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105 ivermectin COVID-19 controlled studies,
52 RCTs
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg viral+ 0/60 2/56 OT1 CT2 Improvement, RR [CI] Dose (4d) Treatment Control Espitia-Hernandez 97% 0.03 [0.01-0.10] 12mg viral+ 0/28 7/7 CT2 Carvallo 85% 0.15 [0.02-1.28] 36mg death 1/32 3/14 CT2 Mahmud (DB RCT) 27% 0.73 [0.60-0.90] 12mg recov. time 183 (n) 180 (n) CT2 Szente Fonseca -14% 1.14 [0.75-1.66] 24mg hosp. 340 (n) 377 (n) Cadegiani 78% 0.22 [0.01-4.48] 42mg death 0/110 2/137 CT2 Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Chaccour (DB RCT) 8% 0.92 [0.77-1.09] 28mg viral+ 12 (n) 12 (n) Ghauri 92% 0.08 [0.01-0.88] 48mg no recov. 0/37 7/53 Babalola (DB RCT) 49% 0.51 [0.29-0.88] 24mg viral time 20 (n) 20 (n) OT1 Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 RIVET-COV Mohan (DB RCT) 24% 0.76 [0.53-1.09] 28mg viral+ 21/40 31/45 Biber (DB RCT) 39% 0.61 [0.29-1.07] 36mg viral+ 13/47 21/42 Elalfy 87% 0.13 [0.06-0.27] 36mg viral+ 7/62 44/51 CT2 López-Me.. (DB RCT) 43% 0.57 [0.16-1.87] 84mg progression 4/200 7/198 Roy 6% 0.94 [0.52-1.93] n/a recov. time 14 (n) 15 (n) CT2 Chahla (CLUS. RCT) 87% 0.13 [0.03-0.54] 24mg no disch. 2/110 20/144 Mourya 89% 0.11 [0.05-0.25] 48mg viral+ 5/50 47/50 Loue (QR) 70% 0.30 [0.04-2.20] 14mg death 1/10 5/15 Merino (QR) 74% 0.26 [0.11-0.57] 24mg hosp. 77,381 (all patients) censored, see notes 5 Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Krolewiecki (RCT) 66% 0.34 [0.10-1.16] 168mg decay rate 20 (n) 14 (n) Vallejos (DB RCT) 33% 0.67 [0.34-1.28] 24mg hosp. 14/250 21/251 TOGETHER Reis (DB RCT) 10% 0.90 [0.70-1.16] 84mg hosp./ER 100/679 111/679 impossible data, see notes COVER Buonfrate (DB RCT) 20% 0.80 [0.36-1.76] 336mg viral load 28 (n) 29 (n) Mayer 55% 0.45 [0.32-0.63] 151mg death 3,266 (n) 17,966 (n) Borody 93% 0.07 [0.04-0.13] 96mg hosp. 5/600 70/600 MD3 CT2 SC4 Abbas (DB RCT) 36% 0.64 [0.43-0.96] 84mg no recov. 26/99 42/103 de Jesús Ascenci.. 59% 0.41 [0.36-0.47] 12mg death/hosp. 7,898 (n) 20,150 (n) CT2 Manomai.. (DB RCT) 5% 0.95 [0.62-1.45] 48mg viral+ 19/36 20/36 de la Ro.. (DB RCT) -187% 2.87 [0.12-67.5] 36mg misc. 1/30 0/26 Rezai (DB RCT) -5% 1.05 [0.07-16.7] 84mg death 1/268 1/281 Mirahma.. (DB RCT) 46% 0.54 [0.21-1.42] 24mg hosp. 6/131 11/130 PLATCOV Schilling (RCT) -9% 1.09 [0.88-1.27] 168mg viral rate 45 (n) 45 (n) COVID-OUT Bramante (DB RCT) -4% 1.04 [0.81-1.31] 90mg progression 105/407 96/391 OT1 Mikamo (DB RCT) -4% 1.04 [0.90-1.21] 63mg no improv. 502 (n) 527 (n) FINCOV Siripongbo.. (RCT) 6% 0.94 [0.65-1.35] 168mg viral+ 30 (n) 30 (n) CT2 Wijewic.. (DB RCT) 51% 0.49 [0.26-0.93] 96mg viral load 80 (n) 81 (n) Tau2 = 0.30, I2 = 85.8%, p < 0.0001 Early treatment 53% 0.47 [0.38-0.59] 341/15,944 619/42,983 53% lower risk Gorial 71% 0.29 [0.01-5.76] 14mg no recov. 0/16 2/71 Improvement, RR [CI] Dose (4d) Treatment Control Kishoria (RCT) -8% 1.08 [0.57-2.02] 12mg viral+ 11/19 7/13 Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Khan 87% 0.13 [0.02-1.00] 12mg death 1/115 9/133 Chachar (RCT) 10% 0.90 [0.44-1.83] 36mg no recov. 9/25 10/25 Soto-Becerra -39% 1.39 [0.88-2.22] 14mg death 47/203 401/2,630 Rajter (PSM) 67% 0.33 [0.12-0.84] 14mg death 26/173 27/107 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg death 0/59 6/70 CT2 Camprubí -25% 1.25 [0.43-3.63] 14mg viral+ 5/13 4/13 Spoorthi 21% 0.79 [0.64-0.98] n/a recov. time 50 (n) 50 (n) CT2 Budhiraja 99% 0.01 [0.00-0.15] n/a death 0/34 103/942 Okumuş (DB RCT) 16% 0.84 [0.55-1.30] 56mg no improv. 16/30 19/30 Shahbazn.. (DB RCT) 19% 0.81 [0.67-0.97] 14mg recov. time 35 (n) 34 (n) Lima-Morales 78% 0.22 [0.12-0.41] 12mg death 15/481 52/287 CT2 Beltran .. (DB RCT) -20% 1.20 [0.77-1.87] 12mg hosp. time 36 (n) 37 (n) Pott-Junior (RCT) -11% 1.11 [0.21-5.93] 14mg viral+ 10/27 1/3 censored, see notes Huvemek (DB RCT) 32% 0.68 [0.38-1.23] 84mg no improv. 13/50 19/50 Ahsan 50% 0.50 [0.28-0.90] 21mg death 17/110 17/55 CT2 Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg death 3/82 4/82 Hazan 93% 0.07 [0.00-1.02] 24mg hosp. 0/24 synthetic CT2 SC4 Elavarasi 20% 0.80 [0.61-1.06] n/a death 48/283 311/1,475 Rezk 80% 0.20 [0.01-4.13] 72mg death 0/160 2/160 I-TECH Lim (RCT) -25% 1.25 [0.87-1.80] 112mg progression 52/241 43/249 Ozer 75% 0.25 [0.06-1.13] 28mg death 2/60 8/60 Ferreira -5% 1.05 [0.32-3.43] n/a death 3/21 11/81 Jamir (ICU) -53% 1.53 [0.88-2.67] n/a death 32/76 69/190 ICU patients Baguma 97% 0.03 [0.00-11.7] n/a death 7 (n) 474 (n) Mustafa 64% 0.36 [0.12-1.14] varies death 3/73 42/371 Shimizu 48% 0.52 [0.29-0.93] 14mg ventilation 39 (n) 49 (n) Zubair -9% 1.09 [0.33-3.64] 12mg death 5/90 5/98 Thairu (PSM) 88% 0.12 [0.01-2.14] 56mg death 0/21 4/26 Efimenko (PSM) 69% 0.31 [0.20-0.48] n/a death 1,072 (n) 40,536 (n) self-censored, see notes 1 Soto -41% 1.41 [1.16-1.76] n/a death 280/484 374/934 Ravikirti 3% 0.97 [0.74-1.24] varies death 53/171 254/794 George (RCT) 30% 0.70 [0.25-1.93] 24mg death 5/35 8/39 ACTIV-6 Naggie (DB RCT) 2% 0.98 [0.89-1.09] 168mg recovery 708 (n) 724 (n) Rezai (DB RCT) 31% 0.69 [0.35-1.39] 84mg death 13/311 18/298 Qadeer 58% 0.42 [0.31-0.56] 48mg viral+ 35/105 84/105 Aref (RCT) 74% 0.26 [0.12-0.55] n/a recov. time 49 (n) 47 (n) LONG COVID Ochoa-Ja.. (DB RCT) -37% 1.37 [0.53-3.57] 28mg ICU 8/37 6/38 Sarojvisut (RCT) -104% 2.04 [0.19-22.3] 112mg ICU 2/157 1/160 Munir 48% 0.52 [0.22-1.21] n/a death 92 (n) 908 (n) Llenas-García 23% 0.77 [0.35-1.69] 14mg progression 96 (n) 96 (n) Wada (DB RCT) -4% 1.04 [0.76-1.43] 14mg viral+ 106 (n) 106 (n) Osati 32% 0.68 [0.45-0.92] n/a death 448 (n) 849 (n) PRINCIPLE Hayward (RCT) -1% 1.01 [0.61-1.68] 73mg death/hosp. 34/2,157 27/1,806 Varnaseri (DB RCT) 82% 0.18 [0.04-0.78] 84mg ventilation 2/55 11/55 REMAP-CAP Hashmi (RCT) 15% 0.85 [0.45-1.62] 56mg death 81 (n) 69 (n) ICU patients Tau2 = 0.16, I2 = 80.2%, p < 0.0001 Late treatment 29% 0.71 [0.61-0.83] 750/8,849 1,959/55,459 29% lower risk Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Improvement, RR [CI] Dose (1m) Treatment Control Carvallo 96% 0.04 [0.00-0.63] 14mg cases 0/131 11/98 see notes 2 Behera 54% 0.46 [0.29-0.71] 42mg cases 41/117 145/255 Carvallo 100% 0.00 [0.00-0.02] 48mg cases 0/788 237/407 see notes 2 Hellwig (ECO.) 78% 0.22 [0.06-0.76] 14mg cases ecological Bernigaud 99% 0.01 [0.00-0.10] 84mg death 0/69 150/3,062 Alam 91% 0.09 [0.04-0.25] 12mg cases 4/58 44/60 IVERCOR PREP 73% 0.27 [0.15-0.48] 48mg cases 13/389 61/486 MD3 Chahla (RCT) 84% 0.16 [0.04-0.46] 48mg cases 4/117 25/117 CT2 Behera 83% 0.17 [0.12-0.23] 42mg cases 45/2,199 133/1,147 Tanioka (ECO.) 88% 0.12 [0.03-0.46] 14mg death ecological Seet (CLUS. RCT) 6% 0.94 [0.61-1.19] 12mg cases 398/617 433/619 OT1 Morgenstern (PSM) 74% 0.26 [0.10-0.71] 56mg cases 5/271 18/271 Mondal 88% 0.12 [0.01-0.55] n/a symp. case 128 (n) 1,342 (n) Samajdar 80% 0.20 [0.11-0.38] n/a cases 12/164 29/81 Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg death 25/3,034 79/3,034 SAIVE Desort-H.. (DB RCT) 72% 0.28 [0.20-0.41] 203mg cases 30/200 105/199 Tau2 = 0.97, I2 = 95.3%, p < 0.0001 Prophylaxis 83% 0.17 [0.10-0.29] 592/8,485 1,529/11,279 83% lower risk All studies 51% 0.49 [0.43-0.56] 1,683/33,278 4,107/109,721 51% lower risk All 105 ivermectin COVID-19 primary outcome results c19 ivmDecember 2024 Tau2 = 0.30, I2 = 89.1%, p < 0.0001 Effect extraction pre-specified, see appendix 1 OT: ivermectin vs. other treatment 3 MD: minimal detail available currently 5 CS: censored, see details 2 CT: study uses combined treatment 4 SC: study uses synthetic control arm Favors ivermectin Favors control Figure S1. Random effects meta-analysis for
primary outcomes (as defined before the trial started).
Figure S2. Random effects meta-analysis for
peer-reviewed studies after exclusions.
Effect extraction is pre-specified, using the most serious outcome reported,
see the appendix for details.
Analysis validating pooled outcomes for
COVID-19 can be found below .
Figure S3. Random effects meta-analysis for
RCT studies after exclusions.
Effect extraction is pre-specified, using the most serious outcome reported,
see the appendix for details.
Analysis validating pooled outcomes for
COVID-19 can be found below .
Figure S4. Random effects meta-analysis for
mortality after exclusions.
Figure S5. Random effects meta-analysis for
mechanical ventilation after exclusions.
Figure S6. Random effects meta-analysis for
ICU admission after exclusions.
Figure S7. Random effects meta-analysis for
hospitalization after exclusions.
Figure S8. Random effects meta-analysis for
recovery results only after exclusions.
Figure S9. Random effects meta-analysis for
COVID-19 case results after exclusions.
Figure S10. Random effects meta-analysis for
viral clearance after exclusions.
Figure S11. Random effects meta-analysis
for studies grouped by strongyloides prevalence.
Data is by
country and from Buonfrate
Figure S12. Random effects meta-analysis
with SSC exclusions.
SSC has not reviewed late treatment and prophylaxis
trials. SSC exclusions are from Nov 27, 2021.
Figure S13. Random effects meta-analysis
with GMK exclusions.
Our main exclusion analyses already exclude all studies
where the GMK team believes there are major data issues. This analysis
corresponds with GMK's recommendation for meta analysis as of Oct 26, 2021.
GMK excludes most non-RCT studies, with the notable exception of several
studies with major issues that report negative or relatively poor results
— Szente Fonseca Elavarasi Soto-Becerra details .
Figure S14. Comparison of results for RCTs versus observational studies.
For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.
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