiasis, and scabies, and
recently in capillary pediculosis. When avermectins were discovered, they represented a new
class of compounds that kill various ranges of disease-causing organisms, as well as pathogen
vectors, inside and outside the body. Ivermectin is a semi-synthetic mixture of two
chemically modified avermectins, comprising 80% 22,23-dihydroavermectin B1 and 20%
22,23-dihydroavermectin-B1b.
Other diseases that have been treated with ivermectin are: trichinosis, vector insects,
malaria, trypanosomiasis, allergic asthma, rosacea, bedbugs, schistosomiasis, chagas disease,
epilepsy, neurological diseases. Furthermore, it has been observed to have effects as an
antibiotic and anticancer (Crump 2017).
In turn, Ivermectin has been described as a broad-spectrum antiviral, inhibiting nuclear
import by its ability to inactivate host nuclear transport proteins, such as integrase and
nonstructural protein 5 (NS5), limiting the ability to infect the western virus of the Nile
in low concentrations (Yang et al. 2020), as well as inhibiting the replication of the yellow
fever virus and other flaviviruses, such as dengue, and encephalitis, probably attacking the
activity of nonstructural helicase 3 (Crump 2017).
Ivermectin, at a dose of 150-200 mcg / kg, is the first line of treatment for river blind
disease (onchocerca volvulus), lymphatic filariasis, and strongyloidiasis(Crump 2017)..
French authorities approved ivermectin for humans in 1987. Shortly thereafter, Merck & Co Inc
donated ivermectin for onchocerciasis control. Since then, more than two billion treatments
have been distributed in Africa and Latin America for onchocerciasis and lymphatic filariasis
(Chaccour et al. 2013; Smit et al. 2016).
In this context, ivermectin adverse events have been mild, transient and associated with the
intensity of the infection. No significant association was found between ivermectin plasma
levels and adverse events(Merck & Co 2009).
Wagstaff et al. published preliminary studies in in vitro cultures, where they observed that
a 5000-fold reduction in the viral RNA content of cells infected with the SARS-CoV-2 virus,
treated with a single dose of ivermectin (Caly et al. 2020).
Ivermectin therapy has not been tested in COVID-19 subjects and is therefore intended to be
used as an adjuvant treatment; therefore, all study subjects will receive ivermectin or
placebo in addition to therapy that their treating physician deems appropriate. Since
ivermectin is in an early phase of clinical development, the use of base therapy will ensure
that all subjects, including subjects who are randomized to receive placebo, have the benefit
of receiving treatment with the base therapy that is available.
Research Objectives The main objective of this study is to evaluate the efficacy, safety and
tolerability of ivermectin in patients with mild SARS-CoV-2 infection, in the rate of
progression to severe COVID-19.
Secondary objectives
- Quantify the replication rate of the SARS-CoV-2 virus at days 5 and 14 after diagnosis
quantitatively by real-time reverse transcription polymerase chain reaction (RT-PCR).
- Evaluate the presence and frequency of symptoms associated with COVID-19 disease (fever,
cough, myalgia, fatigue, shortness of breath, headache, diarrhea, and expectoration)
daily for 14 days.
- Investigate the presence of adverse events associated or not with the study drug for 14
days.
- Search for associations between the morbidities of the evaluated subjects and the
intensity of the disease.
- Search for a relationship between medical history of bacille Calmette Guerin (BCG)
vaccines and the intensity of the disease.
- Evaluate the frequency of death in the subjects, associated with COVID-19.
Drug: Ivermectin
ivermectin 12 mg / day for 3 days, in combination with standard paracetamol therapy (500 mg QID) for 14 days
Drug: Placebo
Placebo of ivermectin 12 mg / day for 3 days, in combination with standard paracetamol therapy (500 mg QID) for 14 days
Inclusion Criteria:
- Diagnosis of acute severe respiratory syndrome due to SARS-CoV-12 coronavirus
infection defined by RT-PCR.
- Asymptomatic, or with mild symptoms who are taking outpatient treatment of the
disease.
- Signed Informed Consent.
Exclusion Criteria:
1. Patients with severe disease COVID-19.
2. Positive to proof of infection by some other virus such as influenza H1N1, SARS, etc.
3. Recurrent urinary tract infections.
4. Alanine Aminotransferase (ALT) or Aspartate Aminotransferase (AST)> 5 times above its
normal limits.
5. Pregnant or lactating patients
6. Patients receiving antihypertensive medication verapamil, the immunosuppressant
cyclosporin A and / or the antipsychotic trifluoperazine.
7. Patients with a known allergy or hypersensitivity to dewormers.
8. Patients who are using an antioxidant supplement.
9. Patients with a history of filariasis, strongyloidiasis, scabies, river blindness, or
any parasitic disease in the last twelve months.
Investigacion Biomédica para el Desarrollo de Fármacos S.A. de C.V.
Zapopan, Jalisco, Mexico
Alma M Perez, MD, Principal Investigator
Centro de Investigación Farmacéutica Especializada de Occidente S.C.