Is ivermectin effective against Covid-19 (Coronavirus disease 2019)?

Ivermectin is Not Effective for COVID-19 Treatment

Ivermectin should not be used for the treatment of COVID-19 as it does not provide clinically meaningful benefits and may divert resources from proven therapies. 1 This recommendation is based on high-quality evidence showing lack of efficacy for reducing mortality, need for mechanical ventilation, symptom resolution, or hospitalization rates.

Evidence Against Ivermectin Use

The most recent and highest quality evidence strongly advises against ivermectin use:

• The Infectious Diseases Society of America (IDSA) provides a strong recommendation against ivermectin use for ambulatory patients (moderate certainty of evidence) and a conditional recommendation against use for hospitalized patients (very low certainty of evidence) 1

• High-certainty evidence demonstrates ivermectin does not result in an important reduction in mortality in COVID-19 patients 2

• Moderate-certainty evidence shows ivermectin probably does not result in meaningful reductions in:

  • Mechanical ventilation
  • Time to symptom resolution
  • Duration of hospitalization 2

• Ivermectin may increase the risk of serious adverse events leading to drug discontinuation (moderate certainty) 2

Why Ivermectin Doesn't Work

Despite initial interest based on in vitro studies, ivermectin fails in clinical practice because:

1. The concentrations required for antiviral activity against SARS-CoV-2 in laboratory settings cannot be safely achieved in humans 1

2. Multiple randomized controlled trials consistently show no significant improvement in clinical outcomes:

   • No reduction in mortality (RR: 0.83; 95% CI: 0.50,1.37; high certainty) 1
   • No improvement in need for mechanical ventilation (RR: 0.40; 95% CI: 0.13,1.27; low certainty) 1
   • No improvement in symptom resolution (RR: 1.07; 95% CI: 0.69,1.65; very low certainty) 1
   • No reduction in hospitalization rates (RR: 0.85; 95% CI: 0.65,1.11; moderate certainty) 1

3. The most recent and comprehensive systematic review (2024) of Phase III clinical trials confirms that ivermectin did not reduce disease severity, need for mechanical ventilation, ICU admission, or in-hospital mortality 3

Risks of Ivermectin Use for COVID-19

Using ivermectin for COVID-19 carries several risks:

• Diversion of attention and resources away from proven therapies 2, 1
• Patients may seek veterinary formulations, risking toxicity 1
• Delay in implementing treatments with established efficacy 1
• Potential drug shortages for conditions where ivermectin is clearly indicated (helminth infections) 2

Recommended COVID-19 Treatments

Instead of ivermectin, clinicians should use evidence-based treatments:

• For high-risk outpatients: FDA-approved antivirals or monoclonal antibodies 1
• For hospitalized patients requiring oxygen: dexamethasone and other proven therapies 1

Common Pitfalls to Avoid

• Don't be misled by early observational studies or pre-prints: Early positive reports about ivermectin were largely based on non-peer-reviewed evidence that did not hold up in rigorous clinical trials 4

• Beware of confirmation bias: Despite continued advocacy by some groups, multiple high-quality systematic reviews consistently show lack of benefit 3

• Avoid relying on in vitro data: Laboratory findings showing antiviral activity do not translate to clinical efficacy 1

• Don't confuse correlation with causation: Reports of population-level improvements after ivermectin distribution campaigns fail to account for confounding variables 4, 3

The World Health Organization guideline development group has concluded that ivermectin is very likely to be ineffective against COVID-19, and its use would divert attention and resources from interventions that are known to work 2.