The Philippines national health authority recently rejected a bid to include the antiparasitic medicine Ivermectin for recommended use against COVID-19. Recently, the Department of Health decided there wasn’t enough evidence to make that recommendation. A common drug used for various parasites mostly found in the tropics but also elsewhere, the drug is also used in some nations and regions. For example, in India certain states, such as Uttar Pradesh, with 205 million residents, has accepted the drug as a compelling early onset treatment targeting COVID-19. In Brazil, some states and local public health departments hand out home treatment kits while at least for a while in nations, such as Peru, the drug was accepted by the national authority. TrialSite produced a documentary on this phenomena which can be watched here. A concern at least in some South American nations has been local abuse of the drug via self-medication and lack of appropriate oversight. Now the Philippines has opted for more evidence before they can greenlight such a recommendation for approval.
COVID-19 in the Philippines
As reported recently by ABS-CBN News in the Philippines, Kristine Sabillo writes that nearly 80 million worldwide have been infected by COVID-19 with nearly 1.7 million deaths reported at Johns Hopkins University. In the Philippines the total number of cases recently reached 461,505 including 23,341 active infections and approaching 9,000 deaths. A total of 429,207 in the Philippines have recovered from the virus. The Philippines started trials in August to test the antiviral drug Avigan (favipiravir) as a potential treatment targeting early onset of the virus.
Ivermectin Use in the Philippines
In the Philippines, ivermectin is used for treatment of parasite infestation such as lymphatic filariasis, which can cause elephantiasis. While studies have been underway in India and Bangladesh, the Philippines Health Undersecretary Maria Rosario Vergeire shared that her and team haven’t been able to review this research.
Small Sample Size
Moreover, the concern in the Philippines among health authorities is lack of sufficient data. Although some studies in India and Bangladesh, for example, have shown promise these initial results are based on what they deem small sample sizes. Hence their formal position: the safety and efficacy of ivermectin for the treatment of COVID-19 cannot be made based on too small a sample size of existing studies.
No Compassionate Use
Interestingly, despite lots of positive reports of the drug’s efficacy, documented in the mounting results of dozens of studies in the form of case series, observational studies and roughly 3 or 4 randomized controlled trials, not one doctor in the Philippines, according to this report, has applied for compassionate use in the Philippines.
World Health Organization
As there is no cure yet for COVID-19 and vaccines are just getting rolled out in the developed and emerging economies, poorer nations such as the Philippines have seen an interest in use of off label drugs. To date, the World Health Organization only includes corticosteroids such as dexamethasone as effective for treating severe cases of COVID-19. But these steroids can include harmful side effects.
Interestingly, the WHO recently included Ivermectin on its Prequalification of Medical Products list: First ivermectin prequalified | WHO – Prequalification of Medical Products (IVDs, Medicines, Vaccines and Immunization Devices, Vector Control). TrialSite has been informed by knowledgeable sources that WHO is looking into ivermectin studies as well.