TY - JOUR
T1 - Ivermectin for Critically and Noncritically Ill Hospitalized Patients With COVID-19
T2 - Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP)
AU - Hashmi, Madiha
AU - Haniffa, Rashan
AU - Jayakumar, Deva
AU - Beane, Abigail
AU - Lorenzi, Elizabeth
AU - Berry, Lindsay R
AU - Nasir Khoso, Muhammad
AU - Ain Khan, Quratul
AU - Kumar, Ashok
AU - Altaf Kidwai, Aneela
AU - Hills, Thomas E
AU - Annane, Djillali
AU - Aryal, Diptesh
AU - Au, Carly
AU - Baillie, Kenneth
AU - Beasley, Richard
AU - Best-Lane, Janis
AU - Bonten, Marc
AU - Bradbury, Charlotte A
AU - Brunkhorst, Frank M
AU - Burrell, Aidan
AU - Buxton, Meredith
AU - Cecconi, Maurizio
AU - Cheng, Allen C
AU - Cove, Matthew E
AU - de Jong, Menno
AU - Detry, Michelle A
AU - Duffy, Eamon
AU - Estcourt, Lise J
AU - Fitzgerald, Mark
AU - Fowler, Rob
AU - Goossens, Herman
AU - Green, Cameron
AU - Hays, Leanne M C
AU - Higgins, Alisa M
AU - Huang, David T
AU - Ichihara, Nao
AU - Koirala, Sabin
AU - Lamontagne, François
AU - Lawler, Patrick R
AU - Lewis, Roger J
AU - Litton, Edward
AU - Mahon, Niamh
AU - Marshall, John C
AU - McAuley, Daniel F
AU - McGlothlin, Anna
AU - McGuinness, Shay
AU - McQuilten, Zoe K
AU - McVerry, Bryan J
AU - Derde, Lennie P G
N1 - Publisher Copyright:
Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
PY - 2026/7/1
Y1 - 2026/7/1
N2 - OBJECTIVE: To determine whether ivermectin improves outcomes for critically and noncritically ill hospitalized patients with COVID-19.DESIGN: An ongoing international, multifactorial, adaptive platform, randomized, controlled trial.SETTING: Hospitals in Pakistan, India, and Ireland between June 11, 2021, and September 9, 2022.PATIENTS: Critically and noncritically ill patients.INTERVENTIONS: Randomized to ivermectin or no ivermectin (control).MEASUREMENTS AND MAIN RESULTS: The primary outcome was respiratory and cardiovascular organ support-free days, assessed on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support through day 21 in survivors. Analyses used a Bayesian cumulative logistic model. Enrollment was closed for operational futility, following external evidence suggesting no benefit with ivermectin in nonhospitalized patients with COVID-19. Among 61 critically ill patients, the median number of organ support-free days was -1, indicating death was the most common vital outcome (interquartile range [IQR], -1 to 17), for the ivermectin group and -1 (IQR, -1 to 17.25) for the control group (adjusted proportional odds ratio [OR], 0.94; 95% credible interval [CrI], 0.40-2.07) and the posterior probability of superiority to control was 44.2%. Among 89 noncritically ill patients, the median number of organ support-free days was 22 (IQR, 18.5-22) for ivermectin and 22 (IQR, 16-22) for control (adjusted proportional OR, 1.04; 95% CrI, 0.48-2.34) and the posterior probability of superiority was 53.7%. Among critically ill patients, hospital survival was 35.1% (13/37) for ivermectin and 37.5% (9/24) for control (adjusted OR, 1.00; 95% CrI, 0.39-2.32), posterior probability of superiority was 50.0%. Among noncritically ill patients, hospital survival was 84.1% (37/44) for ivermectin and 77.8% (35/45) for control (adjusted OR, 1.16; 95% CrI, 0.5-3.07), posterior probability of superiority was 63.3%.CONCLUSIONS: For critically and noncritically ill hospitalized patients with COVID-19, ivermectin was unlikely to improve the primary composite outcome of organ support-free days and hospital survival.
AB - OBJECTIVE: To determine whether ivermectin improves outcomes for critically and noncritically ill hospitalized patients with COVID-19.DESIGN: An ongoing international, multifactorial, adaptive platform, randomized, controlled trial.SETTING: Hospitals in Pakistan, India, and Ireland between June 11, 2021, and September 9, 2022.PATIENTS: Critically and noncritically ill patients.INTERVENTIONS: Randomized to ivermectin or no ivermectin (control).MEASUREMENTS AND MAIN RESULTS: The primary outcome was respiratory and cardiovascular organ support-free days, assessed on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support through day 21 in survivors. Analyses used a Bayesian cumulative logistic model. Enrollment was closed for operational futility, following external evidence suggesting no benefit with ivermectin in nonhospitalized patients with COVID-19. Among 61 critically ill patients, the median number of organ support-free days was -1, indicating death was the most common vital outcome (interquartile range [IQR], -1 to 17), for the ivermectin group and -1 (IQR, -1 to 17.25) for the control group (adjusted proportional odds ratio [OR], 0.94; 95% credible interval [CrI], 0.40-2.07) and the posterior probability of superiority to control was 44.2%. Among 89 noncritically ill patients, the median number of organ support-free days was 22 (IQR, 18.5-22) for ivermectin and 22 (IQR, 16-22) for control (adjusted proportional OR, 1.04; 95% CrI, 0.48-2.34) and the posterior probability of superiority was 53.7%. Among critically ill patients, hospital survival was 35.1% (13/37) for ivermectin and 37.5% (9/24) for control (adjusted OR, 1.00; 95% CrI, 0.39-2.32), posterior probability of superiority was 50.0%. Among noncritically ill patients, hospital survival was 84.1% (37/44) for ivermectin and 77.8% (35/45) for control (adjusted OR, 1.16; 95% CrI, 0.5-3.07), posterior probability of superiority was 63.3%.CONCLUSIONS: For critically and noncritically ill hospitalized patients with COVID-19, ivermectin was unlikely to improve the primary composite outcome of organ support-free days and hospital survival.
KW - COVID-19
KW - adaptive platform trial
KW - antiviral
KW - intensive care
KW - ivermectin
KW - pneumonia
U2 - 10.1097/CCM.0000000000007134
DO - 10.1097/CCM.0000000000007134
M3 - Article
C2 - 42101205
SN - 0090-3493
VL - 54
SP - 1546
EP - 1562
JO - Critical care medicine
JF - Critical care medicine
IS - 7
ER -