• Statistically significant improvements are seen for mortality, ventilation, ICU admission, hospitalization, recovery, cases, and viral clearance. All remain significant after exclusions. 59 studies from 53 independent teams in 23 different countries show statistically significant improvements in isolation (41 primary outcome, 39 most serious outcome).• Meta analysis using the most serious outcome shows 62% [51‑70%] and 82% [73‑88%] improvement for early treatment and prophylaxis, with similar results after exclusion based sensitivity analysis, for primary outcomes, for peer-reviewed studies, and for RCTs.• Results are very robust — in worst case exclusion sensitivity analysis 60 of 95 studies must be excluded to avoid finding statistically significant efficacy.• No treatment, vaccine, or intervention is 100% effective and available. All practical, effective, and safe means should be used based on risk/benefit analysis. Multiple treatments are typically used in combination, which may be significantly more effective. Only 22% of ivermectin studies show zero events with treatment.• Over 20 countries adopted ivermectin for COVID-19. The evidence base is much larger and has much lower conflict of interest than typically used to approve drugs.• All data to reproduce this paper and sources are in the appendix. See [Bryant, Hariyanto, Kory, Lawrie, Nardelli] for other meta analyses with similar results confirming efficacy.

Percentage improvement with ivermectin (more)

	All studies	Early treatment	Prophylaxis	Studies	Patients	Authors
All studies	62% [54‑69%]****	62% [51‑70%]****	82% [73‑88%]****	95	134,554	1,023
Randomized Controlled TrialsRCTs	54% [39‑65%]****	57% [41‑69%]****	79% [50‑91%]***	45	11,643	621
Mortality	51% [37‑62%]****	40% [12‑59%]**	90% [50‑98%]**	48	120,338	549
HospitalizationHosp.	34% [20‑45%]****	53% [27‑69%]***	67% [54‑77%]****	29	44,784	405
Cases	78% [67‑85%]****	-	78% [67‑85%]****	16	13,696	140