Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 34145166 · doi:10.1097/MJT.0000000000001402
What was done
Systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials searching bibliographic databases up to April 25, 2021. Two review authors screened studies, extracted data, assessed risk of bias, and evaluated evidence certainty using GRADE. The review included 24 randomized controlled trials encompassing 3,406 participants assessing mortality, secondary clinical outcomes, and chemoprophylaxis for COVID-19.
What was found
Meta-analysis of 15 trials found ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% CI 0.19-0.73; n = 2,438; I2 = 49%; moderate-certainty evidence), confirmed in trial sequential analyses using DerSimonian-Laird and Biggerstaff-Tweedie methods. Chemoprophylaxis reduced COVID-19 infection by an average of 86% (95% CI 79%-91%; low-certainty evidence). Low-certainty evidence showed no benefit for need for mechanical ventilation, while effect estimates favored ivermectin for improvement and deterioration. Severe adverse events were rare (low-certainty evidence of no difference), and other secondary outcomes were very low certainty.
Why it matters
This paper synthesized early randomized trial evidence to assess whether repurposed ivermectin could serve as an effective, low-cost therapeutic and prophylactic option for COVID-19.
Limits
Certainty of evidence for infection prophylaxis and several clinical secondary outcomes was low or very low, and the primary mortality analysis had moderate heterogeneity (I2 = 49%). Specific drug dosages, timing of administration, and participant baseline disease severities across trials were not detailed in the abstract.
Cited by
- supports A June 2021 systematic review and meta-analysis on ivermectin for COVID-19 concluded there was moderate-certainty evidence that ivermectin reduced mortality compared to standard care or placebo, but low-certainty evidence for other clinical outcomes.