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I have seen few headlines on the repurposing of Ivermectin, a old FDA approved anti-parasitic drug, against #COVID19 infection. The claim is low dose of ivermectin kills #SARSCoV2 in cells. I can see the exaggeration => the new miracle drug. So I decided to have a look in details https://twitter.com/7NewsSydney/status/1246007887316451328
First what is Ivermectin? It is a FDA approved drug discovered ~ 30 years ago listed as essential from WHO. It is cheap and effective against parasitic diseases and relatively safe. It is a good drug to repurpose against #COVID19
So the paper was published yesterday and the paper is actually quite good and doesn't make unreasonable claims https://www.sciencedirect.com/science/article/pii/S0166354220302011
What they did => assessed dose response of Ivermectin against an Australian #SARSCoV2 isolate in Vero2 cells at MOI of 0.1 for 2 hours. They added Ivermectin up to 5µM and assessed the #SARS_CoV2 killing by RT PCR => IC50 ~ 2.2 µM full inhibition at 48 hours which is good
They also observed no toxicity in cells (although no measurement provided). They hypothesized Ivermectin block viral replication by inhibiting nuclear import of the virus. The authors claim Ivermectin could be repurposed against #COVID19 & require further studies
In short I have no problem with this paper at all. Experiments were well performed. However we have to be a lot cautious & careful around claims it rapidly kills the virus that it is going a game changer for couple of very good reasons.
1/ I have been long enough in this field to state that I have cured many times Malaria and bacteria infections in cells but pretty much never in mouse or in humans. Killing a pathogens in cells ≠ to real life. Pathogens evolves & adapts. There are also toxicity issues.
2/ While IC50 of 2.2 µM is OK for Ivermectin, there are also plenty drugs as or more potent => Niclosamide, an anti-parasitic drug is more potent than Ivermectin or Hydroxychloroquine against #SARS_COV_2 in cells with IC50 of 0.28 µM, which is very low https://www.biorxiv.org/content/10.1101/2020.03.20.999730v1.full.pdf
3/ As huge numbers of drugs failed in the pipeline due to toxicity, wrong target or lack efficacy, it is critical a/ To perform pharmacokinetic studies b/ Genetically validate target if possible c/ test pre-clinically d/ If passes these steps, go for a randomized clinical trial.
A good example of my point is on precisely Ivermectin. Ivermectin showed potency against Dengue virus in cells but failed in a randomized human clinical trial in Thailand on Dengue virus. There are many drugs show killing pathogens in cells that have failed in clinical trials
In short 1/ There are to miracle drugs against #COVID19 infection 2/ Killing #COVID19 in cells is very ≠ to real life 3/ The most efficacious treatment against #COVID19 right now is not a miraculous drug but to #selfisolate #stayhome #WashYourHands 
#WearMask and watch Netflix !
#WearMask and watch Netflix !
