A big, multicenter trial Hernandez is running—the sixth in a series of NIH-funded studies called Accelerating Covid‑19 Therapeutic Interventions and Vaccines, or Activ-6—will also look at fluvoxamine, a steroid called fluticasone, and, yes, ivermectin, but at different doses than the Together trial administered. “People recognized back in the spring that there was a gap in the Activ programs, which is how to study drugs that were easily administered at home and had a long safety record,” Hernandez says. In his trial, people can sign up from anywhere and get their drugs (or placebos) by mail. It’s a convenient way to get data, and it also gets around another problem with drug trials. Over the course of a fast-moving pandemic, a local wave of patients might crest and then break before an academic hospital can set up the infrastructure to actually do the study. But people can sign up for Activ-6 from home, making it a lot more flexible. (Together dealt with that issue by studying people in Brazil, where it was easier to find sick people.)
Why do another trial at all if the evidence for ivermectin’s usefulness is collapsing? Well, for one thing, the researchers started planning it before the collapse began. It takes a while for a big trial to change course. Methodologically and bureaucratically, a lot of groups have to sign off, and researchers and administrators have been planning Activ-6 for months—since the days when ivermectin looked like a better bet. “Based on the existing data, particularly the Together trial, there is not any evidence that ivermectin has any role in the outpatient realm,” says David Boulware, an infectious disease physician and researcher at the University of Minnesota who is cochair of the Activ-6 steering committee. “There’s no data on clinical benefit. Does it prevent hospitalization or ER visits? Does it reduce severity or duration of symptoms? When you put the data together, there’s nothing conclusive. The point of Activ-6 is: Let’s get a definitive answer, because people are using it.”
Much of the US response to the pandemic has been exactly this backward—responsive to misinformation rather than getting out in front of it. This has been going on for long enough that the pandemic itself has changed. Vaccination does an excellent job keeping people out of the hospital, but people get breakthrough cases, albeit relatively mild ones, even where vaccination is common. Everyone would benefit from something their physician could prescribe that’d make them feel better and keep ERs clear for the desperately ill—with Covid, or anything else. A drug that actually worked in people, with good data behind it? That’d be worth a “wow.”