Ivermectin repurposing for COVID-19: pharmacological and bibliometric analysis

Since the onset of the COVID-19 pandemic in March 2020, researchers worldwide have sought effective drugs to prevent and manage SARS-CoV-2 and its spectrum of symptoms. Ivermectin, originally developed as an anthelmintic for controlling parasitic infections in humans and animals, has drawn attention based on the hypothesis that it inhibits viral replication. In Austria, ivermectin usage peaked in November 2021, following promotion by the right-wing Freedom Party of Austria (FPÖ) as an alternative treatment to vaccination, resonating strongly within anti-vaccine and skeptical communities. The topic is also very present in the United States of America due to the re-election of D. Trump as US President and the designation of R. Kennedy as the United States' Secretary of Health and Human Services. To critically examine the controversial use of ivermectin for COVID-19 and publication trends during the pandemic, this study analysed all publications listed in PubMed from 1 January 2020 to 31 December 2022 using the keywords 'ivermectin' and 'COVID-19', resulting in a dataset of 353 publications. These publications were assessed for scientific quality, methodological rigour and bias, with particular focus on the influence of social and political dynamics on publication practices, as well as the prevalence of preprints, citation trends and the role of funding sources. Our study shows that many highly cited studies on ivermectin display methodological weaknesses and data gaps, contributing to the propagation of hypotheses lacking substantial empirical support. This analysis underscores the necessity of rigorous quality control during crises and highlights the long-term risks posed to scientific databases and public health by methodologically deficient research.