Abstract: Research for Impact 03 January 2021 URGENT COVID-19 information: 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. Tess Lawrie MBBCh, PhD; E-BMC Ltd, Office 305, Northgate House, Upper Borough Walls, Bath, United Kingdom Email: info@e-bmc.co.uk Website: www.e-bmc.co.uk: ORCID iD 0000-0002-5500-8590 https://www.researchgate.net/profile/Theresa_Lawrie Background to this rapid review Recently a group of expert critical care physicians, called the Front Line COVID-19 Critical Care Alliance (FLCCC), reviewed the evidence on the effects of ivermectin on SARS-CoV-2 virus and COVID-19 infections.1 They concluded that the evidence on ivermectin “demonstrates a strong signal of therapeutic efficacy” and recommended that ivermectin is adopted globally and systematically for the prophylaxis and treatment of COVID-19.1 Ivermectin is an anti-parasitic medication widely used in low- and middle-income countries to treat parasitic worm infections in adults and children.1,2 Having been used for decades for this purpose, it is considered extremely safe and effective2,3 and has an increasing list of indications due to its antiviral and anti-inflammatory properties.4 On the WHO’s Model List of Essential Medicines it is retained in the form of a 3 mg tablet.5 For parasitic infections in adults, ivermectin is commonly administered as a single 12 mg oral dose (0.2mg/kg). The FLCCC review summarizes the findings of 27 studies evaluating ivermectin for prophylaxis and treatment of COVID-19 infection; however, it does not include metaanalyses for the majority of outcomes. The FLCCC has called upon national and international health care agencies to devote the necessary resources to checking and confirming this groundbreaking evidence. Given the urgency of the situation, I undertook this rapid systematic review and metaanalysis of studies included in the FLCCC paper to validate the FLCCC’s conclusions. Target audience This report is aimed primarily at health professionals and policymakers. Methodology Study selection, data extraction and outcome measures I From this list, I included randomized controlled trials (RCTs) and controlled observational studies (OCTs), excluding case-control studies and case series due to their higher risk of bias. I extracted data on the characteristics of the studies, risk of bias and important COVID-19 health outcomes (see Box 1), which I compiled with reference to the FLCCC review tables. Risk of study bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions and the ROBINS-I tools for RCTs and OCTs, respectively.6,7 Box 1. COVID-19 outcome measures A: Ivermectin treatment versus control 1. Death (primary outcome) 2. Condition improvement, as measured by the study authors 3. Condition deterioration, as measured by the study authors 4. Recovery time, in days 5. Length of hospital stay, in days 6. Admission to hospital (for outpatient treatment) 7. Admission to ICU or requiring ventilation 8. Serious adverse events B. Ivermectin prophylaxis versus control 1. COVID-19 infection, defined as a positive COVID-19 test with or without symptoms (primary outcome) 2. Serious adverse events Data analysis and evidence quality assessment 2 I used Review Manager (RevMan) software version 5.4 for..