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Ivermectin Effect on In-Hospital Mortality and Need for Respiratory Support in COVID-19 Pneumonia: Propensity
Jara Llenas-García1,2,3, Alfonso Del Pozo1,2, Alberto Talaya1,2
1Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain.
Introduction:
There is negligible evidence on the efficacy of ivermectin for treating COVID-19 pneumonia. This study aimed to assess the efficacy of ivermectin for pre-emptively treating Strongyloides stercoralis hyperinfection syndrome in order to reduce mortality and the need for respiratory support in patients hospitalized for COVID-19.
Methods:
This single-center, observational, retrospective study included patients admitted with COVID-19 pneumonia at Hospital Vega Baja from 23 February 2020 to 14 March 2021. Because strongyloidiasis is endemic to our area, medical criteria support empiric administration of a single, 200 μg/kg dose of ivermectin to prevent Strongyloides hyperinfection syndrome. The outcome was a composite of all-cause in-hospital mortality and the need for respiratory support.
Results:
Of 1167 patients in the cohort, 96 received ivermectin. After propensity score matching, we included 192 patients. The composite outcome of in-hospital mortality or need for respiratory support occurred in 41.7% of the control group (40/96) and 34.4% (33/96) of the ivermectin group. Ivermectin was not associated with the outcome of interest (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.35, 1.69; p = 0.52). The factors independently associated with this endpoint were oxygen saturation (aOR 0.78, 95% CI 0.68, 0.89, p < 0.001) and C-reactive protein at admission (aOR: 1.09, 95% CI 1.03, 1.16, p < 0.001).
Conclusions:
In hospitalized patients with COVID-19 pneumonia, ivermectin at a single dose for pre-emptively treating Strongyloides stercoralis is not effective in reducing mortality or the need for respiratory support measures.
Insights
Ivermectin did not reduce mortality or respiratory support needs in COVID-19 pneumonia patients with potential Strongyloides stercoralis. This study found no significant benefit of ivermectin for these outcomes.
Area of Science:
- Infectious Diseases
- Pulmonology
- Pharmacology
Background:
- Limited evidence exists on ivermectin's efficacy for COVID-19 pneumonia.
- Strongyloides stercoralis hyperinfection is a concern in endemic areas, potentially exacerbated by COVID-19.
- Preventive treatment for Strongyloides stercoralis in COVID-19 patients is under investigation.
Purpose of the Study:
- To evaluate the efficacy of ivermectin in preventing Strongyloides stercoralis hyperinfection syndrome.
- To determine if ivermectin reduces mortality and the need for respiratory support in hospitalized COVID-19 pneumonia patients.
- To assess the association between ivermectin use and clinical outcomes in this patient cohort.
Main Methods:
- Single-center, observational, retrospective study design.
- Inclusion of patients hospitalized with COVID-19 pneumonia between February 2020 and March 2021.
- Propensity score matching used to compare outcomes between ivermectin recipients and a control group.
Main Results:
- A total of 1167 patients were initially considered; 96 received ivermectin and were matched with 96 controls.
- The composite outcome (in-hospital mortality or respiratory support) occurred in 34.4% of the ivermectin group versus 41.7% of the control group.
- Ivermectin use was not significantly associated with a reduction in the composite outcome (aOR 0.77; p=0.52).
Conclusions:
- Single-dose ivermectin for pre-emptive Strongyloides stercoralis treatment did not effectively reduce mortality or the need for respiratory support in COVID-19 pneumonia patients.
- Oxygen saturation and C-reactive protein levels were independently associated with the study's composite endpoint.
- Further research may be needed to explore other therapeutic strategies for Strongyloides stercoralis in this population.
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