Talk:COVID-19 drug repurposing research/Archive 1

Archive 1

Archive 2

Table needs to be updated, drilled down

The 'Anti-viral status' in the table is generally imported from the review Journal paper: Discovery and development of safe-in-man broad-spectrum antiviral agents (figure 5). However, if possible, I'd like help in citing the most direct source for each of the cells. This can likely be found within the article itself. ProbablyAndrewKuznetsov (talk) 18:43, 20 March 2020 (UTC)

It seems the graphic is from https://drugvirus.info/ which guided me to some clinical trial information ProbablyAndrewKuznetsov (talk) 18:43, 20 March 2020 (UTC)

Open Label vs RCT

I'm actually not 100% the Open Label study can't be combined with the RCT section in the label. Need to find examples or understand the term better. ProbablyAndrewKuznetsov (talk) 20:11, 20 March 2020 (UTC)

Please look over the table for accuracy in importing results.

I've cited all the sources I used, and please check over that the right things made it on the page. I am burnt out right now and may have made mistakes. ProbablyAndrewKuznetsov (talk) 00:36, 21 March 2020 (UTC)

Enabling easy download for researchers?

Is there a way to store these tables in a json format so that it can be downloaded by researchers? ProbablyAndrewKuznetsov (talk) 00:50, 21 March 2020 (UTC)

Vancouver style citations

Due to the sheer number of co-authors of some of the cited papers, I think it would be a good idea to switch to the Vancouver style citations with "|display-authors=3". This would make the citations easier to read. The Diberri template builder that I have linked on my user page makes it very easy. Are there any editors opposed to this?  Bait30  ^{Talk 2 me pls?} 05:45, 21 March 2020 (UTC)

As long as it doesn't go against any Wikipedia best practices, I think making the citations better to read is a good cause. Go for it! From my understanding the main difference is shortening the amount of displayed authors, right? ProbablyAndrewKuznetsov (talk) 15:15, 21 March 2020 (UTC)

I would be okay with it --Guerillero | Parlez Moi 15:26, 21 March 2020 (UTC)

Importing information from WHO Therapeutics Table

I was linked this, which allegedly is WHO's Therapeutics Table. Worthwhile importing into the table. https://www.who.int/blueprint/priority-diseases/key-action/Table_of_therapeutics_Appendix_17022020.pdf?fbclid=IwAR15EjPh5YZ-KiFmfhgOcsuqEruQ5QPmHdB9zO4pMrfpm_enGHoGZVkedxI ProbablyAndrewKuznetsov (talk) 00:52, 21 March 2020 (UTC)

There are several interferons in the list which are not in the article yet. I have seen a few articles from not-so-reliable sources saying that places like Cuba have been using interferon alfa-2b to treat the outbreak. In looking for a better source I found and added a guardian article which refers to a trial of "interferon beta" in the UK. I'm not sure if that beta 1 or beta 3 (beta 2 doesn't exist) or if there's another one I am unaware of. Pelirojopajaro (talk) 16:11, 21 March 2020 (UTC)

Articles to check out

There are a couple of articles that can be used as inspiration for filling out the article, as well as potentially linking here

• https://en.wikipedia.org/wiki/COVID-19_drug_development (although this article should focus more on drug repurposing specifically).
• The 'Research/COVID-19' section of any drug listed in the article
• https://en.wikipedia.org/wiki/Drug_development

ProbablyAndrewKuznetsov (talk) 18:44, 21 March 2020 (UTC)

Need Domain Experts that Can Write/Transfer Drug Development for Repurposing Drugs Process

Many processes, such as legal, are slightly different in the approval process for novel versus repurposed drugs. This information would be great to add to this article but may take me some time. If someone is knowledgeable or knows where to find this information, would help a ton. ProbablyAndrewKuznetsov (talk) 19:01, 21 March 2020 (UTC)

Checks and Xes

Can we please have a key above the table with what the check marks and Xes mean? --Guerillero | Parlez Moi 15:44, 21 March 2020 (UTC)

I'll see what I can do, maybe there's a good template out there. If anyone knows of a good example page, I'd love to take a look. I chose ascii characters since using words makes the table super wide. ProbablyAndrewKuznetsov (talk) 18:33, 21 March 2020 (UTC)

@ProbablyAndrewKuznetsov: Looks good! I might tinker with the icons a bit --Guerillero | Parlez Moi 17:33, 22 March 2020 (UTC)

MEDRS, NOTNEWS and other guidance

@Literaturegeek: and others: there's a discussion at Talk:Coronavirus_disease_2019#Forks_focusing_on_early_research of relevance to this article. Bondegezou (talk) 20:00, 22 March 2020 (UTC)

Thanks for the link ProbablyAndrewKuznetsov (talk) 22:55, 22 March 2020 (UTC)

Checking article for MEDRS and understanding exceptions

The article needs to be looked over and changes noted to ensure we're writing to the standard of MEDRS, keeping in mind whatever exceptions allow for including the 'best available sources'. Thanks everyone, I know this is a fluid time on Wikipedia and the world. In particular, I think the section of MEDRS relating to using secondary sources over primary ones is relevant to some sources on this article. https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine) ProbablyAndrewKuznetsov (talk) 23:29, 22 March 2020 (UTC)

For once I'll write a word I almost never use. Absolutely. Carlstak (talk) 23:47, 22 March 2020 (UTC)

"Report something when there's a trial result - the mere fact of a trial should not be reported"?

"Report something when there's a trial result - the mere fact of a trial should not be reported" I've seen this mentioned in some places around Wikipedia. Is this strict law or are there exceptions? It seems that it is valuable information for a page that explains research progress on drug repurposing research. ProbablyAndrewKuznetsov (talk) 23:25, 22 March 2020 (UTC)

(Update) I asked on MEDRS and the answer seems that including ongoing newsworthy clinical trials is ok, but we should be using a secondary MEDRS source. https://en.wikipedia.org/wiki/Wikipedia_talk:Identifying_reliable_sources_(medicine)#%22%3AReport_something_when_there%27s_a_trial_result_-_the_mere_fact_of_a_trial_should_not_be_reported%22 ProbablyAndrewKuznetsov (talk) 02:47, 23 March 2020 (UTC)

Removed french study

I removed the french study on Hydroxychloroquine and Azithromycin until it gets published in a peer reviewed journal --Guerillero | Parlez Moi 02:26, 21 March 2020 (UTC)

So there is safe therapy that has been shown to be 100% effective in a study of significant number of patients by a world renown French physician and you decided to hide it from people? 71.83.26.180 (talk) 06:11, 23 March 2020 (UTC)

Since the study has gained some notice through press, is it worthwhile including it under a section such as 'Unpublished Claims'. Wondering if it's worthwhile including if it is not notable to medicine but notable as an event? Seems strange to completely not have anything on it. ProbablyAndrewKuznetsov (talk) 15:12, 21 March 2020 (UTC)

Not exactly the only thing "strange" with Wikipedia, either, is it? 71.83.26.180 (talk) 06:11, 23 March 2020 (UTC)

It’s listed[1] as Pre-Proof in the International Journal of Antimicrobial Agents, which means it has been peer-reviewed[2]. —Wulf (talk) 01:54, 24 March 2020 (UTC)

Cure Coronavirus Patient with HIV drugs

A combination of Lopinavir 200mg/Ritonavir 50mg twice a day for corona positive patient........... Sharad015 (talk) 16:02, 24 March 2020 (UTC)

That drug combo only works modestly well if started early in the disease. Benefits do not reach statistical significance when disease is more advanced and serious as it failed a randomised clinical trial for the latter group. Anyway, do you have a reference that you would like to use to edit this article or are you just expressing some thoughts?--Literaturegeek | T@1k? 03:14, 27 March 2020 (UTC)

Ciclesonide

I've relabelled it as a lipid-conjugated corticosteroid since it doesn't work like most corticosteroids.

Inactive when inhaled: "In contrast to other inhaled corticosteroids that bind directly to the glucocorticoid receptor, e.g. fluticasone propionate, ciclesonide is a prodrug with almost no receptor binding affinity."

Activated in the lower respiratory tract: "Airway esterases convert ciclesonide to its pharmacologically active metabolite desisobutyryl-ciclesonide (des-CIC), which has a 100-fold higher binding affinity for the glucocorticoid receptor than its parent compound"

Lipid conjugated (VERY USEFUL -- See Below) "The conjugation of a corticosteroid with highly lipophilic fatty acids in the pulmonary tissue is a mechanism by which the retention time of a drug is increased. The ester bond between the corticosteroid and the fatty acid is formed via a hydroxyl group at position C-21. Des-CIC, but not fluticasone propionate, has the required group at position C-21"

Peer-reviewed source: https://www.researchgate.net/publication/5945089_Ciclesonide_Uptake_and_Metabolism_in_Human_Alveolar_Type_II_Epithelial_Cells_A549

Lipidation increases antiviral activities of coronavirus fusion-inhibiting peptides (peer reviewed): https://www.sciencedirect.com/science/article/pii/S0042682217302520

This might help to explain the promising news from South Korea and Japan about the drugs effectiveness in treating COVID-19 Pneumonia. Preprint paper https://www.biorxiv.org/content/10.1101/2020.03.11.987016v1.full.pdf shows it blocking NSP15 and having an anti-viral effect, however this is not peer-reviewed and the mechanism is unknown. Preprint paper https://www.biorxiv.org/content/10.1101/2020.03.20.999730v1.full.pdf presents data suggesting high efficacy with low toxicity, however again this is not peer-reviewed. — Preceding unsigned comment added by 49.184.202.244 (talk) 14:28, 30 March 2020 (UTC)

FDA has just issued Emergency Use Authorization (EUA) for Chloroquine,Hydroxychloroquine

Amidst concerns about its effectiveness from scientists, FDA has just issued Emergency Use Authorization (EUA) for Chloroquine (and Hydroxychloroquine). We should import some information from here. Thanks everyone. https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization#2019-ncov ProbablyAndrewKuznetsov (talk) 15:39, 30 March 2020 (UTC)

This resource could be useful

COVID-19 drug therapy — updated on April 3 Pharmacists in Elsevier's Clinical Solutions group write about potential treatment options for COVID-19. Contextual web page: https://www.elsevier.com/connect/coronavirus-information-center Paper's link: https://www.elsevier.com/__data/assets/pdf_file/0007/988648/COVID-19-Drug-Therapy_Mar-2020.pdf Another Wikipedian (talk) 20:39, 4 April 2020 (UTC)

Ivermectin???

Found this article.. should I add it?? The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro

Leon Caly1, Julian D. Druce1, Mike G. Catton1, David A. Jans2 and Kylie M. Wagstaff

https://www.sciencedirect.com/science/article/pii/S0166354220302011?fbclid=IwAR2pZmgS1SXTqlQhupYvTAaG3v_KIz_cOJ1YQhCwohbjMs1EQ8bbvVShT8E

I suppose it could go in the table next to Selamectin, another anti-parasite med with in vitro evidence. Although that begs the question as to whether Selamectin should be in the table, as it is a topical drug not approved for human use. David notMD (talk) 16:54, 5 April 2020 (UTC)

Removed Selamectin from table: Topical, not human approved, in ref, not tested against SARS-CoV-2. David notMD (talk) 19:07, 5 April 2020 (UTC)

Ivermectin#COVID19 has a brief comment on a possible COVID-19 relevance. Boud (talk) 23:36, 5 April 2020 (UTC)

Revised to match what is in the reference. David notMD (talk) 23:57, 5 April 2020 (UTC)

Sounds like you are giving me green light.. If you don't respond within 3 hours, I will start writing on this — Preceding unsigned comment added by 210.195.8.58 (talk) 00:09, 6 April 2020 (UTC)

Dunno if people have seen this this yet - clinical study for Hydroxychloroquine showing promising results (in pre-print)

Just posted this on the Chloroquine article, but seems just as relavent here:

Not published yet, but thought it might be good to give people here a heads up: https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2

https://twitter.com/PeterKilmarx pointed out that it seems to have beneficial results (even though the number of patients in the study is rather low - 42 ; dunno if that is the treatment group, or treatment and control together). Whole thing, as I said has not been peer-reviewed / published in a journal yet, but thought it made sense to make people aware of it. Regards Sean Heron (talk) 20:06, 6 April 2020 (UTC)

Colcichine

I read that there is a Canadian trial of using colcichine for it's anti-inflammatory effects in the treatment of COVID-19. Lavateraguy (talk) 19:30, 7 April 2020 (UTC)

Research progression

The Research Progression table is well-meaning, but it's a massive violation of WP:MEDRS and indeed WP:SYNTH. More than that, it is not a good summary of the science. We can summarise one of the recent review articles on drug treatments rather than trying to do this ourselves. Bondegezou (talk) 20:08, 22 March 2020 (UTC)

I agree completely. We should enforce the MEDRS policy even more vigilantly during a pandemic to avoid any possibility of misinforming people or leading them astray. Carlstak (talk) 20:54, 22 March 2020 (UTC)

I agree that we need to strictly adhere to MEDRS, but I haven't seen any review articles about drugs yet. Is there a way we can turn it into prose? --Guerillero | Parlez Moi 20:56, 22 March 2020 (UTC)

Not opposed to a reasonable solution, and strongly believe in keeping to the guidelines. However, removing this information from Wikipedia entirely seems like we're holding something back from readers that is of significant interest. Is there a way we can disclaim or reword things to make it clearer? Could you please elaborate on "Summarise one of the recent review articles on drug treatments"? I'd be happy to help if there was solution that keeps information available and accessible to readers. ProbablyAndrewKuznetsov (talk) 22:53, 22 March 2020 (UTC)

• Agree this is completely inappropriate. Have removed until/unless we can find a secondary source giving us an overview on this topic we can cite. Alexbrn (talk) 07:27, 8 April 2020 (UTC)

Agree with Alex, there are so many studies right now it's hard to keep up. Gammapearls (talk) 08:28, 8 April 2020 (UTC)

Was pleased to see the re-creation of and continued work on this article initiated by Gammapearls et al., discussed at the drug development article, here. A few thoughts to discuss for making content of the two articles coherent for users and editors: 1) if this article focuses on "repurposing", I suggest the hidden table be returned and monitored/edited/displayed for this article; 2) the fastest results on potential repurposed drugs will be the Solidarity and Discovery trials under adaptive designs to rapidly change protocols and zero in on effective doses and outcomes. A section like that should be in this article; 3) regarding the discussion above for keeping up with news on repurposed drug progress, the Milken Institute tracker is being updated every 2-3 days, and the BioCentury report mapped the status for April interim results on 29 studies. These sources aren't strictly MEDRS, but they're reliable (imo), and synthesize status to inform editors to search for more detailed information. PMID 32127666 and its table on research for repurposed antivirals gives additional drugs to watch for progress. I think the Solidarity/Discovery trials - which are expanding internationally and attracting large funding (> $100 M) - will be the ones to watch for results by mid-summer. If positive, plans for other repurposing drug candidates and strategies will likely follow suit. --Zefr (talk) 15:15, 8 April 2020 (UTC)

Merge

There was a clear consensus to merge this page with COVID-19 drug development here --Guerillero | Parlez Moi 16:00, 7 April 2020 (UTC)

Parking the original table of repurposing research. --Zefr (talk) 18:19, 9 April 2020 (UTC)

Drug name	Original use	Status (as COVID-19 treatment)
		Trials			Studies	Randomized clinical trial (RCT)					Approved for COVID-19
		Cell cultures or co-cultures (In-vitro)	Human primary cells or organoids (Ex vivo)	Animal models	Open label	Phase 0	Phase I	Phase II	Phase III	Phase IV
Hydroxychloroquine	Anti-malarial	✔️							?		✔️ FDA EUA
Chloroquine	Anti-malarial	✔️									✔️ FDA EUA
Favipiravir	Broad-spectrum anti-viral	✘			✔️	✔️					✔️ in Japan
Lopinavir/ritonavir	HIV protease inhibitor combination				✘
Remdesivir	Novel broad-spectrum anti-viral	✔️							?
Ribavirin	Broad-spectrum anti-viral	✘
Umifenovir	Broad-spectrum anti-viral									?
Lopinavir	HIV protease inhibitor				✘					?
Ritonavir	HIV protease inhibitor				✘				?
Cepharanthine	Anti-inflammatory compound	✔️
Mefloquine	Anti-malarial	✔️
Penciclovir	Herpesvirus anti-viral	✘
Nitazoxanide	Broad-spectrum anti-viral, antiparasitic	✔️
Nafamostat	Synthetic serine protease inhibitor	✘
Corticosteroids	Steroid hormone								?
Ivermectin	Anti-parasitic	✔️
Emtricitabine/tenofovir	HIV reverse transcriptase inhibitor								?
Teicoplanin	Antibiotic	✔️
Ciclesonide	Lipid-Conjugated Corticosteroid	✔️						?

reviewed/found copyvio

[3]--Ozzie10aaaa (talk) 16:18, 10 April 2020 (UTC)

• this article had been deleted before and was up for review (blanked talk/ during review of article)...please replace any discussion, thank you--Ozzie10aaaa (talk) 17:10, 10 April 2020 (UTC)
  • Why the underlining and page blanking? --Guerillero | Parlez Moi 18:41, 10 April 2020 (UTC)

before I reviewed it, the article info said it had been deleted (it also had a copyvio, if you check the history of the article[4])...I deleted the copyvio and therefore reviewed.I was thinking about merging or redirecting/blanking, as the talk indicated There was a clear consensus to merge this page with COVID-19 drug development[5] In any event I'll replace the talk/--Ozzie10aaaa (talk) 20:31, 10 April 2020 (UTC)

Inclusion of Mefloquine

About this revert [6]

The only non-primary sources I can find are bad even for press sources - Turkish state news agency, RT and The Daily Beast (the last has already been removed by other editors as "sensationalist"). The only other source is the Russian state. We need a secondary source. Gammapearls (talk) 11:32, 12 April 2020 (UTC)

Review article on science direct is slightly different than this page

This review article contains slightly different content than wikipedia

COVID-19: A promising cure for the global panic, Science of The Total Environment Volume 725, 10 July 2020, 138277 https://www.sciencedirect.com/science/article/pii/S0048969720317903

For example, it have Sofosbuvir — Preceding unsigned comment added by Stuartrawsonjoeygarcia (talk • contribs) 12:28, 13 April 2020 (UTC)

Uh ...

Huh? --Brogo13 (talk) 15:52, 13 April 2020 (UTC)

Sorry, my bad. Rupert Loup (talk) 16:05, 13 April 2020 (UTC)

Possible unreliable source on Remdesivir?

The article claims "While its effectiveness at combating Covid-19 is uncertain, there is an uncanny, drastic reduction in mortality among covid-19 patients who are administered remdesivir, testifying the claims it can indeed inhibit the virus." and then cites a Seeking Alpha article (financial news). My gut says this could be an exaggerated conclusion from a less-than-reliable source that needs to be revised or removed, but I currently don't have free time to investigate. The Quirky Kitty (talk) 17:18, 18 April 2020 (UTC)

News on remdesivir

https://www.theguardian.com/world/2020/apr/23/high-hopes-drug-for-covid-19-treatment-failed-in-full-trial —Nightstallion 07:50, 24 April 2020 (UTC)

Milken Institute tracker and clinical trial updates

Also posted on the COVID-19 drug development and COVID-19 vaccine talk pages. The Milken Institute has - as best as I can see - the most frequently updated (at least 2x/week) tracker for all COVID-19-related treatment and vaccine candidates, a report that had been a somewhat awkward PDF for the past weeks, but is now a dynamic Google spreadsheet, today's version shown here. Presuming it enables viewing of updates in real time, the Milken tracker will be a "live" update source going forward. Wondering what other editors think about using this as a source for tracking progress of drugs in late-stage clinical trials (and earlier stages), as it is still awkward to use on a cell phone (or even a widescreen desktop), and its sources are hidden behind another click, but I think it's a substantial resource for keeping an eye on progress. For comparison, the next-best sources are either "draft landscape" reports from WHO (too many of which are dead links under "Therapeutics"), and occasional tracking reports, such as this one by Canadian scientists in the April 24th Lancet, proposing real-time tracking of therapeutic research underway using a diagram to aggregate and display various potential therapeutics here. The Lancet authors mention the new COVID-19 literature tracker from the US National Library of Medicine, called "LitCovid", shown here. Zefr (talk) 15:28, 26 April 2020 (UTC)

I don't think Wikipedia should be doing anything like this, as per WP:NOT and WP:MEDRS. We are an encyclopaedia, not a tracker of experimental medicine. This article should focus on explaining lines of research, not trying to track individual early-stage research. Bondegezou (talk) 15:31, 26 April 2020 (UTC)

Bondegezou - WP:NOW? This is not sourceless "tracking", but rather is stating verifiable sources and content about clinical trial progress. It's not a MEDRS issue which requires weeks/months of peer-review and typical publishing timelines. Note this 18 April Lancet report, "Flooded by the torrent: the COVID-19 drug pipeline". WP:NOW guides to timely information, so editors of this article are obligated to have content based on the most updated tracking sources. Zefr (talk) 16:51, 26 April 2020 (UTC)

WP:NOW is an essay. I referenced a policy and a guideline. Wikipedia has and continues to do a wonderful job of covering the pandemic in a timely manner in a way in which no paper encyclopaedia ever could. But that does not give us carte blanche to do anything, certainly not to ignore policy. We don't do anything like this for other diseases, for good reasons. Bondegezou (talk) 17:29, 26 April 2020 (UTC)

Understood, but a relevant WP essay, as is this Signpost essay. How else can we be current with clinical trial progress? We can't wait for MEDRS reviews for results on clinical trials, some of which are due this week. Zefr (talk) 17:36, 26 April 2020 (UTC)

The answer is we don't try to be. There is no need for Wikipedia to track clinical trials like this. We can summarise what is going on in research generally.

There are good reasons not to cover early research in detail, like what trials are going on, which is why WP:MEDRS says what it says. The public getting carried away by early research on COVID-19 drugs has already led to fatalities. If real evidence emerges that something will work, we will see appropriate coverage of it soon enough. Bondegezou (talk) 17:46, 26 April 2020 (UTC)

Bondegezou - Respectfully, I disagree with you. You're misinterpreting what a tracker is. The Milken tracker is a spreadsheet of clinical trial activity based on public sources that we would be collecting anyway for writing about clinical trial progress on repurposed drugs (and vaccines, shown here). It consolidates WHO and other reputable sources for progress on the research we're discussing in the article. We're not writing about the tracker, but on programs the tracker lists. It just simplifies our research. This article will not be giving advice on poorly researched drugs, but it should contain current, accurate information on trials underway and their results when announced, per WP:NOW. Zefr (talk) 01:22, 27 April 2020 (UTC)

I understood that.

Does the Milken tracker meet WP:RS? I don't know. I'm not clear that it does.

Even if it does or there is something similar that does, should Wikipedia be covering ongoing clinical trial activity in detail? WP:MEDRS says no. It says no because it is dangerous and potentially misleading to discuss unproven medical treatments: readers will misinterpret what coverage means. We don't do anything like this for any other condition. I would argue that WP:NOT also argues against it. We're an encyclopaedia: we don't include every bit of information that exists out there. We summarise and explain the important information.

Tracking trials is of minimal help to covering their results when they are announced. We can just continue to scan the medical literature for results.

WP:NOW remains an essay, however many times you refer to it. We are required to follow policy and guidelines. Bondegezou (talk) 08:33, 28 April 2020 (UTC)

You're out of touch with what Wikipedia is describing for the 2019–20 coronavirus pandemic - the lead COVID-19 article which has had 3000 edits, 1000 sources, and 16 million page views in the past month. This is an ongoing, rapidly changing event which we should be tracking and rewriting as clinical development proceeds, as one of nearly 1000 COVID-19 articles on the pandemic; the majority of COVID-19 articles are being updated hourly, e.g., 2020 coronavirus pandemic in New York City. There's nothing "dangerous" about describing candidate treatments in clinical trials, as Wikipedia users seek such content from the encyclopedia. We have good information on the clinical trial process, and the evolving progression can be readily sourced. The Milken and BioWorld trackers are an invaluable assist for research; they are directly or indirectly sourced for verification. It's up to solid and selective editing to describe the landscape for the Wikipedia articles on COVID-19 drug development. Zefr (talk) 18:03, 28 April 2020 (UTC)

Zinc addition as possible treatment

Zinc addition is missing on the page. I think it should be added after recent study release showing initial favorable/promising results. see link https://www.barrons.com/news/zinc-hydroxychloroquine-found-effective-in-some-covid-19-patients-study-01589234407 — Preceding unsigned comment added by Berkshires (talk • contribs) 21:57, 12 May 2020 (UTC)

Zefr's total deletion my contribution with well sourced study indicating zinc addition as potential treatment on a page COVID-19 drug repurposing research does not make sense. I will undo the deletion for now, and feel free to edit with language you feel is more appropriateBerkshires (talk) 23:51, 14 May 2020 (UTC)

Sufficiently addressed here. User is warned about primary research, WP:NOTNEWS, and WP:3RR. Zefr (talk) 00:27, 15 May 2020 (UTC)

Added it as something that is being researched with adequate citationBerkshires (talk) 22:15, 18 May 2020 (UTC) Zefr! there is at least 5 other therapeutic options mentioned on "this page" that are in middle of research with no results yet. Your insistence on deleting zinc/hydro combo is puzzling. If you have valid argument I would like to hear it, but there is not a single reasonable explanation for singling outBerkshires (talk) 22:50, 19 May 2020 (UTC).

User is warned about bias. See Wiki policy https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_viewBerkshires (talk) 22:57, 19 May 2020 (UTC) There seems to a clear bias from Zfar against this combo option. The info written re toxicity of zinc when the the treatment is for 5 days is highly misleading at best. Cant stay the way it is. User warned again about wiki neutral point of view policy. Berkshires (talk) 02:18, 21 May 2020 (UTC).

If hospitalized people with COVID-19 disease were known to be zinc deficient, that would be rationale for adding zinc to the therapeutic cocktail as part of the treatment. But there is no rationale discussed in the clinical trial protocols involving zinc - or any review literature - for using mega-doses (220 mg/treatment/day) of zinc for people with severe COVID-19 infection. There are no high-quality reviews showing that zinc would benefit a coronavirus infection. That's not bias, that's just stating a fact and disputing what is unpublished, unjustified zinc dosing in the trials underway. Published last week was this review indicating that use of zinc in treating COVID-19 is likely a busted myth. Also, in the clinical trials on hydroxychloroquine cocktails, zinc dose is not being tested, so the only conclusion possible is that zinc was in the cocktail or not, which makes using zinc a hail mary pass. Zefr (talk) 03:26, 21 May 2020 (UTC)

GS-441524 =/ Remedesivir?

Why open a separate subparagraph for GS-441524? isn't it always the metabolized drug version of the pro-drug remdesivir? Michal. 46.19.85.7 (talk) 21:43, 29 May 2020 (UTC)

I have added it under Remdesivir. Have also done the same for the cocktail of hydroxychloroquine with zinc. •Shawnqual• 📚 • 💭 02:25, 30 May 2020 (UTC)

Both your said edits look reasonable to me. Thanks. Michal. 46.19.85.7 (talk) 18:33, 30 May 2020 (UTC)

Surgisphere

Given the publication of various reliable sources (newspapers, well respected journals etc), I've created a stub for Surgisphere.

Obviously we need a section in the hydroxychloroquine section about this. I propose:

> The data for some research behind the evidence for heart arythmias was hospital records data provided by Surgisphere. The quality and accuracy of the data has since come under scrutiny.

References:

• https://www.sciencemag.org/news/2020/06/mysterious-company-s-coronavirus-papers-top-medical-journals-may-be-unraveling
• https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine

Philipwhiuk (talk) 11:18, 3 June 2020 (UTC)

I've gone ahead and added this Philipwhiuk (talk) 20:27, 3 June 2020 (UTC)

Table for drugs with little descriptions

Currently, there are 20 drugs listed under the 'Studies' section. Most of them have little information as their research is also very limited at the moment. I suggest all these drugs be moved into a table under 'Other drugs' in the 'Studies section'. This would prevent the section from becoming overly long and the article becoming cluttered, getting in the way of readers accessing the information in an easier manner.

Once there is sufficient research on any of the drugs from various sources, and at least a paragraph with ten or more lines can be written on them, they can be moved from the table. This is what I am proposing:

Drug		Research
Intravenous vitamin C		According to ClinicalTrials.gov, there are six ongoing clinical trials of intravenous vitamin C for people who are hospitalized and severely ill with COVID‑19; three placebo controlled (China, Canada, US) and three with no control (Italy, US, US).
Azithromycin		New York State began trials for the antibiotic azithromycin on 24 March 2020.
Ciclesonide		Japan's National Center for Global Health and Medicine (NCGM) is planning a clinical trial for Teijin's Alvesco (ciclesonide), an inhaled corticosteroid for asthma, for the treatment of pre-symptomatic patients infected with the novel coronavirus. Ciclesonide was identified as a candidate antiviral in an in vitro drug screening assay done in Korea
APN01		A form of angiotensin-converting enzyme 2, a Phase II trial is underway with 200 patients to be recruited from severe, hospitalized cases in Denmark, Germany, and Austria to determine the effectiveness of the treatment

•Shawnqual• 📚 • 💭 01:49, 28 May 2020 (UTC)

I've gone ahead and done this, please raise any issues you may have here and ping me. Also, added a hidden note at the top of the section to inform editors. •Shawnqual• 📚 • 💭 23:39, 3 June 2020 (UTC)

section “Combined_with_zinc_and_another_antibiotic should it be fixed

As of now it reads as follows.

Because zinc has properties as a cofactor in the immune response for producing antibodies during viral infections,[34] it is being included among multiple-agent "cocktails" for investigating potential treatment of people hospitalized with COVID-19 infection.[35] One such cocktail is hydroxychloroquine combined with zinc (as a sulfate, 220 mg per day for 5 days, a zinc dose 20 times higher than the reference daily intake level)[34] and an approved antibiotic, either Azithromycin or doxycycline in a Phase IV trial in New York State.[36]There was initial report from NYU Hospital, that patients who received the triple-drug combo had a 1.5 times greater probability of getting better from the disease versus those that have not receive zinc.[37] However, caution was recommended as to the combination of chloroquine and hydroxychloroquine with CYP3A4 inhibitors such as Azithromycin.[19]Some researchers have suggested that the combination may be effective with early outpatient illness, which is different than later hospitalized florid disease, and therefore the treatments would differ.[38] Zinc deficiency – which decreases immune capacity to defend against pathogens – is common among elderly people, and may be a susceptibility factor in viral infections.[34] The mechanism for any potential benefit of including zinc in a cocktail treatment for recovery from severe viral infection is unknown.[34][35]

I think it is pretty confusing. Starting with reasoning how zinc works..and why zinc might be beneficial..than describing that there is cocktails of medicine, and going on to dosages, with daily limits.. and finishing up with zinc deficiency. “You wouldn’t find these kind details by any of the other potential treatments options on the page.

A more simple and accurate description would read as follows.

There has been some favorable reports by doctors using a combination of hydroxychloroquine Azithromycin Zinc to treat covid-19 patients, especially when treatment was used outpatient. However, caution was recommended as to the combination of hydroxychloroquine with CYP3A4 inhibitors such as Azithromycin. There are currently several clinical trials testing if this combination is more effective than hydroxychloroquine alone. Results are not expected before Sep 2020. One report from NYU Hospital showed, that patients who received the hydroxychloroquine Azithromycin Zinc combination, had a 1.5 times greater probability of getting better from the disease, versus those that have not received zinc. However this report was retrospective only.

And to finish off. Here is a short quote from Yale Professor Harvey Risch, after reviewing all the studies to date. Does hydroxychloroquine have the potential to be a “game-changer” in the fight against this pandemic? HR: Hydroxychloroquine alone is not the whole story. It needs to be combined with azithromycin or doxycycline and probably with zinc to make it most effective. The game changer is to aggressively treat people as soon as possible, before they are hospitalized, to keep them from becoming hospitalized in the first place. Hydroxychloroquine plus the other medications is what we know about now. In a few months we may have data on other medications that also work. We just have to start with something now.Berkshires (talk) 00:36, 5 June 2020 (UTC)

The NYU study, despite its limitations is an accurate description of the results in the NYU hospital, and no one has questioned the accuracy of the data. I named it as a report and pointed out its retrospective. There is no reason for deletion besides a bias somehow against this combo. Berkshires (talk) 01:06, 5 June 2020 (UTC)— Preceding unsigned comment added by Berkshires (talk • contribs) 00:58, 5 June 2020 (UTC)

New discussion topics go to the bottom of the page. Berkshires argued for the same content at Talk:COVID-19 drug development, and the answer for this article was the same: this is WP:NOTNEWS and WP:PRIMARY research without a systematic review on results for the hydroxychloroquine-azithromycin-zinc regimen for outpatient people with covid, and remains only a possible treatment regimen, as rewritten with this edit. RandomCanadian stated accurately to Berkshires: It's Wikipedia policy: this is not a breaking news website, nor a resource for people to look up the latest developments; but an encyclopedia. We only report things (especially in medical matters) when there is sufficient coverage in adequate reliable sources - in this case the guideline is WP:MEDRS; and there is no problem with waiting until medical experts have taken the time to verify this hypothetical treatment. This has been emphasized to user Berkshires repeatedly in the history of both articles, but the edit warring to defend news and preliminary research, while using illiterate composition and unformatted references, continues. Berkshires has been warned about further disruptive editing. Zefr (talk) 15:03, 5 June 2020 (UTC)

Inclusion criteria?

I'm assuming that MEDRS still applies, and this article isn't going to list every study that might be relevant. I've not been paying a great deal of attention to all the promotion of various possible treatments, but if there is some exception for this page, it should be made crystal clear. --Hipal/Ronz (talk) 23:52, 22 June 2020 (UTC)

Ivermectin

Hipal (talk) requests that the following article content in section COVID-19_drug_repurposing_research#Other_drugs be made less promotional in line with WP:SOAP, WP:MEDRS guidelines. Please assist. Many thanks. -- Sdesalas (talk) 00:49, 23 June 2020 (UTC)

Drug		Research
Ivermectin		A study by Monash University in Australia on 10th April 2020 showed Ivermectin inhibits replication of SARS-CoV-2 in vitro. In addition, on June 10th Florida Broward Health released results of a study of 280 hospital patients associating Ivermectin with lower mortality in critical patients with severe pulmonary disease.

Thanks for copying the content here.

So what's the inclusion criteria, and what's this article for? Are we trying to list any applicable research, regardless of MEDRS? Are we trying to list research programs? Something else? --Hipal/Ronz (talk) 01:50, 23 June 2020 (UTC)

Hi Hipal. No worries, and thanks for fighting the cause to keep spammers away. This is the COVID-19 Drug Repurposing Research article. As you can see, most of the current inclusions already do not meet MEDRS because its an article about research in progress. You might as well get rid of the whole article, but that would detract from Wikipedias WP:SCOPE and WP:NOTABILITY guidelines. I'd say that the above content warrants figuring in with other drugs that are not as further along the research path (do not have clinical trials underway). And besides, Ivermectin is a generic drug that has been available since 1975, nobody makes money out of it, hence there is no point in promoting it. -- Sdesalas (talk) 08:05, 23 June 2020 (UTC)

There's plenty to promote: the drug, the research, the researchers... Welcome to soapboxing on Wikipedia... --Hipal/Ronz (talk) 16:16, 23 June 2020 (UTC)

Ok thanks for expressing your point of view. So here is some updated text referring to a recently updated Stanford University literature review of COVID-19 therapies being researched. This is to address your specific request that it meets WP:MEDRS guidelines (meaning, literature reviews instead of first-hand sources), rather than the less specific soapboaxing comments that seem out of context (but I can understand that to a hammer, everything looks like a nail ;)).

See below. If there is no further comment I'll go ahead and post. Regards. --Sdesalas (talk) 12:24, 25 June 2020 (UTC)

Drug		Research
Ivermectin		Ivermectin is one of an increasing number of additional compounds found to inhibit SARS-CoV-2 without a defined mechanism of action. Plasma levels following oral administration appear too low to inhibit replication, however ivermectin use was associated with significantly reduced mortality in a retrospective study of 280 hospital patients, particularly in persons with severe pulmonary disease. As of June 4, ivermectin is being studied in 10 ongoing and 14 planned clinical trials.

Original research?

The clinical trial information in the section about vitamin C appears to be some sort of original research extraction from the ClinicalTrials.gov search results referenced in the citation. The citation is over two months old and it may no longer be useful/valid/accurate for the text it is supporting. There may be similar issues with the ClinicalTrials.gov search results used in the section about vitamin D. Whywhenwhohow (talk) 20:15, 5 July 2020 (UTC)

Remdesivir

It's been reported by many sources that data presented at a conference about a week ago show that treatment with remdesivir reduces mortality by 62%. If there is a reliable source for this I guess that it should be added. (This is strikingly different from the previous research which had remdesivir having a marginal effect on mortality.) Lavateraguy (talk) 14:42, 19 July 2020 (UTC)

Cinanserin ketanserin, HT-2A inhibitors

As early as February publications out of the PRC, described cinanserin was stated as holding value, as an antagonist on the serotonin receptor site that is responsible for reversing the agonist activity of ergotism and LSD, alongside vasodilating, both serins modulate interleukin releases, Il-6 inflammation via the HT-2A serotonin path. The two compounds did not receive any attention outside of the PRC as far as I can tell, until a few weeks ago Here.

• https://onlinelibrary.wiley.com/doi/10.1002/jmv.25707
• https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03257-y

There are no western trials. Though interest is growing as the latter illuminates. Boundarylayer (talk) 21:45, 22 September 2020 (UTC)

Montelukast

https://www.researchsquare.com/article/rs-52430/v1 Preprint. Posted 05 Aug, 2020.

Montelukast in Hospitalized Patients Diagnosed with covid-19.

The patients who received montelukast were started on 10 mg/day on Day 1 of admission. Patients receiving montelukast experienced significantly fewer events of clinical deterioration compared to patients not receiving montlukast (10% vs 32%, p = 0.022).

What do you think? A preprint yes, but Montelukast drug is extremely safe and the dose is very low, so why everyone isn't give Montelukast just in case??

--ee1518 (talk) 21:09, 19 October 2020 (UTC)

camostat mesylate

There is this article on protease inhibitor .......

SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor Hoffmann M1, Kleine-Weber H2, Schroeder S3, Krüger N4, Herrler T5, Erichsen S6, Schiergens TS7, Herrler G8, Wu NH8, Nitsche A9, Müller MA10, Drosten C3, Pöhlmann S11. https://www.cell.com/cell/fulltext/S0092-8674(20)30229-4

But Matt Hall wrote this on his tweet "OK so let's talk about camostat, because I'm starting to worry about it as a #COVID19 repurposing candidate. It emerged based on this Cell paper, but a LOT of assumptions are buried in the science." https://twitter.com/cispt2/status/1246856029012361218

So how?

Camostat, probably should receive incorporation into the article. It isn't our place to discuss anything on medicines other than what is in reliable medical sources. WP:RSMED. Trials are underway in Japan, as far as I've last read. It is regularly perscribed there for flu symptoms.  As is beta-glucan, most commonly but not exclusively, from oyster mushrooms. An immunomodulator that reduces the prevalence of all cause RTIs (respiratory tract infections). Trials are also underway.

Camostat reduced mortality from "100% to 30%" in mice, infected with SARS-1 the results of the human trial with this SARS-2, is Dec 2020.

https://clinicaltrials.gov/ct2/show/NCT04321096

Boundarylayer (talk) 20:18, 22 September 2020 (UTC)

https://en.wikipedia.org/wiki/Camostat Camostat is only sold in Japan? Prescription or over-the-counter? Some article mentioned the price is very low.

https://cancerdiscovery.aacrjournals.org/content/10/6/779.long Bromhexine is also mentioned. So over-the-counter bromhexine cough medicine might also work?

https://en.wikipedia.org/wiki/Bromhexine

--ee1518 (talk) 21:40, 19 October 2020 (UTC)

Statins reduce covid-19 risk?

https://www.ajconline.org/article/S0002-9149(20)30947-4/fulltext Use of statins prior to admission was associated with a more than 50% reduction in risk of developing severe COVID-19, after controlling for associated comorbid conditions and for concomitant use of ACE inhibitors or ARBs.

... They didn't mention dose or brand of statin.

https://www.reddit.com/r/COVID19/comments/izkeot/statins_reduce_covid19_severity_likely_by/

CK = Creatine Kinase should be monitored when taking statins, but I haven't checked the details how often should it be done when beginning statin therapy. And is it even needed for low-dose or short-time statin therapy.

--ee1518 (talk) 21:11, 19 October 2020 (UTC)

Hydrocortisone / cortisol

Should the article mention Hydrocortisone, in addition to the entry for dexamethasone? See this BBC News story here: [7] Extract: "The latest study brings together all clinical trials involving steroids on coronavirus patients around the world. It confirms dexamethasone works and that another steroid, hydrocortisone, is equally effective." Hallucegenia (talk) 09:38, 11 September 2020 (UTC)

Seems worth mentioning.

Boundarylayer (talk) 21:46, 22 September 2020 (UTC)

Hydrocortisone is not yet in this Wikipedia article, could someone add it?

--ee1518 (talk) 21:42, 19 October 2020 (UTC)

Done. Thanks for the suggestion. •Shawnqual• 📚 • 💭 07:07, 9 November 2020 (UTC)

RfC about the summary of a review article in the Ivermectin section

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.

I am agreeing to the request from other editors who asked for this RfC to be closed pending discussions. --Vrtlsclpl (talk) 04:36, 15 January 2021 (UTC)

---

Two editors differ on the best way to summarize a review article on a novel treatment for COVID-19. Should they just take a direct quote from the review article itself? Here are the two version of the article.--Vrtlsclpl (talk) 19:59, 14 January 2021 (UTC)

Proposals

Remove the December 2020 and January 2021 review notes. New NIH guidelinespublished today supersede those sources, in my opinion. A summary from this source is already in the article as of 14 Jan 2021 (thanks Tvaughan1!). Jdphenix (talk) 00:20, 15 January 2021 (UTC)

References

Why are you not proposing to also remove the review note, "There is only very weak evidence of ivermectin's benefit when used as an add-on therapy for people with non-severe COVID-19."? Seems biased to me. Especially since this sentence fails to conform to the format of the two previous review notes that clearly indicate that the comment is specifically related to a particular piece of research.

I suggest leaving the two research notes, and changing the other to read, "In November 2020, a review was published that demonstrated that there is only very weak evidence of ivermectin's benefit when used as an add-on therapy for people with non-severe COVID-19." AussiePete56 (talk) 01:05, 15 January 2021 (UTC)

Do we still need to keep paragraphs 1-3 in the Ivermectin section? I think there will be significantly less interest in those preliminaries now that they are moving towards large-scale clinical trials.--Vrtlsclpl (talk) 02:57, 15 January 2021 (UTC)

This is just a purely conversational point but re-reading the recommendations - that may actually be the green light for the use of Ivermectin - others may know better.--Vrtlsclpl (talk) 03:10, 15 January 2021 (UTC)

I say that because in an interview I heard Peter McCullough - a fairly influential physician/researcher - suggest that all that was needed from the NIH was a neutral recommendation. That was in the context of the hydroxychloroquine discussion but it applies equally well to Ivermectin.--Vrtlsclpl (talk) 03:17, 15 January 2021 (UTC)

I think the tone of the recommendation is just for face-saving since they have been MIA in this field. --Vrtlsclpl (talk) 03:55, 15 January 2021 (UTC)

Discussion

A second RfC on the specific wording on research of ivermectin? While one is still open? Please close this. It's premature. Jdphenix (talk) 20:15, 14 January 2021 (UTC)

• Agree with above, this is premature with no discussion and (per Talk at ivermectin) several newer/better sources available. Should be closed pending further discussion and reading of new sources. Alexbrn (talk) 21:08, 14 January 2021 (UTC)

A similar discussion about how to describe this article did already take place at Talk at ivermectin that involved Alexbrn, Adriaandh and AussiePete56. I don't really see the harm in getting community input on this discussion at this point. Can either of you provide reasonable alternative language and we can just settle this? Could we just quote directly from the authors conclusion and remove the original text? --Vrtlsclpl (talk) 22:06, 14 January 2021 (UTC)

Yes, stand by. Jdphenix (talk) 00:14, 15 January 2021 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Mccullough et al.

Over at Talk:Ivermectin, Vrtlsclpl (talk · contribs) called for further editors - especially those with more hard-core clinical expertise to comment. I have been a member of the Medicine project for over a decade, am one of the original developers of WP:MEDMOS and WP:MEDRS, and one of the founders of the Pharmacology project. I hope that's enough in the way of expertise. As the RfC has been closed, I am adding my comments here.

The article currently has a direct quotation from the Mccullough et al. review:

there are a number of randomized and prospective studies [of Ivermectin for treatment of COVID-19] and all have shown efficacy in clinical out-comes at the time [of publication].

Unfortunately, this quote is itself a misrepresentation. Of the five cited studies (Alam, Chowdhury, Gorial, Khan, Nunez), only one was randomized and none placebo-controlled. The others are case series and observational research; two are in non-indexed journals, and one a preprint. All—every single one—would fail WP:MEDRS. Not exactly "a number"—well, I guess one is a number (the loneliest number, as the song goes). Presenting the review authors' incorrect, editorialized summary of the state of the research uncritically in the article simply because it is a "review" and is thus high-quality evidence (it isn't; it is a narrative, unsystematic review) is a misinterpretation of WP:MEDRS, and is not productive. Fvasconcellos (t·c) 07:08, 16 January 2021 (UTC)

Further misrepresentation

Talking of misrepresentation, this[8] edit by Vrtlsclpl seems to fail WP:V, and goes against the emergent consensus at ivermectin not to add dates to NIH statements. Alexbrn (talk) 07:40, 16 January 2021 (UTC)

How so? In NIH COVID-19 Treatment Guidelines updated on August 17. 2020:

"The COVID-19 Treatment Guidelines Panel recommends against the use of ivermectin for the treatment of COVID-19, except in a clinical trial (AIII)."

In the the NIH COVID-19 Treatment Guidelines updated on January 14, 2021:

"The COVID-19 Treatment Guidelines Panel (the Panel) has determined that currently there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19."

The statement "...recommends against ..." statement in the earlier recommendation has been removed in the latter. More to the point, the recommendations are boiler-plate language. For interpretation see:( [9], p.17). It is clear from that that the drug is one step closer to full-blown NIH endorsement in COVID-19. --Vrtlsclpl (talk) 15:25, 16 January 2021 (UTC)

You are imposing a non-scientific narrative framework onto this not supported by the sources. This is not a progression that has some pre-ordained plan: the next "step" could as well be that better evidence shows the drug useful or useless for example. In the absence of this better we just don't know (as the good sources say). Please also see WP:SYNTH for why we avoid editorializing text that comes from combining different sources. Test should be WP:Verfified by the sources cites. Alexbrn (talk) 16:35, 16 January 2021 (UTC)

I never used the phrase "...one step closer ..." in the text of the article. I simply stated that the negative recommendation was removed in the update to the NIH treatment guidelines. Are we at a logjam on this language?--Vrtlsclpl (talk) 17:35, 16 January 2021 (UTC)

The current text[10] as tidied by Fvasconcellos is good, with the correct professional WP:TONE. Alexbrn (talk) 17:41, 16 January 2021 (UTC)

I have slightly adjusted the tone in favor of clarity around the dose size. Most people don't understand that "10⁴ dose" means "ten thousand times the normal amount". That means 10,000 pills per day. At an average rate of 60 pills per minute, you'd spend three hours a day swallowing pills. (You would also probably die from the side effects.) If the people advocating for this on the internet can't do math or if they have decided that 1/10000th the amount that worked in that one lab test (the very lab test they're saying proves that it works) will have the same effect as the amount that actually worked in the lab – well, that's not my fault, and I additionally encourage them to watch out for people trying to sell them homeopathy "drugs", too. WhatamIdoing (talk) 19:44, 16 January 2021 (UTC)

This focus on the drug quantities involved in the original research is pointless. Nowhere was it claimed by the original researchers that the quantities used were the minimum required to achieve their result. The leader of the Monash Biomedicine Discovery Institute Dr Wagstaff said at the time, "“Ivermectin is very widely used and seen as a safe drug. We need to figure out now whether the dosage you can use it at in humans will be effective – that’s the next step,” [[11]] Since April there have been dozens of studies which confirm that a normal dose of 200 micrograms/kg of bodyweight is effective against Covid 19, so perhaps its time to retire these references to the quantities used in the original in vitro studies. AussiePete56 (talk) 06:53, 22 January 2021 (UTC)

Where does Vitamin-D fit in?

I am trying to figure out why Vitamin-D is not featured on this page on the other similar one COVID-19 drug development.

There is a surprising amount of research on the go with trials and published papers. Safety at physiological doses is well proven yet widespread deficiencies remain uncorrected. Demonstrated benefits and learned consensus keeps telling us that it should be on the front line as a prophylactic to minimise severity even it it does nothing else.

Here is a secondary source of sorts that has valuable information in the conclusion. Vitamin D and COVID-19: evidence and recommendations for supplementation

Here are some of the published study results Vitamin D is effective for COVID-19: real-time meta analysis of 37 studies

Has this simply been forgotten or what is the reason it is a second class citizen to new drugs that have still to be invented?

Idyllic press (talk) 21:18, 17 January 2021 (UTC)

There's a whole section on vitamin D in the article. Fvasconcellos (t·c) 07:00, 18 January 2021 (UTC)

200 scientists and doctors agree with you... [[12]] AussiePete56 (talk) 06:28, 22 January 2021 (UTC)

AussiePete56, there's content already here. What do you think needs to change? Jdphenix (talk) 06:37, 22 January 2021 (UTC)

Thanks for that Jdphenix. Apologies - I actually misread the above - I thought it was all written by Fvasconcellos and that he was saying that there was no mention of vitamin D in the "drug repurposing" article. What's actually there is not bad AussiePete56 (talk) 07:09, 22 January 2021 (UTC)

Extended-confirmed-protected edit request on 25 January 2021

Change the following under COVID-19 drug repurposing research#Ivermectin,

although it is still prescribed for outpatient use. [13]

to cite this as a source, instead of as a link. Jdphenix (talk) 12:24, 25 January 2021 (UTC)

 Done Alexbrn (talk) 12:53, 25 January 2021 (UTC)

Repurposing psychotropic drugs for treatment of COVID-19

We need a section on repurposing psychotropic drugs. Especially Fluvoxamine, other SSRI inhibitors, and successful amantadine use in Poland (adamantanes in general). — Preceding unsigned comment added by 94.254.144.208 (talk) 19:21, 23 January 2021 (UTC)

Bring sources and discuss. Sounds interesting! Jdphenix (talk) 12:21, 25 January 2021 (UTC)

Found this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785036/ Sloorbeadle (talk) 04:52, 30 January 2021 (UTC)

Extended-confirmed-protected edit request on 3 February 2021

{{edit extended-protected}} Recommend that the Ivermectin section be reordered chronologically, from:

In November 2020, a systematic review found weak evidence of benefit when ivermectin is used as an add-on therapy for people with non-severe COVID-19. A randomized controlled trial (RCT) of 24 patients with non-severe COVID-19 and no risk factors found no difference in PCR-positive nasal swabs nor in viral load between patients who received ivermectin and those given placebo, thus failing the primary outcome of the study.

As of January 2021, the U.S. National Institutes of Health COVID-19 Treatment Guidelines state that the evidence for ivermectin is too limited to allow for a recommendation for or against its use. Ivermectin is not approved by the FDA for anti-viral use. Additional evidence from RCTs and dose-response studies are needed. At least 45 such trials were listed as of January 2021.

It was reported in June 2020 that despite the absence of high-quality evidence to suggest any efficacy, use of ivermectin for prevention or treatment of early-stage COVID-19 has become increasingly widespread especially in Latin America, raising concerns about self-medication, safety, and the feasibility of future clinical trials. In response, the Brazilian Health Regulatory Agency, Brazilian Society of Infectious Diseases, and Brazilian Thoracic Society all issued position statements in July or January 2021 advising against the use of ivermectin for this purpose, and the government of Peru rescinded a previous recommendation for the use of ivermectin (alongside azithromycin and hydroxychloroquine) in hospitalized patients, although as of January 2021 it is still prescribed for outpatient use.

to

It was reported in June 2020 that despite the absence of high-quality evidence to suggest any efficacy, use of ivermectin for prevention or treatment of early-stage COVID-19 has become increasingly widespread especially in Latin America, raising concerns about self-medication, safety, and the feasibility of future clinical trials. In response, the Brazilian Health Regulatory Agency, Brazilian Society of Infectious Diseases, and Brazilian Thoracic Society all issued position statements in July or January 2021 advising against the use of ivermectin for this purpose, and the government of Peru rescinded a previous recommendation for the use of ivermectin (alongside azithromycin and hydroxychloroquine) in hospitalized patients, although as of January 2021 it is still prescribed for outpatient use.

In November 2020, a systematic review found weak evidence of benefit when ivermectin is used as an add-on therapy for people with non-severe COVID-19. A randomized controlled trial (RCT) of 24 patients with non-severe COVID-19 and no risk factors found no difference in PCR-positive nasal swabs nor in viral load between patients who received ivermectin and those given placebo, thus failing the primary outcome of the study.

As of January 2021, the U.S. National Institutes of Health COVID-19 Treatment Guidelines state that the evidence for ivermectin is too limited to allow for a recommendation for or against its use. Ivermectin is not approved by the FDA for anti-viral use. Additional evidence from RCTs and dose-response studies are needed. At least 45 such trials were listed as of January 2021. Rfkrishnan (talk) 22:36, 3 February 2021 (UTC)

References

Suggested additions/inclusions on 04 Feb 2021

I would like to suggest to include the following in the article:

• Camostat approved in Japan for other diseases, with various positive pre-clinical data and multiple clinical trials currently running.
• Disulfiram widely approved for treatment of chronic alcoholism, shown to inhibit proteases of MERS-CoV and SARS-CoV and currently in clinical trials.
• Danoprevir clinical candidate against Hepatitis C virus, in clinical trails against COVID and shown to be favourably compared to lopinavir/ritonavir.
• Tipiracil ?
• Nafamostat approved for other indications in various clinical trials for COVID.

 Not done: please provide reliable sources that support the change you want to be made. Skingo12 (talk) 13:29, 4 February 2021 (UTC)

Each of the respective wiki pages link provide information on the respective drug in the COVID-19 context with proper references/sources for all statements. I did not copy that content here, as I am not sure which form the inclusion in this article should take (e.g. how much detail/repetition from the individual drug pages).

Alleged FDA non sequitur

The article states, "On 15 June, the FDA revoked the emergency use authorization for hydroxychloroquine and chloroquine, stating that although the evaluation of both these drugs under clinical trials continues, the FDA (after interagency consultation with the Biomedical Advanced Research and Development Authority (BARDA)) concluded that, based on new information and other information discussed "... it is no longer reasonable to believe that oral formulations of hydroxychloroquine (HCQ) and chloroquine (CQ) may be effective in treating COVID‑19, nor is it reasonable to believe that the known and potential benefits of these products outweigh their known and potential risks".[28][29][30][31]". While it does seem to be supported by the citations, it seems to me that if Wikipedia is supposed to be an intelligent summary of existing discussion, there should be some acknowledgement that the alleged statement by the FDA is absurd, even if no one has pointed this out in print. It is absurd because 1. anything *may* be effective, no matter how unlikely and therefore to believe that will always be reasonable, and 2. if it really is impossible that it is effective, why is it stated earlier in the sentence that "the evaluation of both these drugs under clinical trials continues"? Surely there should at least be some acknowledgement that this is paradoxical. And has no reputable source noted the paradox? Arctic Gazelle (talk) 17:59, 14 February 2021 (UTC)

Addition suggested

I suggest adding the following to the end of the "ivermectin" section... "On the 27th Jan 2021, Slovakia became the first European nation to approve the use of ivermectin for the prophylaxis and treatment of Covid 19. The approval is for a six month period." AussiePete56 (talk) 03:59, 1 February 2021 (UTC)

 Done Skingo12 (talk) 13:47, 4 February 2021 (UTC)

References

Thanks Skingo12. However, a few days later now, I see that the suggested addition has been removed. Would the editor responsible like to explain why? AussiePete56 (talk) 15:18, 6 February 2021 (UTC)

Don't need a cherry-picked shopping list of countries, esp. from weak sources. What else would be added: South Africa, Australia ... ? Alexbrn (talk) 08:29, 7 February 2021 (UTC)

How can an official government website be a "weak source".[[14]] You will say any nonsense for rhetorical effect. "Cherry-picking" is when you mention ONLY countries that reject ivermectin. The first first-world country to authorise its use against covid-19 is obviously a milestone event for the drug, and is a appropriate addition to this section AussiePete56 (talk) 17:25, 11 February 2021 (UTC)

 Not done for now: Requester is blocked. Elliot321 (talk | contribs) 17:03, 21 February 2021 (UTC)

Deletion of content regarding vitamin D

Alexbrn has selectively deleted half of a direct quote that he does not like in his role policing articles on vitamin D and any of its physiological or medical actions. Here is the source first cited by Whywhenwhohow [15] . This is not a comprehensive source but the full context says Dietary supplements aren’t meant to treat or prevent COVID-19. Certain vitamins and minerals (e.g., Vitamins C and D, zinc) may have effects on how our immune system works to fight off infections, as well as inflammation and swelling. I think we need all of this or nothing at all. We have evidence, and not what they are "meant" to do: see the cited systematic review and meta-analysis on the effects of vitamin D deficiency PMID 33146028. Jrfw51 (talk) 18:41, 22 February 2021 (UTC)

And what does the next bit say? That these vitamins are best got through foods and supplements can have adverse effects. By selecting just the text you have in the context of an article on "drug repurposing research", you're including text that has the unfortunate effect of being misleading. Let's not do that. Alexbrn (talk) 18:46, 22 February 2021 (UTC)

What is misleading about this? (Anyway the physiological source of vitamin D is from UV action on skin if you can get it). The science shows these (bio)chemicals have immune effects and that is why people have tried to increase their intake to "fight off infections" such as COVID-19. Neither you nor I can be sure whether supplements do or do not help specific groups in specific situations. I propose that the whole of this introduction is deleted, and we wait for further quality evidence on the specifics. Neither you nor I have time to keep defending our different POVs. Jrfw51 (talk) 19:04, 22 February 2021 (UTC)

I suggest adding Pyramax to the antiviral category of this document.

It is suggested to add a separate pyramax entry to Antiviral. In addition, the paper of Dr. Sanjeev's research team at St. George's University of London, UK, has been formally listed in Cell magazine's Trends in parasitology. Also, I think the preliminary dissertation is also important because I made the preliminary thesis in July as an important reference thesis in this thesis. I will add the content of the pre thesis in more detail and then suggest the content. If you go to this article I edited, there is a citation paper.

---

It was announced on 3 April 2020 that artesunate/pyronaridine, the main components of a new ACT antimalarial drug sold under the brand name Pyramax, showed an inhibitory effect on SARS-CoV-2 Pyramax showed a virus titer inhibition rate of 99% or more after 24 hours in vitro tests using Hela cells. , while cytotoxicity was also reduced.[7]

A preprint published in July 2020 reported that pyronaridine and artesunate exhibit antiviral activity against SARS-CoV-2 and influenza viruses using human lung epithelial (Calu-3) cells and Vero cells.[8] This in vitro experiment was very important in that the human lung cell Calu-3 was used, the cells were first infected with SARS-COV-2 and then treated with drugs 1 hour later.

Also, this in vitro experiment is encouraging in that the combination of pyronaridine and artesunate showed 100% inhibition in Vero cells. When each component was tested in Vero cells, the effect was less than that of HCQ, but when the two components were combined, it showed 100% inhibition and the effect lasted 48 hours. This shows that the two ingredients have a synergistic effect.

When tested in calu-3 cells with a single component of PYR and ART, the inhibition rate was 80-90%, especially the SI value of ART was very high, reaching 220.

The combination of pyronaridine and artesunate is being studied as a possible treatment for moderate to severe SARS-COV-2. [9] The preprint[8] published in July 2020 is cited as a reference paper for this paper.[9]

It is currently in phase II clinical trial in South Korea, South Africaand Philippine. phase III clinical trial in Burkina Faso, Kenya. The clinical trials in Burkina Faso, Kenya are led by CDC in the USA and The Liverpool School of Tropical Medicine in the UK. — Preceding unsigned comment added by PaperNerd (talk • contribs) 15:05, 27 February 2021 (UTC)

Would need WP:MEDRS - a review article or better published in a reputable journal. Alexbrn (talk) 15:12, 27 February 2021 (UTC)

Agree. Pyramax Korea Phase 2 clinical trial ends in April, so we'll talk again at that time. PaperNerd (talk) 08:23, 28 February 2021 (UTC)

Split section on chloroquine and hydroxychloroquine?

It's the only subsection containing subsubsections in the present article. It even includes a Controversy section, suggesting that it has attracted significant attention. fgnievinski (talk) 03:23, 23 February 2021 (UTC)

I agree with the split. I think Chloroquine and hydroxychloroquine during the COVID-19 pandemic would be the best title for the new article. John P. Sadowski (NIOSH) (talk) 16:18, 23 February 2021 (UTC)

Thank you, it looks great now: Chloroquine and hydroxychloroquine during the COVID-19 pandemic. fgnievinski (talk) 17:25, 4 March 2021 (UTC)

Ivermectin

This statement on study results is false.

A randomized controlled trial (RCT) of 24 patients with non-severe COVID-19 and no risk factors found no difference in PCR-positive nasal swabs nor in viral load between patients who received ivermectin and those given placebo, thus failing the primary outcome of the study

Proposed new text: A randomized controlled trial (RCT) of 24 patients with non-severe COVID-19 and no risk factors found no difference in PCR-positive nasal swabs but non-statistically significant lower viral load (3 times lower day 4 and 18 times lower day 7) as well as statistically significant earlier recovery from hyposmia/anosmia between patients who received ivermectin and those given placebo, thus failing the primary outcome of the study but concluding that further research is warranted

Quoting from the study: the median viral load for both genes was lower at days 4 and 7 post treatment in the ivermectin group with differences increasing from 3-fold lower at day 4 (p = 0·24 for gene E; p = 0·18 for gene N) to around 18-fold lower at day 7 (p = 0·16 for gene E; p = 0·18 for gene N)

At day 7, there was no difference in the proportion of PCR positive patients (RR 0·92, 95% CI: 0·77–1·09, p = 1·0). The ivermectin group had non-statistically significant lower viral loads at day 4 (p = 0·24 for gene E; p = 0·18 for gene N) and day 7 (p = 0·16 for gene E; p = 0·18 for gene N) post treatment as well as lower IgG titers at day 21 post treatment (p = 0·24). Patients in the ivermectin group recovered earlier from hyposmia/anosmia (76 vs 158 patient-days; p < 0.001).

Among patients with non-severe COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 72 h of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of self-reported anosmia/hyposmia, a reduction of cough and a tendency to lower viral loads and lower IgG titers which warrants assessment in larger trials.Adriaandh (talk) 09:03, 12 February 2021 (UTC)

Adriaandh's version is more accurate, but why are we publishing a small, mostly statistically insignificant primary-source piece of original research which fails WP:MEDRS? Wikipedia policy is that secondary sources should be used where available, like this meta-analysis and review performed by a highly reputable independent consultancy which concluded that ivermectin is a, " profoundly effective COVID-19 treatment." [[16]] Publishing only anti-ivermectin propaganda with regards to its potential against Covid 19 is WP:BIAS and WP:INFORMATION SUPPRESSION AussiePete56 (talk) 16:55, 12 February 2021 (UTC)

That PDF is a faked-up self-published "paper" from a one-director consultancy, not quite The Lancet. Alexbrn (talk) 17:08, 12 February 2021 (UTC)

Dear esteemed Mr Alex, could you please comment on the false reporting on the study results?Adriaandh (talk) 09:25, 13 February 2021 (UTC)

I've already commented on this at Talk:Ivermectin. The summary seems fine, except maybe change "no difference" to "no meaningful difference". But I'd not mind removing this content entirely. Alexbrn (talk) 09:52, 13 February 2021 (UTC)

Dear Mister Alex sir, can you in that case please do as you said and just remove the erroneous content? As others (probably with nefarious goals) have said, this study is not representative of the full body of work with regard to Ivermectin. If you do insist on keeping it, please correct the misleading statement and also add all other RCT results to make this a fair representation of all the evidence for and against the drug. I implore you to follow your infinite wisdom and maintain this page unbiased. Much appreciated! Adriaandh (talk) 20:29, 15 February 2021 (UTC)

Then remove it. It was only cherry-picked in the first place because its the only research you could find that didn't strongly endorse ivermectin as an effective anti-Covid 19 agent. You've repeatedly labelled as "fake" anything that doesn't confirm your hostile prejudices - an aggressive and unethical tactic. By the way, the highly esteemed Dr. Theresa Lawrie [[17]] would be very interested, not to mention concerned, that an influential senior editor of Wikipedia has very publicly declared her research to be FAKE. I wonder if you fully considered the laws regarding libel when you made your scurrilous and baseless allegations? Do you have deep pockets and access to a good lawyer? You might need both. AussiePete56 (talk) 11:49, 13 February 2021 (UTC)

It is a faked-up "paper" (i.e. looking like a journal article but it's not). I am reporting you to WP:ANI for making legal threats. Alexbrn (talk) 11:59, 13 February 2021 (UTC)

I see the false reporting on the study outcome is still unchanged. Is reporting on life and death medical research outcomes not considered important enough to maintain accurate information?Adriaandh (talk) 00:21, 18 February 2021 (UTC)

Can somebody, anybody, please explain how 18-fold lower at day 7 (p = 0·16 for gene E; p = 0·18 for gene N) = found no difference in PCR-positive nasal swabs nor in viral load ? I am really perplexed. Why was this page editing restricted if such a blatant false statement is still allowed to be left untouched? Adriaandh (talk) 23:00, 22 February 2021 (UTC)

How is it that the most significant compilation of work done on Ivermectin is not included in this Wikipedia entry? Specifically, <https://hcqmeta.com/> shows beyond any reasonable doubt that Ivermectin has positive effects against COVID 19 regardless of the endpoint used (death, hospitalization, lab results) or stage of the disease (prophylaxis, early/late treatment). Meta-analysis of 42 studies estimates a 75% improvement in outcomes According to another hypothesis, it would be the scabies parasite which confers this protective role against Covid-19. This hypothesis is based on the ability of Sarcoptes scabiei to modulate “for 4 to 8 weeks after initial infestation … the host’s inflammatory and immune responses” . It would be the modulation of the host's inflammatory and immune responses elicited by Sarcoptes scabiei, and not ivermectin, that would have protected EHPAD residents from severe forms of Covid-19

 Not done for now: please establish a consensus for this alteration before using the {{edit extended-protected}} template. ScottishFinnishRadish (talk) 11:13, 15 April 2021 (UTC)

Guidance on reliability/utility of a source

Good afternoon all Wikipedians; and can I ask your advice please on the following source: https://sebastianrushworth.com/2021/05/09/update-on-ivermectin-for-covid-19/ - this source appears to take a reasonably critical overview of the few studies to have been concluded so far (ie as a secondary source) and goes on to conduct a meta-analysis on the results of some of them (ie in this respect is a primary source). Regards and respect to all, Springnuts (talk) 15:23, 10 May 2021 (UTC)

Unreliable. We need good WP:MEDRS (several such sources are cited already). Alexbrn (talk) 15:34, 10 May 2021 (UTC)

Question

Alexbrn, I'm not sure I agree with your reasoning. The section already contains a lot of information about various bodies recommending and not recommending (mostly) to use ivermectin, how is India's health ministry guidance difference from those of Brazil, Peru and EU which are mentioned in the article? Alaexis_¿question? 12:08, 25 May 2021 (UTC)

They are at least linked to the underlying research. We need to keep focus otherwise it opens the door to a "shopping list" of countries and their various stances - rational or not - on ivermectin. For some secondary commentary on India/ivermectin this[18] Reuters fact-check might be useful? Perhaps in the COVID-19 misinformation article? Alexbrn (talk) 12:22, 25 May 2021 (UTC)

Whether they are right or wrong is beside the point. The fact that the health ministry of the second biggest country in the world recommends it is important - even (especially) if they turn out to be wrong. If this section contained only information about research then adding information about India's guidelines would be out of place. There can be no justification for including the official stance of Peru and not India. Maybe you can recommend where to move all the information about individual countries from this article? Alaexis_¿question? 16:35, 25 May 2021 (UTC)

I'd be fine with removal of the Peru content - it seems irrelevant too. Alexbrn (talk) 16:38, 25 May 2021 (UTC)

Okay, so this is my suggestion. We are starting with and giving most space to the research, then mention the WHO's official position and then mention briefly the stances of individual countries and blocks, starting with the US and EU and noting alternative positions.

“ In vitro, ivermectin has antiviral effects against several distinct positive-sense single-strand RNA viruses, including SARS-CoV-2.[110] Subsequent studies found that ivermectin could inhibit replication of SARS-CoV-2 in monkey kidney cell culture with an IC50 of 2.2–2.8 μM.[91][111] Based on this information, however, doses much higher than the maximum approved or safely achievable for use in humans would be required for an antiviral effect.[112] Aside from practical difficulties, such high doses are not covered by current human-use approvals of the drug and would be toxic, as the antiviral mechanism of action is considered to operate via the suppression of a host cellular process,[112] specifically the inhibition of nuclear transport by importin α/β1.[113]

In November 2020, a systematic review found weak evidence of benefit when ivermectin is used as an add-on therapy for people with non-severe COVID-19.[114] Merck, the company from which the drug originated, has said that there is no good evidence ivermectin is plausible or effective as a drug used against COVID-19, and that attempting such use may be unsafe.[115]

The WHO say that ivermectin should not be used to treat COVID-19 except in a clinical trial.[129] This is also the position of the European Medicines Agency (EMA) and the FDA. In a number of countries, including India, ivermectin has been approved by local health authorities.

”

Alaexis_¿question? 16:53, 25 May 2021 (UTC)

Doesn't look good, because of the tacked on India stuff which has nothing to do with research. We know, sadly, that some Indian health authorities are up to their neck in quackery. Alexbrn (talk) 16:55, 25 May 2021 (UTC)

Who are "we" and how is it based on Wikipedia policies? Alaexis_¿question? 17:13, 25 May 2021 (UTC)

"We" means Wikipedia editors who look at sources, and sources are the basis for all content here. e.g.[19] Alexbrn (talk) 17:25, 25 May 2021 (UTC)

How is it relevant? This is a different ministry. Again, this is not about whether ivermectin works or not (personally I agree with the WHO that it's not a good idea to use it before clinical studies are complete). There are high-quality sources that prove that this is the guideline of the Ministry of Health (USA today article and the guidelines themselves. If the positions of major public health agencies is relevant then there can be no grounds to remove the Indian position. If they are not, I'm happy to leave the WHO statement and move everything else to a different place. Alaexis_¿question? 17:54, 25 May 2021 (UTC)

This is an article about research. We have different articles about the COVID-19 pandemic in India, and about misinformation. Maybe your content would be dues in those (and maybe not). But it aint't due here. Alexbrn (talk) 18:02, 25 May 2021 (UTC)

Then why do we have information about its use in Latin America? It's not related to research. Alaexis_¿question? 18:21, 25 May 2021 (UTC)

I'd be fine with removal of the Peru content - it seems irrelevant too. Alexbrn (talk) 18:23, 25 May 2021 (UTC)

---

(responding to the Adriaandh's reverted post) Please note that I opened an RfC at Talk:Ivermectin#Survey. Considering that this is an article about research, I think that the information about different countries' stances belongs there. There is little outside feedback so far, please feel free to add your opinion. Alaexis_¿question? 05:45, 27 May 2021 (UTC)

I agree with Alexbrn. Regulatory approval, whether in India or in South American countries, is not in the scope of this article, which is about research. When good research produces reliable results (whether positive or negative), they can be mentioned here. --Fernando Trebien (talk) 23:14, 29 May 2021 (UTC)

Extended-confirmed-protected edit request on 1 June 2021

Change "Self-medication has led to..." to "Self-medication with a formula intended for horses has led to..." in order to avoid confusion and to better reflect the cited source. Anthropoentomophagology (talk) 20:10, 1 June 2021 (UTC)

 Done --Fernando Trebien (talk) 20:23, 1 June 2021 (UTC)

Extended-confirmed-protected edit request on 2 June 2021

I would like to completely remove the following sentence: "Misinformation, lower degrees of trust, a sense of loss of control and despair over the increase in the number of cases and deaths led to an increase in the use of the drug and the emergence of a black market in Central and Eastern Europe, Latin America"

This sentence is blatantly biased, implying the only reason for people taking Ivermectin is because people are feeling "misinformation, lower degrees of trust, a sense of loss of control and despair", which is not at all an accurate picture of the primary reasons people are taking Ivermectin.

Even the source cited at the end of this sentence states in no unambiguous terms "Self-medication is on the rise because people can easily buy ivermectin at drug stores, says pharmacologist Carlos Calderón Ospina from the University of El Rosario in Bogotá" and "The municipality of Natal, in Rio Grande Do Norte, Brazil, also promoted it as a preventative — to be taken by health-care professionals and people at increased risk of severe illness from the virus, because of “its safe pharmacological profile, clinical experience using it against other diseases, cost and dosage convenience”.", yet the current sentence implies that everyone is getting Ivermectin from their local weed dealer or something. It is one-sided to imply that the black market is the only source of Ivermectin for these countries without mentioning that it is literally an OTC drug in "Central and Eastern Europe, Latin America", to use the vague geographical wording in the current sentence.

I am not against the mentioning of a black market for Ivermectin, but I am against implying that Ivermectin is only a black market drug, as I believe the current sentence does. Perhaps someone can come up with a better way to word the sentence, but as it stands right now, it would be better to remove this sentence since it is incredibly misleading by omission. Zombychicken (talk) 00:30, 2 June 2021 (UTC)

As presented, all you are asking is to delete content that you personally don't like. That approach has no chance here. --Hipal (talk) 02:34, 2 June 2021 (UTC)

Ftrebien, I think it's your wording, could you clarify which sources give these reasons for the ivermectin usage (lack of trust, despair, misinformation)? I see them neither in Nature nor in One health articles which are cited. Alaexis_¿question? 06:01, 2 June 2021 (UTC)

@Alaexis: Politico, which is a trusted source and is cited in that paragraph.

@Zombychicken: the same paragraph also says that some governments have allowed its use. In these cases, it is not a black market. That's the case of Natal, in Rio Grande Do Norte, but the legal situation in Brazil is a limbo because ivermectin is still not allowed for COVID-19 at the federal level, despite the political turmoil, and doctors prescribing its use for this purpose may be prosecuted. For this reason, the mayor of Natal is being investigated. But then, rule abiding varies by society.

We may add to the article that it is literally an OTC drug in "Central and Eastern Europe, Latin America" if one can provide a good reference. --Fernando Trebien (talk) 11:47, 2 June 2021 (UTC)

the only reason for people taking Ivermectin is because people are feeling "misinformation, lower degrees of trust, a sense of loss of control and despair", which is not at all an accurate picture of the primary reasons people are taking Ivermectin So what are the primary reasons people are taking ivermectin? This article is about COVID-19 only. --Fernando Trebien (talk) 12:11, 2 June 2021 (UTC)

Thanks. I think that the part about trust refers not to the use of ivermectin per se but to the conspiracy theory mentioned in the previous paragraph ("The implication that Big Pharma is blocking the use of ivermectin fits into the broader pattern of seeing "some sort of big conspiracy 'against us ordinary people,"). Btw the article mentions "[p]romising research on the drug's potential" in the same sentence. Alaexis_¿question? 14:37, 2 June 2021 (UTC)

trust refers not to the use of ivermectin per se Right.

but to the conspiracy theory mentioned in the previous paragraph Not exactly. The article says People only listen to sources that they trust and this is the sense it adopts for this word elsewhere, which is the same sense as in Trust (social science) or even more specifically as in High trust and low trust societies. What Politico is saying is that more fragmented societies are more susceptible to misinformation in general: since these people distrust authorities and/or groups within their societies, they are more likely to believe propositions that suggest someone is trying to deceive them. --Fernando Trebien (talk) 15:03, 2 June 2021 (UTC)

 Not done for now: please establish a consensus for this alteration before using the {{edit extended-protected}} template. Run n Fly (talk) 15:48, 2 June 2021 (UTC)

2-DG

Do you think this follows WP:MEDRS? --Fernando Trebien (talk) 23:14, 7 June 2021 (UTC)

It's better now, and I've put some content at COVID-19 misinformation too since it seems a feature here is the lack of research. Alexbrn (talk) 14:17, 12 June 2021 (UTC)

Extended-confirmed-protected edit request on 22 June 2021

In 22, Jun 2021 philippines president Rodrigo Duterte publicly stated that ivermectin is "used for pigs"

Please update the article with this new information. Kreyren (talk) 21:06, 22 June 2021 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. ScottishFinnishRadish (talk) 00:11, 23 June 2021 (UTC)

References

Extended-confirmed-protected edit request on 28 June 2021

Propose adding to the ivermectin section: "Despite the lack of FDA approval for COVID-19 treatment, an increase in off-label ivermectin prescriptions occurred in the US following initial publications showing potential benefit. "During March 16, 2019–April 2, 2021, national estimates of ivermectin dispensed from outpatient retail pharmacies increased from an average of 3589 prescriptions per week at the pre-pandemic baseline to a peak of 39,102 prescriptions in the week ending on January 8, 2021 (989% relative percent increase)"

I think this would follow well after "Ivermectin is not approved by the U.S. Food and Drug Administration (FDA) for use in treating any viral illness and is not authorized for use to treat COVID-19 within the European Union" Caprilyc (talk) 13:39, 28 June 2021 (UTC)

References

 Not done The source for "showing potential benefit" is a letter, and doesn't support it in any case. More generall this is not relevant to the topic of "drug repurposing research". Maybe something respectful of WP:V could be due at COVID-19 misinformation. Alexbrn (talk) 13:58, 28 June 2021 (UTC)

I don't have edit access there and the talk page is locked as well but propose adding "Despite the lack of FDA approval for COVID-19 treatment, an increase in off-label ivermectin prescriptions occurred in the US following widespread media coverage of the drug. "During March 16, 2019–April 2, 2021, national estimates of ivermectin dispensed from outpatient retail pharmacies increased from an average of 3589 prescriptions per week at the pre-pandemic baseline to a peak of 39,102 prescriptions in the week ending on January 8, 2021 (989% relative percent increase)" Caprilyc (talk) 15:20, 28 June 2021 (UTC)

Caprilyc possibly also at Ivermectin and/or COVID-19 pandemic in the United States if it's notable. Alaexis_¿question? 14:43, 28 June 2021 (UTC)

Point taken. I did not mean to add it as an endorsement of efficacy, more as a statement on how even very preliminary scientific findings affected physician behavior in the field. Given that there is discussion of people taking horse dewormer perhaps that is also better moved to COVID-19 misinformation instead of this research section. Caprilyc (talk) 15:01, 28 June 2021 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Melmann 09:29, 30 June 2021 (UTC)

Extended-confirmed-protected edit request on 1 July 2021

Concerning Ivermectin, it seems reasonable to include a statement, such as:

The National Institute of Health (NIH) is currently neutral in its stance on the efficacy of Ivermectin as a COVID-19 therapy: "There are insufficient data for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19." "Some observational cohorts and clinical trials have evaluated the use of ivermectin for the prevention and treatment of COVID-19." See, https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin/ 2600:8802:330F:A00:895B:ADAD:F26F:315A (talk) 20:04, 1 July 2021 (UTC)

References

 Not done The position of the NIH is already included in the article. Alexbrn (talk) 20:11, 1 July 2021 (UTC)

Invermectin again. Claimed peer reviewed meta-analysis.

This any use? https://journals.lww.com/americantherapeutics/Fulltext/2021/06000/Review_of_the_Emerging_Evidence_Demonstrating_the.4.aspx

Regards all. Springnuts (talk) 06:49, 2 July 2021 (UTC)

No. It's been raised (in at least 3 sections) at Talk:Ivermectin. Alexbrn (talk) 06:57, 2 July 2021 (UTC)

Thank you. Springnuts (talk) 19:12, 3 July 2021 (UTC)

Extended-confirmed-protected edit request on 4 July 2021

There is now peer reviewed evidence that Ivermectin does work for CoVid. https://journals.lww.com/americantherapeutics/Abstract/9000/Ivermectin_for_Prevention_and_Treatment_of.98040.aspx 108.243.106.82 (talk) 23:45, 4 July 2021 (UTC)

•  Not done The URL throws a 404 error. dudhhr_Contribs 02:45, 6 July 2021 (UTC)

Chloroquine and hydroxycholoquine

For Ivermectin it is correctly written that “some governments have allowed its off-label use”, including India (despite the opinion comments added like “Misinformation”, “despair”…). But this is not written for Chloroquine and hydroxycholoquine, despite the fact that Indian Ministry oh Health advises the use of hydroxycholoquine for mild cases in its latest Clinical management protocol, amended on May 24 2021.

The Protocol https://www.mohfw.gov.in/pdf/UpdatedDetailedClinicalManagementProtocolforCOVID19adultsdated24052021.pdf,

Article about the amended protocol and ivermectin Hindustan Times,

Article about the amended protocol and hydroxycholoquine Times of India.

Could someone add the info, at least for hydroxycholoquine? I have not enough edits to be able to do it myself… Thanks. Ceveris (talk) 10:38, 10 July 2021 (UTC)

Pyramax (pyronaridine/artesunate) phase2 result

As a result of plaque assay, after 3 days of administration, the amount of viable virus was reduced by 96.3%. (Initial viral load)

The Pyramax group achieved a 100% negative change after 10 days in all patients, whereas the amount of infectious virus on the 3rd day of administration of the infectious virus Pyramax was significantly reduced 2.8-fold compared to the placebo group [the amount of change in the amount of virus before administration, the adjusted mean of the Pyramax group 96.3% reduction vs. 34.5% reduction in placebo group, p=0.0143)]. PaperNerd (talk) 01:57, 11 July 2021 (UTC)

Would need a source that was reliable according to WP:MEDRS. Alexbrn (talk) 04:32, 11 July 2021 (UTC)

New Cochrane report regarding Ivermectin

I cannot add it (maybe @Alexbrn:), but a new Cochrane report (PMID 34318930) came to the conclusion that "the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID-19 outside of well-designed randomized trials.". --Julius Senegal (talk) 06:58, 30 July 2021 (UTC)

More information about withdrawn ivermectin promoting paper

can be found on nature news: doi:10.1038/d41586-021-02081-w --Julius Senegal (talk) 07:51, 13 August 2021 (UTC)

Extended-confirmed-protected edit request on 28 August 2021

change: Aside from practical difficulties, such high doses are not covered by current human-use approvals of the drug and would be toxic, as the antiviral mechanism of action is considered to operate by the suppression of a host cellular process.

to: Aside from practical difficulties, such high doses of ivermectin that were effective in cell culture are not approved for human-use; administering sufficiently high dosages to reach the dosage in the cell culture medium (in the study) for humans would be toxic, as the antiviral mechanism operates by suppressing required human cellular processes. In fact, currently there are no good quality studies showing that Ivermectin is both safe and beneficial to treat COVID-19 (cite many meta-analyses). Thus, ivermectin is unlikely to be prescribed in many countries to treat SARS-COV-2, the viral agent causing COVID-19, but prescription is likely to result in malpractice lawsuits and human deaths. To explain simply, the study using ivermectin to treat COVID-19 showed that as cells die, they will produce less virus. Uncc23 (talk) 06:58, 28 August 2021 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. ScottishFinnishRadish (talk) 03:19, 29 August 2021 (UTC)

Extended-confirmed-protected edit request on 31 August 2021

Under Research, COVID-19, the last paragraph states that the governments of some countries have granted official approval ivermectin for use as a treatment of COVID-19. One country listed is the Philippines. The citation says the exact opposite. The Philippines has approved ivermectin for use as an anti-nematode drug, in line with it historical usage. The citation specifically states that the government of the Philippines has, in no way, shape, or form, approved ivermectin for use as treatment of COVID-19.

I am asking for the line mentioning the Philppines to be deleted. 2601:582:300:2F7E:4C73:CC65:4E98:361 (talk) 05:06, 31 August 2021 (UTC)

 Done Source seemed clear that it was not authorized for off-label use EvergreenFir (talk) 05:27, 31 August 2021 (UTC)

Aspirin

There was research into aspirin (for its blood thinning properties) to treat COVID-19. https://www.ukri.org/news/aspirin-does-not-reduce-deaths-for-hospitalised-covid-19-patients/#:~:text=Aspirin%20does%20not%20reduce%20deaths%20for%20hospitalised%20COVID%2D19%20patients,-10%20June%202021&text=The%20'RECOVERY'%20trial%20has%20released,patients%20hospitalised%20with%20COVID%2D19.

DouglasHeld (talk) 18:21, 20 August 2021 (UTC)

DouglasHeld, The thing about this, is that it's not repurposing. It's using it for the purposes we already know about, in a new disease. This article is more about using drugs for previously unknown purposes, in the treatment of COVID-19.  — Shibbolethink ^{(♔ ♕)} 18:39, 20 August 2021 (UTC)

Thank you. I thought perhaps blood thinning is still considered an off-label use of aspirin.

DouglasHeld (talk) 20:56, 8 September 2021 (UTC)

Extended-confirmed-protected edit request on 13 September 2021

Change this line: "Self-medication with a highly concentrated formula intended for horses has led to numerous hospitalizations, and overdose can lead to death, possibly due to interaction with other medications.[94] "

to:

Self-medication with a highly concentrated formula intended for horses has led to at least some hospitalizations, and overdose can lead to death, possibly due to interaction with other medications.[94]"

Because the cited article actually states: "...the FDA has received multiple reports of patients who have required medical attention, including hospitalization, after self-medicating with ivermectin intended for livestock." 71.167.166.177 (talk) 13:14, 13 September 2021 (UTC)

Comment: I'm not personally comfortable making the change without either consensus or a source with specific numbers, which I couldn't immediately find. I will propose using "multiple hospitalizations" as a compromise between "some" and "numerous", especially since that phrasing was previously used in the article. @Ftrebien and Autodidact1: Perhaps you could provide some input here? — LauritzT (talk) 14:01, 13 September 2021 (UTC)

@LauritzT: I agree that "multiple hospitalizations" is the best option, following the description given by the source. I tried to find some numbers, but all I could find was that the number of exposures (including those cases with major effects and those with minor effects) rose from 133 to 459 from July to August in the US. It also more than doubled relative to 2020 from January to August.— Preceding unsigned comment added by Ftrebien (talk • contribs)

Agree that "multiple" is the best term here. This is such an evolving phenomenon that we don't want to pin ourselves down too firmly imo.— Shibbolethink ^{(♔ ♕)} 23:10, 13 September 2021 (UTC)

References

Extended-confirmed-protected edit request on 16 September 2021

Suggest that the following conclusion from "Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVOC-19" appearing in the American Journal of Therapeutics (2021)be added:

The findings indicate with moderate certainty that ivermectin treatment in COVID-19 provides a significant survival benefit. . . . Overall, the evidence also suggests that early use of ivermectin may reduce morbidity and mortality from COVID-19. This is based on (1) reductions in COVID-19 infections when ivermectin was used as prophylaxis, (2) the more favorable effect estimates for mild to moderate disease compared with severe disease for death due to any cause, and (3) on the evidence demonstrating reductions in deterioration. 2601:189:C480:FFB0:0:0:0:CFEE (talk) 19:06, 16 September 2021 (UTC)

 Not done for now: please establish a consensus for this alteration before using the {{edit extended-protected}} template. This will be "a whole thing." I suggest you seek consensus here on the talk page for that addition. ScottishFinnishRadish (talk) 19:16, 16 September 2021 (UTC)

Extended-confirmed-protected edit request on 18 September 2021

I think this article deserves to be included. It is a well sourced and reputable newspaper in India. It writes how the State with the highest population in India used Ivermectin to treat Covid-19 and how it was sanctioned by the State's Health Department.

Uttar Pradesh government says early use of Ivermectin helped to keep positivity, deaths low The 13th 4postle (talk) 15:14, 18 September 2021 (UTC)

 Not done. Re: India, we already discuss this with other sources that are more recent. Sub-topic discussion of just Uttar Pradesh would be WP:UNDUE. — Shibbolethink ^{(♔ ♕)} 15:39, 18 September 2021 (UTC)

Extended-confirmed-protected edit request on 5 October 2021

Change “After reviewing the evidence on ivermectin, the European Medicines Agency (EMA) advised against it's use” to “After reviewing the evidence on ivermectin, the European Medicines Agency (EMA) advised against its use”

Remove incorrect apostrophe DarthTaper (talk) 00:23, 5 October 2021 (UTC)

 Done Firefangledfeathers (talk) 00:27, 5 October 2021 (UTC)