Question explored with the scientific record
Are there any human trials for ivermectin
The short version: ivermectin has been tested in dozens of human trials for COVID-19, and the largest, highest-quality ones show it does not work for that disease. It does work for scabies.
The most definitive evidence comes from a 2025 meta-analysis of 23 randomized trials involving 12,345 patients [1]. It found no statistically significant improvement in viral clearance, hospitalization duration, or symptom resolution. The pooled effect on hospitalization was not significant (p=0.15), and symptom resolution also missed significance (p=0.07) [1]. This is the kind of evidence that matters: a large, pooled analysis of randomized, placebo-controlled trials. The earlier, smaller studies that showed benefit, like a 2021 trial of ivermectin plus doxycycline that reported faster recovery (median 7 vs 9 days, p=0.003) [2], were not replicated at scale.
For scabies, the picture is different. Multiple trials show oral ivermectin is effective, though topical permethrin is usually somewhat better. A 2025 trial of 100 patients found permethrin significantly more effective at reducing clinical scores over two weeks [3]. A 2019 study of 195 patients found permethrin had 89% improvement in pruritus versus 80% for ivermectin, a difference that was not statistically significant (p=0.14) [5]. A 2016 study found 79.5% cure with ivermectin versus 88.1% with permethrin (p=0.157) [6]. So ivermectin works for scabies, just not as well as the topical alternative.
| Outcome | Ivermectin | Comparator | Statistical significance |
|---|---|---|---|
| COVID-19 hospitalization (meta-analysis, 23 trials, n=12,345) | No significant reduction | Placebo | p=0.15 [1] |
| COVID-19 symptom resolution (meta-analysis) | No significant improvement | Placebo | p=0.07 [1] |
| Scabies cure at 4 weeks (2016 trial, n=86) | 79.5% | Permethrin 88.1% | p=0.157 [6] |
| Scabies pruritus improvement at 6 weeks (2019 trial, n=195) | 80% | Permethrin 89.2% | p=0.14 [5] |
The safety signal is worth noting. A pharmacovigilance analysis of 517 reports found systemic ivermectin was associated with a 3.34-fold increased reporting odds for severe cutaneous adverse reactions (SCARs) like Stevens-Johnson syndrome, and a 7.08-fold increase for toxidermias specifically [4]. These are rare but serious. The absolute risk is low, but the signal is real.
My call: for COVID-19, the evidence from large randomized trials is clear that ivermectin provides no meaningful benefit. For scabies, it works but is second-line to topical permethrin. Confidence: high for COVID-19, moderate for scabies.
Sources used 6
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Repurposing Anthelmintic Drugs for COVID-19 Treatment: A Comprehensive Meta-Analysis of Randomized Clinical Trials on Ivermectin and Mebendazole
An up-to-date meta-analysis of 23 randomized trials (n = 12,345) evaluating ivermectin and mebendazole for COVID-19 found no statistically significant improvement in viral clearance, hospitalization duration, or symptom resolution overall, although some individual studies sugges…
DOI: 10.3390/antibiotics14050459 -
Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial
Combining ivermectin with doxycycline shortened time to clinical recovery and reduced disease progression and viral persistence in adults with mild-to-moderate COVID-19 compared with placebo.
DOI: 10.1177/03000605211013550 -
Comparative Efficacy and Safety of Permethrin and Ivermectin in the Treatment of Scabies
A comparative study of 100 scabies patients in Bangladesh found that topical permethrin was significantly more effective than oral ivermectin in reducing clinical scores over a two-week period, with distinct but mild adverse effect profiles for each treatment.
DOI: 10.70818/bmcj.2025.v011i01.0173 -
Severe cutaneous adverse reactions associated with systemic ivermectin: A pharmacovigilance analysis
Systemic ivermectin was significantly associated with increased reporting of severe cutaneous adverse reactions (SCARs) in FAERS, especially toxidermias, though causality cannot be ascertained.
DOI: 10.1111/1346-8138.16398 -
Comparative study of oral ivermectin, topical permethrin and benzyl benzoate in the treatment of scabies
In a quasi-experimental comparison of 195 patients with uncomplicated scabies, single-application topical permethrin gave the highest 6-week improvement in pruritus (89.2%) and lesions (87.7%), significantly better than benzyl benzoate but not statistically different from oral i…
DOI: 10.18203/2320-6012.ijrms20195549 -
Comparison of efficacy and safety of oral ivermectin with topical permethrin in treatment of scabies
In a quasi-experimental study, oral ivermectin (200 µg/kg, repeated once) was as effective as topical permethrin 5% for scabies at week 4 (79.5% vs 88.1%, p=0.157), but ivermectin had significantly more side effects (p=0.05).
DOI: 10.66344/jpad.v20i4.382