Dr John Campbell: Best Ivermectin Meta Analysis and COVID-19

Ivermectin for Prevention and Treatment of COVID-19 Infection 

A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines

https://journals.lww.com/americantherapeutics/Abstract/9000/Ivermectin_for_Prevention_and_Treatment_of.98040.aspx

Background 

The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials. A 2018 application for ivermectin use for scabies gives a direct cost of $2.90 for 100 12-mg tablets. Most trials were registered, self-funded, and undertaken by clinicians.

Areas of uncertainty:

We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemoprophylaxis, among people with, or at high risk of, COVID-19 infection.

Data sources:

We searched bibliographic databases up to April 25, 2021. Two review authors sifted for studies, extracted data, and assessed risk of bias. Meta-analyses were conducted and certainty of the evidence was assessed using the GRADE approach and additionally in trial sequential analyses for mortality. Twenty-four randomized controlled trials involving 3406 participants met review inclusion.
  • 24 randomized controlled trials 
  • N = 3,406 participants 
  • Ivermectin reduced risk of death compared with no ivermectin 
  • Meta-analysis of 15 trials (n = 2,438)
GRADE approach 
https://training.cochrane.org/grade-approach
  • GRADE (Grading of Recommendations, Assessment, Development and Evaluations) 
  • GRADE has four levels of evidence, certainty in evidence:
  1. very low 
  2. low 
  3. moderate 
  4. high
Results

Certainty in evidence: Moderate 
  • Ivermectin reduced risk of death compared with no ivermectin 
  • Meta-analysis of 15 trials (n = 2,438)
  • Ivermectin verses no ivermectin in hospital patients 
  • Ivermectin, 2.3% vs No ivermectin, 7.8% 
Certainty of evidence: Low
  • Ivermectin prophylaxis reduced COVID-19 infection 
  • 3 trials, n = 738 
  • Average reduction 86%

Conclusions

  • Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin.
  • Using ivermectin early in the clinical course may reduce numbers progressing to severe disease.
  • The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally.



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