Study design	Participants (inclusion and exclusion)	Intervention	Comparator	Outcomes	Method changes	Results	Authors' conclusion
Protocol (20 April 2021; Popp 2021a)
Differences1	None	None	None	None	1. We added a new outcome: 'patients discharged without respiratory deterioration or death at 28 days' 2. We changed the timing of outcome measurement for serious adverse events and adverse events ('within 14 days' to 'within 28 days')	New added a new methods section: 'methods for future updates'	Not applicable	Not applicable
Review (28 July 2021; Popp 2021b)
Differences2	New exclusion criteria ‐ we excluded trials if they were: 1. not prospectively registered; or 2. had concerns regarding research integrity	Trials investigating prevention of infection have to report on the vaccination status of included participants.	For clarity, we named the intervention group ‘ivermectin plus standard of care’.	For clarity, we named the comparator group ‘standard of care plus/minus placebo’.	New outcome sets for: 1. inpatients; 2. outpatients; 3. prevention of an infection. Core outcomes are in accordance with the Core Outcome Measures in Effectiveness Trials (COMET) Initiative for COVID‐19 patients (COMET 2020; Marshall 2020). Additional outcomes have been prioritized by consumer representatives and the German guideline panel for inpatient therapy of people with COVID‐19 (German AWMF Guideline 2021a) and for outpatient therapy (German AWMF Guideline 2021b). Changes to the outcomes were necessary due to the risk of competing events associated with the original outcome set. This review update no longer has secondary outcomes. We treated all outcomes as primary outcome sets which informed the summary of findings tables.	1. Research integrity check of trials as part of the eligibility screening 2. No differentiation between primary and secondary analyses based on risk of bias ratings; all included trials were eligible for the main analyses which informed the summary of findings tables 3. New data extraction items ('vaccination status', 'start of treatment since symptom onset') 4. Data synthesis methods added for time‐to‐event outcomes 5. We no longer performed the subgroup analysis ‘severity of condition at baseline’ independent of heterogeneity. In case of heterogeneity, we planned different subgroup analyses. 6. We added new sensitivity analyses considering risk of bias, vaccination status, and starting time point of treatment. 7. The summary of findings tables included the new outcome sets.	1. Six trials included in the original review were not prospectively registered, and one additional trial was found to be non‐randomized; we had to exclude all 7 trials. The remaining 7 trials from the original review plus 4 newly‐identified trials resulted in a new pool of 11 trials. 2. Direction of effect moved closer to 1 (no effect) for 1 inpatient and 1 outpatient outcome. 3. Certainty of evidence increased from very low to low for 2 inpatient outcomes and 1 outpatient outcome. We could evaluate certainty of evidence for the first time for 1 inpatient outcome and 2 outpatient outcomes. Overall, we included more participants for outpatient outcomes.	The conclusion did not change, however gained some strength regarding certainty of the evidence: "Overall, the reliable evidence available not support the use of ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized controlled trials (RCTs). "
First review update (June 2022)