Take that, ivermectin: Merck announces a COVID pill that actually works

Amid all the anger, overreaction, and polarization surrounding the coronavirus pandemic these days, you may have missed some excellent news.

New antiviral drug

Way back in April 2020 (link) I told you not to expect a cure for COVID-19, and explained why it’s so hard to create antiviral drugs (as opposed to antibiotics which are effective against bacterial infections). That remains true. But a new drug, while not a cure, seems to prevent severe disease if given early in infection. Merck’s new antiviral molnupiravir is so effective they were able to stop the clinical trial early. {journal article Nature}

 In the study, molnupiravir reduced COVID hospitalizations by 50% (in unvaccinated people) and no one in the small study who took the drug died. (STAT News on the study; STAT News analysis; Merck press release; Science magazine commentary) A key feature: this is an oral medication. You can take it as a pill, unlike the other COVID therapies which are given through an IV (remdesivir and the monoclonal antibodies).

Patients in the molnupiravir study had mild-to-moderate Covid-19, were within five days of symptom onset when dosed, and had at least one risk factor associated with poor disease outcomes. They took the drug for five days. Patients unknowingly getting the placebo (so-called sugar pill) were more likely to drop out of the trial because of side effects than the people who were actually getting the drug.

No fun without the crazy

For those of you living in the Marvel universe, molnupiravir was named after Thor’s hammer. But apparently that’s not enough to excite the science-free social media universe. Take away the conspiracy theories and all you’re left with is graphs and tables. How boring.

Ivermectin, on the other hand, is subversive and sexy. Like hydroxychloroquine last year, because of a surge in popular interest as a COVID treatment ivermectin is now in short supply or unavailable for its proven uses (autoimmune disease for hydroxychloroquine; for ivermectin, parasitic infections in animals and humans). (CDC alert; NYT article; Inside Indiana Business article)

{What happened to the hydroxychloroquine frenzy, anyway? So last year, apparently.}

Merck’s small but well-designed clinical trial shows that molnupiravir can prevent hospitalizations and deaths from COVID. Can ivermectin? Well, the jury is still out. If you wade into the internet and ask the question, you’ll quickly be overwhelmed by opinions backed up by selective interpretations of confusing and messy data. The key for me is messy data. Badly designed studies are worse than no studies at all. Ivermectin research has been plagued with them–and worse. One of the most influential studies supporting the use of ivermectin in COVID was widely read as a pre-print article–until someone noticed that much of the paper was plagiarized. (story link) That paper was retracted. “Meta-analyses” that included that paper’s data then became less reliable.

I’m not an expert at studying clinical research. I rely on the opinions of other experts. The World Health Organization, CDC, and others (Science Magazine editorial) agree that evidence is lacking to justify using ivermectin to treat coronavirus infection outside of a proper clinical trial. Anecdotes of effectiveness are persuasive to people, but they are not accurate measures of reality.

Is it outrageous to just try the drug anyway? I suppose not, as long as you’re taking it at the right dose and method. The problem is, people aren’t just trying it anyway. They’re advocating for it, making outrageous claims of effectiveness, and worst of all, using it as an excuse to avoid the MOST important, MOST effective, BEST tested and proven therapeutic we have: vaccination.

If we didn’t have vaccines, and you were at high risk of COVID death, you might be desperate enough to try an unproven therapy. But we DO have safe and effective vaccines. If you choose the unproven thing over the proven thing, that says a lot more about you than it says about the things. 

It’s all about trust

When people on social media talk about ivermectin, they’re not really talking about a particular pharmaceutical. They’re talking about trust. They don’t trust the data on vaccines. And they don’t trust the medical establishment’s handling of ivermectin research.

The mystery to me is how they end up trusting various other sources of information.

Apparently some social media users have gone so far as to say that molnupiravir is actually ivermectin, just repackaged and repriced. (Reuters) The level of distrust here is profound and profoundly disturbing to me. One could argue the facts, that ivermectin binds chloride channels of invertebrates; and molnupiravir is a prodrug of a nucleoside analog that targets RNA-dependent RNA polymerase. But since hardly anyone knows what that means, we’re still talking about trust.

Without trust, even advanced scientific knowledge is no argument.

The profit motive

So there is another confounding factor. Merck happens to be the maker of both ivermectin and molnupiravir.

Why did Merck design and pay for a proper clinical trial of monupiravir but not ivermectin?

Once again, trust comes into play. I don’t know what was discussed or planned at Merck. All I have is their statement of ivermectin and COVID-19 (link):

Company scientists continue to carefully examine the findings of all available and emerging studies of ivermectin for the treatment of COVID-19 for evidence of efficacy and safety. It is important to note that, to-date, our analysis has identified:

• No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies;

• No meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease

According to this, Merck scientists didn’t see a compelling reason to invest company resources in such a trial. Bear in mind, however, that such an analysis would necessarily factor in potential study costs vs potential profits. Merck is expected to charge about $700 for a full course of molnupiravir (in the US); as of January 2021, a course of ivermectin to treat parasitic infections in humans cost about $50 at a US pharmacy (source). That’s a big difference.

So I don’t blame Merck for not running a trial that their scientists deemed unlikely to yield a positive result. Unfortunately it seems that everybody who is doing ivermectin trials is not doing it up to the high standards needed for FDA approval of a new drug. Thus the answer about ivermectin effectiveness remains muddled.

I would say Merck is a business not a charity, but in modern capitalism a company can be some of both. A Merck company scientist, Dr. William C. Campbell, isolated ivermectin in 1978 and was awarded a Nobel prize for his work in 2015 (source). Ivermectin was the only treatment for a horrendous parasitic infection called river blindness that “plagued remote communities in Africa, Latin America, and Yemen.” In 1987, Merck committed to donate the drug – as much as needed, for as long as needed – with the goal to help eliminate river blindness. In 1988 Merck expanded its commitment to donate ivermectin to treat filariasis (another horrible parasitic infection also called elephantiasis) in Africa and Yemen. (source)

Since then Merck has donated more than 4 billion treatments and “river blindness transmission has been interrupted – meaning no new cases have been identified – in four of the six affected countries in Latin America and regions in five African countries. “

Sounds to me like a conspiracy to end river blindness.

Molnupiravir has been submitted for FDA emergency use authorization and is not yet available to the general public.

Amy Rogers, MD, PhD, is a Harvard-educated scientist, novelist, journalist, and educator. Learn more about Amy’s science thriller novels, or download a free ebook on the scientific backstory of SARS-CoV-2 and emerging infections, at AmyRogers.com.