BACKGROUND: We systematically assessed benefits and harms of the use of ivermectin (IVM) in COVID-19 patients.
METHODS: Published and preprint randomized controlled trials (RCTs) assessing IVM effects on COVID-19 adult patients were searched until March 22, 2021 in five engines. Primary outcomes were all-cause mortality, length of stay (LOS), and adverse events (AE). Secondary outcomes included viral clearance and severe AEs. Risk of bias (RoB) was evaluated using Cochrane RoB 2·0 tool. Inverse variance random effect meta-analyses were performed. with quality of evidence (QoE) evaluated using GRADE methodology.
RESULTS: Ten RCTs (n=1173) were included. Controls were standard of care [SOC] in five RCTs and placebo in five RCTs. COVID-19 disease severity was mild in 8 RCTs, moderate in one RCT, and mild and moderate in one RCT. IVM did not reduce all-cause mortality vs. controls (RR 0.37, 95%CI 0.12 to 1.13, very low QoE) or LOS vs. controls (MD 0.72 days, 95%CI -0.86 to 2.29, very low QoE). AEs, severe AE and viral clearance were similar between IVM and controls (all outcomes: low QoE). Subgroups by severity of COVID-19 or RoB were mostly consistent with main analyses; all-cause mortality in three RCTs at high RoB was reduced with IVM.
CONCLUSIONS: In comparison to SOC or placebo, IVM did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease. IVM did not have an effect on AEs or severe AEs. IVM is not a viable option to treat COVID-19 patients.
Clinicians` faith in the construct of evidence-based medicine (EBM) were tested over the past 18 months during COVID-19 (http://pmid.us/32651176). Clinicians and academicians appeared on daily news shows promoting largely untested and certainly unproven therapies for SARS CoV2, providing intellectual shelter for world leaders who viewed COVID-19 through the lens of political opportunity rather than societal health. Ivermectin remains the poster child for the abandonment of EBM in the rush to stem panic, as evidenced by a recent non-peer reviewed "systematic review" (https://journals.lww.com/americantherapeutics/Fulltext/2021/08000/Ivermectin_for_Prevention_and_Treatment_of.7.aspx) that included 9 pre-prints with significant risk of bias. This systematic review provides a meaningful analysis of the current state of knowledge of ivermectin as a COVID-19 therapeutic and should be incorporated into ACEP`s resource page (https://www.acep.org/covid19-management-tool).
Many keep holding out hope for ivermectin in the treatment of COVID. This paper again shows it has no benefit.