Current best evidence for clinical care (more info)
BACKGROUND: We systematically assessed benefits and harms of the use of ivermectin (IVM) in patients with coronavirus disease 2019 (COVID-19).
METHODS: Published and preprint randomized controlled trials (RCTs) assessing the effects of IVM on adult patients with COVID-19 were searched until 22 March 2021 in 5 engines. Primary outcomes were all-cause mortality rate, length of hospital stay (LOS), and adverse events (AEs). Secondary outcomes included viral clearance and severe AEs (SAEs). The risk of bias (RoB) was evaluated using the Cochrane Risk of Bias 2.0 tool. Inverse variance random effect meta-analyses were performed, with quality of evidence (QoE) evaluated using GRADE methods.
RESULTS: Ten RCTs (n = 1173) were included. The controls were the standard of care in 5 RCTs and placebo in 5. COVID-19 disease severity was mild in 8 RCTs, moderate in 1, and mild and moderate in 1. IVM did not reduce all-cause mortality rates compared with controls (relative risk [RR], 0.37 [95% confidence interval, .12-1.13]; very low QoE) or LOS compared with controls (mean difference, 0.72 days [95% confidence interval, -.86 to 2.29 days]; very low QoE). AEs, SAEs, and viral clearance were similar between IVM and control groups (low QoE for all outcomes). Subgroups by severity of COVID-19 or RoB were mostly consistent with main analyses; all-cause mortality rates in 3 RCTs at high RoB were reduced with IVM.
CONCLUSIONS: Compared with the standard of care or placebo, IVM did not reduce all-cause mortality, LOS, or viral clearance in RCTs in patients with mostly mild COVID-19. IVM did not have an effect on AEs or SAEs and is not a viable option to treat patients with COVID-19.
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Clinicians` faith in the construct of evidence-based medicine (EBM) were tested over the past 18 months during COVID-19 (http://pmid.us/32651176). Clinicians and academicians appeared on daily news shows promoting largely untested and certainly unproven therapies for SARS CoV2, providing intellectual shelter for world leaders who viewed COVID-19 through the lens of political opportunity rather than societal health. Ivermectin remains the poster child for the abandonment of EBM in the rush to stem panic, as evidenced by a recent non-peer reviewed "systematic review" (https://journals.lww.com/americantherapeutics/Fulltext/2021/08000/Ivermectin_for_Prevention_and_Treatment_of.7.aspx) that included 9 pre-prints with significant risk of bias. This systematic review provides a meaningful analysis of the current state of knowledge of ivermectin as a COVID-19 therapeutic and should be incorporated into ACEP`s resource page (https://www.acep.org/covid19-management-tool).
Many keep holding out hope for ivermectin in the treatment of COVID. This paper again shows it has no benefit.