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

In an ongoing international, multifactorial, adaptive platform, randomized, open label, controlled trial, critically and noncritically ill patients were randomized to receive ivermectin (n = 81) or no ivermectin (control, n = 69) in addition to standard care in Pakistan, India, and Ireland. Organ support-free days and survival did not significantly differ between the ivermectin and control groups in analysis with a Bayesian cumulative logistic model.

  • 8 May 2026
  • Madiha Hashmi, Rashan Haniffa, Deva Jayakumar, Abigail Beane, Elizabeth Lorenzi, Lindsay R Berry, Muhammad Nasir Khoso, Quratul Ain Khan, Ashok Kumar, Aneela Altaf Kidwai, Thomas E Hills, Djillali Annane, Diptesh Aryal, Carly Au, Kenneth Baillie, Richard Beasley, Janis Best-Lane, Marc Bonten, Charlotte A Bradbury, Frank M Brunkhorst, Aidan Burrell, Meredith Buxton, Maurizio Cecconi, Allen C Cheng, Matthew E Cove, Menno de Jong, Michelle A Detry, Eamon Duffy, Lise J Estcourt, Mark Fitzgerald, Rob Fowler, Herman Goossens, Cameron Green, Leanne M C Hays, Alisa M Higgins, David T Huang, Nao Ichihara, Sabin Koirala, François Lamontagne, Patrick R Lawler, Roger J Lewis, Edward Litton, Niamh Mahon, John C Marshall, Daniel F McAuley, Anna McGlothlin, Shay McGuinness, Zoe K McQuilten, Bryan J McVerry, Paul R Mouncey, Susan Morpeth, Mihai Netea, Katrina Orr, Rachael L Parke, Jane C Parker, Asad Patanwala, Svenja Peters, Luis Felipe Reyes, Kathryn M Rowan, Hiroki Saito, Christina T Saunders, Marlene Santos, Christopher W Seymour, Manu Shankar-Hari, Vanessa Singh, Matthew Slater, Paul A Tambyah, Steven Y C Tong, Alexis F Turgeon, Anne M Turner, Frank van de Veerdonk, Sebastian Weis, Ryan Zarychanski, Colin J McArthur, Derek C Angus, Scott M Berry, Anthony C Gordon, Lennie P G Derde, Steve A Webb, Srinivas Murthy, Yaseen Arabi, Alistair D Nichol, and the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) Investigators
  • Critical Care Medicine

OBJECTIVES
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.

SETTINGS
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.

Download