Table 2.
Ivermectin compared with control intervention for COVID-19 treatment or prevention. Patient or population: Patients with COVID-19 for treatment studies; healthcare personnel and household contacts for prevention studies. Settings: outpatients and hospitalized patients. Intervention: ivermectin ± standard treatment. Comparison: standard treatment.
| Outcomes | Illustrative Comparative Risks * (95% CI) | Relative Effect (95% CI) | No of Participants (Studies) | Quality of the Evidence (GRADE) | Comments | |
|---|---|---|---|---|---|---|
| Assumed Risk | Corresponding Risk | |||||
| Control | Ivermectin | |||||
| Mortality according to baseline conditions | Low-risk population (mild/moderate disease) |
RD −0.01 (−0.01/0.00) RD −0.17 (−0.24/−0.10) |
1283 (7) 304 (3) |
⊕⊕⊝⊝ low 1 ⊕⊕⊝⊝ low 2 |
On average, it is unclear whether or not use of ivermectin compared to control decreases mortality in low-risk population. The average benefit is higher in the high-risk population. |
|
| mortality ranged from 0 to 1.6% | mortality was 1% lower (from 0 to 1% lower) | |||||
| High risk population (severe disease) | ||||||
| mortality ranged from 20% to 30% | mortality was 17% lower (from 10% to 24% lower) | |||||
| Viral clearance (% patients) | At 6–10 days |
RD 0.10 (−0.12/0.31) RD 0.21 (0.05/0.36) |
430 (5) 360 (2) |
⊕⊝⊝⊝ very low 3 ⊕⊕⊝⊝ low 4 |
On average, it is unclear whether or not use of ivermectin compared to control decreases rate of patients with RT-PCR negative test after 6–10 days. After 14 days, ivermectin increases rates of pts with negative RT-PCR test compared to control. |
|
| rate of patients with negative RT-PCR ranged from 0 to 46.6 per 100 | rate of patients with negative RT-PCR was 10% higher (from 31% higher to 12% lower) | |||||
| At 14 days | ||||||
| rate of patients with negative RT-PCR ranged from 36 to 80 per 100 |
rate of patients with negative RT-PCR was 21% higher (from 5% to 36% higher) | |||||
| Disease progression (severe pneumonia, admission to intensive care unit, and/or mechanical ventilation) according to baseline conditions | Low-risk population (mild/moderate disease) |
RD −0.05 (−0.11 to 0.00) RD −0.09 (−0.16/−0.02) |
1405 (7) 302 (3) |
⊕⊝⊝⊝ very low 3 ⊕⊕⊝⊝ low 4 |
On average, it is unclear as to whether or not use of ivermectin compared to control decreases disease progression in the low-risk population. The average benefit is higher in the high-risk population. |
|
| disease progression ranged from 0 to 22 per 100 | rate of patients with disease progression was 5% lower (from 0 to 11% lower) |
|||||
| High-risk population (severe disease) | ||||||
| disease progression ranged from 30 to 46 per 100 | rate of patients with disease progression was 9% lower (from 16 to 2% lower) | |||||
| Serious adverse events | serious adverse events ranged from 0 to 2.5 per 100 | serious adverse events were 1% higher (from 1% lower to 2% higher) | RD 0.01 (−0.01/0.02) | 1428 (6) | ⊕⊕⊝⊝ low 1 |
Serious adverse events were rarely reported in both ivermectin and control groups. |
| Prevention of infection in healthcare and household contacts of COVID-19 pts | rate of infection ranged from 10 to 58 per cent | rate of infection was 28% lower (from 61 to 41% lower) |
RD −0.28 (−0.33/−0.23) | 736 (3) | ⊕⊝⊝⊝ very low 5 |
Prophylaxis with ivermectin increased the likelihood of preventing COVID-19 compared to controls. |
* The assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RD: risk difference. GRADE: working group grades of evidence. High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. 1 Downgraded for risk of bias and imprecision (95% CI includes line of no effect); 2 downgraded twice for risk of bias; 3 downgraded for risk of bias, imprecision, and inconsistency (due to heterogeneity); 4 downgraded for risk of bias and inconsistency; 5 downgraded for risk of bias, inconsistency, and indirectness.