Remdesivir und Ivermectin lösten mehr Kontroversen aus als jede andere Behandlung gegen COVID-19. Remdesivir wurde das erste für die Erkrankung zugelassene antivirale Medikament; Ivermectin war ein günstiges Generikum, das bereits zur Behandlung von Parasiten eingesetzt wurde.
Die größte Studie zeigte keinen klaren Überlebensvorteil, verkürzte jedoch die Krankenhausaufenthalte, während spätere Sicherheitsmeldungen Hinweise auf Leber- und Nierenschäden hervorhoben. Ivermectin, das an Tausenden von ambulanten Patienten getestet wurde, reduzierte weder die Hospitalisierungsraten noch beschleunigte es die Genesung oder senkte die Sterblichkeit durch COVID-19.
Findings & Outcomes
In 2020, remdesivir became the first fully approved treatment for COVID-19. It never showed that it kept patients alive. Ivermectin, an inexpensive generic tested in thousands of outpatients, did not help against the disease at all.
What The Trials Set Out To Test
Remdesivir is an intravenous antiviral, first built against other viruses and repurposed in 2020 for the one that causes COVID-19. Ivermectin is an oral antiparasitic, among the most widely used medicines in the world. Both were reasonable candidates early in the pandemic, and both were tested against placebo or standard care in large randomized trials.
What The Trials Found
Remdesivir: faster recovery, no clear survival benefit
In the ACTT-1 trial, Beigel and colleagues randomized 1,062 hospitalized patients. Remdesivir shortened median time to recovery from 15 days to 10, a recovery rate ratio of 1.29. Deaths ran 6.7% with the drug against 11.9% with placebo by day 15, but that gap did not reach statistical significance (hazard ratio 0.73, 95% CI 0.52 to 1.03).
The larger and more decisive test came from the WHO SOLIDARITY trial, run across 405 hospitals in 30 countries. Death occurred in 301 of 2,743 remdesivir patients and 303 of 2,708 controls, a rate ratio of 0.95 (95% CI 0.81 to 1.11). The trial concluded the drug had little or no effect on survival, the need for ventilation, or length of stay. Faster recovery is a separate result. On death, the largest trial found no clear benefit.
The WHO's own living-guideline panel then weighed the pooled data. On 20 November 2020, after reviewing four international trials covering more than 7,000 patients, it issued a conditional recommendation against remdesivir for hospitalized patients. A drug can win approval for shortening an illness before anyone shows it saves lives; remdesivir did.
Ivermectin: no benefit against COVID-19
Ivermectin was tested in large, careful outpatient trials. TOGETHER assigned 1,358 higher-risk outpatients to ivermectin or placebo, and found no drop in hospitalization or extended emergency-department stay (relative risk 0.90). ACTIV-6 gave 1,591 outpatients the drug or placebo, with no faster recovery (hazard ratio 1.07). Median recovery ran 12 days against 13 with placebo, and hospitalizations or deaths matched at 1.2% in each group. A Cochrane review pooling the randomized evidence reached the same result. At the doses tested, ivermectin did not help against COVID-19.
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Respiratory Infection
Remdesivir sped recovery from 15 days to 10 but showed no survival benefit (rate ratio 0.95)
Remdesivir helped hospitalized patients recover a few days faster but did not clearly reduce deaths. The biggest trial, the WHO SOLIDARITY study, found no survival benefit at all.
Beigel and colleagues (ACTT-1) randomized 1,062 hospitalized patients and found remdesivir shortened median time to recovery from 15 days to 10 (rate ratio for recovery 1.29, 95% CI 1.12 to 1.49); Kaplan-Meier mortality was 6.7% with remdesivir versus 11.9% with placebo (hazard ratio 0.73, 95% CI 0.52 to 1.03), a difference that did not reach statistical significance. Pan and colleagues, in the WHO SOLIDARITY trial across 405 hospitals in 30 countries, found death in 301 of 2,743 remdesivir patients versus 303 of 2,708 controls (rate ratio 0.95, 95% CI 0.81 to 1.11), and concluded that remdesivir had little or no effect on hospitalized patients as judged by mortality, ventilation and hospital stay. A faster recovery is a separate result; on survival, the outcome that matters most, the strongest trial found no clear benefit.
Who this may not transfer to:Measured in hospitalized adults with COVID-19; these are findings about inpatient treatment, not prevention or mild illness at home.
The studies · 2
Beigel et al., remdesivir for the treatment of Covid-19: final report (ACTT-1) · N Engl J Med 2020;383(19):1813-1826
Pan et al., repurposed antiviral drugs for Covid-19: interim WHO Solidarity trial results · N Engl J Med 2021;384(6):497-511
WHO recommended against remdesivir after pooling four trials of more than 7,000 patients
The World Health Organization's guideline panel reviewed the pooled trial data and, in November 2020, recommended against using remdesivir in hospitalized patients.
Agarwal and colleagues, in the BMJ Rapid Recommendations living WHO guideline on drugs for covid-19 (BMJ 2020;370:m3379), reported a WHO Guideline Development Group conditional recommendation against remdesivir in hospitalized COVID-19 patients regardless of severity. The panel pooled evidence from four international randomized trials of more than 7,000 patients and found no important effect on mortality, need for mechanical ventilation, time to clinical improvement, or other patient-important outcomes. A conditional recommendation reflects low-certainty evidence: the panel did not conclude the drug is harmful, only that the pooled trials did not show it improved the outcomes that matter to patients. The recommendation was published 20 November 2020; the FDA had granted full approval of remdesivir on 22 October 2020.
Who this may not transfer to:A guideline judgment about treating hospitalized COVID-19 patients; it does not address prevention, outpatient use, or later variants and treatments.
The study · 1
Agarwal et al., a living WHO guideline on drugs for covid-19 · BMJ 2020;370:m3379
Ivermectin gave no COVID-19 benefit in randomized trials of 1,358 and 1,591 outpatients
The large, careful trials of ivermectin for COVID-19 came back null: it did not reduce hospitalization, speed recovery, or lower deaths. It is an important medicine for parasites, but it did not help against COVID-19 at the doses studied.
Reis and colleagues, in the TOGETHER randomized platform trial, assigned 1,358 higher-risk outpatients with early COVID-19 to ivermectin (400 micrograms per kilogram for 3 days) or placebo and found no significant reduction in the primary outcome of hospitalization or prolonged emergency-department observation (relative risk 0.90, 95% Bayesian credible interval 0.70 to 1.16). Naggie and colleagues, in the ACTIV-6 platform trial, gave 1,591 US outpatients the same ivermectin dose or placebo and found no improvement in time to sustained recovery (hazard ratio 1.07, 95% credible interval 0.96 to 1.17; median recovery 12 versus 13 days), with hospitalizations or deaths equal in both groups (1.2% each). Popp and colleagues, in a Cochrane systematic review, pooled the randomized evidence and concluded that ivermectin has little or no effect on mortality, clinical progression or hospital admission in COVID-19. Ivermectin is a Nobel-recognized antiparasitic with strong, established efficacy against the parasitic diseases it is licensed to treat; for COVID-19, the randomized evidence settled the question in the null direction.
Who this may not transfer to:Measured in mostly outpatient adults with early COVID-19; it says nothing about ivermectin's established use for parasitic disease.
The studies · 3
Reis et al., effect of early treatment with ivermectin among patients with Covid-19 (TOGETHER) · N Engl J Med 2022;386(18):1721-1731
Naggie et al., effect of ivermectin vs placebo on time to sustained recovery in outpatients with COVID-19 (ACTIV-6) · JAMA 2022;328(16):1595-1603
Popp et al., ivermectin for preventing and treating COVID-19 · Cochrane Database Syst Rev 2022;6:CD015017
Those rows carry different grades by design. The remdesivir survival row and the ivermectin row rest on large randomized trials, over 1,000 patients apiece, and are graded strong. The WHO guideline row is graded strong as a statement of what the pooled evidence supported. The liver and kidney signals are graded emerging, because a spontaneous-reporting database is weaker evidence than a controlled trial.
How These Drugs Were Meant To Work
As a nucleotide analogue, remdesivir blocks the enzyme the virus uses to copy its genome, slowing replication. That is why it was expected to help the hospitalized patients in the 2020 trials.
Ivermectin binds ion channels that parasites carry and mammals largely lack, the reason it clears worms and mites safely. The COVID-19 case for it came from 2020 cell-culture studies, where high concentrations suppressed the virus. Those concentrations sat far above what a standard oral dose reaches in the body, one reason the clinical trials were needed to settle the question.
Safety Once Millions Were Treated
A controlled trial follows a selected group closely, so some rarer harms surface only after a drug reaches very large numbers of ordinary patients. Global safety reporting flagged liver and kidney events more often for remdesivir than for comparable drugs, logged in the WHO safety database by 2021. Hospitalized COVID-19 patients frequently develop liver and kidney injury from the disease itself, so a report may signal the illness as well as the drug. A disproportionality signal from spontaneous reports flags a drug for investigation, but does not prove it caused any one case. The signals carry more weight because remdesivir never proved it saved lives.
A reporting signal is a reason to look harder at a drug, never proof that it harmed a given patient.
Go Deeper
The COVID-19 evidence here connects to three related pages:
- Ivermectin, the antiparasitic in full, what it treats and the doses used.
- Long COVID, the recognized post-viral condition and what helps the people living with it.
- Expectancy and belief, why a treatment can feel effective even when a trial finds no benefit.
Common Questions
Why did the WHO recommend against a drug the FDA had approved?
In 2020, the FDA and WHO reached opposite calls on the same drug. The FDA asked whether remdesivir beat placebo on a measured endpoint, and the recovery data cleared that bar. The WHO's panel asked whether the pooled trials helped patients survive, and judged that they had not. Its verdict was a conditional recommendation based on low-certainty evidence. The panel did not find that the drug harms patients.
What are the liver and kidney signals?
In medical terms these are hepatobiliary (liver) and renal (kidney) adverse events, flagged during the COVID-19 pandemic. They come from a spontaneous-reporting database, where clinicians log a suspected drug reaction after they see it. A disproportionality signal means one drug drew such reports at a higher rate than other drugs. That is how the liver and kidney reports were first flagged.
Did ivermectin work for COVID-19?
For COVID-19, no. The large 2022 outpatient trials found no benefit at those doses. Ivermectin remains a genuinely effective, Nobel-recognized medicine against parasites such as river blindness and scabies. The 2022 trials rule out ivermectin for COVID-19; they say nothing about its use against parasites, where it still works.
Cautions
Everything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
Liver (hepatobiliary) adverse events reported disproportionately for remdesivir once used at scale
Kim and colleagues analyzed individual case safety reports in VigiBase, the WHO's international pharmacovigilance database, and found a disproportionality signal for hepatobiliary adverse drug reactions associated with remdesivir compared with the full database and with relevant comparators. Disproportionality analysis compares how often an event is reported for a drug versus for all other drugs; a raised reporting odds ratio flags a potential signal for follow-up, not establishing that the drug caused the event. The signal is notable because it emerged in a drug whose survival benefit was not established, so its risk-benefit balance turns on exactly this kind of real-world safety information.Kim et al., hepatobiliary adverse drug reactions associated with remdesivir: the WHO international pharmacovigilance study
Kidney failure reported ~20-fold above expected for remdesivir at scale (reporting odds ratio 20.3)
Gérard and colleagues used disproportionality analysis of the WHO safety database (VigiBase) and found a statistically significant signal of acute renal failure for remdesivir: 138 observed cases against 9 expected, a reporting odds ratio of 20.3 (95% CI 15.7 to 26.3, P < 0.0001) versus comparator drugs used in similar COVID-19 situations (hydroxychloroquine, tocilizumab, lopinavir/ritonavir). Disproportionality analysis compares how often an event is reported for a drug against other drugs; a raised reporting odds ratio identifies a signal for further study, not a proven causal link. Because hospitalized COVID-19 patients often develop acute kidney injury from the disease itself, the authors framed the signal as warranting a full assessment, not a firm causal conclusion.Gérard et al., remdesivir and acute renal failure: a potential safety signal from disproportionality analysis of the WHO safety database
No dosing or treatment advice here
These are prescription decisions made with a clinician for a specific patient.
Read the safety signals in context
The liver and kidney reports come from patients often severely ill with COVID-19 itself. The disease damages both organs, so these reports are graded emerging.
Take any treatment decision with a professional who knows your situation.
Explore Related
Other pages this one connects to, by the evidence they share, the outcomes they touch, and the ground they cover.
All 8 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 10, 2026.
Evidence strength
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