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      Efficacy and safety of ivermectin for the treatment of COVID-19: a systematic review and meta-analysis

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          Summary

          Background

          Ivermectin became a popular choice for COVID-19 treatment among clinicians and the public following encouraging results from pre-print trials and in vitro studies. Early reviews recommended the use of ivermectin based largely on non-peer-reviewed evidence, which may not be robust. This systematic review and meta-analysis assessed the efficacy and safety of ivermectin for treating COVID-19 based on peer-reviewed randomized controlled trials (RCTs) and observational studies (OSs).

          Methods

          MEDLINE, EMBASE and PubMed were searched from 1 January 2020 to 1 September 2021 for relevant studies. Outcomes included time to viral clearance, duration of hospitalization, mortality, incidence of mechanical ventilation and incidence of adverse events. RoB2 and ROBINS-I were used to assess risk of bias. Random-effects meta-analyses were conducted. GRADE was used to evaluate quality of evidence.

          Results

          Three OSs and 14 RCTs were included in the review. Most RCTs were rated as having some concerns in regards to risk of bias, while OSs were mainly rated as having a moderate risk of bias. Based on meta-analysis of RCTs, the use of ivermectin was not associated with reduction in time to viral clearance, duration of hospitalization, incidence of mortality and incidence of mechanical ventilation. Ivermectin did not significantly increase incidence of adverse events. Meta-analysis of OSs agrees with findings from RCT studies.

          Conclusions

          Based on very low to moderate quality of evidence, ivermectin was not efficacious at managing COVID-19. Its safety profile permits its use in trial settings to further clarify its role in COVID-19 treatment.

          Protocol registration

          The review was prospectively registered in PROSPERO (CRD42021275302).

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          Most cited references45

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          Is Open Access

          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2025)
          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            RoB 2: a revised tool for assessing risk of bias in randomised trials

            Jonathan A C Sterne, Jelena Savović, Matthew J L Page … (2022)
            Article 0 comments Cited 6474 times – based on 0 reviews     Review now
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              Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

              Mark Peters (2021)
              Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)
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                Author and article information

                Journal
                Journal ID (nlm-ta): QJM
                Journal ID (iso-abbrev): QJM
                Journal ID (publisher-id): qjmedj
                Title: QJM: An International Journal of Medicine
                Publisher: Oxford University Press
                ISSN (Print): 1460-2725
                ISSN (Electronic): 1460-2393
                Publication date (Electronic): 27 September 2021
                Publication date PMC-release: 27 September 2021
                Electronic Location Identifier: hcab247
                Affiliations
                [1 ] From the Faculty of Health Sciences, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8, Canada
                [2 ] Mayo Clinic Alix School of Medicine, Mayo Clinic , 200 1st St SW, Rochester, MN 55905, USA
                [3 ] School of Medicine, University of Ottawa , 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
                Author notes
                Address correspondence to Jiawen Deng, BHSc, c/o Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON L8S4L8, Canada. email: dengj35@ 123456mcmaster.ca
                Author information
                https://orcid.org/0000-0002-8274-6468
                https://orcid.org/0000-0001-6236-764X
                Article
                Publisher ID: hcab247
                DOI: 10.1093/qjmed/hcab247
                PMC ID: 8500108
                PubMed ID: 34570241
                SO-VID: f893c746-6216-4196-b403-ce2045a12f6d
                Copyright © © The Author(s) 2021. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com
                License:

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 13 September 2021
                Page count
                Pages: 14
                Categories
                Subject: Original Paper
                Subject: AcademicSubjects/MED00010
                Custom metadata
                edited-state corrected-proof
                article-lifecycle PAP

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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