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Ivermectin meta
5/15 Early, Late, PrEP, PEP
Covid Analysis (Preprint) (meta analysis)
Ivermectin for COVID-19: real-time meta analysis of 55 studies
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• 100% of 36 early treatment and prophylaxis studies report positive effects (96% of all 55 studies). 26 studies show statistically significant improvements in isolation.
• Random effects meta-analysis with pooled effects using the most serious outcome reported shows 79% and 85% improvement for early treatment and prophylaxis (RR 0.21 [0.11-0.37] and 0.15 [0.09-0.25]). Results are similar after exclusion based sensitivity analysis: 81% and 87% (RR 0.19 [0.14-0.26] and 0.13 [0.07-0.25]), and after restriction to 29 peer-reviewed studies: 82% and 88% (RR 0.18 [0.11-0.31] and 0.12 [0.05-0.30]).
• 81% and 96% lower mortality is observed for early treatment and prophylaxis (RR 0.19 [0.07-0.54] and 0.04 [0.00-0.58]). Statistically significant improvements are seen for mortality, ventilation, hospitalization, cases, and viral clearance.
• 100% of the 17 Randomized Controlled Trials (RCTs) for early treatment and prophylaxis report positive effects, with an estimated improvement of 73% and 83% respectively (RR 0.27 [0.18-0.41] and 0.17 [0.05-0.61]), and 93% of all 28 RCTs.
• The probability that an ineffective treatment generated results as positive as the 55 studies to date is estimated to be 1 in 23 trillion (p = 0.000000000000043).
Heterogeneity arises from many factors including treatment delay, patient population, the effect measured, variants, and treatment regimens. The consistency of positive results across a wide variety of cases is remarkable. Heterogeneity is low in specific cases, for example early treatment mortality.
• While many treatments have some level of efficacy, they do not replace vaccines and other measures to avoid infection. Only 29% of ivermectin studies show zero events in the treatment arm. Multiple approaches are required to protect everyone from all existing and future variants.
• Many studies do not specify administration, or specify fasting. Administration with food may significantly increase plasma and tissue concentration.
• All data to reproduce this paper and the sources are in the appendix. See [Bryant, Hill, Kory, Lawrie, Nardelli] for other meta analyses, all with similar results confirming effectiveness.
ImprovementStudies AuthorsPatients
Early treatment 79% [63‑89%] 222022,510
Late treatment 46% [28‑60%] 191496,431
Prophylaxis 85% [75‑91%] 141088,789
Mortality 74% [56‑85%] 201797,361
RCTs only 66% [50‑76%] 282704,997
All studies 73% [65‑79%] 5545917,730
Evidence base used for other COVID-19 approvals
Budesonide (UK)11,77917%
Remdesivir (USA)11,06331%
Casiri/imdevimab (USA)179966%
Ivermectin evidence5517,730 73% [65‑79%]

Details of all 93 studies    Meta analysis
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