The July issue of the Journal of Bangladesh College of Physicians and Surgeons includes, “A Case Series of 100 COVID-19 Positive Patients Treated with a Combination of Ivermectin and Doxycycline.” Given the studies showing Ivermectin can limit SARS-CoV-2 in the test tube, the researchers set out to see if this would translate to an effective medicine. The study looked at 100 patients, and the results were as follows: among patients aged 8 to 84 given the drug plus an antibiotic, retesting was done at 4 and 18 days of starting the medication. “All patients tested negative and their symptoms improved within 72 hours. There were no noticeable side effects.” The paper concludes that “Combination of Ivermectin and doxycycline was found to be very effective in viral clearance in mild and moderately sick COVID-19 patients. Medical societies and institutions should undertake larger multi center studies to validate and recommend this combination therapy to include in national guidelines.”
No Control Group, More Study Needed
The authors note that the study was a relatively small group, and there was no control group. But they posit, “the results encourage us to continue the clinical study for people of the world in this improbable crisis as each and every life counts. We urge the different medical societies and international organizations to take up this unique observation and quickly give it a trial and clearance because these drugs are FDA approved for many years with excellent safety and efficacy reviews. At the very least, using them in the first few days of being positive with or without symptoms may save the admissions of that 20% who suffer and the unnecessary deaths on ventilators. We can also stop the community transmission by asymptomatic carriers by treating the asymptomatic COVID-19 positive patients. Above all, it is a very cheap combination, and if fast-tracked by a quick trial would cost pennies and save a lot of lives, specifically designed for resource-poor settings.”
Lead Author Has Good Record with Ivermectin; BCPS Founded Along with Bangladesh
TrialSite News had had the past privilege of interviewing Prof. Mohammed Tarek Alam, Professor and Head of Department of Medicine, Bangladesh Medical College: and the lead author of this study. His previous Ivermectin work was covered by TrialSite recently: in a prior study, a 98% cure rate was found using the same two drugs as the current study. The Journal of Bangladesh College of Physicians and Surgeons is a peer-reviewed quarterly of the Bangladesh College of Physicians and Surgeons. BCPS is a pioneer in Bangladeshi post-graduate medical education, and the qualifications it confers are recognized in many nations. According to BCPS, their “examination system has been continuously updated to keep at par with the development of medical education and training in developed countries.” Before Bangladeshi independence in 1971, BCPS was a wing of a Pakistani institute. By 1972 it was established as an independent organization. Bangladesh’s ongoing development as a future research hub for contract organizations was covered by TrialSite here.
This story reminds us that COVID-19 is a global problem and that while richer nations have the resources for countless “tight” double-blind studies, many lower-to-middle-income countries (LMICs) do not. Despite an abundance of wealth, the COVID-19 crisis has hit the United States particularly hard. Yet, in other cases, LMICs appear to be leveraging a defense, yet with so fewer resources. Does COVID-19 represent a real challenge that perhaps necessitates a look south and east? Our recent documentary filmed in Peru took a balanced and objective approach to observe the needs and actions on the ground in that nation: with limited resources, community-minded physicians sought to capitalize on the findings out of Australia, that Ivermectin kills COVID-19 in a cell culture, while acknowledging the great need in that Andean nation for coupling real-world data with rigorous “gold standard” research. In many LMICs, such as Peru, it’s difficult to ramp up research quickly if at all in the short run, but based on the experience of COVID-19, perhaps there is a way for global collaborations to change this. Bangladesh has done an admirable job in tough circumstances in designing high quality observational (real world) studies while recognizing the need for more comprehensive randomized and controlled trials. So, as we look to the US and Europe, among others, for perhaps faster generation of the rigorous “evidence” needed to fully defeat the virus, we might also look to LMICs for “on the ground” intelligence about what is working as they fight to save lives with scarce resources. Perhaps moving forward, in some positive and proactive way, the different worlds came team-up to combine and synthesize real-world experience and randomized gold standard data in a more dynamic, engaging, and constructive way for the basis of expediting our fighting knowledge against COVID-19?
Dr. Tarek Alam, Associate Professor, Department of Medicine, Bangladesh Medical College, Dhaka