1/12/2024 0 Comments Sequential analysisSevere adverse events were rare among treatment trials and evidence of no difference was assessed as low certainty. Low-certainty evidence suggested that there may be no benefit with ivermectin for “need for mechanical ventilation,” whereas effect estimates for “improvement” and “deterioration” clearly favored ivermectin use. Secondary outcomes provided less certain evidence. Low-certainty evidence found that ivermectin prophylaxis reduced COVID-19 infection by an average 86% (95% confidence interval 79%–91%). This was also robust against a trial sequential analysis using the Biggerstaff–Tweedie method. This result was confirmed in a trial sequential analysis using the same DerSimonian–Laird method that underpinned the unadjusted analysis. Meta-analysis of 15 trials found that ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19–0.73 n = 2438 I 2 = 49% moderate-certainty evidence). Twenty-four randomized controlled trials involving 3406 participants met review inclusion. Meta-analyses were conducted and certainty of the evidence was assessed using the GRADE approach and additionally in trial sequential analyses for mortality. Two review authors sifted for studies, extracted data, and assessed risk of bias. We searched bibliographic databases up to April 25, 2021. 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. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials. Repurposed medicines may have a role against the SARS-CoV-2 virus. The work cannot be changed in any way or used commercially without permission from the journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. This article discusses off-label use of the FDA-approved medication ivermectin against COVID-19. All authors reviewed and approved the final version of the manuscript. Tham contributed to the interpretation of the evidence in the discussion and conclusions. Hill prepared the brief economic commentary. Fordham prepared the text on ivermectin mechanisms, use in pregnancy, and among the elderly. Bryant cowrote the review they also sifted the search and classified studies for inclusion and entered and checked the data in RevMan and performed analyses. The authors have no conflicts of interest to declare. This updated version was funded by the crowdfunding initiative The preprint of this review received no funding. ![]() *Address for correspondence: Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, United Kingdom. ![]() 1Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom ĢEvidence-based Medicine Consultancy, Bath, United Kingdom ģEmergency Department, Princess Elizabeth Hospital, Guernsey, United Kingdom andĤDivision of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland, United Kingdom.
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