This is a very biased meta analysis designed to exclude almost
all studies. Authors select a small subset of studies, with a majority of
results based on only 1 or 2 studies, showing positive
(non-statistically significant) results for 8 of 9 outcomes across a total of
13 studies. 5 outcomes are based on a single study, and 4 are based on 2
This analysis splits up studies in order to dilute the effects
and avoid statistical significance. However, we can consider the probability
of 8 of 9 positive effects occurring due to chance for an ineffective
treatment, which is very unlikely (0.02 with an independence
The study is entirely retrospective in the current version. The
protocol is dated April 20, 2021, and the most recent study included is from
March 9, 2021. The protocol was modified after publication in order to
include a close to null result (Gonzalez et al. "patients discharged without
respiratory deterioration or death at 28 days"), so the current protocol is
dated July 28, 2021.
Authors excluded many studies by requiring results at a
specific time, for example mortality, ventilation, etc. required results at
exactly 28 days. Authors excluded all prophylaxis studies by requiring
results at exactly 14 days.
Studies comparing with other medications were excluded, however
these studies confirm efficacy of ivermectin. The only case where they could
overstate the efficacy of ivermectin is if the other medication was harmful.
There is some evidence of this for excessive dosage/very late stage use,
however that does not apply to any of the studies here.
Studies using combined treatment were excluded, even when it is
known that the other components have minimal or no effect. 3 of 4 RCTs with
combined treatment use doxycycline in addition [sciencedirect.com]
Other studies were excluded by requiring PCR confirmation.
Authors are inconsistent regarding active comparators. They
state that hydroxychloroquine “does not work”, yet excluded trials comparing
ivermectin to a drug they hold to be inactive. On the other hand, remdesivir
was an acceptable comparator, although it is considered to be effective
standard of care in some locations [osf.io]
Authors fail to recognize that Risk of Bias (RoB) domains such
as blinding are far less important for the objective outcome of
Bryant et al. note several other issues [osf.io]
Cochrane was reputable in the past, but is now controlled by
pharmaceutical interests. For example, see the news related to the expulsion
of founder Dr. Gøtzsche and the associated mass resignation of board members
in protest [blogs.bmj.com, bmj.com, en.x-mol.com]
For another example of bias see [ebm.bmj.com]
The BiRD group gave the following early comment: "Yesterday’s
Cochrane review surprisingly doesn’t take a pragmatic approach comparing
ivermectin versus no ivermectin, like in the majority of other existing
reviews. It uses a granular approach similar to WHO’s and the flawed Roman et
al paper, splitting studies up and thereby diluting effects. Consequently,
the uncertain conclusions add nothing to the evidence base. A further
obfuscation of the evidence on ivermectin and an example of research waste.
Funding conflicts of interests of the authors and of the journal concerned
should be examined."
Authors report funding from the German Federal Ministry of
Education and Research, which may be influenced by [gcgh.grandchallenges.org]
Popp et al., 7/28/2021, preprint, 8 authors.