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All Studies   Meta Analysis   Recent:  
Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials
Roman et al., Clinical Infectious Diseases, doi:10.1093/cid/ciab591 (date from earlier preprint) (meta analysis)
Roman et al., Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled.., Clinical Infectious Diseases, doi:10.1093/cid/ciab591 (date from earlier preprint) (meta analysis)
Jun 2021   Source   PDF  
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This is a severely flawed meta analysis. An open letter signed by 40 physicians detailing errors and flaws, and requesting retraction, can be found at []. See also [].
Authors cherry-pick to include only 4 studies reporting non-zero mortality and they initially claimed a mortality RR of 1.11 [0.16-7.65]. However, they reported incorrect values for Niaee et al., claiming an RR of 6.51 [2.18-19.45], when the correct RR for Niaee et al. is 0.18 [0.06-0.55]. After correction, their cherry-picked studies show >60% mortality reduction, however authors did not correct the conclusion.
Similarly, for viral clearance and NCT04392713 (history), they report 20/41 treatment, 18/45 control, whereas the correct day 7 clearance numbers are 37/41 and 20/45 (sum of clearance @72hrs and @7 days), or 17/41 and 2/45 @72 hrs.
The duration of hospital stay for Niaee et al. is also incorrectly reported, showing a lower duration for the control group.
All of the errors are in one direction - incorrectly reporting lower than actual efficacy for ivermectin. Authors claim to include all RCTs excluding prophylaxis, however they only include 10 of the 24 non-prophylaxis RCTs (28 including prophylaxis at the time of publication). Authors actually reference meta analyses that do include the missing RCTs, so they should be aware of the missing RCTs.
The PubMed search strategy provided is syntactically incorrect. For additional errors, see []. Also see [].
The authors state that they have no conflicts of interest on medRxiv, however Dr. Pasupuleti’s affiliation is Cello Health, whose website [] notes that they provide services such as “brand and portfolio commercial strategy for biotech and pharma”, and that their clients are "24 of the top 25 pharmaceutical companies”.
Only one of these errors has been partially fixed as of 5/29 - the Niaee RR was corrected, but the associated conclusion was not. Other errors have not been corrected. Comments on this article appear to be censored, with zero comments posted as of July 5.
Currently there are 95 ivermectin studies and meta analysis shows:
Mortality51% lower [37‑62%]
Ventilation29% lower [13‑42%]
ICU admission41% lower [16‑58%]
Hospitalization34% lower [20‑45%]
Cases78% fewer [67‑85%]
Roman et al., 28 Jun 2021, peer-reviewed, 6 authors.
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Abstract: Clinical Infectious Diseases Major Article Ivermectin for the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-analysis of Randomized Controlled Trials 1 Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA; 2Universidad Científica del Sur, Lima, Peru; 3Centro de Investigación, Instituto Peruano de Oncología y Radioterapia, San Isidro, Lima, Peru; 4Cello Health, Yardley, Pennsylvania, USA; 5Unidad de Revisiones Sistemáticas y Meta-análisis, Guías de Práctica Clínica y Evaluaciones de Tecnologías Sanitarias (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, La Molina, Lima, Peru; 6Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; 7Department of Neurology, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil; and 8Laboratory of Medical Investigation, Unit 49, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil Background. We systematically assessed benefits and harms of the use of ivermectin (IVM) in patients with coronavirus disease 2019 (COVID-19). Methods. Published and preprint randomized controlled trials (RCTs) assessing the effects of IVM on adult patients with COVID-19 were searched until 22 March 2021 in 5 engines. Primary outcomes were all-cause mortality rate, length of hospital stay (LOS), and adverse events (AEs). Secondary outcomes included viral clearance and severe AEs (SAEs). The risk of bias (RoB) was evaluated using the Cochrane Risk of Bias 2.0 tool. Inverse variance random effect meta-analyses were performed, with quality of evidence (QoE) evaluated using GRADE methods. Results. Ten RCTs (n = 1173) were included. The controls were the standard of care in 5 RCTs and placebo in 5. COVID-19 disease severity was mild in 8 RCTs, moderate in 1, and mild and moderate in 1. IVM did not reduce all-cause mortality rates compared with controls (relative risk [RR], 0.37 [95% confidence interval, .12–1.13]; very low QoE) or LOS compared with controls (mean difference, 0.72 days [95% confidence interval, −.86 to 2.29 days]; very low QoE). AEs, SAEs, and viral clearance were similar between IVM and control groups (low QoE for all outcomes). Subgroups by severity of COVID-19 or RoB were mostly consistent with main analyses; all-cause mortality rates in 3 RCTs at high RoB were reduced with IVM. Conclusions. Compared with the standard of care or placebo, IVM did not reduce all-cause mortality, LOS, or viral clearance in RCTs in patients with mostly mild COVID-19. IVM did not have an effect on AEs or SAEs and is not a viable option to treat patients with COVID-19. Keywords. ivermectin; SARS-CoV-2; COVID-19; mortality; meta-analysis. The coronavirus disease 2019 (COVID-19) pandemic represents a global sanitary, social, and economic challenge. However, scientific advances have also amplified deficiencies and misinformation [1]. Biological plausibility, pathophysiological considerations, in vitro research, observational studies, and/or clinical trials with heterogeneous quality were used to evaluate several repurposed drugs repurposed for indications different from the approved ones. Some policy makers and regulatory institutions authorized emergency use of unproven COVID-19 treatments; the use of some of these treatments has been heavily politicized in some regions [2, 3]. Ivermectin (IVM) is a semisynthetic,..
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