Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease.

There was however a marked reduction of self-reported anosmia/hyposmia, a reduction of cough and a tendency to lower viral loads and lower IgG titers which warrants assessment in larger trials.

Based on the very low-certainty evidence for inpatients, we are still uncertain whether ivermectin prevents death or clinical worsening or increases serious adverse events, while there is low-certainty evidence that it has no beneficial effect regarding clinical improvement, viral clearance and adverse events. No evidence is available on ivermectin to prevent SARS-CoV-2 infection.

IvermectinThis FDA-approved antiparasitic drug has demonstrated a degree of efficacy in vitro against SARS-CoV-2 infection (Caly et al., 2020; Yang et al., 2020), and uncontrolled, interventional studies have reported a degree of efficacy or no benefits (Amhed et al., 2020; Chachar et al., 2020; Khan et al., 2020). However, the NIH Panel indicates that there is insufficient evidence for COVID-19 treatment and recommended against its use (COVID-19 Treatment Guidelines Panel, 2022).

Even though ivermectin had no effect on viral load, SARS-Cov-2-associated pathology was greatly attenuated. IVM had a sex-dependent and compartmentalized immunomodulatory effect, preventing clinical deterioration and reducing olfactory deficit in infected animals. Importantly, ivermectin dramatically reduced the Il-6/Il-10 ratio in lung tissue, which likely accounts for the more favorable clinical presentation in treated animals. Our data support IVM as a promising anti-COVID-19 drug candidate.

In conclusion, ivermectin seems to be effective to diminish MHV viral load and disease in mice, being a useful model for further understanding new therapies against coronavirus diseases.

Remdesivir-ivermectin combination displays synergistic interaction with improved in vitro antiviral activity against SARS-CoV-2