A Meta-analysis of Mortality, Need for ICU admission, Use of Mechanical Ventilation and Adverse Effects with Ivermectin Use in COVID-19 Patients

{ 'institution': [{'name': 'medRxiv'}], 'indexed': {'date-parts': [[2024, 5, 1]], 'date-time': '2024-05-01T16:17:29Z', 'timestamp': 1714580249537}, 'posted': {'date-parts': [[2021, 5, 4]]}, 'group-title': 'Infectious Diseases (except HIV/AIDS)', 'reference-count': 149, 'publisher': 'Cold Spring Harbor Laboratory', 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'accepted': {'date-parts': [[2021, 9, 17]]}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Importance</jats:title><jats:p>Repurposing ' 'Ivermectin, a known anti-parasitic agent, for treating COVID-19 has demonstrated positive ' 'results in several studies. We aim to evaluate the benefit and risk of Ivermectin in ' 'COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a ' 'systematic search for full-text manuscripts published from February 1, 2020, to August 15th, ' '2021 focusing on Ivermectin therapy against COVID-19. The primary outcomes were mortality, ' 'need for intensive care unit (ICU) admission; secondary outcomes were - adverse effects, need ' 'for mechanical ventilation, viral clearance, time to viral clearance, need for ' 'hospitalization, and length of hospital stay. Random-effects models were used for all ' 'analyses.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included a ' 'total of 52 studies (n=17561) in the qualitative analysis, out of these, 44 studies (n=14019) ' 'were included in the meta-analysis. In the mortality meta-analysis (N=29), odds of death were ' 'lower in the Ivermectin-arm compared to control (OR 0.54, p=0.009). Although lower odds of ' 'mortality were observed in various subgroup analyses of RCTs, they did not reach statistical ' 'significance: therapeutic RCTs: mild-moderate COVID-19 (OR 0.31, p=0.06), therapeutic RCTs: ' 'severe/critical COVID-19 (OR 0.86, p=0.56), inpatient RCTs: mild-moderate COVID-19 (OR 0.18, ' 'p=0.08), inpatient RCTs: severe/critical COVID-19 (OR 0.86, p=0.56). Ivermectin, mostly as ' 'adjuvant therapy, was associated with higher odds of viral clearance (N=22) (OR 3.52, ' 'p=0.0002), shorter duration to achieve viral clearance (N=8) (MD - 4.12, p=0.02), reduced ' 'need for hospitalization (N=6) (OR 0.34, ' 'p=008).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Our ' 'meta-analysis suggests that the mortality benefit of Ivermectin in COVID-19 is uncertain. But ' 'as adjuvant therapy, Ivermectin may improve viral clearance and reduce the need for ' 'hospitalization.</jats:p></jats:sec><jats:sec><jats:title>Highlights</jats:title><jats:sec><jats:title>What ' 'We Already Know about This Topic</jats:title><jats:list ' 'list-type="order"><jats:list-item><jats:p>COVID-19 is an ongoing global pandemic, for which ' 'Ivermectin has been tried on a therapeutic and prophylactic ' 'basis.</jats:p></jats:list-item><jats:list-item><jats:p>Results from several clinical trials ' 'and observational studies suggest that Ivermectin may improve survival and clinical outcomes ' 'with a good safety profile when compared with other treatments; however, the current evidence ' 'is limited..</jats:p></jats:list-item></jats:list></jats:sec><jats:sec><jats:title>What This ' 'Article Tells Us That Is New</jats:title><jats:list ' 'list-type="order"><jats:list-item><jats:p>This systematic review and meta-analysis provide a ' 'summary of the latest literature on the efficacy and safety of Ivermectin use for ' 'COVID-19.</jats:p></jats:list-item><jats:list-item><jats:p>Based on our analysis of the ' 'latest evidence, we found that Ivermectin’s benefit in reducing mortality cannot be concluded ' 'with confidence. However, as an adjuvant therapy it may help reduce the need for ' 'hospitalization, duration for viral clearance while increasing the likelihood of achieving ' 'viral clearance.</jats:p></jats:list-item><jats:list-item><jats:p>We need more high-quality ' 'data for conclusive evidence regarding the benefit of Ivermectin in reducing the need for ICU ' 'admissions, mechanical ventilation and duration of hospital stay in COVID-19 ' 'patients.</jats:p></jats:list-item></jats:list></jats:sec></jats:sec>', 'DOI': '10.1101/2021.04.30.21256415', 'type': 'posted-content', 'created': {'date-parts': [[2021, 5, 6]], 'date-time': '2021-05-06T16:08:53Z', 'timestamp': 1620317333000}, 'source': 'Crossref', 'is-referenced-by-count': 10, 'title': 'An Updated Systematic Review and Meta-Analysis of Mortality, Need for ICU admission, Use of ' 'Mechanical Ventilation, Adverse effects and other Clinical Outcomes of Ivermectin Treatment in ' 'COVID-19 Patients', 'prefix': '10.1101', 'author': [ {'given': 'Smruti', 'family': 'Karale', 'sequence': 'first', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0001-6047-5559', 'authenticated-orcid': False, 'given': 'Vikas', 'family': 'Bansal', 'sequence': 'additional', 'affiliation': []}, {'given': 'Janaki', 'family': 'Makadia', 'sequence': 'additional', 'affiliation': []}, {'given': 'Muhammad', 'family': 'Tayyeb', 'sequence': 'additional', 'affiliation': []}, {'given': 'Hira', 'family': 'Khan', 'sequence': 'additional', 'affiliation': []}, {'given': 'Shree Spandana', 'family': 'Ghanta', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0003-3777-5670', 'authenticated-orcid': False, 'given': 'Romil', 'family': 'Singh', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-1891-2118', 'authenticated-orcid': False, 'given': 'Aysun', 'family': 'Tekin', 'sequence': 'additional', 'affiliation': []}, {'given': 'Abhishek', 'family': 'Bhurwal', 'sequence': 'additional', 'affiliation': []}, {'given': 'Hemant', 'family': 'Mutneja', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ishita', 'family': 'Mehra', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-4383-3411', 'authenticated-orcid': False, 'given': 'Rahul', 'family': 'Kashyap', 'sequence': 'additional', 'affiliation': []}], 'member': '246', 'reference': [ { 'key': '2021092001550866000_2021.04.30.21256415v2.1', 'doi-asserted-by': 'publisher', 'DOI': '10.23750/abm.v91i1.9397'}, { 'key': '2021092001550866000_2021.04.30.21256415v2.2', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S1473-3099(20)30120-1'}, { 'key': '2021092001550866000_2021.04.30.21256415v2.3', 'unstructured': 'Domecq JP , Lal A , Sheldrick CR , et al. 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