Ivermectin for the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 34181716 · doi:10.1093/cid/ciab591
What was done
Authors searched five databases up to 22 March 2021 for published and preprint randomized controlled trials (RCTs) evaluating ivermectin in adult patients with COVID-19. Primary outcomes were all-cause mortality, length of hospital stay (LOS), and adverse events (AEs); secondary outcomes included viral clearance and severe adverse events (SAEs). Risk of bias was assessed with Cochrane RoB 2.0, quality of evidence with GRADE, and data were pooled using inverse variance random-effects meta-analyses.
What was found
Ten RCTs (n = 1,173 participants) were included (5 placebo-controlled, 5 standard-of-care; 8 mild disease, 1 moderate, 1 mixed). Ivermectin did not significantly reduce all-cause mortality (RR 0.37, 95% CI 0.12–1.13; very low QoE) or LOS (mean difference 0.72 days, 95% CI -0.86 to 2.29; very low QoE). AEs, SAEs, and viral clearance were similar between groups (low QoE). A mortality reduction was observed only within a subgroup of 3 RCTs evaluated at high risk of bias.
Why it matters
This review synthesized early randomized evidence and showed that ivermectin does not improve mortality, hospital stay, or viral clearance in COVID-19.
Limits
Total sample size across 10 trials was modest (n = 1,173), GRADE certainty was low to very low for all outcomes, several included trials had high risk of bias or were preprints, and populations were restricted almost entirely to mild COVID-19.
Cited by
- contradicts In a systematic meta-analysis of ivermectin clinical trials for COVID-19, the only consistent finding across studies was a reduction in time to negative PCR (faster viral clearance).