Posted on 08/04/2021 4:43:38 PM PDT by gas_dr
Background
Ivermectin, an antiparasitic agent used to treat parasitic infestations, inhibits the replication of viruses in vitro. The molecular hypothesis of ivermectin's antiviral mode of action suggests an inhibitory effect on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) replication in the early stages of infection. Currently, evidence on efficacy and safety of ivermectin for prevention of SARS‐CoV‐2 infection and COVID‐19 treatment is conflicting.
Objectives
To assess the efficacy and safety of ivermectin compared to no treatment, standard of care, placebo, or any other proven intervention for people with COVID‐19 receiving treatment as inpatients or outpatients, and for prevention of an infection with SARS‐CoV‐2 (postexposure prophylaxis).
Search methods
We searched the Cochrane COVID‐19 Study Register, Web of Science (Emerging Citation Index and Science Citation Index), medRxiv, and Research Square, identifying completed and ongoing studies without language restrictions to 26 May 2021.
Selection criteria
We included randomized controlled trials (RCTs) comparing ivermectin to no treatment, standard of care, placebo, or another proven intervention for treatment of people with confirmed COVID‐19 diagnosis, irrespective of disease severity, treated in inpatient or outpatient settings, and for prevention of SARS‐CoV‐2 infection.
Co‐interventions had to be the same in both study arms.
We excluded studies comparing ivermectin to other pharmacological interventions with unproven efficacy.
Data collection and analysis
We assessed RCTs for bias, using the Cochrane risk of bias 2 tool. The primary analysis excluded studies with high risk of bias. We used GRADE to rate the certainty of evidence for the following outcomes 1. to treat inpatients with moderate‐to‐severe COVID‐19: mortality, clinical worsening or improvement, adverse events, quality of life, duration of hospitalization, and viral clearance; 2. to treat outpatients with mild COVID‐19: mortality, clinical worsening or improvement, admission to hospital, adverse events, quality of life, and viral clearance; (3) to prevent SARS‐CoV‐2 infection: SARS‐CoV‐2 infection, development of COVID‐19 symptoms, adverse events, mortality, admission to hospital, and quality of life.
Main results
We found 14 studies with 1678 participants investigating ivermectin compared to no treatment, placebo, or standard of care. No study compared ivermectin to an intervention with proven efficacy. There were nine studies treating participants with moderate COVID‐19 in inpatient settings and four treating mild COVID‐19 cases in outpatient settings. One study investigated ivermectin for prevention of SARS‐CoV‐2 infection. Eight studies had an open‐label design, six were double‐blind and placebo‐controlled. Of the 41 study results contributed by included studies, about one third were at overall high risk of bias.
Ivermectin doses and treatment duration varied among included studies.
We identified 31 ongoing and 18 studies awaiting classification until publication of results or clarification of inconsistencies.
Ivermectin compared to placebo or standard of care for inpatient COVID‐19 treatment
We are uncertain whether ivermectin compared to placebo or standard of care reduces or increases mortality (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.14 to 2.51; 2 studies, 185 participants; very low‐certainty evidence) and clinical worsening up to day 28 assessed as need for invasive mechanical ventilation (IMV) (RR 0.55, 95% CI 0.11 to 2.59; 2 studies, 185 participants; very low‐certainty evidence) or need for supplemental oxygen (0 participants required supplemental oxygen; 1 study, 45 participants; very low‐certainty evidence), adverse events within 28 days (RR 1.21, 95% CI 0.50 to 2.97; 1 study, 152 participants; very low‐certainty evidence), and viral clearance at day seven (RR 1.82, 95% CI 0.51 to 6.48; 2 studies, 159 participants; very low‐certainty evidence). Ivermectin may have little or no effect compared to placebo or standard of care on clinical improvement up to 28 days (RR 1.03, 95% CI 0.78 to 1.35; 1 study; 73 participants; low‐certainty evidence) and duration of hospitalization (mean difference (MD) −0.10 days, 95% CI −2.43 to 2.23; 1 study; 45 participants; low‐certainty evidence). No study reported quality of life up to 28 days.
Ivermectin compared to placebo or standard of care for outpatient COVID‐19 treatment
We are uncertain whether ivermectin compared to placebo or standard of care reduces or increases mortality up to 28 days (RR 0.33, 95% CI 0.01 to 8.05; 2 studies, 422 participants; very low‐certainty evidence) and clinical worsening up to 14 days assessed as need for IMV (RR 2.97, 95% CI 0.12 to 72.47; 1 study, 398 participants; very low‐certainty evidence) or non‐IMV or high flow oxygen requirement (0 participants required non‐IMV or high flow; 1 study, 398 participants; very low‐certainty evidence). We are uncertain whether ivermectin compared to placebo reduces or increases viral clearance at seven days (RR 3.00, 95% CI 0.13 to 67.06; 1 study, 24 participants; low‐certainty evidence). Ivermectin may have little or no effect compared to placebo or standard of care on the number of participants with symptoms resolved up to 14 days (RR 1.04, 95% CI 0.89 to 1.21; 1 study, 398 participants; low‐certainty evidence) and adverse events within 28 days (RR 0.95, 95% CI 0.86 to 1.05; 2 studies, 422 participants; low‐certainty evidence). None of the studies reporting duration of symptoms were eligible for primary analysis. No study reported hospital admission or quality of life up to 14 days.
Ivermectin compared to no treatment for prevention of SARS‐CoV‐2 infection
We found one study. Mortality up to 28 days was the only outcome eligible for primary analysis. We are uncertain whether ivermectin reduces or increases mortality compared to no treatment (0 participants died; 1 study, 304 participants; very low‐certainty evidence). The study reported results for development of COVID‐19 symptoms and adverse events up to 14 days that were included in a secondary analysis due to high risk of bias. No study reported SARS‐CoV‐2 infection, hospital admission, and quality of life up to 14 days.
Authors' conclusions
Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID‐19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials.
This is from the most recent Cochrane analysis of a topic many people have opinions on. I am posting the data without comment. I am sure the comments will come later.
The data show low level confidence that Ivermectin helps on one hand. On the other hand, the authors to point to several studies in process which I think will be important to analyze as the data become available.
In other CoVID news, Regeneron (monoclonal antibodies) have been approved for post-exposure prophylaxis in the unvaccinated and for high risk populations such as SNF or LTAC patients to be infused monthly — monoclonals continue to demonstrate high efficacy in treatment, and now hopefully another pathway to prophylaxis in those who exercise their choice to remain unvaccinated.
I am sure the usual donnybrook will ensue.
Blessings to all this evening.
Heretic! You’ll smoke a turd in hell for posting this! /s
Top Kek.
Look at the width of the 95% confidence interval: a factor of 18 between the top & bottom.
That's even worse than the factor of 10 error bar on the supposed background rate of youngsters getting myocarditis or whatever.
Sounds like you're feeling the heat, troll-boi.
I am not feeling the heat — I am posting a Cochrane analysis which is generally the gold standard. Please also note that I accept and published that further analysis may move the needle — but these are the data as of today.
“I am posting a Cochrane analysis which is generally the gold standard”
Hummm...where have I heard that before, oh yes “The Lancet is the gold standard”
A Cochrane analysis is a specific statistical analysis not a journal — so I respectfully submit you are comparing apples to oranges.
Thanks guy. It is interesting as opposed to anecdotal reports.
You’re full of crap.
Anytime I hear “the gold standard” it means the field doesn’t KNOW the answer and goes by consensus.
Which is not science, no matter how much cargo-cultists try to pretend that it is.
I’m sure liking my apple flavored horse paste. Yum-Yum.
The famous Communist, Walter Cronkite, who lost the Vietnam War.
"And that's the way it is..."
You need to realize that your gold standard is iron pyrite, if it openly says of all the studies (look at the leading paragraphs again) "very low-quality evidence".
And one of the studies pretended to have "randomization" with just 14 patients. Nice error bars from that one, I bet.
On the other hand, at least the trolls sure to swarm your post won’t have worms!
Why would anyone take HCQ or Ivermectin when the gold standard prevents 99.8% of the deaths. This was a fine thing to consider pre-vaccine. and yes, it might even help with breakthrough cases..
Any cigar will do.
They kind of ruined their credibility at the end when they stated they are uncertain of the safety of a drug that has been given billions of times. But that aside, corona viruses evolve so quickly it seems likely they will evolve around Ivermectin as fast as it did around the vaccines. Keep healthy folks and live your life.
This report raises concerns about the Cochrane report
https://infoarmed.com/ivermectin-analysis-by-cochrane-could-be-biased-conclusion-in-doubt/
This was just published and attempts to sift through multiple trials and outcomes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248252/
If I have covid, ivermectin won’t hurt me, a 5 day course costs about $10 and shows results in 2-3 days that might stop the viral progression and need for hospitalization ….why deny it?
>No study compared ivermectin to an intervention with proven efficacy.
There is no “intervention with proven efficacy,” because if there were all the emergency use authorizations would have been auto-cancelled. Which includes all the vaccines, remdesivir and I think the monoclonal antibodies like Trump got, which likely do do some good. I’m not sure, but suspect that lack of a non-placebo control group downgrades the results of a Cochrane meta-analysis.
“ If I have covid, ivermectin won’t hurt me, a 5 day course costs about $10 and shows results in 2-3 days that might stop the viral progression and need for hospitalization ….why deny it?”
It will hurt you if this five days of treatment, does not work, and this delays getting treatments that will work.
Doctors on this site have written that they are not opposed to this treatment on a “right to try” basis, but at some point , if it is not working then more effective treatments need to be used. There is a finite amount of time in which to turn around the course of the disease.
But, I am not a doctor, so there is that.
I doubt you get a response.
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