El Instituto Mexicano del Seguro Social (IMSS) precisó sobre el uso que hizo del medicamento Ivermectina para tratamiento de COVID-19 en pacientes ambulatorios con sintomatología no grave, y afirmó que no se trató de un experimento.
"Durante las segunda y tercera olas de la pandemia de COVID-19, el IMSS empleó una estrategia integral de manejo de pacientes ambulatorios no graves, a quienes se recomendó el uso de Ivermectina con base en la evidencia científica disponible a nivel mundial en el año 2020. No se trató de un experimento.
⬇⬇ PDF COMPLETO AQUÍ ⬇⬇
DOCUMENTO IMSSEl uso de la Ivermectina, afirmó, estuvo recomendado en los pacientes con diagnóstico de neumonía leve o neumonía moderada estables, y candidatos potenciales para recibir atención domiciliaria, lo que representó entre el 10 y 15% de la población afectada.
La recomendación vino de un grupo de expertos neumólogos e infectólogos que consideraron la etapa de la pandemia, que había cobrado la vida de muchos mexicanos y apenas estaba por comenzar el programa de vacunación, por lo que se consideró su uso ante una situación de emergencia sanitaria, tomando en cuenta:
- En ese momento, la inexistencia de algún tratamiento con eficacia comprobada, ni de estudios con un alto grado de evidencia.
- El beneficio potencial de la Ivermectina en etapas tempranas, a partir de la evidencia disponible.
- Su disponibilidad y alta seguridad clínica.
- El componente ético que maximizó el beneficio sobre un riesgo prácticamente nulo.
- Esta estrategia también incluyó el uso de pruebas rápidas para el diagnóstico oportuno, recomendaciones de cuidados en casa, cubrebocas, oxímetro, algunos medicamentos, y de manera importante el seguimiento telefónico de la sintomatología de los pacientes para detectar casos graves y su hospitalización oportuna en caso necesario.
- Este medicamento está aprobado en el país, ha sido utilizado para tratar diversas parasitosis y otras enfermedades con mucho éxito, sin efectos adversos severos.
- En el seguimiento de esta estrategia se realizó una evaluación que documentó la disminución de la necesidad de hospitalización, atribuible a la estrategia integral de atención de los pacientes.
- En agosto de 2021 el Gobierno Federal emitió la Guía Clínica para el tratamiento de la COVID-19 en México, en donde no recomienda el uso de este medicamento, por lo cual el IMSS dejó de incluirlo en los kits de tratamiento entregados en los Módulos de Atención Respiratoria del Seguro Social (MARSS) durante la cuarta ola.
Enlista principales características de estudios sobre el uso de Ivermectina en COVID-19:
- Ciudades en donde se ha dado Ivermectina
1. Itajaí (Brasil) (Julio 2020 - Diciembre 2020) https://www.cureus.com/articles/82162-ivermectin-prophylaxis-used-forcovid-19-a-citywide-prospective-observational-study-of-223128-subjectsusing-propensity-score-matching
2. Natal, Brazil (Octubre 2020) https://apublica.org/2020/10/prefeitura-de-nataloferece-ivermectina-e-cloroquina-ate-no-ginasio-municipal/ y https://crfrn.org.br/noticias_crfrn/nota-tecnica-do-crf-rn-sobre-o-uso-deivermectina-no-tratamento-de-covid-19/
3. Uttar Pradesh (India - Mayo-Junio 2020) https://www.msn.com/enin/news/other/uttar-pradesh-government-says-early-use-ofivermectinhelped-to-keep-positivity-deaths-low/ar-BB1gDp5U
4. Agra, India (Mayo -Junio 2020) https://www.msn.com/en-in/news/other/uttarpradesh-government-says-early-use-ofivermectin-helped-to-keep-positivitydeaths-low/ar-BB1gDp5U
5. Bolivia (nivel nacional) (2005) https://www.minsalud.gob.bo/4157-ministeriode-salud-autoriza-uso-de-ivermectina-contra-el-covid-19-bajo-protocolo
6. Bulgaria (2020) https://www.medrxiv.org/content/10.1101/2020.04.11.20061804v2.full.pdf
7. Slovakia (junio 2021) https://trialsitenews.com/slovakia-becomes-the-first-eunation-to-formally-approve-ivermectin-for-both-prophylaxis-and-treatmentfor-covid-19-patients/
8. Zimbabwe (28-01-2021) https://www.aa.com.tr/en/africa/zimbabwe-oks-use-ofivermectin-after-officials-deaths/2125442
9. Uttarakhand (India - Mayo-Junio 2020) https://www.livemint.com/news/india/covid19-uttarakhand-to-distributeivermectin-tablets-to-all-residents-11620876111456.html y
10. https://www.indiatoday.in/coronavirus-outbreak/story/ivermectin-tabletuttarakhand-residents-prevent-covid-govt-1801863-2021-05-12 1
11. Delhi (India) (13 junio - 24 Julio 2021) https://www.thedesertreview.com/news/national/ivermectin-obliterates-97- percent-of-delhi-cases/article_6a3be6b2-c31f-11eb-836d-2722d2325a08.html y https://www.forbes.com/sites/siladityaray/2021/05/11/indian-state-will-offerivermectin-to-entire-adult-population---even-as-who-warns-against-its-useas-covid-19-treatment/?sh=3820594b6d9f
12. Perú (Lima, Cusco, La Libertad, Arequipa, Loreto, Ucayali, Tumbes, Moquegua, Piura) (Agosto- diciembre 2020) https://osf.io/9egh4/
13. Argentina (Salta, Tucumán, Corrientes, Jujuy, Misiones, Catamarca)(Julio - Diciembre 2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415509/ y https://www.argentina.gob.ar/noticias/un-estudio-demuestra-la-respuestaantiviral-de-la-ivermectina-en-pacientes-con-covid-19
14. Belize - en todo el país - se usó para casos serios– (Diciembre 2020) https://www.breakingbelizenews.com/2020/12/18/ministry-of-health-nowusing-ivermectin-to-treat-covid-19-patients/
15. Sudáfrica (Enero - Febrero 2021) https://covid19criticalcare.com/ivermectin-incovid-19/epidemiologic-analyses-on-covid19-and-ivermectin/ y https://www.bbc.com/news/world-africa-56526632
16. Panamá (Enero - Febrero 2021) https://www.nature.com/articles/d41586-020- 03289-y
17. Filipinas (Abril - Mayo 2021) https://www.reuters.com/business/healthcarepharmaceuticals/philippines-start-clinical-trials-ivermectin-other-drugscovid-19-2021-04-20/
18. Guatemala (Agosto- diciembre 2020) https://medicamentos.mspas.gob.gt/phocadownload/Comunicados2020/KIT %20DE%20MEDICAMENTOS%20PARA%20COVID-
Artículos académicos con evidencia a favor de Ivermectina
1. Ahmed et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.11.191, A five day course of ivermectin for the treatment of COVID-19 may reduce the duration of illness https://www.sciencedirect.com/science/article/pii/S1201971220325066
2. Bryant A, Lawrie TA, Dowswell T, Fordham EJ, Mitchell S, Hill SR, Tham TC. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. Am J Ther. 2021 Jun 21;28(4):e434-e460. doi: 10.1097/MJT.0000000000001402. PMID: 34145166; PMCID: PMC8248252.
3. BUKHARI, Syed Karamat Hussain Shah, et al. Efficacy of ivermectin in COVID-19 patients with mild to moderate disease. Medrxiv, 2021
4. Chamie-Quintero, J. J., Hibberd, J., & Scheim, D. (2021). Sharp Reductions in COVID-19 Case Fatalities and Excess Deaths in Peru in Close Time Conjunction, State-By-State, with Ivermectin Treatments. State-By-State, with Ivermectin Treatments (January 12, 2021).
5. Caly, L., Druce, J. D., Catton, M. G., Jans, D. A., & Wagstaff, K. M. (2020). The FDAapproved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral research, 178, 104787.
6. CHAHLA, Rossana Elena, et al. A randomized trial-intensive treatment based in ivermectin and iota-carrageenan as pre-exposure prophylaxis for COVID-19 in healthcare agents. Medrxiv, 2021.
7. Evaluation of Ivermectin as a Potential Treatment for Mild to Moderate COVID19: A Double-Blind Randomized Placebo Controlled Trial in Eastern IndiaRoy, R., Pattadar, C., Raj, R., Agarwal, N., Biswas, B., Majhi, P. K., ... & Sarfaraz, A. (2021). Ivermectin as a potential treatment for mild to moderate COVID-19–a double blind randomized placebo-controlled trial. MedRxiv.
8. Evaluation of Ivermectin as a Potential Treatment for Mild to Moderate COVID19: A Double-Blind Randomized Placebo Controlled Trial in Eastern IndiaRoy, R., Pattadar, C., Raj, R., Agarwal, N., Biswas, B., Majhi, P. K., ... & Sarfaraz, A. (2021). Ivermectin as a potential treatment for mild to moderate COVID-19–a double blind randomized placebo-controlled trial. MedRxiv.
9. Guerrero, R., Bravo, L. E., Muñoz, E., Ardila, E. K. G., & Guerrero, E. (2020). COVID-19: The Ivermectin African Enigma. Colombia Médica, 51(4).
10. Hashim, H. A., Maulood, M. F., Rasheed, A. M., Fatak, D. F., Kabah, K. K., & Abdulamir, A. S. (2020). Controlled randomized clinical trial on using Ivermectin with Doxycycline for treating COVID-19 patients in Baghdad, Iraq. medRxiv.
11. Hill, A., Garratt, A., Levi, J., Falconer, J., Ellis, L., McCann, K., ... & Wentzel, H. (2021, November). Meta-analysis of randomized trials of ivermectin to treat SARS-CoV2 infection. In Open forum infectious diseases (Vol. 8, No. 11, p. ofab358). US: Oxford University Press.
12. Khan, M. S. I., Khan, M. S. I., Debnath, C. R., Nath, P. N., Al Mahtab, M., Nabeka, H., ... & Akbar, S. M. F. (2020). Ivermectin treatment may improve the prognosis of patients with COVID-19. Archivos de bronconeumologia, 56(12), 828.
13. Kerr L, Cadegiani F A, Baldi F, et al. (January 15, 2022) Ivermectin Prophylaxis Used for COVID-19: A Citywide, Prospective, Observational Study of 223,128 Subjects Using Propensity Score Matching
14. Low, Z. Y., Yip, A. J. W., & Lal, S. K. (2022). Repositioning Ivermectin for Covid-19 treatment: Molecular mechanisms of action against SARS-CoV-2 replication. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease, 1868(2), 166294.
15. Mohan, A., Tiwari, P., Suri, T. M., Mittal, S., Patel, A., Jain, A., ... & Guleria, R. (2021). Single-dose oral ivermectin in mild and moderate COVID-19 (RIVET-COV): a single-centre randomized, placebo-controlled trial. Journal of Infection and Chemotherapy, 27(12), 1743-1749.
16. OKUMUŞ, Nurullah, et al. Evaluation of the effectiveness and safety of adding ivermectin to treatment in severe COVID-19 patients. BMC infectious diseases, 2021, vol. 21, no 1, p. 1-11.
17. Singh A, Sheth PG, Dhaneria S, Gupta D. Efficacy and safety of ivermectin for COVID-19: A systematic review and meta-analysis. Asian Pac J Trop Med 2021;14:440-50.
18. Lima-Morales, R., Méndez-Hernández, P., Flores, Y. N., Osorno-Romero, P., Sancho-Hernández, C. R., Cuecuecha-Rugerio, E. & Salmerón, J. (2021). Effectiveness of a multidrug therapy consisting of Ivermectin, Azithromycin, Montelukast, and
19. Acetylsalicylic acid to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, Mexico. International journal of infectious diseases, 105, 598-605.
20. BIBER, Asaf, et al. Favorable outcome on viral load and culture viability using Ivermectin in early treatment of non-hospitalized patients with mild COVID-19–A double-blind, randomized placebo-controlled trial. MedRxiv, 2021.
21. BEHERA, Priyamadhaba, et al. Prophylactic Role of Ivermectin in Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare Workers. Cureus, 2021, vol. 13, no 8
22. Pott-Junior, H., Paoliello, M. M. B., Miguel, A. D. Q. C., da Cunha, A. F., de Melo Freire, C. C., Neves, F. F., ... & Chachá, S. G. F. (2021). Use of ivermectin in the treatment of Covid-19: a pilot trial. Toxicology reports, 8, 505-510.
23. Tanioka, H., Tanioka, S., & Kaga, K. (2021). Why COVID-19 is not so spread in Africa: How does Ivermectin affect it?. medRxiv.
24. Abbas et al., Indian Journal of Pharmaceutical Sciences, doi:10.36468/pharmaceutical-sciences.spl.416, The Effect of Ivermectin on Reducing Viral Symptoms in Patients with Mild COVID-19, https://www.ijpsonline.com/abstrac..tients-with-mild-covid19-4455.html.
25. MORGENSTERN, Jose, et al. Ivermectin as a SARS-CoV-2 Pre-Exposure Prophylaxis Method in Healthcare Workers: A Propensity Score-Matched Retrospective Cohort Study. Cureus, 2021, vol. 13, no 8.
26. Hariyanto, T. I., Halim, D. A., Rosalind, J., Gunawan, C., & Kurniawan, A. (2021). Ivermectin and outcomes from Covid‐19 pneumonia: a systematic review and meta‐analysis of randomized clinical trial studies. Reviews in Medical Virology, e2265.
27. MAYER, Marcos Alejandro, et al. Safety and efficacy of a MEURI Program for the use of high dose ivermectin in COVID-19 patients. 2021.
28. Alam, M. T., Murshed, R., Bhiuyan, E., Saber, S., Alam, R. F., & Robin, R. C. (2020). A case series of 100 COVID-19 positive patients treated with combination of ivermectin and doxycycline. Journal of Bangladesh College of Physicians and Surgeons, 10-15
29. de Jesús Ascencio-Montiel, I., Tomás-López, J. C., Álvarez-Medina, V., GilVelázquez, L. E., Vega-Vega, H., Vargas-Sánchez, H. R., ... & Duque-Molina, C. (2022). A Multimodal Strategy to Reduce the Risk of Hospitalization/death in Ambulatory Patients with COVID-19. Archives of Medical Research.
Evidencia que Ivermectina no tiene efectos secundarios
1. (February 5, 2021) Efficacy of Ivermectin in COVID-19 Patients with Mild toModerate Disease. https://www.medrxiv.org/content/medrxiv/early/2021/02/05/2021.02.02 2125 0840.full.pdf
2. (2020 Aug 18) White paper on Ivermectin as a potential therapy for COVID19. Agam Vora,∗ V.K. Arora, and D. Behera. Academy of Advanced Medical Education, Vora Clinic, 302, Soni Shopping Center, L T Road, Borivali West, Mumbai, 400092, Maharashtra, India. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434458/
3. Ottesen, E. A., & Campbell, W. (1994). Ivermectin in human medicine. Journal of antimicrobial chemotherapy, 34(2), 195-203
4. Victoria, J., & Trujillo, R. (2001). Topical ivermectin: a new successful treatment for scabies. Pediatric dermatology, 18(1), 63-65
5. (2020-06-12) Alam, M. T., Murshed, R., Bhiuyan, E., Saber, S., Alam, R. F., & Robin, R. C. (2020). A Case Series of 100 COVID-19 Positive Patients Treated with Combination of Ivermectin and Doxycycline. Journal of Bangladesh College of Physicians and Surgeons, 38, 10–15. https://doi.org/10.3329/jbcps.v38i0.47512.
6. Taylor, H. R., & Greene, B. M. (1989). The status of ivermectin in the treatment of human onchocerciasis. The American journal of tropical medicine and hygiene, 41(4), 460-466
7. Crump, A., & Omura, S. (2011). Ivermectin,‘wonder drug’from Japan: the human use perspective. Proceedings of the Japan academy, Series B, 87(2), 13-28
8. Fox, L. M. (2006). Ivermectin: uses and impact 20 years on. Current opinion in infectious diseases, 19(6), 588-59
9. Alam, M. T., Murshed, R., Bhiuyan, E., Saber, S., Alam, R. F., & Robin, R. C. (2020). A case series of 100 COVID-19 positive patients treated with combination of ivermectin and doxycycline. Journal of Bangladesh College of Physicians and Surgeons, 10-15
Ensayos Clínicos en proceso
1. Oxford university (june 2021), https://www.clinicaltrialsarena.com/features/c-difficile/
2. University of Minnesota (January 26, 2022) https://www.startribune.com/university-of-minnesota-ivermectin-trialnearing-completion/600139471/
3. Clinical trial Kowa Co Ltd and Tokyo's Kitasato University (January 31, 2022)
4. Duke University (Jan. 21, 2022) https://www.webmd.com/lung/news/20220121/ivermectin-potential-covid19-treatment-studied-at-duke-university
