Ivermectin: It is irresponsible to attribute a side effect without proof

Prof Nathi Mdladla responds to an article in Times Live, which quotes Dr Emmanuel Taban’s controversial view on Ivermectin and the liver.

Dear journalist, Mr Paul Ash

I would like to respond to your article (20 July 2021) that references a WhatsApp message sent out of context by a doctor who is not involved in early outpatient treatment of COVID19 at all. With his anecdotal message, you are helping to scaremonger out of context, and have not bothered to do the necessary journalistic groundwork of researching the basis for his claims.

I have treated more than 200 COVID-19 outpatients including relatives and friends, and their contacts. Between myself and other colleagues who’ve been managing outpatient COVID-19 with Ivermectin, we have thousands of patients with very few who have progressed to hospitalization and even fewer who had liver failure as claimed by Dr Taban. I am also an ICU specialist in an academic hospital managing COVID-19. We are the only academic institution currently treating COVID-19 patients with Ivermectin in the 3rd wave and getting phenomenal results, we have not observed a disproportionate increase in cases of liver failure, but we have saved hundreds of patients with the drug.

There is in fact a meta-analysis on safety of high dose Ivermectin published by the Journal of Antimicrobial Chemotherapy in April 2020 which is a peer reviewed article that is the highest level of evidence looking at multiple studies that have reported on safety. Here is the link to that study for your own verification https://doi.org/10.1093/jac/dkz524. In their discussion they note that side effects were not any worse, even with high doses with Ivermectin, and interestingly, severe liver affectation or liver failure is not something they picked up.

There have been many studies on Ivermectin where safety has been investigated, interestingly they have all reached the conclusion that the side effect profile of patients on Ivermectin was no different than that of patients on placebo. Even the two largest trials with neutral effect on efficacy for Ivermectin by Lopez-Medina et al and Vallejos et al, found no increased observation of side effects with Ivermectin.

There is however something we know about severe COVID-19 and the observation of abnormal liver function. We have been doing Liver Function Tests (LFT’s) on patients admitted with severe COVID-19 since the 1st wave. We have always known that some patients present with severe derangements in their liver functions and sometimes failure, in fact I admitted such a patient this week. It is therefore irresponsible for Dr Taban to attribute an observation without proof to one drug.

Additionally, context matters, as we need to break down what formulations these patients were taking and in what doses. Due to the obstructive nature of SAHPRA’s “compassionate use program” and the disinformation that is propagated by mainstream media like this article, a lot of patients are still using animal products which contain excipients (binding and storage compounds) that are known to cause liver failure in high doses. Has Dr Taban verified the source and formulations these patients were using? Some animal products in fact contain ethylene glycol as a compound, which in very high doses, can cause liver failure.

We now have the ability to prescribe Ivermectin on script to be used off-label for COVID-19. These are tablets supplied legally by dispensing and compounding pharmacists and they carry pure grade Ivermectin verified by SAHPRA. The message we should be sending to patients out there, if we claim to be saving lives, is to seek doctors who will script this type of product to be procured from a legal source. This is what I have been prescribing and perhaps why we have not seen what he is claiming.

We are 16 months into the pandemic with no clearly proven cure for COVID-19. Ivermectin is one drug that has the most robust available evidence for safety and efficacy against the disease. Vaccines are failing in some patients who eventually need hospital admission, and I have treated a number of these with Ivermectin, yet I will never say patients should not get vaccinated.

We need to be careful about our messaging around all interventions in COVID-19. The opinions of those who know should be sought when something controversial come up. I put the challenge to this newspaper and Dr Taban to produce literature evidence that Ivermectin causes liver failure.

Sincerely

Prof Nathi Mdladla

HOD ICU at Dr George Mukhari Academic Hospital and Sefako Makgatho University

• Written in my personal capacity as a frontline health care worker.