Below the text of a letter sent by email on June 16 to various members of the Irish HSE’s expert group on the decision to not recommend oral ivermectin or any other antiviral treatments in the context of the current COVID situation
Dear members of the COVID-19 EAG,
I read with some alarm the 5 February advice issued by HIQA concerning the use of interventions to prevent the progression of severe COVID-19 in an ambulatory setting.
The document appears to include information which is either not correct, incomplete, or has since lost topicality and therefore is in need of urgent update:
‘Very low certainty’ evidence was identified from a further two studies (both published as preprints) of two interventions: ivermectin plus doxycycline and sulodexide. Serious concerns were raised with regard to the high risk of bias, small sample sizes and short durations of follow-up within the trials. As such, results from these studies should not be used to inform decision-making with Advice to the National Public Health Emergency Team: Interventions in an ambulatory setting to prevent progression to severe disease in patients with COVID-19 Health Information and Quality Authority Page 11 of 16 respect to effectiveness. Neither study was considered applicable to the Irish healthcare setting due to differences in usual care provided in the trials.” (Pages 10-11)
as well as:
“The EAG agreed that there is currently no evidence of benefit associated with the treatments considered within the present review and there is insufficient information on whether any of these may be safely used in the treatment of Advice to the National Public Health Emergency Team: Interventions in an ambulatory setting to prevent progression to severe disease in patients with COVID-19 Health Information and Quality Authority Page 12 of 16 COVID-19. Furthermore, some of the interventions investigated within the trials would not be considered applicable to the Irish setting due to differences in the standard of care and or on the basis of safety concerns.” (page 11-12)
Regarding safety concerns, I am sure you are all well aware of the fact that ivermectin, when administered in appropriate doses, has a safety track-record spanning many decades.
Concerning efficacy, note that the American Journal of Therapeutics has published, in May 2021, a “Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19” (Kory et al, 2021), which concludes that:
“Meta-analyses based on 18 randomized controlled treatment trials of ivermectin in COVID-19 have found large, statistically significant reductions in mortality, time to clinical recovery, and time to viral clearance. Furthermore, results from numerous controlled prophylaxis trials report significantly reduced risks of contracting COVID-19 with the regular use of ivermectin. Finally, the many examples of ivermectin distribution campaigns leading to rapid population-wide decreases in morbidity and mortality indicate that an oral agent effective in all phases of COVID-19 has been identified.“
This conclusion is echoed by Bryant et al*, still in pre-print, but expected to pass peer review in the coming days.
I would urge you to consider, as a matter of priority, updating your advice, taking into account the wider range of RCTs available, as well as the meta-analysis results published by the AJT. Furthermore, given the fast-moving nature of the pandemic, I would further urge you to be more flexible regarding your position on dismissing non-peer-reviewed evidence on this topic, even if this requires a more ‘hands-on’ approach to evaluating the evidence in question, in order to ensure academic rigour.
At the risk of sounding trite, lives may well depend on it.
Is mise le meas,
Graham Stull
* Bryant, Andrew & Lawrie, Theresa & Dowswell, Therese & Fordham, Edmund & Scott, Mitchell & Hill, Sarah & Tham, Tony. (2021). Ivermectin for prevention and treatment of COVID-19 infection: a systematic review, meta-analysis and trial sequential analysis to inform clinical guidelines.
