Talk:Ivermectin

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Treatments for COVID-19: Current consensus

A note on WP:MEDRS: Per this Wikipedia policy, we must rely on the highest quality secondary sources and the recommendations of professional organizations and government bodies when determining the scientific consensus about medical treatments.

  1. Ivermectin: The highest quality sources (1 2 3) do not support Ivermectin as an effective treatment for COVID-19. In all likelihood, ivermectin does not reduce all-cause mortality (moderate certainty) or improve quality of life (high certainty) when used to treat COVID-19 in the outpatient setting (4). Recommendations from relevant organizations can be summarized as: Evidence of efficacy for ivermectin is inconclusive. It should not be used outside of clinical trials. (May 2021, June 2021, June 2021, July 2021, July 2021) (WHO, FDA, IDSA, ASHP, CDC, NIH)
  2. Chloroquine & hydroxychloroquine: The highest quality sources (1, 2, 3 4) demonstrate that neither is effective for treating COVID-19. These analyses accounted for use both alone and in combination with azithromycin. Some data suggest their usage may worsen outcomes. Recommendations from relevant organizations can be summarized: Neither hydroxychloroquine nor chloroquine should be used, either alone or in combination with azithromycin, in inpatient or outpatient settings. (July 2020, Aug 2020, Sep 2020, May 2021) (WHO, FDA, IDSA, ASHP, NIH)
  3. Ivmmeta.com, c19ivermectin.com, c19hcq.com, hcqmeta.com, trialsitenews.com, etc: These sites are not reliable. The authors are pseudonymous. The findings have not been subject to peer review. We must rely on expert opinion, which describes these sites as unreliable. From published criticisms (1 2 3 4), it is clear that these analyses violate basic methodological norms which are known to cause spurious or false conclusions. These analyses include studies which have very small sample sizes, widely different dosages of treatment, open-label designs, different incompatible outcome measures, poor-quality control groups, and ad-hoc un-published trials which themselves did not undergo peer-review. (Dec 2020, Jan 2021, Feb 2021)

Last updated (diff) on 15 December 2022 by Shibbolethink (t · c)

Change description regarding use for covid.[edit]

The Association of American Physicians and Surgeons (AAPS) recently filed a motion and amicus brief with the federal district court in Galveston urging it to allow the lawsuit to proceed against the FDA for its misleading statements against ivermectin. The FDA published multiple statements and sent letters to influential organizations to falsely disparage ivermectin, implying that it was not approved for treating Covid-19. Many, including courts and state medical boards, were misled by the FDA into thinking that its lack of approval for this treatment meant that ivermectin should not be used to treat Covid-19. 189.215.155.255 (talk) 03:59, 5 October 2022 (UTC)Reply[reply]

The AAPS is not considered a reliable source on wikipedia. — Shibbolethink ( ) 20:26, 10 November 2022 (UTC)Reply[reply]

Medical authorities advising against using it vs. merely not approving it[edit]

@Julius Senegal: the off-label use/prescription of drugs is extremely common, and it does not imply that those drugs are being used improperly. For instance, of the 14.3 million psychiatric treatment visits in the US where antipsychotics were prescribed, 9.0 million (63%) of those were prescriptions for antipsychotics drugs without FDA approval. It's also very common in pediatric medicine: "Sixty-two percent of outpatient pediatric visits included off-label prescribing. Approximately 96% of cardiovascular-renal, 86% of pain, 80% of gastrointestinal, and 67% of pulmonary and dermatologic medication prescriptions were off label."

Right now the lead just says that those medical authorities merely didn't approve it to treat COVID-19. That's trying to reflect some of the epistemically careful and precise language some of those bodies tend to use, which is understandable, but it's actually quite a weak statement for us to quote in isolation here. It does not necessarily imply that ivermectin doesn't work in treating COVID-19 or that you shouldn't take it to treat COVID-19, but that is exactly what those bodies were actually saying, e.g: "WHO recommends that the drug only be used within clinical trials."; the FDA titled its PSA "Why You Should Not Use Ivermectin to Treat or Prevent COVID-19", and the EMA titled theirs "EMA advises against use of ivermectin for the prevention or treatment of COVID-19 outside randomised clinical trials". These are stronger statements than the one in the article, and get more to the heart of the point of the information we are trying to convey here. Endwise (talk) 05:07, 11 November 2022 (UTC)Reply[reply]

Please stick to WP:OR, and sorry, I am not interested in what stands in a title, rather than what stands in the text. I have cited the FDA: "The FDA has not authorized or approved ivermectin for use in preventing or treating COVID-19 in humans or animals." Ivermectin has not been approved for this, this is a fact.
Just saying "advised against" could imply that there is approval for the treatment but in that particular case they just do not advise it. --Julius Senegal (talk) 11:58, 11 November 2022 (UTC)Reply[reply]
@Endwise I understand your motivation, and what you say here is right. But with WP:MEDRS, we are bound to stick as closely to the text as possible. There are other sources we could probably use to say it isn't recommended, but these authorities don't actually say that explicitly in those docs. There may be other places where they say they don't recommend it, though. — Shibbolethink ( ) 14:53, 11 November 2022 (UTC)Reply[reply]

How does Wikipedia manage damage control for compromised sources.[edit]

I am interested to know where in Wikipedia procedures and protocols are explained on what happens when a source is found to be inaccurate or fraudulent? How promptly can these kind of corrections be managed? Is there a tool available that will flag all data from a given author, journal, public health authority or news source to warn readers?

Is there a mechanism where Wikipedia flags articles as having a notable shift in encyclopaedic information because of deprecation of a source, do they apologise for using poor source selection? Has this happened before where a source was considered good and then relegated to untrusted and how was this communicated?

If there is a large body of peer reviewed primary sources that contradicts secondary non peer reviewed sources is it time to consider if Wikipedia has been compromised as a source of information?

Wikipedia is at a cross roads, they can be a public-hero or a laughing-stock and it needs to be prepared to act fast if it wants to have a chance to select which fork it will take.

This comment is very topical for this page and should not be removed lightly. If a better venue for this discussion is available moving it and leaving a forwarding link could be beneficial but silencing this line of discussion is not in the interest of the future of Wikipedia.

Idyllic press (talk) 16:35, 14 November 2022 (UTC)Reply[reply]

I am interested to know where in Wikipedia procedures and protocols are explained on what happens when a source is found to be inaccurate or fraudulent? That is usually dealt with at WP:RSN and a source's (un)reliability may be added to WP:RSP.
How promptly can these kind of corrections be managed? Within an article, they are dealt with immediately. For ones like WP:DAILYMAIL, it's a longer process and usually we get someone to program a bot to remove them site wide.
Is there a tool available that will flag all data from a given author, journal, public health authority or news source to warn readers? Not that I'm aware of, but WP:VP would be a decent place to suggest the creation of such a tool. There's {{unreliable sources}} you can use too.
Is there a mechanism where Wikipedia flags articles as having a notable shift in encyclopaedic information because of deprecation of a source, do they apologise for using poor source selection? No, the encyclopedia is self-correcting and ever-changing. We do not have the equivalent of "retractions" that academic journals do because we do not use a static unchangable media like paper journals.
Has this happened before where a source was considered good and then relegated to untrusted and how was this communicated? Yes. That happens at WP:RSN. Major changes are sometimes communicated at WP:AN but WP:RSP is the best place to look up a source's status.
If there is a large body of peer reviewed primary sources that contradicts secondary non peer reviewed sources is it time to consider if Wikipedia has been compromised as a source of information? No, as a WP:TERTIARY source we wait for WP:SECONDARY sources to catch up to the primary sources. We are always behind the curve. EvergreenFir (talk) 16:43, 14 November 2022 (UTC)Reply[reply]
Wikipedia is at a cross roads, they can be a public-hero or a laughing-stock and it needs to be prepared to act fast if it wants to have a chance to select which fork it will take. This sounds an awful lot like you're about to tell us that ivermectin actually works really well for COVID-19 and we (and all the best available scholarly journals) were all wrong. (Edit: Yep...[1])
From you: ...see if you can find many mentions in the mainstream media about the Senate Directive SA0620, it should be shouted out by all the Horse Paste news channels... but maybe it is just too much facts that are better kept quiet. The anti-Ivermectin lobby is much stronger and more dangerous than the pro-Ivermectin movement and the only reason for the narrative you hold dear. As editors on Wikipedia it behoves you to have a balanced view and this Ivermectin4covid page has only negative things to say, it is the height of biased editing and reflects very poorly on the original goals of Wikipedia.
Key to this discussion: Wikipedia follows, it does not lead. If our sources are wrong, then so are we, and as soon as the consensus of our sources shifts, then so do we. This is not the place to be a "hero" or a "laughing stock". We reflect the literature, our scholarly sources, and the news media (where applicable), and it is those sources which would have egg on their face in such a situation, not WiIki.
Wikipedia's policies have proven extremely adept at preventing the spread of misinformation. See for example: [2] [3] [4] [5] [6] [7]
if you think those policies need to be changed (e.g. WP:BESTSOURCES or WP:BMI or WP:MEDRS) then you should probably make your case at those talk pages. This would be an inappropriate venue for such a discussion. On talk pages like this, we talk about how to apply those policies, not how to change them. — Shibbolethink ( ) 17:05, 14 November 2022 (UTC)Reply[reply]

Covid effectiveness[edit]

Has the consensus on Ivermectin's effectiveness for covid changed since February, when ToBeFree placed the section at the top? I'm seeing three reviews or literature surveys at PubMed that are now saying it might provide some benefit in certain circumstances. If this holds up, it may require changes to the last paragraph of the lead, which is pretty categorical that there's no indication of any benefit whatever, and these surveys don't seem to fit that kind of language. Mathglot (talk) 11:53, 15 December 2022 (UTC)Reply[reply]

The issue was always how claims were being made that were not true, such as it was a cure. Slatersteven (talk) 11:59, 15 December 2022 (UTC)Reply[reply]
Which reviews specifically? Bon courage (talk) 12:06, 15 December 2022 (UTC)Reply[reply]
Yeah, I get that. The two sentences of the lead that I was referring to, are these:
During the COVID-19 pandemic, misinformation has been widely spread claiming that ivermectin is beneficial for treating and preventing COVID-19.[19][20] Such claims are not backed by credible scientific evidence.
(edit conflict) I think the first part is undoubtedly accurate (misinformation widely spread); but less sure about the rest. If it's beneficial some of the time, for some of the people, then the second part is too strong, or unbalanced. The way it's written now ("*is* beneficial") would not be supported by the surveys I saw either, but that's a pretty categorical statement, that we generally wouldn't use even for approved drugs that have clear benefits almost all of the time. We talk about the benefit of flu vaccines even in some years when they are 10-20% effective. Maybe time to revisit the wording in that paragraph? Mathglot (talk) 12:10, 15 December 2022 (UTC)Reply[reply]
I'll have to respond tomorrow, but it was trivial to find them, just include "survey" or "literature review" with your search terms, or go to Cochrane or Pubmed. Mathglot (talk) 12:12, 15 December 2022 (UTC)Reply[reply]
All the reviews I know of are junk (and have been repeatedly discussed). So just wondered if there was anything new. I believe the settled state of knowledge is that ivermectin for COVID is a total fraud, just the province of scammers and cranks these days. It's all covered at Ivermectin during the COVID-19 pandemic. Bon courage (talk) 12:21, 15 December 2022 (UTC)Reply[reply]
If all the reviews are junk, that leaves us (as editors) with very little to go on to build an article, because they are the secondary sources. How could we even summarize general reliable opinion, if the reviews themselves do not? That would undermine a lot of things, if that's actually the case. Mathglot (talk) 21:15, 15 December 2022 (UTC)Reply[reply]
I meant all the review with positive results wrt ivermectin/COVID, which I assumed you were referring to. Bon courage (talk) 02:08, 16 December 2022 (UTC)Reply[reply]
No, by review, I meant things like literature surveys/reviews and meta-analyses. I'm not aware of any literature reviews that are "junk", although I know of two that were questioned, because of inclusion (due to the inclusion criteria in their methodology) of studies that were questionable (one in each, iirc), thus calling into question how to deal with that at the level of a survey or meta-analysis. Mathglot (talk) 07:32, 16 December 2022 (UTC)Reply[reply]
I think probably what's been happening is that new trials have come out which show small benefit, but then when integrated into the overall evidence picture, these trials do not end up moving the needle much. The confidence intervals keep getting smaller, but they still overlap 1 for odds ratios, indicating the drug probably has just as much likelihood of harming as it does of helping. (see below). Various trials are always coming out as well that have bad methodologies which render them unsuited to answer the questions, and it doesn't come out until later that there are numerous issues. (e.g. Raoult's trials which are now being investigated for research misconduct [8]). — Shibbolethink ( ) 17:46, 15 December 2022 (UTC)Reply[reply]
Hi Mathglot, I didn't place the section at the top; I have never edited this page here. My protection of Template:COVID-19 treatments (current consensus) is the template's latest revision, so my name is displayed there. ~ ToBeFree (talk) 17:26, 15 December 2022 (UTC)Reply[reply]
Yes, I think that was probably me who added the template. I just updated it slightly to include the 2022 cochrane review, so it should show my name instead — Shibbolethink ( ) 17:50, 15 December 2022 (UTC)Reply[reply]
Oops, sorry ToBeFree; misread that as a small sig. Mathglot (talk) 21:11, 15 December 2022 (UTC)Reply[reply]
This 2022 cochrane review (updated as of 21 June 2022)[1] says:
We found no evidence to support the use of ivermectin for treating COVID-19 or preventing SARS-CoV-2 infection. The evidence base improved slightly in this update, but is still limited. (plain language summary)
and more technically speaking (edited only to trim for space, bolded and underlined to emphasize):
Inpatient data
  • We are uncertain whether ivermectin plus standard of care compared to standard of care plus/minus placebo reduces or increases all-cause mortality at 28 days (RR 0.60, 95% CI (0.14 to 2.51); 3 trials, 230 participants; very low-certainty evidence)
  • or [affect] clinical worsening at 28 days (RR 0.82, 95% CI 0.33 to 2.04; 2 trials, 118 participants; very low-certainty evidence)
  • or [reduce] serious adverse events during the trial period (RR 1.55, 95% CI 0.07 to 35.89; 2 trials, 197 participants; very low-certainty evidence)
  • may have little or no effect on ... viral clearance at 7 days (RR 1.12, 95% CI 0.80 to 1.58; 3 trials, 231 participants; low-certainty evidence).
Outpatient data
  • probably has little or no effect on all-cause mortality at day 28 (RR 0.77, 95% CI 0.47 to 1.25; 6 trials, 2860 participants; moderate-certainty evidence)
  • little or no effect on quality of life (measured with the PROMIS Global-10 scale) (physical component mean difference (MD) 0.00, 95% CI -0.98 to 0.98; and mental component MD 0.00, 95% CI -1.08 to 1.08; 1358 participants; high-certainty evidence).
  • may have little or no effect on clinical worsening, assessed by admission to hospital or death within 28 days (RR 1.09, 95% CI 0.20 to 6.02; 2 trials, 590 participants; low-certainty evidence);
  • may have little or no effect ... on clinical improvement, assessed by the number of participants with all initial symptoms resolved up to 14 days (RR 0.90, 95% CI 0.60 to
    1.36; 2 trials, 478 participants; low-certainty evidence)
  • may have little or no effect ... on serious adverse events (RR 2.27, 95% CI 0.62 to 8.31; 5 trials, 1502 participants; low-certainty evidence)
  • may have little or no effect ... on any adverse events during the trial period (RR 1.24, 95% CI 0.87 to 1.76; 5 trials, 1502 participants; low-certainty evidence)
  • may have little or no effect ... on viral clearance at day 7 compared to placebo (RR 1.01, 95% CI 0.69 to 1.48; 2 trials, 331 participants; low-certainty evidence)
Overall, I would say the evidence base has not changed much. We can be essentially certain that the drug does not reduce mortality or improve quality of life in the outpatient setting. Basically the only difference between this and the 2021 review is that the confidence intervals on these things got a little smaller, but they still overlap 1 (clinical equipoise) and even include relatively large ranges of "negative effect" in each. There is no reason based on this evidence to conclude that ivermectin improves the clinical picture for patients in either an inpatient or outpatient setting. — Shibbolethink ( ) 17:34, 15 December 2022 (UTC)Reply[reply]
That looks pretty persuasive; I wonder if my search terms were biased in some way? I'll have to go back and see what it was I was looking at, assuming I can repeat what I did, or find them some other way. Mostly what I remember is Pubmed results, linking mostly to ncbi. I'll post again, if there's anything worth saying. Mathglot (talk) 21:00, 15 December 2022 (UTC)Reply[reply]
I guess it is just because the people who write Cochrane reviews understand the subject better than a Google search does, even with the best search terms, and can summarize it better. But maybe I misunderstand what is going on here. --Hob Gadling (talk) 06:40, 16 December 2022 (UTC)Reply[reply]


Sources

  1. ^ Popp, Maria; Reis, Stefanie; Schießer, Selina; Hausinger, Renate Ilona; Stegemann, Miriam; Metzendorf, Maria-Inti; Kranke, Peter; Meybohm, Patrick; Skoetz, Nicole; Weibel, Stephanie (21 June 2022). "Ivermectin for preventing and treating COVID-19". Cochrane Database of Systematic Reviews. 2022 (6). doi:10.1002/14651858.CD015017.pub3. eISSN 1465-1858. PMC 9215332. PMID 35726131.

SAIVE Trial[edit]

Shall we mention the results of this trial? https://www.businesswire.com/news/home/20230105005896/en/MedinCell-Announces-Positive-Results-for-the-SAIVE-Clinical-Study-in-Prevention-of-Covid-19-Infection-in-a-Contact-Based-Population Pakbelang (talk) 08:13, 26 January 2023 (UTC)Reply[reply]

It's just PR. WP:MEDRS needed. Bon courage (talk) 08:20, 26 January 2023 (UTC)Reply[reply]