Table 1.
Characteristics of studies entered into meta-analysis.
| Study Authors (Year) | Name of publication | Country (Sample Size) | IVM Dose and Duration | ControlGroup | COVID-19 Severity by WHO Classification | Patient Age, Mean (SD) or Median (IQR), y | Patients, % |
Evaluated outcomes | Duration of Follow-up, d | Funding | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Laboratory-confirmed COVID-19 | Hospitalized | Female Sex | CVD or CHD | DM | HTN | ||||||||||
| Abbas et al. (2022) [63] | Indian J. Pharm. Sci. | China (n = 202) | 300 μg/kg per day for 5 days | Placebo | Mild in 100% | IVM: 38.33 (6.84) Control: 37.33 (5.84) | 100 | 100 | 55.4 | 0 | 0 | 0 | All-cause mortality rate, Symptoms resolved, SAEs, Hospitalization due to progression | 21 | ND |
| Abd-Elsalam et al. (2021) [65] | J. Med. Virol. | Egypt (n = 164) | 12 mg (single dose) for 3 days + SOC | SOC | Mild to moderate | IVM: 42.38 (16.02) Control: 39.38 (16.92) | 100 | 100 | 50 | ND | 16.5 | 19.5 | MV requirement, All-cause mortality rate, LOS | 30 | ND |
| Ahmed et al. (2021) [61] | Int. J. Infect. Dis. | Bangladesh (n = 48) | 12 mg once daily for 5 d | Placebo | Mild in 100% | 42 (NR) | 100 | 100 | 54 | 0 | 0 | 0 | Remission of symptoms, LOS, SAEs, Oxygen requirement, Time to viral clearance | 14 | Industry |
| Angkasekwinai et al. (2022) [80] | Antibiotics | Thailand (n = 447) | 400–600 μg/kg, once daily for 2 days | Placebo | Mild in 11.6%, moderate in 88.4% | 39.5 (12.1) | 100 | 7.4 | 56.8 | 1.8 | 6.9 | 11.2 | All-cause mortality rate, AEs, Symptoms resolved, SAEs, | 28 | Government |
| Aref et al. (2021) [66] | Int. J. Nanomed. | Egypt (n = 114) | spray twice daily + SOC | SOC | Mild in 100% | 45.1 (18.9) | 100 | 0 | 28.1 | 3.5 | 12.3 | 17.5 | PCR negative conversion, Progress to more severe disease, Duration taken for negative, AEs | 18 | Government |
| Babalola et al. (2022) [76] | QJM | Nigeria (n = 62) | given every 84 h, twice a week for 2 weeks + SOC: A1: 6 mg; A2: 12 mg | Placebo + SOC | Asymptomatic or mild/moderate symptoms | 44.1 (14.7) | 100 | ND | 30.6 | ND | 3.2 | 14.5 | All-cause mortality rate, Duration taken for negative, AEs, SAEs | 42 | ND |
| Beltrán-Gonzalez et al. (2022) [74] | Infect. Dis. Rep. | Mexico (n = 106) | 12 mg or 18 mg, according to patient weight | Placebo | Severe in 100% | 53 (16.9) | 100 | 100 | 37.8 | ND | 33.9 | 32.1 | All-cause mortality rate, clinical recovery, LOS, AEs, Respiratory deterioration | 28 | Government |
| Biber et al. (2022) [72] | Int. J. Infect. Dis. | Israel (=89) | Ivermectin 0.2 mg/kg for 3 days | Placebo | Mild to moderate, not requiring O2 and asymptomatic cases | 35 (28–47) (IQR) | 100 | 0 | 21.3 | ND | ND | ND | PCR negative conversion, AEs, Hospitalization due to progression, SAEs | 21 | ND |
| Bramante et al. (2022) [21] | New Engl. J. Med. | USA (n = 1323) | 390–470 μg/kg per day, for 3 days | Placebo | Mild in 100% | 46 ([IQR]37–55) | 100 | 0 | 56 | 22.8 | 1.6 | ND | Hypoxemia, emergency department visit, Hospitalization, mortality | 14 | ND |
| Bukhari et al. (2021) [77] | Medrxiv | Pakistan (n = 86) | Single dose: 12 mg | SOC | Mild in most patients (percentage unclear) | 39 (42) | 100 | 100 | 15 | 5.8 | 12 | 14 | Time to viral clearance, AEs | 28 | ND |
| Buonfrate et al. (2022) [22] | Int. J. AG. | Italy (n = 93) | Single dose A1: 600 μg/kg; A2: 1200 μg/kg | Placebo | Mild in 83.9%, moderate in 16.1% | 47 (31–58) | 100 | 100 | 41.9 | 23.4 | 4.7 | ND | Viral clearance, Hospitalization due to progression, Mean durations of symptoms, Mean reduction in viral load, SAEs | 14 | Government |
| Chaccour et al. (2021) [79] | EClinicalMedicine | Spain (n = 24) | Single dose 400 μg/kg | Placebo | Mild in 100% | 26 (19–36) | 100 | 0 | 50 | 0 | 0 | 0 | All-cause mortality rate, AEs, PCR at d 7 | 28 | Government |
| Chachar et al. (2020) [78] | Int. J. Sci. | Pakistan (n = 50) | 12 mg, 12 mg at 12 h, and 12 mg at 24 h | SOC | Mild in 100% | 42 (16) | 100 | 0 | 38 | 8 | 40 | 26 | Asymptomatic at d 7 | 7 | ND |
| Chahla et al. (2021) [58] | medRxiv | Argentina (n = 172) | 24 mg every 7 days for 4 weeks + SOC | SOC | Mild in 100% | IVM: 40 (19–53) Placebo: 37.5 (31,49) IQR | 100 | 0 | 52.3 | ND | 6.4 | 11 | Symptoms resolved, Discharged from hospital | 28 | Government |
| Elshafie et al. (2022) [23] | Expert Rev. Anti. Infect. Ther. | Egypt （n = 206） | 36 mg on day 1, 3, 6 | Placebo | moderate to severe | 59 (16) | 35.4 | 100 | 46.6 | 9.7 | 27.7 | 38.3 | All-cause mortality rate, AEs, Time or number of recovery | 90 | ND |
| Kishoria et al. (2020) [67] | Indian J. Res. | India (n = 32) | 12 mg + SOC | SOC | Asymptomatic/Mild patients in 100% | 38 | 100 | 100 | 28.1 | ND | ND | ND | PCR negative conversion, Discharged from hospital | 6 | ND |
| Krolewiecki et al. (2021) [59] | EClinicalMedicine | Argentina (n = 45) | 0.6 mg/kg once daily for 5 d | SOC | Mild in 87%, moderate in 13% | 41 (12) | 100 | 100 | 44 | ND | 16 | 13 | Viral load at d 5, IVM plasma level | 30 | Government |
| Lim et al. (2022) [24] | JAMA Intern. Med. | Malaysia (n = 490) | 0.4 mg/kg body weight daily for 5 days + SOC | SOC | Mild in 34.1%, moderate in 65.9% | 62.5 (8.7) | 100 | 0 | 54.5 | 11.6 | 53.5 | 75.3 | All-cause mortality rate, LOS, Symptoms resolved, Admission to ICU, MV requirement, Progress to more severe disease | 28 | ND |
| López-Medina et al. (2021) [64] | JAMA | Colombia (n = 398) | 300 μg/kg once daily for 5 d | Placebo | Mild in 100% | 37 (29–48) | 100 | 1 | 78 | 1.7 | 6 | 13 | All-cause mortality rate, Time to complete resolution, AEs, SAEs, Escalation of care | 21 | Government |
| Manomaipiboon et al. (2022) [25] | Trials | Thailand (n = 72) | 12 mg per day, for 5 days | SOC | Mild to moderate | 48.57 (14.8) | 100 | 100 | 62.5 | 2.8 | 23.6 | 40.3 | PCR negative conversion, Symptoms resolved, Mean durations of symptoms | 28 | Government |
| Mirahmadizadeh et al. (2022) [26] | Respirology | Iran (n = 391) | 3 mg for 2 days, cumulative dose of 24 mg | Placebo | Mild in 100% | 39 (17) | 100 | 0 | 49 | 1.1 | 5 | 6.9 | All-cause mortality rate, Symptoms resolved, MV requirement, Hospitalization due to progression, AEs, SAEs, Mean durations of symptoms | Government | |
| Mohan et al. (2021) [68] | J. Infect. Themother. | India (n = 157) | A1: Ivermectin 12 mg (single dose); A2: Ivermectin 24 mg (single dose) | Placebo | Mild in 64%, moderate in 36% | 35.3 (10.4) | 100 | 100 | 11.2 | 0.8 | 8.8 | 11.2 | PCR negative conversion, Progress to more severe disease, Discharged from hospital, AEs, SAEs | 14 | Government |
| Naggie et al. (2022) [82] | JAMA | USA (n = 1591) | Ivermectin 400 μg/kg for 3 days | Placebo | Mild-to-moderate | 48 (12) | 100 | 0 | 59 | ND | 11.5 | 26 | All-cause mortality rate, Admission to ICU, MV requirement, Hospitalization due to progression, Mean durations of symptoms, AEs, SAEs | 28 | Government |
| Naggie et al. (2023) [83] | JAMA | USA (n = 1206) | Ivermectin 600 μg/kg for 6 days | Placebo | Mild-to-moderate | IVM: 47 (38–58) Control:48 (39–58) | 100 | 0 | 59.1 | 3.9 | 9 | 26.3 | Time to sustained recovery, All-cause hospitalization rate, All-cause mortality rate | 28 | Government |
| Okumuş et al. (2021) [81] | BMC Infect. Dis. | Turkey (n = 60) | 0.2 mg/kg for 5 days + SOC | SOC | Severe pneumonia | IVM: 58.17 (11.52) Control: 66.23 (13.31) | 100 | 100 | 33.3 | 23.3 | 31.6 | 45 | All-cause mortality rate, PCR negative conversion, Clinical improvement, AEs, SAEs | 5 | Government |
| Podder et al. (2020) [62] | IMC J. Med. Sci. | Bangladesh (n = 62) | Single dose: 200 μg/kg | SOC | Mild in 81%, moderate in 19% | 39 (12) | 100 | ND | 29 | ND | ND | ND | Time to full recovery, Viral clearance | 10 | Government |
| Ravikirti et al. (2021) [69] | J. Pharm. Sci. | India (n = 115) | 12 mg/d for 2 days | Placebo | Mild in 79%, moderate in 21% | 53 (15) | 100 | 100 | 28 | 11 | 36 | 35 | All-cause mortality rate, Admission to ICU, MV requirement, Viral clearance at d 6 | 10 | ND |
| Reis et al. (2022) [10] | New Engl. J. Med. | Brazil (n = 679) | Ivermectin: 400 μg per kilogram of body weight once daily for 3 days + SOC | Placebo + SOC | Mild-to-moderate | 49 (38–57) | 100 | 0 | 58.2 | 1.8 | 12.9 | 8.4 | MV requirement, AEs, Hospitalization due to progression, Viral clearance | 21 | Government |
| Rezai et al. (2022) [70] | Front. Med. | Iran (n = 1158) | 0.4 mg/kg per day for 3 days + SOC | Placebo + SOC | Moderate in 53.9%, severe in 46.1% | 44.9 (5–96) | 100 | 52.6 | 50 | 7.7 | 20.1 | 18.7 | Clinical improvement, Recovery, LOS, ICU admission, MV requirement, AEs, Mortality | 7 | ND |
| Rocha et al. (2022) [75] | BMC Infect. Dis. | Mexico (n = 56) | 12 mg per day for 3 days + SOC | Placebo + SOC | asymptomatic and mild | IVM: 40.4 (15.2) Control:36.4 (13) | 100 | 100 | 67.8 | 3/30: 1/26 | 2/30: 1/26 | 4/30 1/26 | PCR negative conversion, Symptoms resolved, Progress to more severe disease, AEs | 14 | Industry |
| Shahbaznejad et al. (2021) [71] | Clin. Ther. | Iran (n = 69) | 0.2 mg/kg + SOC | SOC | Moderate in 55%, severe in 45% | 46.4 (22.5) | 64 | 100 | 47.8 | ND | ND | ND | Duration of hospital stay, Overall clinical improvement | 10 | ND |
| Vallejos et al. (2021) [60] | BMC Infect. Dis. | Argentina (n = 501) | IVM: BW < 80 kg: 12 mg at inclusion and another 12 mg after 24 h; 80 kg < BW < 110 kg:18 mg at inclusion and another 18 mg after 24 h; 110 kg < BW: 24 mg at inclusion and another 24 mg after 24 h + SOC | Placebo + SOC | Mild in 100% | 42.5 (15.5) | 100 | 0 | 47.3 | 2.6 | 9.6 | 23.6 | All-cause mortality rate, PCR negative conversion, MV requirement, Hospitalization due to progression, AEs, SAEs | 30 | ND |
| Wada et al. (2023) [73] | Front. Med. | Japan (n = 221) | 200 μg/kg | Placebo | Asymptomatic or mild/moderate symptoms | 47.7 (15.0) | 100 | 0 | 35.4 | ND | 13.7 | ND | Time to a negative, All-cause mortality rate, MV requirement, Hospitalization due to progression, AEs | 45 | Government |
AEs: adverse events, CHD: coronary heart disease, CVD: cerebrovascular disease, DM: diabetes mellitus, HTN: hypertension, ICU: Intensive Care Unit, IVM: ivermectin, LOS: length of hospital stay, MV: mechanical ventilation, ND: No data available, PCR: polymerase chain reaction, SAEs: severe adverse events, SD: standard deviation, SOC: standards of care, IQR: interquartile range.