Ivermectin for COVID-19: real-time meta analysis of 95 studies
Covid Analysis, Feb 23, 2023, Version 208 — Scott Alexander response
All Treatments Recent: 47% lower mortality with exercise during hospitalization
ACTIV-6, TOGETHER, COVID-OUT, PRINCIPLE, GidMK, Scott Alexander, Strongyloides, Popp
Ivermectin Conclusion:
Ivermectin is an effective treatment for COVID-19. Treatment is more effective when used early.
Meta analysis using the most serious outcome shows 62% [51‑70%] and 82% [73‑88%] improvement for early treatment and prophylaxis, with similar results after exclusion based sensitivity analysis, for primary outcomes, for peer-reviewed studies, and for RCTs.
Statistically significant improvements are seen for mortality, ventilation, ICU admission, hospitalization, recovery, cases, and viral clearance.
All remain significant after exclusions. 59 studies from 53 independent teams in 23 different countries show statistically significant improvements in isolation (41 for primary outcomes, and 39 for the most serious outcome).
Results are very robust — in worst case exclusion sensitivity analysis 60 of 95 studies must be excluded to avoid finding statistically significant efficacy.
- Statistically significant improvements are seen for mortality, ventilation, ICU admission, hospitalization, recovery, cases, and viral clearance. All remain significant after exclusions. 59 studies from 53 independent teams in 23 different countries show statistically significant improvements in isolation (41 primary outcome, 39 most serious outcome).
- Meta analysis using the most serious outcome shows 62% [51‑70%]and 82% [73‑88%] improvement for early treatment and prophylaxis, with similar results after exclusion based sensitivity analysis, for primary outcomes, for peer-reviewed studies, and for RCTs.
- Results are very robust — in worst case exclusion sensitivity analysis 60 of 95 studies must be excluded to avoid finding statistically significant efficacy.
- No treatment, vaccine, or intervention is 100% effective and available. All practical, effective, and safe means should be used based on risk/benefit analysis. Multiple treatments are typically used in combination, which may be significantly more effective. Only 22% of ivermectin studies show zero events with treatment. Pharmacokinetics show significant inter-individual variability [Guzzo].
- Over 20 countries adopted ivermectin for COVID-19. The evidence base is much larger and has much lower conflict of interest than typically used to approve drugs.
- All data to reproduce this paper and sources are in the appendix. See [Bryant, Hariyanto, Kory, Lawrie, Nardelli] for other meta analyses with similar results confirming efficacy.
Percentage improvement with ivermectin (more) All studiesEarly treatmentProphylaxisStudiesPatientsAuthors
| All studies | 62% [54‑69%]**** | 62% [51‑70%]**** | 82% [73‑88%]**** | 95 | 134,554 | 1,023 |
| Randomized Controlled Trials | 54% [39‑65%]**** | 57% [41‑69%]**** | 79% [50‑91%]*** | 45 | 11,643 | 621 |
| Mortality | 51% [37‑62%]**** | 40% [12‑59%]** | 90% [50‑98%]** | 48 | 120,338 | 549 |
| Hospitalization | 34% [20‑45%]**** | 53% [27‑69%]*** | 67% [54‑77%]**** | 29 | 44,784 | 405 |
| Cases | 78% [67‑85%]**** | – | 78% [67‑85%]**** | 16 | 13,696 | 140 |
HIGHLIGHTS
Ivermectin reduces risk for COVID-19 with very high confidence for mortality, ventilation, ICU admission, hospitalization, progression, recovery, cases, viral clearance, and in pooled analysis.
We show traditional outcome specific analyses and combined evidence from all studies, incorporating treatment delay, a primary confounding factor in COVID-19 studies.
Real-time updates and corrections, transparent analysis with all results in the same format, consistent protocol for 49 treatments.
Source: https://c19ivm.org