Ivermectin for COVID-19: real-time meta analysis of 96 studies
Covid Analysis,
Apr 21, 2023,
Version 210 —
Scott Alexander response
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All Treatments Recent: 47% lower mortality with exercise during hospitalization
ACTIV-6,
TOGETHER,
COVID-OUT,
PRINCIPLE,
GidMK,
Scott Alexander,
Strongyloides,
Popp
•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 85% [77‑90%] 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 61 of 96 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]. Efficacy may vary depending on the manufacturer [
Williams].
•
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 showing efficacy.
Percentage improvement with ivermectin
(more)
| All studies | Early treatment | Prophylaxis | Studies | Patients | Authors |
|---|
| All studies | 63%[55‑70%]
**** | 62%[51‑70%]
**** | 85%[77‑90%]
**** | 96 | 135,554 | 1,030 |
| Randomized Controlled Trials | 56%[41‑68%]
**** | 57%[41‑69%]
**** | 89%[57‑97%]
** | 45 | 11,643 | 625 |
| Mortality | 51%[37‑61%]
**** | 40%[12‑59%]
** | 90%[50‑98%]
** | 49 | 121,338 | 552 |
| Hospitalization | 34%[20‑45%]
**** | 53%[27‑69%]
*** | 67%[54‑77%]
**** | 29 | 44,784 | 405 |
| Cases | 81%[71‑87%]
**** | - | 81%[71‑87%]
**** | 16 | 13,696 | 144 |
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
51 treatments.
