Ivermectin therapy is associated with changes in SARS-CoV-2 RNA load in asymptomatic patients: a randomized controlled trial

BACKGROUND: Ivermectin, an antiparasitic agent with reported antiviral properties, has been investigated for repurposing in the treatment of COVID-19. This study aimed to assess the efficacy of a single weight-adjusted oral dose of ivermectin in reducing viral load and improving clinical outcomes in asymptomatic individuals infected with SARS-CoV-2. METHODS: A randomized controlled trial was conducted with 126 asymptomatic SARS-CoV-2-positive participants. Subjects were assigned to receive either standard care (zinc and vitamin C supplementation) or standard care plus a single dose of ivermectin. Reverse transcription-PCR was used to assess changes in cycle threshold (Ct) values after 96 h. Clinical symptom development and hospitalization rates were also monitored. RESULTS: Baseline Ct values were similar between groups. After 96 h, participants in the ivermectin group showed a greater increase in Ct values (from 15.97 ± 2.823 to 24.35 ± 3.086) compared with controls (from 16.65 ± 3.593 to 19.84 ± 3.743; p < 0.001), the mean increase in Ct was 8.38 (95% CI, 7.56-9.20) in the ivermectin group versus 3.19 (95% CI, 2.36-4.02) in the control group (mean difference 5.19 (95% CI, 3.72 to 6.66); p < 0.001), suggesting a potential for more rapid reduction in viral load. Participants receiving ivermectin also reported fewer symptoms (e.g., anosmia, fatigue, myalgia) and had a lower hospitalization rate, though these clinical trends should be interpreted cautiously. CONCLUSION: A single oral dose of ivermectin may accelerate viral clearance and reduce symptom progression in asymptomatic SARS-CoV-2-positive individuals. Further large-scale, multi-center randomized trials are warranted to confirm these findings and evaluate ivermectin's potential role in early COVID-19 management. TRIAL REGISTRATION: This randomized controlled trial was conducted between November and December 2021 and was registered in the World Health Organization Clinical Trial Registry (ChiCTR2000033627; Date of Registration: 2020-06-07).