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Ivermectin interview, Precis, Dr. Tess Lawrie Video 1, the importance of EBP Synthesised evidence Video 2, Ivermectin Heard publicity around Christmas / New Year Front line covid-19 critical care alliance https://covid19criticalcare.com Dr. Pierre Kory Dr. Lawrie has background expertise required for analysis We / I do not prescribe Impressed with body of evidence from FLCCC Several plausible mechanisms of Ivermectin action, antiviral and anti-inflammatory Prevents viral life cycles and replication Reduces inflammatory markers Some studies show Ivermectin reduces viral load Studies show possible action against yellow fever, dengue, zika and others Let’s explore with more studies on viral illnesses Practical empirical evidence Preventing death and preventing infection Including RCT and better quality observational studies = 83% reduction in deaths Appraised each study for risk of bias Talked to authors Reviewed manager software Pooled studies and data Submitted to Matt Hancock’s office 4th Jan, no response Publications coming Researchers have a moral duty to relay information ASAP, so preprint site (2015) Next, RCT only Starting from scratch with a review team, 68% fewer deaths Using very strict criteria Forest plot Plotting deaths in treatment group and deaths in placebo group Out of 1,000 deaths Ivermectin group, 27 deaths out of 1,000 cases Placebo group, 82 deaths out of 903 cases 65% reduction P = 0.002 Findings of RCT was the same as observational studies Useful in all stages of the disease 88% reductions in infection rates And mild and moderate disease to reduce viral load, so disease worsening ? Long covid Possible evidence from Argentina and Peru Placebo controlled trial for 2 weeks, with options to treat Placebo controlled treatment trial, not ethical Reduces symptoms, low certainty, 48% Safety Billions of doses have been given over 40 years WHO, essential medicines list Third of the world’s population, 4,600 adverse events 16 deaths (Remdesivir, 417 deaths over past year) Safe at 10x dose 3, 6, 12 mg tabs 0.2 mg / Kg to 0.4 mg / Kg Oral tabs Cost, $168 per KG WHO, 100, 12mg tabs $2.90 BIRD, recommended for prevention and treatment in UK, and told everyone, WHO, FDA etc. Helsinki declaration, doctors should give what they know to be effective Large RCT would have to stop at interim analysis, probably at about 1,000 patients Protection from infection in workers and contacts Ivermectin group, 25 out of 1,397 got covid Control group, 386 out of 833 got covid Risk reduction 93% reduction in infection rates Or 87% with the best study taken out Medical oil tankers Ivermectin reduces the risk of death from COVID-19 -a rapid review and meta-analysis in support of the recommendation of the Front Line COVID-19 Critical Care Alliance. https://www.researchgate.net/publication/348297284_Ivermectin_reduces_the_risk_of_death_from_COVID-19_-a_rapid_review_and_meta-analysis_in_support_of_the_recommendation_of_the_Front_Line_COVID-19_Critical_Care_Alliance_Latest_version_v12_-_6_Jan_2021 Kory P, Meduri GU, Iglesias J, et al. Review of the emerging evidence demonstrating the efficacy of ivermectin in the prophylaxis and treatment of COVID-19. 18 Dec 2020. https://covid19criticalcare.com/wp-content/uploads/2020/11/FLCCC-Ivermectin-in-the-prophylaxis-and-treatment-of-COVID-19.pdf World Health Organization. 21st Model List of Essential Medicines. Geneva, Switzerland. 2019. https://www.who.int/publications/i/item/WHOMVPEMPIAU2019.06 Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 Cochrane, 2019. www.training.cochrane.org/handbook. The GRADE Working Group. GRADE [website] 2020 www.gradeworkinggroup.org. Alam MT, Murshed R, Gomes PF, Masud ZM, Saber S, Chaklader MA, Khanam F, Hossain M, Momen ABIM, Yasmin N, Alam RF, Sultana A, Robin RC. Ivermectin as Pre-exposure Prophylaxis for COVID-19 among Healthcare Providers in a Selected Tertiary Hospital in Dhaka – An Observational Study

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