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P105: Regional Prescribing Patterns of Ivermectin and Zinc Sulfate during the COVID-19 Pandemic in New York State

Poster Presenter

Sharon Kim

Principal Research Analyst
Surescripts
United States

Objectives

Describe prescribing trends of ivermectin by comparing ivermectin prescribing rates with zinc sulfate prescribing rates, publicly available COVID-19 case data, and timing of public health announcements related to the use of ivermectin for the prevention or treatment of COVID-19.

Method

E-prescription data from outpatient visits from January 1, 2019 through December 31, 2021 in New York were obtained from Surescripts. COVID-19 transmission data were gathered from the Centers of Disease Control and Prevention. Correlations between e-prescriptions and COVID-19 cases were reported.

Results

E-prescriptions for ivermectin as a percentage of e-prescriptions for all medications in the region (normalized ivermectin e-prescriptions) increased significantly in just 2 of the 11 regions in the state of New York from 2019 to 2020 (Finger Lakes and Mid-Hudson) but increased significantly from 2020 to 2021 and from 2019 to 2021 in all regions, despite treatment guidelines and public statements advising against the use of ivermectin to treat COVID-19. Normalized e-prescriptions for zinc sulfate increased significantly from 2019 to 2020 for all regions but increased significantly from 2020 to 2021 for just 5 of the 11 regions (Capital, Central, Finger Lakes, Long Island, Western). Weekly normalized volumes of ivermectin e-prescriptions and weekly new COVID-19 cases were positively correlated in all regions in 2020 except for the Southern Tier region. In 2021, weekly normalized ivermectin prescription volumes were no longer significantly correlated with weekly new COVID-19 cases in 3 regions (Finger Lakes, North Country, Tug Hill Seaway), and the correlation was weaker for 5 regions (Capital, Central, Long Island, Mid-Hudson, Mohawk Valley). Weekly normalized volume of zinc sulfate e-prescriptions were significantly and positively correlated with weekly new COVID-19 cases for all regions in 2020 and for all regions except North Country in 2021.

Conclusion

The volume of e-prescriptions for ivermectin and zinc sulfate demonstrate how the prescribing behavior changed during the COVID-19 pandemic. Prescriptions for zinc sulfate rose in 2020 when the first COVID cases emerged and there was no vaccine or proven treatment (the first COVID vaccines were administered in December 2020). Zinc could have also served as reassurance during the first year of COVID, as it is available in various low-cost forms and well-established as treatment for cold and flu symptoms. The rise in ivermectin e-prescriptions from 2020 to 2021 suggest institutions like the World Health Organization, American Medical Association, U.S. Food and Drug Administration, and the Centers for Disease Control and Prevention that were set up to provide guidelines and standards of care for health care providers and protect the public’s health do not solely influence providers’ behavior around prescribing and delivery of care. Interest in ivermectin could be partially attributed to anti-vaccination groups and some physician groups who continue to promote the use of ivermectin to treat COVID. As variants have emerged and COVID has become accepted as an endemic virus, ivermectin has been touted by these groups as a viable therapeutic to treat long COVID. The narrative that is promoted by the groups endorsing ivermectin and the politicization of treatment options may be among the reasons why prescribing of ivermectin did not return to pre-pandemic levels and some providers are prescribing against guidelines. The COVID-19 pandemic has revealed a polarization in health care providers’ compliance with standards of care and trust in medical research itself.