The association between the use of ivermectin and mortality in patients with COVID-19: a meta-analysis

Kow et al., Pharmacological Reports, doi:10.1007/s43440-021-00245-z

Mar 2021

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Small meta analysis of 6 RCTs showing mortality OR 0.21 [0.11-0.42]. Authors do not include two more recent RCTs with mortality results, 10 other studies with mortality results, and a total of 42 other studies including other outcomes. Authors do not distinguish between studies with very different treatment delays (earlier treatment is more successful).

7 meta analyses show significant improvements with ivermectin for mortality Bryant, Hariyanto, Kory, Lawrie, Nardelli, Zein, hospitalization Schwartz, recovery Kory, and cases Kory.

Currently there are 99 ivermectin for COVID-19 studies, showing 49% lower mortality [35‑60%], 29% lower ventilation [13‑42%], 38% lower ICU admission [14‑56%], 34% lower hospitalization [20‑45%], and 81% fewer cases [71‑87%].

1. Bryant et al., Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines, American Journal of Therapeutics, doi:10.1097/MJT.0000000000001402.lww.com, doi.org.

2. Hariyanto et al., Ivermectin and outcomes from Covid-19 pneumonia: A systematic review and meta-analysis of randomized clinical trial studies, Reviews In Medical Virology, doi:10.1002/rmv.2265.wiley.com, doi.org.

3. Kory et al., Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19, American Journal of Therapeutics, doi:10.1097/MJT.0000000000001377.lww.com, doi.org.

4. Lawrie et al., Ivermectin reduces the risk of death from COVID-19 – a rapid review and meta-analysis in support of the recommendation of the Front Line COVID-19 Critical Care Alliance, Preprint, b3d2650e-e929-4448-a527-4eeb59304c7f.filesusr.com/ugd/593c4f_8cb655bd21b1448ba6cf1f4c59f0d73d.pdf.filesusr.com.

5. Nardelli et al., Crying wolf in time of Corona: the strange case of ivermectin and hydroxychloroquine. Is the fear of failure withholding potential life-saving treatment from clinical use?, Signa Vitae, doi:10.22514/sv.2021.043.signavitae.com, doi.org.

6. Schwartz, E., Does ivermectin have a place in the treatment of mild Covid-19?, New Microbes and New Infections, doi:10.1016/j.nmni.2022.100989.sciencedirect.com, doi.org.

7. Zein et al., Ivermectin and mortality in patients with COVID-19: A systematic review, meta-analysis, and meta-regression of randomized controlled trials, Diabetes & Metabolic Syndrome: Clinical Research & Reviews, doi:10.1016/j.dsx.2021.102186.sciencedirect.com, doi.org.

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Kow et al., 29 Mar 2021, peer-reviewed, 4 authors.

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The association between the use of ivermectin and mortality in patients with COVID-19: a meta-analysis

Chia Siang Kow, Hamid A Merchant, Zia Ul Mustafa, Syed Shahzad Hasan

Pharmacological Reports, doi:10.1007/s43440-021-00245-z

Objective The effect of ivermectin on mortality in patients with novel coronavirus disease 2019 (COVID-19) has been investigated in many studies. We aimed to perform a meta-analysis of randomized controlled trials to investigate the overall effect of ivermectin on the risk of mortality in patients with COVID-19. Methods We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, and preprint repository databases (up to February 28, 2021). Random-effects and inverse variance heterogeneity meta-analysis were used to pool the odds ratio of individual trials. The risk of bias was appraised using Version 2 of the Cochrane risk-of-bias tool for randomized trials. Results Six randomized controlled trials were included in this analysis with a total of 658 patients who were randomized to receive ivermectin and 597 patients randomized in the control group who did not receive ivermectin. Of six trials, four had an overall high risk of bias. The estimated effect of ivermectin indicated mortality benefits (pooled odds ratio = 0.21; 95% confidence interval 0.11-0.42, n = 1255), with some evidence against the hypothesis of 'no significant difference' at the current sample size. Conclusion We observed a preliminary beneficial effect on mortality associated with ivermectin use in patients with COVID-19 that warrants further clinical evidence in appropriately designed large-scale randomized controlled trials.

Declarations Conflict of interest All named authors declare that they have no potential conflict of interest.

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Fig, 2 Forest plot showing the pooled odds ratio of mortality between ivermectin users and non-ivermectin users with COVID-19

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