Molnupiravir vs ivermectin according to Dr. John Campbell

Dr. John Campbell recently discussed an interesting study comparing Molnupiravir, Merck's new Covid pill, to an out-of-patent drug, also from Merck: ivermectin. To know how that comparison works out, it is of course best to read the study for yourself But not everything is easy to understand. Then it is a relief when a critical craftsman such as Dr. John Campbell walks through it and interprets it in his own phlegmatic, sometimes forcefully neutral way. Video at the bottom of this article.

The discoverer of ivermectin, Satoshi Ömura, has asked Merck to investigate the effect of ivermectin on COVID-19 in a thorough Randomized Controlled Trial. Merck refused. So we have to make do with dozens of smaller studies.

Campbell's key points in a table:

Key points according to Dr Campbell

[with a single addition on my part]

Molnupiravir [MP] wacht op dit moment op goedkeuring om te mogen worden voorgeschreven tegen Covid-19. Oorspronkelijk ontwikkeld om influenza tegen te gaan en later MERS, blijkt het nu ook eigenschappen te hebben die het SARS-CoV2 virus bestrijden. Dus een ‘repurposed drug’, een hergebruikt medicijn. Net als ivermecine, dat wordt soms beschreven als 'paardenontwormer' omdat het ook op dieren wordt gebruikt. Alsof dat ongebruikelijk is; een middel als Aspirine wordt ook veterinair gebruikt. [Volgens Jerusalem Post blijkt Aspirine nu het risico op Covid-19 met almost half to reduce, but that's beside the point.]

Ivermectin [IVM] is the most studied "repurposed" drug ever. Since 2015, IVM has revolutionized the treatment of parasitic diseases worldwide. The drug won a Nobel Prize and, partly due to its minimal side effects, was also applied to animals.

The comparative study in question was published by the Austin Publishing Group, which subjects each submission to a double-blind peer review process before publishing.

Dr. John Campbell loopt de studie door en benadrukt allereerst sterk voorstander te zijn van zowel vaccinatie als voor medicatie. Met goede medicijnen kunnen landen geholpen worden waar nog niet voldoende vaccins beschikbaar zijn. Hij wil zowel medicijnen als vaccinaties. [Hij denkt niet aan 'vaccinatiebereidheid' die zou kunnen zakken als er goede medicijnen op de markt komen.]

Both broad spectrum

Molnupiravir [from now on MP] is a broad-spectrum drug: started as an anti-MERS and influenza pill [that apparently never really broke through?] and now also effective against Covid-19.

Ivermectin [as of now IVM] is an FDA-approved Nobel Prize-winning broad-spectrum drug. It has a proven effect against RNA viruses including HIV, Zika and the MERS coronavirus.

Efficacy in vitro/in vivo

As early as 2020, the effectiveness of IVM against Covid was demonstrated in the lab. This resulted in a lot of protest, but gradually it has become widely accepted. Its high efficacy within 48 hours was demonstrated with a tremendously high dose – so not intended for similar dosing in humans. [Opponents countered that such high doses would never reach the affected cells.]

MP would be effective at a lower dose, so IVM requires a different dose, which should not be problematic given the minimal side effects. Both pills are well absorbed.

Exposure time and half-life

MP works within 2 hours and loses half of the action after every 7 hours (half-life of 7 hours).

IVM works within 6 hours and loses half of its effect after every 80 hours (half-life of more than three days). It spreads well in adipose tissue and accumulates in lung tissue and remains there for a long time.

Operation

MP uses mutations to disrupt the multiplication of the virus RNA, making it ineffective. There is a suspicion that it does not stop there and that human DNA is also being corrupted. Disrupting cell division could then lead to cancer and birth defects. So that still requires some research. Merck has since sworn that there is no problem there. [The video is from October 5th, a quick search shows that there are quite a few cautionary studies, also in October just before and again after the video. They all refer to this study, in which it has been found that the DNA is also affected.]

IVM, on the other hand, binds to the Spike protein, hardens the ACE2 receptors and inhibits the viral process. IVM is also anti-inflammatory. This can also help long-covid patients.

It seems obvious to first give MP for the quick effect and then switch to IVM Both drugs could reinforce each other afterwards, also something to investigate carefully.

Price

Merck has set the price of MP at around €650 (€65 per pill), depending on what a country can pay.

IVM heeft een lage productieprijs. Een kuur kost enkele euro's om te maken. Daar liggen in Nederland dus de nodige opslagen op want het is duurder dan dat, op dit moment enkele tientjes voor een kuur. [Bovendien mag het not be prescribed for Covid-19. because that would not help the willingness to vaccinate.]

Side effects

The side effects of MP, certainly in the long term, are still unknown. There is debate about mutagenesis: Altering human DNA. From This readable piece I understand that it is especially a problem with cell division. The author suspects that it will not be recommended for pregnant women and children. The target group of the elderly is likely to tolerate it well.

For the safety of IVM, Campbell looks to Vigibase: 3.7 billion doses of IVM have already been given to humans, 5693 adverse reactions have been reported.

To compare:

Ibuprofen has reported 165,558 adverse reactions. Unfortunately, Campbell does not say how many doses were needed for this. In any case, keep in mind that Ibuprofine has never been distributed prophylactically on a large scale.

The safety among animals shows the possibility that it could also be well tolerated by humans. It is strange that this is not seen as a positive signal and is even used against IVM, while animal experiments always have to show whether a drug could be suitable for human use. If that metabolism is so similar, why not see a positive signal in drugs that have been used in animals for years without any problems?

Effectiveness

MP: approx. 50% ZH and mortality. (44-47% effective)

IVM, according to ivmmeta.com:

• Prophylactic: 86% effective

• Early (home) treatment: 66% effective

• Late Treatment (ZH) 40% effective

In search of objections, Campbell doesn't get much further than the Cochrane Library: "We weten niet van IVM of het beschermt, leidt tot minder ZH, IC of sterfte." Die conclusie dateert van een half jaar geleden, op basis van een twintigtal studies. Kijk voor meer info op ivmmeta.

Criticism

So much for Campbell. Now there really are more anti-ivermectin websites to be found. They all complain about the chaotic variety of studies from all corners of the world. A statistician has calculated how small the probability is that all those reports indicate the same probability. As long as there is no thorough large-scale study, patients have to wait at home without medication until it is bad enough to have to go to the hospital. Their doctors should not be entrusted to try something at the first symptoms.

An excellent example is this:

PolitiFact | Fact-checking claim about the use of ivermectin to treat COVID-19

And there are countless articles that claim that the removal of a withdrawn, possibly fraudulent investigation has eliminated all evidence.

Huge study supporting ivermectin as Covid treatment withdrawn over ethical concerns | Medical research | The Guardian

There is a great call for a large-scale, solid, double-blind RCT.

Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19 (nih.gov)

The above review is a fact check by the organizers of a fact-checking festival with Dr Fauci:

The discoverer of ivermectin, Satoshi Ömura, has asked Merck to investigate the effect of ivermectin on COVID-19 in a thorough Randomized Controlled Trial. Merck refused.