Discover and read the best of Twitter Threads about #CultOfIvermectin

Most recents (7)

Yet another large trial of ivermectin is now complete & the results are negative.

ACTIV-6 found no difference in mortality or hospitalization when people with COVID were randomized to ivermectin.

Yet another nail in the ivermectin ⚰️

Preprint medrxiv.org/content/10.110…

1/
ACTIV6 is a large placebo controlled RCT performed at 93 sites in the 🇺🇸 by @DCRINews

It enrolled adults >30yo w symptomatic COVID. They were randomized to either ivermectin or placebo.

The primary endpoints were death, Hospitalization, & symptoms
clinicaltrials.gov/ct2/show/NCT04…
2/
It was a “fully decentralized study”, meaning patients could be enrolled remotely & medication shipped to their home (via next day mail). Follow up was either remote or in person.

Theoretically this is a great pragmatic way to enroll a large number of people in a trial.
3/
Read 17 tweets
The #CultOfIvermectin has invented new excuses. Let’s address those:

“eVeRyOnE iN bRaZiL wAs AlReAdY TaKiNg IvErMeCtIn OTC!”

While Ivermectin use in the 30 days prior to screening wasn’t an absolute exclusion criteria, they appear to have de facto excluded those patients.
1/
It’s also worth wondering *why* someone who was taking ivermectin would enroll in a RCT of ivermectin vs placebo.

Also - if ivermectin prophylaxis was so effective - why would so many people on ivermectin be getting COVID in the first place?
2/
“tHeY dIdN’t UsE ZINC!!!!”

The original in vitro studies of ivermectin (Caly et al) didn’t use zinc.

None of the fraudulent “positive” RCTs of ivermectin combined it with zinc.

There has been *one* RCT of early zinc in COVID and it was *NEGATIVE*.
jamanetwork.com/journals/jaman…

3/
Read 5 tweets
The largest trial of #ivermectin in early #COVID is now published @NEJM & the results are *NEGATIVE*

#TOGETHER randomized n=1358 outpatients with COVID in 🇧🇷 to IVM vs placebo. No difference in hospitalizations, mechanical ventilation, or death.

nejm.org/doi/full/10.10…

A 🧵
1/
I’ve written about the #TOGETHER trial before (see my fluvoxamine 🧵below)

Briefly #TOGETHER is a large double blind multi-arm platform RCT. Pretty much the 1st 🥇 gold standard for high quality medical research.

2/
TOGETHER enrolled high risk people with COVID from 12 outpatient clinics in Brazil.

Patients could be enrolled up to 7 days after symptom onset (more on this later).

They were randomized to either placebo or to ivermectin 0.4mg/kg daily for 3 days. (Also more on dose later)
3/
Read 16 tweets
🚨Results of the #ITECH RCT in Malaysia 🇲🇾 are in & it’s yet another NEGATIVE result for ivermectin:
-n=500 high risk outpatients w/COVID randomized to 0.4 mg/kg IVM x5 days vs SOC
-no difference in rate of progression or time to recovery
-3x more adverse events w/ ivermectin
1/ Image
I-TECH was an open label RCT of IVM (0.4 mg/kgx5 days) vs standard of care (SOC)

It enrolled high risk outpatients (>50 yo w/ ≥ 1 comorbidity) w/in 7 days of COVID symptoms

In summary, HIGH risk pts given HIGH dose IVM EARLY & adequately powered 🤔
clinicaltrials.gov/ct2/show/NCT04…
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We don’t have the full results yet but based on the 🇲🇾 Ministry of Health data this was a NEGATIVE trial.
- IVM recipients did numerically worse: 21.2% progressed to severe disease vs 17.9% receiving SOC (OR 1.29 CI 0.8-2.0)
- time to progression was similar: 2.9 vs 3 days
3/ Image
Read 8 tweets
Interesting results from the #TOGETHER RCT of #fluvoxamine vs placebo in n=1497 high risk outpatients in 🇧🇷 with #COVID:
-people who received fluvoxamine were less likely to require extended ED visit or hospitalization (11% vs 16%, RR 0.68 CI 0.52-0.88)
thelancet.com/journals/langl…
1/ ImageImageImageImage
TOGETHER was a large, multi-arm adaptive platform DB-RCT done in 🇧🇷 Brazil from June 2020 to Jan 2021.

Patients were identified after testing positive, stratified by age (>50 or <50 yo) & randomized to fluvoxamine 100 mg BID x 10 days vs placebo.
2/
It builds upon 2 studies:
-an observational study in 🇫🇷 that found better outcomes among inpts already taking SSRIs
nature.com/articles/s4138…
-a small n=152 RCT done in 🇺🇸 showing a decrease in clinical deterioration among outpts randomized to Fluvoxamine
jamanetwork.com/journals/jama/…
3/ ImageImageImageImage
Read 10 tweets
I’m old enough to remember when the #cultOfVitaminC claimed it was unethical to do more RCTs of vitamin C in sepsis. Now the #CultOfIvermectin is making the same claims about ivermectin in COVID.

Charlatans & quacks don’t like RCTs. Especially when they disprove snake oil.
1/
I guess this shouldn’t come as a surprise; It’s the exact same people (Marik et)

After vitamin C as a miracle cure imploded in January 2020 they decided to go double or nothing on a different miracle cure: ivermectin.

2/
It should come as no surprise that they are making literally identical arguments about ivermectin that they made about their last miracle cure:
“I’ve seen it work thousands of times”
“Real world medicine”
“unethical to do RCTs”
Any negative study must be “designed to fail”
3/
Read 4 tweets
As the evidence supporting ivermectin as COVID treatment collapses, you might expect *less* certainty from the drug’s evangelists.

Instead they’ve doubled down on ivermectin.

It’s worth reading this passage from Festinger’s Theory of Cognitive Dissonance to understand:
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For context, Festinger & colleagues joined a cult (“The Seekers”) who believed the world would end on December 21, 1954 & that true believers would be rescued by a UFO

The researchers wondered how the Seekers would react to “disconfirmation” when this didn’t happen.
2/
As the date approached, the researchers watched many “Seekers” take irrevocable steps because of their belief: they quit their jobs, severed ties to loved ones, & disposed of possessions.

What would happen when their beliefs were discredited?
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Read 16 tweets

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