Abstract: e576
5. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA
2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. doi: 10.1136/bmj.n71.
Available at: https://www.bmj.com/content/372/bmj.
n71. Accessed August 9, 2021.
6. López-Medina E, López P, Hurtado IC. Effect of Ivermectin on time to resolution of symptoms among adults
with mild COVID-19: a randomized clinical trial. J Am
Med Assoc. 2021. doi: 10.1001/jama.2021.3071.
7. Scheim D, Hibberd JA, Chamie-Quintero J. Protocol violations in López-Medina et al.: 38 switched Ivermectin
(IVM) and placebo doses, failure of blinding, widespread
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doi: 10.31219/osf.io/u7ewz. Available at: https://osf.
io/u7ewz. Accessed August 9, 2021.
8. Hill A, Garratt A, Levi J, et al. Meta-analysis of randomized
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Letters to the Editor
9.
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at: https://academic.oup.com/ofid/advance-article/doi/
10.1093/ofid/ofab358/6316214. Accessed August 9, 2021.
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Living Guideline; 2021. Available at: https://www.who.
int/publications/i/item/WHO-2019-nCoVtherapeutics-2021.2. Accessed July 22, 2021.
Roman YM, Burela PA, Pasupuleti V, et al. Ivermectin
for the treatment of COVID-19: a systematic review and
meta-analysis of randomized controlled trials. Clin Infect
Dis. 2021. doi: 10.1093/cid/ciab591.
Neil M, Fenton NE. Bayesian meta analysis of Ivermectin
effectiveness in treating covid-19 disease. Res Gate. 2021. doi:
10.13140/RG.2.2.31800.88323. Available at: https://doi.org/
10.13140/RG.2.2.31800.88323. Accessed August 9, 2021.
Neil, M. & Fenton, N. E. (2021). Bayesian meta-analysis
of ivermectin effectiveness in treating Covid-19 (with
sensitivity analysis to account for possibly flawed studies). Submitted to Am J Therapeutics. Available at: http://
dx.doi.org/10.13140/RG.2.2.19713.58723.
Bayesian Hypothesis Testing and Hierarchical Modeling of
Ivermectin Effectiveness
To the Editor:
A recent meta-analysis of the trials evaluating ivermectin that was published in AJT1 (referred to here as
Bryant) was widely welcomed by those who argue
that this antiparasitic drug is a cheap and effective
treatment for COVID-19 infections. The study
concluded:
“Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin.
Using ivermectin early in the clinical course may reduce
numbers progressing to severe disease. The apparent
safety and low cost suggest that ivermectin is likely to
have a significant impact on the severe acute respiratory
syndrome coronavirus 2 pandemic globally.”
These conclusions stand in stark contrast to those of
a later meta-analysis2 (referred to here as Roman) that
looked at a subset of the trials. Roman concluded:
“In comparison to standard of care or placebo, ivermectin
(IVM) did not reduce all-cause mortality, length of stay, or
viral clearance in randomized controlled trials in COVID19 patients with mostly mild disease. IVM did not have
effect on adverse events or severe adverse events. IVM is
not a viable option to treat COVID-19 patients.”
Irrespective of the errors in the data and the analysis
performed by Roman that were already highlighted by
American Journal of Therapeutics (2021) 28(5)
Crawford,3 we believe that this conclusion is not..
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