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1.
BMC Infect Dis ; 21(1): 411, 2021 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-33947344

RESUMEN

BACKGROUND AND OBJECTIVES: An effective treatment option is not yet available for SARS-CoV2, which causes the COVID-19 pandemic and whose effects are felt more and more every day. Ivermectin is among the drugs whose effectiveness in treatment has been investigated. In this study; it was aimed to investigate the presence of gene mutations that alter ivermectin metabolism and cause toxic effects in patients with severe COVID-19 pneumonia, and to evaluate the effectiveness and safety of ivermectin use in the treatment of patients without mutation. MATERIALS AND METHODS: Patients with severe COVID19 pneumonia were included in the study, which was planned as a prospective, randomized, controlled, single-blind phase 3 study. Two groups, the study group and the control group, took part in the study. Ivermectin 200 mcg/kg/day for 5 days in the form of a solution prepared for enteral use added to the reference treatment protocol -hydroxychloroquine + favipiravir + azithromycin- of patients included in the study group. Patients in the control group were given only reference treatment with 3 other drugs without ivermectin. The presence of mutations was investigated by performing sequence analysis in the mdr1/abcab1 gene with the Sanger method in patients included in the study group according to randomization. Patients with mutations were excluded from the study and ivermectin treatment was not continued. Patients were followed for 5 days after treatment. At the end of the treatment and follow-up period, clinical response and changes in laboratory parameters were evaluated. RESULTS: A total of 66 patients, 36 in the study group and 30 in the control group were included in the study. Mutations affecting ivermectin metabolism was detected in genetic tests of six (16.7%) patients in the study group and they were excluded from the study. At the end of the 5-day follow-up period, the rate of clinical improvement was 73.3% (22/30) in the study group and was 53.3% (16/30) in the control group (p = 0.10). At the end of the study, mortality developed in 6 patients (20%) in the study group and in 9 (30%) patients in the control group (p = 0.37). At the end of the follow-up period, the average peripheral capillary oxygen saturation (SpO2) values of the study and control groups were found to be 93.5 and 93.0%, respectively. Partial pressure of oxygen (PaO2)/FiO2 ratios were determined as 236.3 ± 85.7 and 220.8 ± 127.3 in the study and control groups, respectively. While the blood lymphocyte count was higher in the study group compared to the control group (1698 ± 1438 and 1256 ± 710, respectively) at the end of the follow-up period (p = 0.24); reduction in serum C-reactive protein (CRP), ferritin and D-dimer levels was more pronounced in the study group (p = 0.02, p = 0.005 and p = 0.03, respectively). CONCLUSIONS: According to the findings obtained, ivermectin can provide an increase in clinical recovery, improvement in prognostic laboratory parameters and a decrease in mortality rates even when used in patients with severe COVID-19. Consequently, ivermectin should be considered as an alternative drug that can be used in the treatment of COVID-19 disease or as an additional option to existing protocols.


Asunto(s)
Antivirales/uso terapéutico , Ivermectina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Subfamilia B de Transportador de Casetes de Unión a ATP/genética , Anciano , Amidas/uso terapéutico , Antivirales/farmacocinética , Azitromicina/uso terapéutico , /mortalidad , Citocromo P-450 CYP3A/genética , Quimioterapia Combinada , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Ivermectina/farmacocinética , Masculino , Persona de Mediana Edad , Neumonía Viral/sangre , Neumonía Viral/virología , Estudios Prospectivos , Pirazinas/uso terapéutico , Método Simple Ciego , Resultado del Tratamiento
2.
S Afr Med J ; 111(4): 288-290, 2021 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-33944756

RESUMEN

Some South African (SA) healthcare practitioners are promoting the prescription and use of products claiming to contain ivermectin for the treatment and/or prevention of COVID-19 in SA. This study qualitatively analysed seven samples of ivermectin formulations (5 tablet and 2 capsule formulations) being sold in SA for human use. The samples were analysed using a high-performance liquid chromatography instrument connected to a Sciex X500R quadrupole time-of-flight high-resolution mass spectrometer. The study found that all the samples had both the major homologues of ivermectin (B1a and B1b) and also that 4 out of the 5 tablet formulations tested had at least one additional undeclared active pharmaceutical ingredient.


Asunto(s)
/tratamiento farmacológico , Ivermectina/análisis , /epidemiología , Cápsulas , Cromatografía Líquida de Alta Presión , Humanos , Ivermectina/uso terapéutico , Espectrometría de Masas , Investigación Cualitativa , Sudáfrica/epidemiología , Comprimidos
3.
Rev Bras Parasitol Vet ; 30(2): e025120, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33950148

RESUMEN

This study evaluated the resistance status of Haemonchus contortus from sheep flocks in the state of São Paulo, Brazil, through comparison between the fecal egg count reduction test (FECRT) and the larval development test (LDT). For the FECRT, 35 sheep were selected in each of five flocks and divided into groups treated with: benzimidazole, levamisole, ivermectin, monepantel and control. Feces were collected for EPG and fecal cultures. The LDT was performed using thiabendazole (TBZ), levamisole (LEV), ivermectin aglycone (IVM-A) and Zolvix (ZLV). Resistance to all drugs was detected using FECRT in 100% of the flocks, except in relation to ZLV (40% resistant and 20% suspected of resistance). LDT indicated resistance to TBZ and IVM-A in all flocks, to LEV in 80% of flocks and to ZLV in 10%. Total agreement was obtained between the two tests for TBZ and IVM (k = 1.0), while for LEV (k = 0.8) and ZLV (k = 0.9), substantial and almost perfect agreement were obtained, respectively. The concordance between the tests was significant, thus showing that it is possible to use the outcome of the LDT to predict the FECRT, and hence validating the former as a fast diagnostic test for use by sheep farmers in Brazil.


Asunto(s)
Antihelmínticos , Hemoncosis , Haemonchus , Enfermedades de las Ovejas , Animales , Antihelmínticos/farmacología , Antihelmínticos/uso terapéutico , Brasil , Resistencia a Medicamentos , Heces , Hemoncosis/diagnóstico , Hemoncosis/tratamiento farmacológico , Hemoncosis/veterinaria , Ivermectina/uso terapéutico , Recuento de Huevos de Parásitos/veterinaria , Ovinos , Enfermedades de las Ovejas/diagnóstico , Enfermedades de las Ovejas/tratamiento farmacológico
4.
J Int Med Res ; 49(5): 3000605211013550, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33983065

RESUMEN

OBJECTIVE: We evaluated whether ivermectin combined with doxycycline reduced the clinical recovery time in adults with COVID-19 infection. METHODS: This was a randomized, blinded, placebo-controlled trial in patients with mild-to-moderate COVID-19 symptoms randomly assigned to treatment (n = 200) and placebo (n = 200) groups. The primary outcome was duration from treatment to clinical recovery. Secondary outcomes were disease progression and persistent COVID-19 positivity by RT-PCR. RESULTS: Among 556 screened patients, 400 were enrolled and 363 completed follow-up. The mean patient age was 40 years, and 59% were men. The median recovery time was 7 (4-10, treatment group) and 9 (5-12, placebo group) days (hazard ratio, 0.73; 95% confidence interval, 0.60-0.90). The number of patients with a ≤7-day recovery was 61% (treatment group) and 44% (placebo groups) (hazard ratio, 0.06; 95% confidence interval, 0.04-0.09). The proportion of patients who remained RT-PCR positive on day 14 and whose disease did not progress was significantly lower in the treatment group than in the placebo group. CONCLUSIONS: Patients with mild-to-moderate COVID-19 infection treated with ivermectin plus doxycycline recovered earlier, were less likely to progress to more serious disease, and were more likely to be COVID-19 negative by RT-PCR on day 14. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04523831. DATA REPOSITORY ID: Dryad. doi:10.5061/dryad.qjq2bvqf6.


Asunto(s)
Ivermectina , Adulto , Doxiciclina/uso terapéutico , Femenino , Humanos , Ivermectina/uso terapéutico , Masculino , Resultado del Tratamiento
5.
Ann Parasitol ; 67(1): 133-136, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34022785

RESUMEN

Psoroptes ovis (Acari: Psoroptidae, Hering, 1838) is an ectoparasite that poses a high risk to herd animals and causes a severe dermal disease called psoroptic mange. This work aimed to report P. ovis parasitism in a dog. A male Pinscher that lives in rural areas and had free access to sheep farming showed hair loss in the dorsal region and mild itching. Dermatological examination demonstrated irregular alopecia, scabs, dry desquamation and erythema around the dorsal region of the thorax and pelvis. Hemogram has shown mild eosinophilia and the fungal culture was negative. In skin scrapings, P. ovis was observed, and its morphological characteristics were recorded. Treatment with ivermectin (0.5 mg/kg) was initiated orally once weekly for six weeks and amitraz for environmental control shown positive results. The diagnosis of psoroptic mange in dogs was performed based on morphological characterization of mite and the report of sheep contact. This is the first report of the occurrence of P. ovis in dog.


Asunto(s)
Enfermedades de los Bovinos , Infestaciones por Ácaros , Psoroptidae , Enfermedades de las Ovejas , Animales , Brasil/epidemiología , Bovinos , Perros , Ivermectina/uso terapéutico , Masculino , Infestaciones por Ácaros/tratamiento farmacológico , Infestaciones por Ácaros/epidemiología , Infestaciones por Ácaros/veterinaria , Ovinos , Enfermedades de las Ovejas/tratamiento farmacológico , Enfermedades de las Ovejas/epidemiología
6.
s.l; CONETEC; 7 mayo 2021.
No convencional en Español | LILACS, BRISA/RedTESA | ID: biblio-1222803

RESUMEN

INTRODUCCIÓN: La ivermectina es un fármaco antiparasitario con actividad inmuno-moduladora y antiinflamatoria, no autorizado para mujeres embarazadas o en período de lactancia, ni para niños de menos de 15 kg de peso corporal. La dosis para el tratamiento antiparasitario varía entre 150 mcg/Kg y 250 mcg/Kg por vía oral y única vez, con un posible re tratamiento a partir de los 14 días para algunas indicaciones. La ivermectina se encuentra aprobada solamente como antiparasitario por la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT), Administración de Drogas y Alimentos de los Estados Unidos (FDA, su sigla del inglés Food and Drug Administration) y por la Agencia Europea de Medicina (EMA, su sigla del inglés European Medicine Agency). Durante los años previos, se ha demostrado la capacidad de la ivermectina in vitro, de disminuir la replicación viral, a través de diferentes mecanismos, entre los que se incluye la inhibición de la interacción entre la proteína integrasa (IN) del virus de la inmunodeficiencia humana-1 (VIH-1) y el heterodímero α/ß1 de importina (IMP) responsable de la importación nuclear de esta proteína.3-4 Los estudios sobre las proteínas del SARS-CoV han revelado que podría existir un rol potencial de la ivermectina a través de este mecanismo de acción de IMPα/ß1, principalmente durante el proceso de infección a las células del huésped, en el cierre nucleocitoplasmático dependiente de la señal de la proteína de la nucleocápside del SARS-CoV. OBJETIVO: El objetivo del presente informe es evaluar parámetros de eficacia, seguridad, conveniencia y recomendaciones disponibles acerca del uso ivermectina para la profilaxis de la infección por el virus SARS-CoV-2 y para el tratamiento de pacientes con COVID-19. MÉTODOS: Teniendo en cuenta la velocidad con la que la información relacionada a la pandemia aparece y se modifica (link), se desarrolló un protocolo sustentado en proyectos que resume activamente la evidencia científica a medida que la misma se hace disponible. Con este fin se utilizó la plataforma Love de Epistemonikos para identificar revisiones sistemáticas "vivas". Se seleccionaron aquellas con una calidad metodológica apropiada evaluada a través de la herramienta AMSTAR-2, y que a su vez llevaran un proceso de actualización frecuente.8 De cada una de las revisiones sistemáticas identificadas se extractaron los efectos de la intervención sobre los desenlaces priorizados como importantes o críticos separando los efectos del tratamiento sobre pacientes expuestos (infección por SARS-CoV-2 confirmada por laboratorio) y en pacientes infectados y con COVID-19 (mortalidad, ingreso en asistencia ventilatoria mecánica, duración de estadía hospitalaria, tiempo a la resolución de síntomas o mejoría clínica al día 7-28 y eventos adversos graves) y la certeza en dichos efectos. Adicionalmente se extractaron datos relacionados a efectos de subgrupo potencialmente relevantes para la toma de decisión, con especial énfasis en el tiempo de evolución y la severidad de la enfermedad. RECOMENDACIONES: Se identificaron siete recomendaciones de las cuales cinco cumplen con los criterios de inclusión del presente informe. CONCLUSIONES: En personas no infectadas expuestas al SARS-CoV-2, existe incertidumbre en el efecto de la ivermectina para prevenir la infección sintomática, presunta o confirmada por este virus. El cuerpo de evidencia disponible hasta el momento muestra que, en pacientes con COVID-19, existe incertidumbre en el efecto de ivermectina sobre la mortalidad y los eventos adversos graves. La ivermectina podría no tener efecto sobre el ingreso en ventilación mecánica o la duración de la internación y probablemente no tenga efecto en el tiempo de resolución de los síntomas La ivermectina se encuentra ampliamente disponible en Argentina y está aprobada por ANMAT para el tratamiento de infecciones parasitarias. Sin embargo, no se encuentra aprobada para su uso en la prevención de la infección por el virus SARS-CoV-2 o para el tratamiento de personas con COVID-19. Su costo comparativo es bajo. Las guías de práctica clínica identificadas consistentemente brindan recomendaciones en contra del empleo de ivermectina en personas expuestas al virus SARS-CoV-2 o con enfermedad por COVID-19.


Asunto(s)
Humanos , Neumonía Viral/tratamiento farmacológico , Ivermectina/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Betacoronavirus/efectos de los fármacos , Evaluación de la Tecnología Biomédica , Análisis Costo-Eficiencia
7.
Parasite ; 28: 25, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33812457

RESUMEN

Esafoxolaner, a purified enantiomer of afoxolaner with insecticidal and acaricidal properties, is combined with eprinomectin and praziquantel in NexGard® Combo, a novel topical endectoparasiticide product for cats. The efficacy of this novel formulation was assessed in two experimental studies against induced infestations with Amblyomma americanum, a tick species of major importance, highly prevalent in a large southeastern quarter of the United States. In each study, 10 cats were randomly allocated to a placebo control group and 10 cats to a novel formulation treated group. Infested cats were treated topically once at the minimum recommended dose. Both studies were designed to test curative efficacy on existing infestation, 72 h after treatment, and to test preventive efficacy, 72 h after subsequent weekly (Study #1) or fortnightly (Study #2) infestations for one month. For each infestation, all cats were infested with 50 unfed adult A. americanum. At each tick count, in both studies, at least 8 in 10 placebo control cats were infested with 13 (26%) or more live ticks, demonstrating adequate infestation throughout the studies. Curative efficacy of the novel formulation was 99% in both studies; preventive efficacy was 92% and 100% for at least one month.


Asunto(s)
Enfermedades de los Gatos , Infestaciones por Garrapatas , Animales , Enfermedades de los Gatos/tratamiento farmacológico , Enfermedades de los Gatos/prevención & control , Gatos , Ivermectina/análogos & derivados , Ivermectina/uso terapéutico , Praziquantel/uso terapéutico , Infestaciones por Garrapatas/tratamiento farmacológico , Infestaciones por Garrapatas/prevención & control , Infestaciones por Garrapatas/veterinaria , Resultado del Tratamiento
8.
Br J Hosp Med (Lond) ; 82(3): 1-9, 2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-33792391

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread and have grave health and socioeconomic consequences worldwide. Researchers have raced to understand the pathophysiological mechanisms underpinning the disease caused by SARS-CoV-2 so that effective therapeutic targets can be discovered. This review summarises the key pharmacotherapies that are being investigated for treatment of COVID-19, including antiviral, immunomodulator and anticoagulation strategies.


Asunto(s)
Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , Glucocorticoides/uso terapéutico , Factores Inmunológicos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Azetidinas/uso terapéutico , Colchicina/uso terapéutico , Dexametasona/uso terapéutico , Humanos , Inmunización Pasiva , Ivermectina/uso terapéutico , Inhibidores de las Cinasas Janus/uso terapéutico , Purinas/uso terapéutico , Pirazoles/uso terapéutico , Sulfonamidas/uso terapéutico
9.
Trials ; 22(1): 262, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33836826

RESUMEN

OBJECTIVES: The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation. The secondary objectives are: 1. To assess the efficacy of ivermectin to reduce the SARS-CoV-2 viral load in the nasopharyngeal swab on days 4, 7, 14 and 21 post-treatment initiation 2. To assess the efficacy of ivermectin on the improvement of symptoms 3. To assess the proportion of seroconversions at day 21 4. To assess the safety of ivermectin at the proposed dose 5. To determine the magnitude of the immune response against SARS-CoV-2 6. To assess correlation of the presence of intestinal helminths on participants on baseline and day 14 with COVID-19 progression and treatment. TRIAL DESIGN: SAINT PERU is a triple-blinded, randomized, placebo-controlled trial with two parallel arms to evaluate the efficacy of ivermectin in negativizing nasopharyngeal PCR in patients with SARS-CoV-2 infection. PARTICIPANTS: The trial is conducted in two national hospitals in Lima-Peru. The study population is patients with a positive PCR test for SARS-CoV-2 in a nasopharyngeal specimen, symptomatic for 96 hours or less, with non-severe COVID-19 disease at baseline, regardless of the presence of risk factors for progression to severity. The study will not include pregnant women or minors (17 years old or younger). Inclusion criteria 1. COVID-19 symptomatology (cough, fever, anosmia, etc.) lasting no more than 96 hours, with a positive nasopharyngeal swab PCR test for SARS-CoV-2. 2. 18 years or older. 3. No use of ivermectin in the month prior to the visit. 4. No known history of ivermectin allergy. 5. Capable to give informed consent. 6. Not current use of CYP 3A4 or P-gp inhibitor drugs such as quinidine, amiodarone, diltiazem, spironolactone, verapamil, clarithromycin, erythromycin, itraconazole, ketoconazole, cyclosporine, tacrolimus, indinavir, ritonavir, cobicistat or critical CYP3A4 substrate drugs such as warfarin. Exclusion criteria 1. COVID-19 pneumonia diagnosed by the attending physician (oxygen saturation < 95% or lung examination) 2. Positive pregnancy test for women at childbearing age. 3. Positive IgG against SARS-CoV-2 by rapid diagnostic test at screening. Participants will be recruited by the investigators at the emergency services of the study sites. They are expected to remain in the trial for a period of 21 days. Follow-up visits will be conducted by the trial medical staff at the participant's home or at a hospital in case of hospitalization. Follow-up visits will assess clinical and laboratory parameters of the patients. INTERVENTION AND COMPARATOR: Ivermectin (300 mcg/kg) or placebo will be administered in one daily dose for three consecutive days. Currently, there is no solid data on the efficacy of ivermectin against the virus in vivo; therefore the use of placebo in the control group is ethically justified. MAIN OUTCOMES: Primary Proportion of patients with a positive SARS-CoV-2 PCR from a nasopharyngeal swab at day 7 post-treatment. Secondary 1. Mean viral load as determined by PCR cycle threshold (Ct) on days 4, 7, 14, and 21 2. Proportion of patients with fever and cough at days 4, 7, 14, and 21 as well as proportion of patients progressing to severe disease or death during the trial 2. Proportion of patients with a positive rapid diagnostic test at day 21 3. Proportion of drug-related adverse events during the trial 4. Median levels of IgG, IgM, IgA measured by Luminex RANDOMIZATION: Participants will be randomized to receive one dose of 300 mcg/kg ivermectin or placebo daily for three consecutive days. The epidemiologist will generate a list of correlative numbers, in randomized blocks of size 4, with the assignment to the treatment groups (a and b). The randomization list will be kept in an encrypted file accessible only to the trial statistician. This list will be handed directly to the pharmacist. Independently, the principal investigator will randomly assign the intervention (ivermectin) to one of the two groups (a or b) by tossing a coin, and will inform the pharmacist of the result of this process. The pharmacist will prepare and label the treatment vials according to the randomization list prepared by the epidemiologist and the treatment assignment given by the principal investigator. Eligible patients will be allocated in a 1:1 ratio using this randomization list. BLINDING (MASKING): The clinical trial team, the statistician, and the patients will be blinded as to arm allocation. The vials with placebo will be visibly identical to the ones with the active drug. Treatment will be administered by staff not involved in the clinical care or participant's follow up. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): The planned sample size is 186 SARS-CoV-2 PCR positive patients: 93 patients to treatment and 93 to the placebo group. TRIAL STATUS: Current protocol version: 2.0 dated January 15th, 2021. Recruitment started on Aug 29th, 2020. Recruitment is expected to be completed April 30th 2021. TRIAL REGISTRATION: "Ensayo Clínico aleatorizado de Fase IIa para comparar la efectividad de la ivermectina versus placebo en la negativización del PCR en pacientes en fase temprana de COVID-19" Peru National Health Institute REPEC with number: PER-034-20 , registered July 17th 2020 (National Peruvian Registration before the first participant enrolled). "Randomized Phase IIA Clinical Trial to Evaluate the Efficacy of Ivermectin to Obtain Negative PCR Results in Patients With Early Phase COVID-19" Clinicaltrials.gov: NCT04635943 , retrospectively registered in November 19th 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
/diagnóstico , Ivermectina/uso terapéutico , Humanos , Estudios Multicéntricos como Asunto , Nasofaringe/virología , Perú , Reacción en Cadena de la Polimerasa , ARN Viral/aislamiento & purificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
10.
Front Immunol ; 12: 663586, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33859652

RESUMEN

As of January 2021, SARS-CoV-2 has killed over 2 million individuals across the world. As such, there is an urgent need for vaccines and therapeutics to reduce the burden of COVID-19. Several vaccines, including mRNA, vector-based vaccines, and inactivated vaccines, have been approved for emergency use in various countries. However, the slow roll-out of vaccines and insufficient global supply remains a challenge to turn the tide of the pandemic. Moreover, vaccines are important tools for preventing the disease but therapeutic tools to treat patients are also needed. As such, since the beginning of the pandemic, repurposed FDA-approved drugs have been sought as potential therapeutic options for COVID-19 due to their known safety profiles and potential anti-viral effects. One of these drugs is ivermectin (IVM), an antiparasitic drug created in the 1970s. IVM later exerted antiviral activity against various viruses including SARS-CoV-2. In this review, we delineate the story of how this antiparasitic drug was eventually identified as a potential treatment option for COVID-19. We review SARS-CoV-2 lifecycle, the role of the nucleocapsid protein, the turning points in past research that provided initial 'hints' for IVM's antiviral activity and its molecular mechanism of action- and finally, we culminate with the current clinical findings.


Asunto(s)
Transporte Activo de Núcleo Celular/efectos de los fármacos , Antivirales/uso terapéutico , Ivermectina/uso terapéutico , /efectos de los fármacos , Animales , Línea Celular , Chlorocebus aethiops , /metabolismo , Reposicionamiento de Medicamentos , Humanos , Fosfoproteínas/antagonistas & inhibidores , Fosfoproteínas/metabolismo , Transporte de Proteínas/efectos de los fármacos , Células Vero , Replicación Viral/efectos de los fármacos , alfa Carioferinas/antagonistas & inhibidores , beta Carioferinas/antagonistas & inhibidores
11.
Rev Med Inst Mex Seguro Soc ; 59(1): 87-94, 2021 02 02.
Artículo en Español | MEDLINE | ID: mdl-33667048

RESUMEN

Background: Strongyloides stercolaris is one of the most important intestinal nematodes due to its worldwide distribution. It's estimated that it affects 50 to 100 million people in 70 countries of the world. In a large percentage of cases it is asymptomatic, however, patients with immunosuppression may present more serious symptoms. The life cycle of this parasite comprises two phases: one as a free-living organism and the other as a parasite. The objective of this case report is to describe the histological findings compatible with this parasitosis and the importance of recognizing them in order to provide adequate and timely treatment. Case report: This is a 37-year-old male patient who began his condition in December 2018, with an acute respiratory condition that occurs after a diarrheal event. Due to the initial evolution, the presumptive diagnosis of Crohn's disease was made, treated with prednisone without showing improvement. During follow-up, stomach and duodenal biopsies were performed, among others, which allowed the detection of S. stercolaris, which was managed with ivermectin. Conclusions: The case presented agrees with what is referred to in the consulted literature, as it demonstrates the wide spectrum of clinical manifestations, the relationship with immunosuppression states and how frequent it is to make a first-instance erroneous diagnosis. Likewise, it exemplifies the difficulty involved in making the diagnosis of a parasitosis through histological study, due to the particularities of the parasite itself, as well as the little familiarity that the surgical pathologist may have due to how unusual this pathology is outside of tropical environments.


Asunto(s)
Strongyloides stercoralis , Estrongiloidiasis , Adulto , Animales , Humanos , Huésped Inmunocomprometido , Ivermectina/uso terapéutico , Masculino , Estrongiloidiasis/diagnóstico
13.
JAMA ; 325(14): 1426-1435, 2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33662102

RESUMEN

Importance: Ivermectin is widely prescribed as a potential treatment for COVID-19 despite uncertainty about its clinical benefit. Objective: To determine whether ivermectin is an efficacious treatment for mild COVID-19. Design, Setting, and Participants: Double-blind, randomized trial conducted at a single site in Cali, Colombia. Potential study participants were identified by simple random sampling from the state's health department electronic database of patients with symptomatic, laboratory-confirmed COVID-19 during the study period. A total of 476 adult patients with mild disease and symptoms for 7 days or fewer (at home or hospitalized) were enrolled between July 15 and November 30, 2020, and followed up through December 21, 2020. Intervention: Patients were randomized to receive ivermectin, 300 µg/kg of body weight per day for 5 days (n = 200) or placebo (n = 200). Main Outcomes and Measures: Primary outcome was time to resolution of symptoms within a 21-day follow-up period. Solicited adverse events and serious adverse events were also collected. Results: Among 400 patients who were randomized in the primary analysis population (median age, 37 years [interquartile range {IQR}, 29-48]; 231 women [58%]), 398 (99.5%) completed the trial. The median time to resolution of symptoms was 10 days (IQR, 9-13) in the ivermectin group compared with 12 days (IQR, 9-13) in the placebo group (hazard ratio for resolution of symptoms, 1.07 [95% CI, 0.87 to 1.32]; P = .53 by log-rank test). By day 21, 82% in the ivermectin group and 79% in the placebo group had resolved symptoms. The most common solicited adverse event was headache, reported by 104 patients (52%) given ivermectin and 111 (56%) who received placebo. The most common serious adverse event was multiorgan failure, occurring in 4 patients (2 in each group). Conclusion and Relevance: Among adults with mild COVID-19, a 5-day course of ivermectin, compared with placebo, did not significantly improve the time to resolution of symptoms. The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand the effects of ivermectin on other clinically relevant outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT04405843.


Asunto(s)
/tratamiento farmacológico , Ivermectina/uso terapéutico , Adulto , Anciano , Antiinfecciosos/efectos adversos , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Ivermectina/efectos adversos , Masculino , Persona de Mediana Edad , Gravedad del Paciente , Factores de Tiempo , Insuficiencia del Tratamiento
15.
Int J Infect Dis ; 105: 598-605, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33578014

RESUMEN

OBJECTIVE: There is an urgent need for effective treatments to prevent or attenuate lung and systemic inflammation, endotheliitis, and thrombosis related to COVID-19. This study aimed to assess the effectiveness of a multidrug-therapy consisting of Ivermectin, Azithromycin, Montelukast, and Acetylsalicylic acid ("TNR4" therapy) to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, Mexico. DESIGN AND METHODS: A comparative effectiveness study was performed among 768 confirmed SARS-CoV-2 cases aged 18-80 years, who received ambulatory care at the Ministry of Health of Tlaxcala. A total of 481 cases received the TNR4 therapy, while 287 received another treatment (comparison group). All participants received home visits and/or phone calls for clinical evaluation during the 14 days after enrollment. RESULTS: Nearly 85% of cases who received the TNR4 recovered within 14 days compared to 59% in the comparison group. The likelihood of recovery within 14 days was 3.4 times greater among the TNR4 group than in the comparison group. Patients treated with TNR4 had a 75% and 81% lower risk of being hospitalized or death, respectively, than the comparison group. CONCLUSIONS: TNR4 therapy improved recovery and prevented the risk of hospitalization and death among ambulatory COVID-19 cases.


Asunto(s)
Acetatos/uso terapéutico , Antivirales/uso terapéutico , Aspirina/uso terapéutico , Azitromicina/uso terapéutico , Ciclopropanos/uso terapéutico , Ivermectina/uso terapéutico , Quinolinas/uso terapéutico , Sulfuros/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Combinada , Hospitalización , Humanos , Masculino , México , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
16.
Drug Discov Ther ; 15(1): 39-41, 2021 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-33612572

RESUMEN

An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which began in Wuhan, China in December 2019, has rapidly spread all over the world. The World Health Organization characterized the disease caused by SARS-CoV-2 (COVID-19) as a pandemic in March 2020. In the absence of specific treatments for the virus, treatment options are being examined. Drug repurposing is a process of identifying new therapeutic uses for approved drugs. It is an effective strategy to discover drug molecules with new therapeutic indications. This strategy is time-saving, low-cost, and has a minimal risk of failure. Several existing approved drugs such as chloroquine, hydroxychloroquine, doxycycline, azithromycin, and ivermectin are currently in use because of their efficacy in inhibiting COVID-19. Multidrug therapy, such as a combination of hydroxychloroquine and azithromycin, a combination of doxycycline and ivermectin, or a combination of ivermectin, doxycycline, and azithromycin, has been successfully administered. Multidrug therapy is efficacious because the mechanisms of action of these drugs differ. Moreover, multidrug therapy may prevent the emergence of drug-resistant SARS-CoV-2.


Asunto(s)
/tratamiento farmacológico , Quimioterapia Combinada/métodos , Azitromicina/uso terapéutico , Doxiciclina/uso terapéutico , Reposicionamiento de Medicamentos , Humanos , Hidroxicloroquina/uso terapéutico , Ivermectina/uso terapéutico , Resultado del Tratamiento
17.
J Med Virol ; 93(5): 3176-3183, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33590901

RESUMEN

This trial compared the rate and time of viral clearance in subjects receiving a combination of nitazoxanide, ribavirin, and ivermectin plus Zinc versus those receiving supportive treatment. This non-randomized controlled trial included 62 patients on the triple combination treatment versus 51 age- and sex-matched patients on routine supportive treatment. all of them confirmed cases by positive reverse-transcription polymerase chain reaction of a nasopharyngeal swab. Trial results showed that the clearance rates were 0% and 58.1% on the 7th day and 13.7% and 73.1% on the 15th day in the supportive treatment and combined antiviral groups, respectively. The cumulative clearance rates on the 15th day are 13.7% and 88.7% in the supportive treatment and combined antiviral groups, respectively. This trial concluded by stating that the combined use of nitazoxanide, ribavirin, and ivermectin plus zinc supplement effectively cleared the SARS-COV2 from the nasopharynx in a shorter time than symptomatic therapy.


Asunto(s)
/tratamiento farmacológico , Ivermectina/uso terapéutico , Nitrocompuestos/uso terapéutico , Ribavirina/uso terapéutico , Tiazoles/uso terapéutico , Zinc/uso terapéutico , Adulto , Antimetabolitos/administración & dosificación , Antimetabolitos/uso terapéutico , Antiparasitarios/administración & dosificación , Antiparasitarios/uso terapéutico , Femenino , Humanos , Ivermectina/administración & dosificación , Masculino , Nitrocompuestos/administración & dosificación , Ribavirina/administración & dosificación , Tiazoles/administración & dosificación , Oligoelementos/administración & dosificación , Oligoelementos/uso terapéutico , Zinc/administración & dosificación
19.
PLoS One ; 16(2): e0247163, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33592050

RESUMEN

BACKGROUND: Ivermectin is one among several potential drugs explored for its therapeutic and preventive role in SARS-CoV-2 infection. The study was aimed to explore the association between ivermectin prophylaxis and the development of SARS-CoV-2 infection among healthcare workers. METHODS: A hospital-based matched case-control study was conducted among healthcare workers of AIIMS Bhubaneswar, India, from September to October 2020. Profession, gender, age and date of diagnosis were matched for 186 case-control pairs. Cases and controls were healthcare workers who tested positive and negative, respectively, for COVID-19 by RT-PCR. Exposure was defined as the intake of ivermectin and/or hydroxychloroquine and/or vitamin-C and/or other prophylaxis for COVID-19. Data collection and entry was done in Epicollect5, and analysis was performed using STATA version 13. Conditional logistic regression models were used to describe the associated factors for SARS-CoV-2 infection. RESULTS: Ivermectin prophylaxis was taken by 76 controls and 41 cases. Two-dose ivermectin prophylaxis (AOR 0.27, 95% CI, 0.15-0.51) was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Those involved in physical activity (AOR 3.06 95% CI, 1.18-7.93) for more than an hour/day were more likely to contract SARS-CoV-2 infection. Type of household, COVID duty, single-dose ivermectin prophylaxis, vitamin-C prophylaxis and hydroxychloroquine prophylaxis were not associated with SARS-CoV-2 infection. CONCLUSION: Two-dose ivermectin prophylaxis at a dose of 300 µg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Chemoprophylaxis has relevance in the containment of pandemic.


Asunto(s)
/prevención & control , Personal de Salud/estadística & datos numéricos , Ivermectina/uso terapéutico , Adulto , Ácido Ascórbico/administración & dosificación , Ácido Ascórbico/uso terapéutico , Estudios de Casos y Controles , Quimioprevención/métodos , Combinación de Medicamentos , Femenino , Humanos , India , Ivermectina/administración & dosificación , Masculino , Persona de Mediana Edad
20.
Actas dermo-sifiliogr. (Ed. impr.) ; 112(2): 118-126, feb. 2021. ilus, tab
Artículo en Español | IBECS | ID: ibc-194162

RESUMEN

Frente a la necesidad de encontrar una alternativa terapéutica que logre disminuir el impacto negativo de la COVID-19 y mejore el pronóstico actual de los pacientes, investigadores de todo el mundo se esfuerzan por aportar información que nos acerque a esta meta. Dentro de los potenciales fármacos, existen algunos de uso frecuente en dermatología: los antipalúdicos (cloroquina e hidroxicloroquina), la ivermectina, los antiandrógenos y la melatonina. Tanto estos como otros tratamientos se encuentran en la mira de la comunidad científica, siendo algunos foco de polémica y controversia. En el presente trabajo realizamos una revisión breve de los fármacos previamente mencionados, presentando los más recientes hallazgos con relación a su uso en la COVID-19


Researchers the world over are working to find the treatments needed to reduce the negative effects of coronavirus disease 2019 (COVID-19) and improve the current prognosis of patients. Several drugs that are often used in dermatology are among the potentially useful treatments: ivermectin, antiandrogenic agents, melatonin, and the antimalarial drugs chloroquine and hydroxychloroquine. These and other agents, some of which have proven controversial, are being scrutinized by the scientific community. We briefly review the aforementioned dermatologic drugs and describe the most recent findings relevant to their use against COVID-19


Asunto(s)
Humanos , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Pandemias , Cloroquina/uso terapéutico , Hidroxicloroquina/uso terapéutico , Ivermectina/uso terapéutico , Antagonistas de Andrógenos/uso terapéutico , Melatonina/uso terapéutico
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