Two COVID-19 treatments drew enormous hope and argument: remdesivir, the first antiviral approved for the disease, and ivermectin, an inexpensive generic already used for parasites. Both were reasonable ideas, and both were tested the way a drug should be, in large randomized trials against placebo or standard care. Remdesivir shortens hospital recovery by a few days, from a median of 15 to 10, but the biggest trial found no clear effect on survival, and later safety reporting flagged liver and kidney signals.
Ivermectin, tested in thousands of outpatients, did not reduce hospitalization, speed recovery, or lower deaths from COVID-19. This page lays out what the trials and the WHO's guidance found for each drug, at the weight the evidence supports. It is education about the evidence, not medical advice.
Findings & Outcomes
Remdesivir and ivermectin drew more hope and more argument than any other COVID-19 treatments: remdesivir, the first antiviral approved for the disease, and ivermectin, an inexpensive generic already trusted for parasites. Both were reasonable ideas, and both were put through large randomized trials. This page lays out what those trials, and the World Health Organization's guidance, found for each drug, at the weight the evidence supports.
What The Trials Set Out To Test
Remdesivir is an intravenous antiviral first developed against other viruses and repurposed for the virus that causes COVID-19. Ivermectin is an oral antiparasitic, one of the most widely used medicines in the world, that suppressed the virus in laboratory cell studies. Both were plausible candidates early in the pandemic, and each was tested the way a drug should be, in randomized controlled trials that compare it against placebo or standard care. Remdesivir moved through that process quickly: it was granted emergency use authorization on 1 May 2020 and became the first drug fully approved to treat COVID-19 with full FDA approval on 22 October 2020.
What The Trials Found
Remdesivir: faster recovery, no clear survival benefit
Beigel and colleagues, in the ACTT-1 trial, randomized 1,062 hospitalized patients and found remdesivir shortened median time to recovery from 15 days to 10 (rate ratio for recovery 1.29). Deaths were 6.7% with remdesivir and 11.9% with placebo by day 15, a difference that did not reach statistical significance (hazard ratio 0.73, 95% CI 0.52 to 1.03).
The larger and more decisive test, the WHO SOLIDARITY trial across 405 hospitals in 30 countries, found death in 301 of 2,743 remdesivir patients and 303 of 2,708 controls (rate ratio 0.95, 95% CI 0.81 to 1.11) and concluded the drug had little or no effect on survival, the need for ventilation, or length of stay. A faster recovery is a separate result. On survival, the outcome that matters most, the largest trial found no clear benefit.
The WHO's own living guideline panel weighed the pooled evidence and, on 20 November 2020, issued a conditional recommendation against remdesivir for hospitalized patients, having reviewed four international trials covering more than 7,000 people. 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 FDA had granted full approval on 22 October 2020; the two bodies weighed different evidence, the recovery-time result on one side and the pooled survival data on the other.
Ivermectin: no benefit against COVID-19
Ivermectin was tested in large, careful outpatient trials. The TOGETHER trial assigned 1,358 higher-risk outpatients to ivermectin or placebo and found no reduction in hospitalization or extended emergency-department observation (relative risk 0.90). The ACTIV-6 trial gave 1,591 outpatients ivermectin or placebo and found no faster recovery (hazard ratio 1.07); median recovery was 12 days with ivermectin and 13 with placebo, and hospitalizations or deaths were the same in both groups (1.2% each). A Cochrane review pooling the randomized evidence reached the same conclusion. Ivermectin is an important antiparasitic medicine, a Nobel-recognized drug that clears river blindness, scabies, and other infections, covered in full on its own page. For COVID-19, at the doses tested, the trials found it did not help.
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
The grades on those rows differ by design. The remdesivir survival row and the ivermectin row rest on large randomized trials and are graded strong. The WHO guideline row is strong as a statement of what the pooled evidence supported. The liver and kidney signals are graded emerging, because a disproportionality signal from a spontaneous-reporting database flags something to investigate, not a finished causal verdict.
How These Drugs Were Meant To Work
Remdesivir is a nucleotide analogue: it interferes with the enzyme the virus uses to copy its genome, which slows viral replication. That mechanism is why it was expected to help, and it does measurably shorten recovery in hospitalized patients. Ivermectin binds channels in parasites that mammals largely lack, which is why it is so safe and effective against worms and mites; the interest for COVID-19 came from cell-culture studies where high concentrations suppressed the virus. The concentrations that worked in a dish were far above what a standard oral dose reaches in the body, which is one reason the clinical trials were needed to settle the question.
Safety Once Millions Were Treated
In a controlled trial, a selected group is followed closely, and some rarer harms of a drug appear only once it is given to very large numbers of ordinary patients. For remdesivir, global safety reporting flagged liver and kidney signals, both set out in the cautions below. Hospitalized COVID-19 patients often develop liver and kidney injury from the disease itself, so a reporting signal can reflect the illness as much as the drug.
A disproportionality signal from spontaneous reports is a flag to investigate, not proof the drug caused each case.
Go Deeper
This page covers the drug evidence. The pages that connect to it:
- Ivermectin, the antiparasitic in full: what it treats, the doses used, and where the COVID-19 trials landed.
- 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
Was remdesivir the first approved COVID-19 drug?
Yes. Remdesivir was granted emergency use authorization on 1 May 2020 and full FDA approval on 22 October 2020, making it the first drug fully approved to treat COVID-19. The approval rested mainly on the finding that it shortened time to recovery in hospitalized patients by a few days. The survival data did not show a mortality benefit, and the largest trial found none.
Did remdesivir save lives?
The strongest evidence says it did not clearly do so. The ACTT-1 trial found faster recovery, from a median of 15 days to 10, but its mortality difference did not reach statistical significance. The larger WHO SOLIDARITY trial, across 30 countries, found a death rate ratio of 0.95 and concluded the drug had little or no effect on hospitalized patients. Faster recovery is a separate result; a clear survival benefit is the one the biggest trial did not find.
Why did the WHO recommend against a drug the FDA had approved?
They were weighing different things. The FDA approval leaned on the recovery-time result. The WHO's guideline panel pooled four international trials covering more than 7,000 patients and concluded the pooled evidence did not show remdesivir improved the outcomes that matter to patients, so on 20 November 2020 it issued a conditional recommendation against its use in hospitalized patients. A conditional recommendation reflects low-certainty evidence and is not a finding that the drug is harmful.
What are the liver and kidney signals?
Once remdesivir was used at scale, analyses of the WHO's global safety database found that liver (hepatobiliary) and kidney (renal) adverse events were reported for it at a disproportionately high rate compared with other drugs. These are signals from spontaneous reports, which flag something to investigate rather than proving the drug caused each case, especially because hospitalized COVID-19 patients often develop liver and kidney injury from the disease itself. They matter because they surfaced in a drug whose survival benefit was never established, which shapes how its risks and benefits weigh against each other.
Did ivermectin work for COVID-19?
The large randomized trials say it did not. The TOGETHER and ACTIV-6 trials, together enrolling thousands of outpatients, found no reduction in hospitalization, no faster recovery, and no lower death rate, and a Cochrane review pooling the randomized evidence reached the same conclusion. Ivermectin is an important antiparasitic medicine, but for COVID-19 at the doses tested it did not help.
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 rather than 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 rather than a firm causal conclusion.Gérard et al., remdesivir and acute renal failure: a potential safety signal from disproportionality analysis of the WHO safety database
This page does not give dosing or treatment advice
These are prescription decisions made with a clinician for a specific patient. The page covers what the trials and safety data found so a reader can understand the evidence, and nothing here is a recommendation to take or avoid any drug.
Read the safety signals in context
The liver and kidney reports come from patients who were often severely ill from COVID-19 itself, which can damage both organs, so a reporting signal can reflect the illness as much as the drug. That is why these are graded emerging and framed as questions to investigate.
Read the evidence, weigh it, and take any treatment decision with a professional who knows your situation. This page is here to inform your understanding, not make a medical choice for you.
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
How confidently the research supports a claim. Strength describes the evidence, not our endorsement.