What question did this study set out to answer?

To assess whether ivermectin improves outcomes in critically and noncritically ill hospitalized patients with COVID-19.

May 10, 2026Critical Care Medicine0 citationsOpen Access

Ivermectin for Critically and Noncritically Ill Hospitalized Patients With COVID-19: Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP)

MHMadiha Hashmi RHRashan Haniffa DJDeva Jayakumar

Key Points

To assess whether ivermectin improves outcomes in critically and noncritically ill hospitalized patients with COVID-19.
Randomized controlled trial comparing ivermectin to control in hospitalized patients.
Conducted in hospitals across Pakistan, India, and Ireland from June 2021 to September 2022.
Primary outcome measured was organ support-free days using a cumulative logistic model.
In critically ill patients, median organ support-free days was -1 for both ivermectin and control (adjusted OR 0.94, 95% CrI 0.40-2.07).
In noncritically ill patients, median organ support-free days was 22 in both groups (adjusted OR 1.04, 95% CrI 0.48-2.34).
Hospital survival rates were similar: 35.1% for ivermectin vs. 37.5% for control in critically ill; 84.1% for ivermectin vs. 77.8% for control in noncritically ill.

Abstract

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.

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