Controversial group of doctors tout ivermectin as long COVID treatment: What to know

This is a story from MedPage Today.

As long-time COVID-19 patients scour the internet desperately for relief, doctors fear they may stumble upon an unproven treatment plan touted by a group known for pushing the anti-parasitic drug ivermectin.

The Front Line COVID-19 Critical Care Alliance (FLCCC) lists approximately 20 drugs, vitamins and therapies as part of its “i-recover” protocol for the long COVID-19, with ivermectin topping the list.

The group said they developed the protocol to help the large number of patients with persistent symptoms and a lack of available treatment options. However, doctors treating patients in hospital centers for post-COVID care were quick to point out the dangers of the treatment plan.

“Recently I saw the FLCCC Long COVID ‘protocol’ and oh boy are these crazy non-evidence based prescriptions: HIV meds, steroids, diuretics and of course ivermectin,” said Dr Nick Mark, an intensive care unit physician in Seattle, wrote on Twitter.

“What concerns me is that the FLCCC presents ‘protocols’ as proven treatments for long COVIDs,” he added. “Throwing 20 drugs (9 prescription) at a problem with little (or no) evidence is irresponsible. As we will see, it is both unethical and probably dangerous.”

In an interview with MedPage Today, Mark said he pitches the protocol as a cure for something that potentially afflicts millions of people and tells those people to find someone who will prescribe the list of drugs for them, shell out thousands of dollars for these drugs and then taking these drugs is “deeply irresponsible and unethical conduct.”

The FLCCC protocol includes first-, second- and third-line therapies, as well as “optional complementary therapies”. Ivermectin tops the list of first-line treatments, along with the steroid prednisone, the opioid antagonist naltrexone, omega-3 fatty acids and vitamin D.

The antidepressant fluvoxamine and the statin atorvastatin are listed as second-line treatments, and the HIV drug maraviroc is a third-line treatment. A test called InCellDx is also recommended as a third-line strategy, but Mark said there was very little data behind the test, which assesses 14 types of cytokines, or inflammatory cells.

There is no evidence to start or stop therapy based on test results, Mark said.

“Optional and complementary” therapies include compounds like curcumin, nigella sativa, vitamin C, melatonin and quercetin. This group also includes H1 and H2 receptor blockers, the asthma drug montelukast, and the anti-androgens spironolactone and dutasteride.

Mark called it a “kitchen sink” approach, which can be harmful for patients who have had COVID-19 for a long time as well as patients who are already using certain medications in the treatment plan for legitimate reasons.

For example, some of the most common symptoms of long COVID-19 include muscle weakness, fatigue, shortness of breath, anxiety, depression and post-traumatic stress disorder (PTSD), Mark said. He wondered what would happen to patients who might take a high-dose steroid on the FLCCC’s drug list. It could make their muscle weakness or pre-existing diabetes worse, he said. It could also make it harder for them to sleep or contribute to depression.

What’s more, there’s little evidence to support these treatments, especially ivermectin, said Dr. Thomas Walsh, an infectious disease physician with the Allegheny Health Network in Pennsylvania.

The drug has developed an almost cult following during the pandemic, he said. The increase in calls to poison control centers and people ingesting the drug without a prescription – and doses for large animals like horses and cattle – has been particularly dangerous and concerning, he added.

Walsh said other COVID-related treatment protocols issued by the FLCCC also lack an evidence base.

Walsh compared the group’s approach to dealing with the long-running COVID-19 to “throwing spaghetti against the wall” and called it “extremely dangerous and unethical.”

“The main point to remember is that you should contact your doctor [who] can guide you through the workup of these symptoms,” Walsh said.

There are clinics that specialize in treating post-COVID patients, he said. Allegheny Health Network deploys a multidisciplinary team that includes pulmonologists, neurologists, behavioral medicine specialists and infectious disease physicians to help create a personalized approach to patient care.

“There’s obviously the fear that people will turn to the internet and social media,” Walsh said. “It’s easy to go down that rabbit hole.”

But, he added, it is important to remember that there is a huge amount of work being done to address post-COVID symptoms and there is also huge interest in the different strategies that may prove effective in treating these symptoms.

Long COVID-19 probably isn’t just one disease, Mark said. Post-USI syndrome has been known for many years before the pandemic. But that’s different from someone who had mild COVID-19 but developed persistent symptoms. Depending on an individual’s specific problems, there will be different treatments for them, he said.

The FLCCC did not immediately return a request for comment. However, the group states the following about its lengthy COVID-19 treatment plan: “As with all FLCCC protocols, we must emphasize that multiple aspects of the protocol may change as scientific data and clinical experience in this condition evolve.”

This is worrying for Mark, who noted people who may feel hopeless and believe they have to choose between FLCCC or nothing.

“To dangle a magic cure for these symptoms is irresponsible,” Mark said.