假設伊維菌素對新冠肺炎感染者的療效普通,但如果以公衛手段廣發或預防性投藥,降低病毒傳染力的作用還是有可能會讓疫情降溫。我曾摘錄過的巴黎養老院研究(發表在British Journal of Dermatology),原本是預防性投藥伊維菌素防止疥瘡擴散,卻正好讓院民與照服員躲過巴黎第一波死傷慘重的養老院大流行。看過五月底才發表的黎巴嫩研究後,對巴黎養老院研究就會有新的看法:有可能是伊維菌素降低病毒傳染力,救了這些老人。
給確診者服用伊維菌素是無效治療嗎?在此引述美國Chuck Dinerstein醫師的文章。Dinerstein醫師是American Council on Science and Health這組織的Director of Medicine。他在今年五月七日,先發表一篇”I’m Ivermectin Hesitant”的文章,細數十餘篇伊維菌素臨床研究的缺陷。
七月七日,他又發表一篇”Could We Be Wrong About Ivermectin And COVID-19?”。在文章前言,他說「我不相信伊維菌素對新冠肺炎的療效,但我還是有可能是錯的」----因為治療新冠肺炎的抗病毒藥物在研究設計上很不容易。他會這麼說是因為一篇七月六日發布於PLoS Medicine的研究論文(動作好快!隔天他就寫好文章),研究者找來一群沒有服用任何治療藥物的感染者,每天PCR紀錄CT值,觀察自然狀態下病毒量的升降。
Effects of a Single Dose of Ivermectin on Viral and Clinical Outcomes in Asymptomatic SARS-CoV-2 Infected Subjects: A Pilot Clinical Trial in Lebanon
以色列研究
Favorable outcome on viral load and culture viability using Ivermectin in early treatment 1 of non-hospitalized patients with mild COVID-19 – A double-blind, randomized placebo-2 controlled trial
巴黎養老院研究
Oral ivermectin for a scabies outbreak in along-term care facility: potential value inpreventing COVID-19 and associated mortality
秘魯研究
Ivermectin for COVID-19 in Peru: 14-fold reduction in nationwide excess deaths, p 0.002 2 for effect by state, then 13-fold increase after ivermectin use restricted
對Together研究的介紹
Could Fluvoxamine Work as COVID Treatment? (MedScape)
Chuck Dinerstein醫師引用的研究
Detection of significant antiviral drug effectson COVID-19 with reasonable sample sizes in randomized controlled trials: A modeling study