🚨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…
2/ ImageImageImageImage
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
We have *even less* data on secondary endpoints (the trial has 12 of them) but the one that ICR has shared is worrisome:
- 3x higher adverse events in the ivermectin arm, most commonly diarrhea

(Side note: great use of graphics in the visual abstract 👏🏻)
4/ Image
Bottom line:
- #ITECH was a large/adequately power RCT of high dose IVM, given early to high risk outpatients (pretty much exactly what the IVM stans have been clamoring for)
- it found absolutely no benefit to ivermectin in COVID19 in terms of preventing disease progression
5/
Now I'm sure that the #CultOfIvermectin will invent some reasons to discount this study.

ITECH is conspicuously absent from ivnmeta and other "realtime" websites. But don't worry, I'm sure those anom stats hacks will find a secondary endpoint to fixate on & call it a win.
6/
For anyone looking objectively:
-multiple large RCTs (EPIC, IVERCORCOVID, TOGETHER, & now ITECH) have found no benefit to IVM
-literally *every* study that found a mortality benefit (Elegazzar, Niaee, etc) has been exposed as fraud
-it doesn't look good for IVM as COVID cure
7/7
Here’s an even crazier & desperate rationalization 👇

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More from @nickmmark

5 Nov
💊Exciting news today about another oral therapy for early COVID: reduced hospitalization & mortality.

Here’s a Deep dive 🧵 on the new PF-07321332 protease inhibitor (“Paxlovid”) & the very impressive results announced from the EPIC-HR trial.
TL/DR: this is a big deal.
1/ ImageImageImage
What the heck is PF-07321332?

All coronaviruses produce a polypeptide that must be cleaved by a protease into 11 proteins. Without this protease the virus can’t co-opt cellar machinery & reproduce.

PF-07321332 Inhibits the viral main protease (Mpro).
2/

pdb101.rcsb.org/motm/242 ImageImage
Specifically PF-07321332 binds to the catalytic site of Mpro.

Mpro is a great target because there are unique features of Mpro not found in *any* human enzymes & because spike protein mutations wouldn’t confer resistance.

In short, an ideal drug🎯
3/

medrxiv.org/content/10.110… Image
Read 15 tweets
30 Oct
If you think no one is getting rich off of ivermectin, definitely don't watch this video from FLCCC founder Dr. Fred Wagshul.

For just $276 (cash only, no insurance), this quack will prescribe ivermectin "no questions asked." Don't worry he's got "plenty of product."

Yikes!
1/
His website makes it really clear.

You just fill out this form (including your SSN) and send it to a not at all sketchy gmail address.

Then you pay $211 for a 3 minute phone call and get your prescription. Plus $75 for a followup. Then $75 recurring every 6 months.
2/
There are quite a few 🚩 on this website.

Aside from referring to $276 telehealth prescriptions for ivermectin as "preventive maintenance" this pulmonologist is also apparently an expert in... interstitial cystitis?

So pulm and urology under one roof. Not at all sketchy.
3/
Read 7 tweets
27 Oct
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
24 Oct
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
23 Oct
A new paper is circulating, leading to a new & improbable claim that "ivermectin treats staph aureus."

There is absolutely no evidence that this is true.

A short thread about pharmacology (MICs, IC50s, and Cmax) explaining why this claim is so unlikely.
1/ ImageImage
This paper by Ashraf et al is an in vitro study of repurposed meds on MRSA & MSSA.

Right off the bat, there are weird things going on. They grew 21 strains and report results for...2

And when they treated those strains with ivermectin, they used some insanely high doses...
2/
How high?
They found the minimum inhibitor conc (MIC) to kill MSSA was 12.5 ug/mL
How high is that? Let's do some math:
Ivermectin has two forms B1a & B1b. The average MW is 868 g/mol.Converting 12.5 ug/mL mass concentration to molar concentration we get 14 uM! Yikes!
3/ ImageImage
Read 6 tweets
7 Oct
To the ivermectin die hards asking "What about Uttar Pradesh?!?" Perhaps you can answer the question "Why *ONLY* Uttar Pradesh?"
You realize that IVM was tried and failed in Peru, Brazil, & elsewhere. Why have the benefits of IVM *never* been seen in RCTs or other countries?
1/
Alternatively, perhaps the "Uttar Pradesh Miracle" has to do with proven interventions: lockdown, curfew, mask mandate, testing/quarantine, & vaccines.

There's also major under-reporting in UP. (Unless you think IVM has decreased deaths from car accidents & cancer too).
2/ From https://www.nature.com/articles/s41562-020-01009-0 Source: https://www.medrxiv.org/content/10.1101/2021.08.04.2
To those saying UP "was only 5% vaccinated" when cases started to drop, realize that vaccinating frontline people can/does reduce transmission & vaccinating high risk people reduces mortality.

If you are looking for why cases REMAIN low, UP is >50% partially vaxxed right now
3/
Read 6 tweets

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