May 25, 2021 – The Caribbean Public Health Agency (CARPHA) is urging Ministries of Health and clinicians to only use the medicine, ivermectin, under the conditions of well-regulated clinical trials for COVID-19, or for approved indications. This is a result of the limited evidence available to assure a favorable benefit-risk balance when used in treating patients with COVID-19. This is also reflected by the recommendations of the global health authority, World Health Organization (WHO).
In its “Therapeutics and COVID-19: Living Guideline”, March 31, 2021, the WHO Guideline Development Group explains “The effects of ivermectin on mortality, mechanical ventilation, hospital admission, duration of hospitalization and viral clearance remain uncertain because of very low certainty of evidence addressing each of these outcomes.” The WHO in its press release on ivermectin also noted that the current evidence is of “very low certainty,” due to the small sizes and methodological limitations of available trial data.
In light of this, Executive Director, CARPHA, Dr. Joy St. John says “I am aware that some countries have already begun to use ivermectin in the treatment of COVID-19, and others may be considering using the drug as a possible treatment. However, CARPHA is urging our Member States to heed the current advice of the WHO, regardless of disease severity or duration of symptoms.”
The Pan American Health Organization (PAHO) “Living Update of COVID-19 Therapeutic Options Rapid Review” of May 6, 2021 notes that after review of 28 clinical trials “New evidence from randomized clinical trials was evaluated, however there is no change to the assessment that the medicine does not significantly reduce mortality and probably does not improve time to symptom resolution.”
Also recognizing the need for further research, the US National Institutes of Health (NIH) states “Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19”. According to the NIH, ivermectin is an antiparasitic drug that is used to treat several neglected tropical diseases, including scabies. Furthermore, ivermectin is not approved by the US Food and Drug Administration (FDA) for the treatment of any viral infection.
CARPHA does not support the use of ivermectin outside of appropriately designed, well-regulated clinical trials for the treatment of COVID-19. Further CARPHA maintains that large randomised controlled clinical trials, with robust study design, meaningful endpoints, and significant results are essential to inform public health decision-making about treatments for COVID-19, as these are designed to rule out findings of benefits and risks that may appear due to chance.