Fact Check: Ivermectin Precursor Did Win Nobel Prize (October 2021)

The claim: Ivermectin won Nobel Prize for its role in treating human disease  

Debate over potential COVID-19 treatments has been a constantly evolving saga over the last year, with drugs like hydroxychloroquine and recently ivermectin touted by many despite a lack of convincing scientific evidence.  

Demand for ivermectin reached a fever pitch as prescriptions for the anti-parasitic agent shot up by 2,400% by the middle of August compared to the weekly average prior to the pandemic, according to the Centers for the Disease Control and Prevention. Ivermectin poisoning calls have also increased by 163%, according to data collected by the American Association of Poison Control Centers

Despite this, some social media users continue to support the drug, citing a high-profile award in an attempt to legitimize its controversial use against the virus.

"If you just got finessed into calling the medicine that won the 2015 Nobel Prize for its role in treating human disease 'horse de-wormer', then you need to sit the next couple of plays out," reads a graphic shared in a Sept. 6 Facebook post

The graphic has been shared widely on the social media platform, and it was recently echoed by popular podcaster and UFC commentator Joe Rogan – who reportedly used ivermectin when being treated for COVID-19. He raised the issue during an episode of the "Joe Rogan Experience," a clip of which was shared in a Sept. 8 Instagram post

The posts have collected thousands of interactions across Facebook and Instagram within the last few weeks, according to CrowdTangle, a social media insights tool.

While a precursor of ivermectin, known as avermectin, did win its two discoverers the 2015 Nobel Prize in Physiology and Medicine, it was related to treatment of parasites. It wasn't related to anything like a coronavirus.

USA TODAY has reached out to the Facebook and Instagram users, and Joe Rogan, for comment. 

From golf course to veterinary drug

Avermectin's origin story calls to mind the famous case of penicillin's discovery, when it was fortuitously extracted from a mold left growing in a lab. Avermectin was extracted from a soil-dwelling bacteria growing outside a Japanese golf course southwest of Tokyo. 

The bacteria, later christened Streptomyces avermectinius, was cultured in the 1970s by biochemist Satoshi Omura, who had been collecting soil samples all over Japan while hunting for new medicinal compounds.

The sample would later be sent to Merck Research Laboratories, which struck a royalties agreement with Omura's Kitasato Institute. The pharmaceutical giant, at the time, was particularly interested in creating therapeutics for veterinary use. 

In the late 1970s, a Merck researcher, parasitologist William Campbell, found that when mice infected with intestinal roundworms were given the bacteria from Omura's soil sample, the parasites were effectively wiped out. 

The key ingredient stifling the parasites, Campbell's team discovered, was a chemical they named avermectin, which turned out to be a mixture of eight closely related compounds. The most effective of these compounds, Avermectin B1 (made of a pair of molecules), was further tweaked and modified to overpower its parasitic targets yet be safe enough for the animals treated. In 1981, after clinical trials in animals, Merck commercialized the Avermectin B1 derivative, ivermectin, for veterinary use. 

Potential for human use 

By the 1980s, ivermectin was the top-selling veterinary drug in the world. This is also when potential human applications emerged. 

Onchocerciasis is a parasitic disease transmitted to humans through the bites of infected blackflies. The parasite, commonly found in tropical climates of Africa and South America, infests by migrating into its host's eye, causing inflammation, bleeding and other symptoms resulting in blindness.

Campbell's team at Merck had discovered ivermectin was effective against a close relative of that parasite in horses but doesn't cause disease. This discovery encouraged Merck to test ivermectin in treating river blindness, which, in 1981, led to the first clinical trial of human volunteers in Senegal.

The success of these, and many other, human trials over the next several years, led to ivermectin being distributed in 1988 to countries affected by river blindness and another parasitic disease called lymphatic filariasis, which is caused by microscopic worms that invade the human lymph system.

The FDA approved ivermectin for human use as an antiparasitic drug in 1996 for treatment of river blindness and strongyloidiasis, another parasitic infection that mostly infects animals but humans as well.

In 2015, Campbell and Omura were awarded the Nobel Prize in Physiology or Medicine for the drug's application in roundworms. The Nobel announcement praised the duo – and another recipient awarded for a malaria treatment – for developing "therapies that have revolutionized the treatment of some of the most devastating parasitic diseases."

Read More: https://www.usatoday.com/story/news/factcheck/2021/09/14/fact-check-ivermectin-did-win-nobel-prize-not-proven-covid-19/8258399002/


FLCCC (Front Line COVID-19 Critical Care) I-MASK+ Protocol


FLCCC Putting Patients First

Some media channels argue that there is very little evidence to support the use of ivermectin in COVID-19. We have included the relevant supporting scientific evidence together with the sources and references in this article below and we leave it up to you, the reader, to decide who is the real 'fact-checker'. 

The initial MATH+ protocol was released in April 2020. In early July and August, it was updated to include quercetin and a number of optional nutrients and drugs, not only for critical care but also for prophylaxis and mild disease being treated at home.

There is evidence that vitamin C and quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral and immuno-modulatory properties and the capacity of ascorbate to recycle quercetin, increasing its efficacy.

I-MASK+ Prevention & Early Outpatient Treatment Protocol for COVID-19 was designed for use as a prevention and in early outpatient treatment, for those who test positive for COVID-19. Component nutrients include vitamin D, C, melatonin, quercetin and zinc.

All the component medicines are FDA-approved (except ivermectin), inexpensive, readily available and have been used for decades with well-established safety profiles.

IMPORTANT UPDATE TO FIGHT THE DELTA VARIANT
Once again FLCCC medical team strengthened the I-MASK+ prevention & early treatment protocol to counter the new COVID-19 variant. 


PREVENTION Protocol (for Delta variant)

Should I take ivermectin as a prophylaxis? For prevention, the Front Line COVID-19 Critical Care Working Group (FLCCC) I-MASK+ protocol recommends (September 24, 2021 version):

Anti-Virals & AntiSeptics
  • Gargle mouthwash: 2 x daily – gargle (do not swallow) antiseptic mouthwash with cetylpyridinium chloride (e.g. Scope mouthwash™, Crest mouthwashColgate mouthwash) or povidone/iodine 1 % solution as alternative (e.g. Betadine® Antiseptic Sore Throat Gargle™). 
  • lvermectin
    • Chronic Prevention: 0.2 mg/kg per dose (take with or after a meal) — twice a week for as long as disease risk is elevated in your community 
    • Post COVID-19 Exposure Prevention: 0.4 mg/kg per dose (take with or after a meal)  — one dose today, repeat after 48 hours
Immune Fortifying / Supportive Therapy
Notes:
  • High risk Individuals: > 60 years with co-morbidities (hypertension, diabetes, chronic lung disease, chronic kidney disease), obesity, long term care facilities, etc.
  • Post COVID-19 exposure: To use if a household member is COVID-19 positive, or you have prolonged exposure to a COVID-19 positive patient without wearing a mask.
  • Precautionary Note: Ivermectin has a number of potentially serious drug-drug interactions. Please check for potential drug interaction at Ivermectin Drug Interactions - Drugs.com. The most important drug interactions occur with cyclosporin, tacrolimus, anti-retroviral drugs, and certain anti-fungal drugs. 
  • Due to the possible drug interaction between quercetin and ivermectin (may increase ivermectin levels), these drugs should not be taken simultaneously (i.e. should be staggered morning and night). 
  • Ivermectin is also lipophilic and therefore, bioavailability is maximised on a full stomach; or best to be taken with meal.
  • Vitamin D3 RDA (Recommended Daily Allowance) is 800–1000 IU/day. The safe upper-dose daily limit is likely < 4000 IU/day. Vitamin D deficiency has been associated with an increased risk of acquiring COVID-19 and from dying from the disease. Vitamin D supplementation may therefore prove to be an effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, i.e. the elderly and obese.
  • When Is the Best Time to Take Vitamin D? Morning or Night? It is possible that increasing vitamin D levels during the day may act, in part, as a signal that suppresses melatonin generation (source). Therefore, it's better to take vitamin D (with meal) during the day and melatonin to be taken just before bedtime.
  • It is likely that vitamin C and quercetin have synergistic prophylactic benefit. Quercetin should be used with caution in patients with hypothyroidism and TSH levels should be monitored.
  • Please consult with a qualified doctor and only use human ivermectin. Ivermectin for animals contain excipients (binding and storage compounds such as polyethylene glycol (PEG)) that are known to cause liver failure in high doses. 
Related: 

EARLY TREATMENT PROTOCOL

For early outpatient protocol (COVID-19 positive), the Front Line COVID-19 Critical Care Working Group, FLCCC I-MASK+ protocol recommends (updated September 24, 2021):

1. First line agents (use any or all medicines; listed in order of priority/importance)

Anti-Virals
  • Ivermectin: 0.4–0.6 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (Find a Doctor). Use upper dose range if:  1) in regions with more aggressive variants; 2) treatment started on or after day 5 of symptoms or in pulmonary phase; or 3) multiple comorbidities/risk factors.
  • and/or Nitazoxanide: 500 mg 2 x daily for 5 days after meals. Combine with ivermectin (preferred) or substitute if ivermectin is not available. (Nitazoxanide is often unavailable or high-priced in the USA)
Anti-Septic Anti-virals
  • Antiviral mouthwash: Gargle 3 x daily (do not swallow; must contain chlorhexidine,  povidone-iodine, or cetylpyridinium chloride). (e.g. Scope mouthwash™, Crest mouthwashColgate mouthwashBetadine® Antiseptic Sore Throat Gargle)
  • Iodine Nasal Spray: Use 1 % povidone iodine commercial product as per instructions 2–3 x daily. If 1 %-product not available, must first dilute the more widely available 10 %-solution and apply 4–5 drops to each nose every 4 hours. (No more than 5 days in pregnancy.)
Anti-Coagulants + Immune Fortifying
  • Aspirin: 325 mg/day unless contraindicated. (Amazon)
  • Vitamin D3: 5,000 IU daily. Preferred forms if available: Calcitriol (Rocaltrol) 0.5 mcg on day 1, then 0.25 mcg daily for 7 days – or Calcifediol 0.5 mg on day 1, then 0.2 mg on days  3 + 7, then 0.2 mg weekly until recovered.
  • Melatonin: 10 mg before bedtime (causes drowsiness). (Amazon)
Adjunctive / Synergistic Therapies
  • Vitamin C: 500 - 1,000 mg BID (twice daily) (Amazon) (iHerb)
  • Quercetin: 250 mg twice a day. (Amazon) (iHerb)
  • Zinc: 100 mg/day. Zinc lozenges are preferred. (Amazon) (iHerb)
Nutritional Therapeutics (New)
  • Curcumin (turmeric) 500mg 2 x daily for 14 days (Amazon)
  • Nigella Sativa 80mg/kg daily for 14 days (Amazon)
  • Honey 1gram/kg daily for 14 days
Pulse Oximeter

FLCCC also recommend monitoring your oxygen saturation with a pulse oximeter and to go to the hospital if you get below 94%. (Amazon)

2. Second line agents (listed in order of priority /importance)

Add to first line therapies above if: 
1) ≥5 days of symptoms; 
2) Poor response to therapies above; 
3) Significant comorbidities

Dual anti-androgen Therapy
  1. Spironolactone 100 mg 2 x daily for ten days
  2. Dutasteride 2 mg on day 1, followed by 1 mg daily for 10 days. If dutasteride is not available, use finasteride 10 mg daily for 10 days.
Fluvoxamine

Fluvoxamine: 50 mg twice daily for 10 days. 
Consider fluoxetine (Prozac) 30mg daily for 10 days as an alternative (it is often better tolerated).
Avoid if patient is already on an SSRI.

Monoclonal antibody therapy

Casirivimab/imdevimab: 600 mg each in a single subcutaneous injection for patients with one or more risk factors as follows: Age > 65y; obesity; pregnancy; chronic lung, heart, or kidney disease; diabetes; immunosuppressed; developmental disability; chronic tracheostomy; or tube feeding.

Alternatives: 
* Not available on Amazon

Behavioral Prevention:
  • Face Masks - Must wear cloth, surgical, or N95 mask (without valve) in all indoor spaces with non-household persons. Must wear a N95 mask (without valve) during prolonged exposure to non-household persons in any confined, poorly ventilated area.
  • Social Distancing - Until the end of the COVID-19 crisis, we recommend keeping a minimum distance of approx. 2 m / 6 feet in public from people who are not from your own household.
  • Wash Hands - We recommend, after a stay during and after outings from home (shopping, sub - way etc.), a thorough hand cleaning (20–30 sec. with soap), or also to use a hand disinfectant in between.
For an up-to-date overview of all published studies on ivermectin in the treatment and prevention of COVID-19 we recommend visiting c19ivermectin.com; in addition, a meta-analysis of all studies can be found at ivmeta.com (constantly updated). For adoption and regulatory status of ivermectin globally, check out "Countries using Ivermectin".

For post-covid or long covid syndrome, check out FLCCC I-Recover Post-COVID Protocol. For a simplified version of the I-MASK+ protocol, the FLCCC has also developed the I-MASS protocol.


Comments

Popular Posts