Has anyone been cured of COVID-19 with ivermectin, Duterte asks

Ivermectin, the medicine which many say may cure COVID-19 despite warnings from the World Health Organization and the Department of Health, has caught President Rodrigo Duterte's attention.

In his weekly talk to the people on Monday night, Duterte asked Food and Drug Administration director general Dr. Eric Domingo if ivermectin has cured anyone of COVID-19.

"May nalaman ka ba na may sakit na COVID na gumaling sa ivermectin?" Duterte asked in the middle of Domingo's presentation on the availability of medicines which are being used to treat COVID-19.

[Do you know of a COVID patient who was cured because of ivermectin?]

Domingo said that many patients had been claiming that ivermectin cured them of COVID-19 but added that the same patients had also been taking other medicines.

The FDA chief told Duterte that experts had said there was still not enough evidence that ivermectin caused a person to be cured of the deadly disease.

"I think that medicine is for animal use," Duterte said.

Domingo said ivermectin had yet to be included in the DOH's protocol for the treatment of COVID-19.

He, however, added that as of last week, three companies had signified their intention to register ivermectin for use among humans.

Domingo said that at present ivermectin in the Philippines was being used as a cream for humans and for animals.

He said there are also pharmacies which have permits to do "what we call compounding" of ivermectin.

Domingo said such pharmacies combine ingredients of the medicine and place them in a capsule.

"So pwede silang magpunta sa compounding pharmacy at pwedeng timpalhin ang gamot for them but this requires prescription at individually pineprepare ito," Domingo said.

The agency on April 8 granted a hospital's application for "compassionate use" of the anti-parasitic ivermectin for use on humans with COVID-19.

Domingo, however, said that the distribution of ivermectin as part of treatment for COVID-19 was still prohibited.

He said only the hospital which was given the permit for ivermectin’s compassionate use for humans would be allowed to import the drug through a licensed importer.

The World Health Organization has recommended that ivermectin should only be used within clinical trials to determine if the anti-parasitic drug is effective in treating COVID-19.

Socorro Escalante, coordinator for essential medicines and health technologies of the WHO Western Pacific, said the recommendation stemmed from an analysis of available data on ivermectin.

“The evidence has shown that there is no direct effect or any mechanism of any antiviral action against SARS-CoV-2 [the virus that causes COVID-19] that currently exists,” Escalanta said in an online press conference.

“The effects of ivermectin on end points that are being studied such as mortality, prevention of mechanical ventilation, hospital admissions, duration of hospitalizations and viral clearance are all uncertain," she added.

"It is very important to emphasize that at this point the WHO’s recommendation for this drug is not to use it except in the context of [a] clinical trial,” Escalante said.

The use of ivermectin is now the subject of debate in the medical community following the resurgence of COVID-19 cases in the country and the increase in deaths caused by the disease.

In a recent fireside chat organized by the Philippine-American Academy of Science and Engineering, Dr. Tess Lawrie of The Evidence-Based Medicine Consultancy Ltd. presented her analysis of studies that looked into the use of ivermectin as a COVID-19 treatment.

She said her meta-analysis showed there were few serious adverse events (SAEs) recorded during ivermectin use during these studies.

Citing data from VigiAccess, an international database of adverse events, Lawrie said only 16 deaths had been reported involving ivermectin, compared to much higher totals for remdesivir, which is used to treat COVID-19 symptoms, as well as COVID-19 vaccines.

Lawrie said there was a "double standard" for why ivermectin is being considered unsafe as a COVID-19 treatment. "It doesn't make any sense at all."

In response, Dr. Jacinto Blas Mantaring III, the chairman of  the Department of Clinical Epidemiology of the University of the Philippines College of Medicine, explained the use of systematic reviews and meta-analyses in research.

He showed a meta-analysis from covid-nma.com, an international research initiative a living systematic review of COVID-19 trials.

Searching the website for ivermectin studies, Mantaring filtered the results for comparisons against placebo, which showed the relative risk for the drug.

"There's a chance that ivermectin causes harm as much as there's a chance that it causes benefit," Mantaring said.

Infectious diseases expert Dr. Benjamin Co, for his part, questioned the lack of Phase 2 studies on the appropriate dose of ivermectin, either to be given for patients who are being treated for COVID-19 or its use as prophylaxis.

Lawrie suggested that the Philippines do a study on the efficacy of ivermectin as prophylaxis for health workers, given the slow rollout of the COVID-19 vaccine in the country.

"By doing that, you provide an answer to this very important question," she said.

Lawrie also cited "clinical evidence worldwide" that ivermectin worked.

"I think what you have to remember is we are in a pandemic, there are people dying. We don’t need to know about every single thing about this medicine," she said, noting that with more use comes more information," Lawrie said.

"We can see it reduces inflammatory markers and this is one of its great benefits in the late stage of disease. So i just think just look at the science. It’s very safe. Let’s just start using it at least for treatment," she added. --NB, GMA News