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Ivermectin is effective for COVID-19: real-time meta analysis of 52 studies
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98% of the 52 studies to date report positive effects (25 statistically significant in isolation). Random effects meta-analysis for early treatment and pooled effects shows an 81% reduction, RR 0.19 [0.09-0.38], and prophylactic use shows 85% improvement, RR 0.15 [0.09-0.25]. Mortality results show 76% lower mortality, RR 0.24 [0.14-0.42] for all treatment delays, and 84% lower, RR 0.16 [0.04-0.63] for early treatment.
96% of the 27 Randomized Controlled Trials (RCTs) report positive effects, with an estimated 65% improvement, RR 0.35 [0.24-0.52].
The probability that an ineffective treatment generated results as positive as the 52 studies to date is estimated to be 1 in 85 trillion (p = 0.000000000000012).
All data to reproduce this paper and the sources are in the appendix. See [Bryant, Hill, Kory, Lawrie, Nardelli] for other meta analyses, all with similar results confirming effectiveness.
Show results for:
All studies
With exclusions
Mortality results
COVID-19 cases
Viral clearance
Peer reviewed
RCT mortality
All RCTs
00.250.50.7511.251.51.752+Kory et al.0.31[0.20-0.47]RRCIHill et al.0.25[0.12-0.52]Bryant et al.0.32[0.14-0.72]Lawrie et al.0.17[0.08-0.35]Nardelli et al.0.21[0.11-0.36]ivmmeta0.24[0.14-0.42]Ivermectin meta analysis mortality resultsivmmeta.com 4/20/21Lower RiskIncreased Risk
ImprovementStudies AuthorsPatients
Early treatment 81% [62‑91%] 181751,942
Late treatment 43% [27‑56%] 201436,831
Prophylaxis 85% [75‑91%] 141088,789
Mortality 76% [58‑86%] 181557,267
RCTs only 65% [48‑76%] 272464,854
All studies 72% [64‑78%] 5242617,562
WHO ivermectin approval status
IndicationStudiesPatientsEffect sizeStatus
Scabies661335% [22‑46%]Approved
COVID‑195217,562 72% [64‑78%] Pending
    
  
A
00.250.50.7511.251.51.752+Chowdhury (RCT)0.19[0.01-3.96]14mghosp.0/602/56OT​1 CT​2RRCIDose (4d)TreatmentControlEspitia-Hernandez0.03[0.01-0.11]12mgviral+0/287/7CT​2Carvallo0.12[0.01-1.06]36mgdeath1/333/12CT​2Cadegiani0.22[0.01-4.48]42mgdeath0/1102/137Ahmed (DB RCT)0.15[0.01-2.70]48mgsymptoms0/173/19Chaccour (DB RCT)0.47[0.19-1.16]28mgsymp. prob.1212Afsar0.08[0.00-1.32]48mgsymptoms0/377/53Babalola (DB RCT)0.36[0.10-1.27]24mgviral+4020OT​1Kirti (DB RCT)0.11[0.01-2.05]24mgdeath0/554/57Bukhari (RCT)0.18[0.07-0.46]12mgviral+4/4125/45Raad (SB RCT)0.14[0.01-2.70]14mghosp.0/503/50MD​3Mohan (DB RCT)0.38[0.08-1.75]28mgno recov.2/406/45Schwartz (DB RCT)0.19[0.01-3.92]36mghosp.0/492/45Elalfy0.13[0.06-0.27]36mgviral+7/6244/51CT​2López-Me.. (DB RCT)0.33[0.01-8.11]84mgdeath0/2001/198Roy0.94[0.52-1.93]n/arecov. time1415CT​2Chahla (CLUS. RCT)0.11[0.02-0.52]24mgno disch.2/1108/62Mourya0.11[0.05-0.25]48mgviral+5/5047/50Tau​2 = 1.52; I​2 = 85.0%Early treatment0.19[0.09-0.38]21/1,008164/93481% improvementShouman (RCT)0.09[0.03-0.23]36mgsymp. case15/20359/101RRCIDose (1m)TreatmentControlCarvallo0.04[0.00-0.63]14mgcases0/13111/98CT​2Behera0.46[0.29-0.71]42mgcases41/117145/255Elgazzar (RCT)0.20[0.04-0.89]112mgcases2/10010/100Carvallo0.00[0.00-0.02]48mgcases0/788237/407CT​2Hellwig (ECO.)0.22[0.05-0.89]14mgcasesecologicalBernigaud0.01[0.00-0.10]84mgdeath0/69150/3,062Alam0.09[0.04-0.24]12mgcases4/5844/60Vallejos0.27[0.15-0.48]48mgcases13/38961/486MD​3Chahla (RCT)0.05[0.00-0.80]48mgcases0/11710/117CT​2Behera0.17[0.12-0.23]42mgcases45/2,199133/1,147Tanioka (ECO.)0.12[0.03-0.51]14mgdeathecologicalSeet (CLUS. RCT)0.50[0.33-0.76]12mgsevere case32/61764/619OT​1Morgenstern (PSM)0.20[0.01-4.15]56mghosp.0/2712/271Tau​2 = 0.58; I​2 = 83.8%Prophylaxis0.15[0.09-0.25]152/5,059926/6,72385% improvementAll studies0.16[0.10-0.25]173/6,0671,090/7,65784% improvementIvermectin COVID-19 early treatment and prophylaxis studiesivmmeta.com 4/20/211 OT: ivermectin vs. other treatment2 CT: study uses combined treatment3 MD: minimal detail available currentlyTau​2 = 1.02; I​2 = 90.8%; Z = 7.89 (p < 0.0001)Lower RiskIncreased Risk
    
  
B
00.250.50.7511.251.51.752+All studiesEarly treatmentmin, Q1, median, Q3, maxLower RiskIncreased Riskivmmeta.com 4/20/21
    
  
C
100+ 75 50 25 25 50 75 100 Chowdhuryhosp., p=0.23Espitia-Hernandezviral+, p<0.0001Carvallodeath, p=0.05Cadegianideath, p=0.50Ahmedsymptoms, p=0.09Chaccoursymp. prob., p<0.05Afsarsymptoms, p=0.04Babalolaviral+, p=0.11Kirtideath, p=0.12Bukhariviral+, p<0.0001Raadhosp., p=0.24Mohanno recov., p=0.27Schwartzhosp., p=0.23Elalfyviral+, p<0.0001López-Medinadeath, p=0.50Royrecov. time, p=0.87Chahlano disch., p=0.005Mouryaviral+, p<0.0001Early treatment% Lower Risk% Increased Riskivmmeta.com 4/20/21Probability results fromineffective treatmentDec 15 p<0.011 in 100Jan 16 p<0.0011 in 1 thousandFeb 16 p<0.00011 in 10 thousandMar 30 p<0.000011 in 100 thousand
    
  
D
100+ 75 50 25 25 50 75 100 Gorial, death, p=1.00Chowdhury, hosp., p=0.23Espitia-Hernandez, viral+, p<0.0001Shouman, symp. case, p<0.001Kishoria, no disch., p=1.00Podder, recov. time, p=0.34Carvallo, death, p=0.05Khan, death, p<0.05Chachar, no recov., p=0.50Soto-Becerra, death, p=0.01Mahmud, death, p=0.25Rajter, death, p=0.04Carvallo, cases, p<0.0001Hashim, death, p=0.27Behera, cases, p<0.0001Cadegiani, death, p=0.50Camprubí, ICU, p=1.00Elgazzar, death, p<0.0001Elgazzar, cases, p=0.03Spoorthi, recov. time, p=0.03Carvallo, cases, p<0.0001Budhiraja, death, p=0.04Niaee, death, p=0.001Hellwig, cases, p<0.02Bernigaud, death, p=0.08Ahmed, symptoms, p=0.09Chaccour, symp. prob., p<0.05Afsar, symptoms, p=0.04Alam, cases, p<0.0001Vallejos, cases, p<0.0001Babalola, viral+, p=0.11Kirti, death, p=0.12Chahla, cases, p=0.002Okumuş, death, p=0.55Bukhari, viral+, p<0.0001Raad, hosp., p=0.24Rezai, recov. time, p=0.02Mohan, no recov., p=0.27Lima-Morales, death, p<0.001Schwartz, hosp., p=0.23Behera, cases, p<0.001Elalfy, viral+, p<0.0001Beltran-Gonzalez, death, p=1.00López-Medina, death, p=0.50Pott-Junior, ICU, p=0.25Roy, recov. time, p=0.87Huvemek, no improv., p=0.28Tanioka, death, p=0.002Chahla, no disch., p=0.005Mourya, viral+, p<0.0001Seet, severe case, p=0.01Morgenstern, hosp., p=0.50All studies% Lower Risk% Increased Riskivmmeta.com 4/20/21Probability results fromineffective treatmentOct 9 p<0.011 in 100Nov 13 p<0.00011 in 10 thousandNov 18 p<0.000011 in 100 thousandNov 28 p<0.0000011 in 1 millionDec 15 p<0.00000011 in 10 millionJan 161 in 1 billionMar 121 in 1 trillion
Figure 1. A. Random effects meta-analysis excluding late treatment. This plot shows pooled effects, analysis for individual outcomes is below, and more details on pooled effects can be found in the discussion section. Simplified dosages are shown for comparison, these are the total dose in the first four days for treatment, and the monthly dose for prophylaxis, for a 70kg person. For full details see the appendix. B. Scatter plot showing the distribution of effects reported in early treatment studies and in all studies. C and D. Chronological history of all reported effects, with the probability that the observed frequency of positive results occurred due to random chance from an ineffective treatment.
Introduction
We analyze all significant studies concerning the use of ivermectin for COVID-19. Search methods, inclusion criteria, effect extraction criteria (more serious outcomes have priority), all individual study data, PRISMA answers, and statistical methods are detailed in Appendix 1. We present random effects meta-analysis results for all studies, for studies within each treatment stage, for mortality results, for COVID-19 case results, for viral clearance results, for peer-reviewed studies, for Randomized Controlled Trials (RCTs), and after exclusions.
We also perform a simple analysis of the distribution of study effects. If treatment was not effective, the observed effects would be randomly distributed (or more likely to be negative if treatment is harmful). We can compute the probability that the observed percentage of positive results (or higher) could occur due to chance with an ineffective treatment (the probability of >= k heads in n coin tosses, or the one-sided sign test / binomial test). Analysis of publication bias is important and adjustments may be needed if there is a bias toward publishing positive results.
Figure 2 shows stages of possible treatment for COVID-19. Prophylaxis refers to regularly taking medication before becoming sick, in order to prevent or minimize infection. Early Treatment refers to treatment immediately or soon after symptoms appear, while Late Treatment refers to more delayed treatment.
Figure 2. Treatment stages.
Results
Figure 3, 4, and 5 show results by treatment stage. Figure 6, 7, 8, and 9 show forest plots for a random effects meta-analysis of all studies with pooled effects, and for studies reporting mortality results, COVID-19 case results, and viral clearance results only. Figure 10 shows results for peer reviewed trials only. Table 1 summarizes the results.
Treatment timeNumber of studies reporting positive effects Total number of studiesPercentage of studies reporting positive effects Probability of an equal or greater percentage of positive results from an ineffective treatmentRandom effects meta-analysis results
Early treatment 18 18 100% 0.0000038 3.8e-06
1 in 262 thousand
81% improvement
RR 0.19 [0.09‑0.38] p < 0.0001
Late treatment 19 20 95.0% 0.00002 2e-05
1 in 50 thousand
43% improvement
RR 0.57 [0.44‑0.73] p < 0.0001
Prophylaxis 14 14 100% 0.000061 6.1e-05
1 in 16 thousand
85% improvement
RR 0.15 [0.09‑0.25] p < 0.0001
All studies 51 52 98.1% 0.000000000000012 1.2e-14
1 in 85 trillion
72% improvement
RR 0.28 [0.22‑0.36] p < 0.0001
Table 1. Results by treatment stage.
    
  
00.250.50.7511.251.51.752+All studiesLate treatmentEarly treatmentProphylaxismin, Q1, median, Q3, maxLower RiskIncreased Riskivmmeta.com 4/20/21
Figure 3. Results by treatment stage.
    
  
100+ 75 50 25 25 50 75 100 Chowdhuryhosp., p=0.23Espitia-Hernandezviral+, p<0.0001Carvallodeath, p=0.05Cadegianideath, p=0.50Ahmedsymptoms, p=0.09Chaccoursymp. prob., p<0.05Afsarsymptoms, p=0.04Babalolaviral+, p=0.11Kirtideath, p=0.12Bukhariviral+, p<0.0001Raadhosp., p=0.24Mohanno recov., p=0.27Schwartzhosp., p=0.23Elalfyviral+, p<0.0001López-Medinadeath, p=0.50Royrecov. time, p=0.87Chahlano disch., p=0.005Mouryaviral+, p<0.0001Early treatment% Lower Risk% Increased Riskivmmeta.com 4/20/21Probability results fromineffective treatmentDec 15 p<0.011 in 100Jan 16 p<0.0011 in 1 thousandFeb 16 p<0.00011 in 10 thousandMar 30 p<0.000011 in 100 thousand
    
  
100+ 75 50 25 25 50 75 100 Gorialdeath, p=1.00Kishoriano disch., p=1.00Podderrecov. time, p=0.34Khandeath, p<0.05Chacharno recov., p=0.50Soto-Becerradeath, p=0.01Mahmuddeath, p=0.25Rajterdeath, p=0.04Hashimdeath, p=0.27CamprubíICU, p=1.00Elgazzardeath, p<0.0001Spoorthirecov. time, p=0.03Budhirajadeath, p=0.04Niaeedeath, p=0.001Okumuşdeath, p=0.55Rezairecov. time, p=0.02Lima-Moralesdeath, p<0.001Beltran-Gonzalezdeath, p=1.00Pott-JuniorICU, p=0.25Huvemekno improv., p=0.28Late treatment% Lower Risk% Increased Riskivmmeta.com 4/20/21Probability results fromineffective treatmentOct 13 p<0.051 in 20Nov 13 p<0.011 in 100Nov 24 p<0.0011 in 1 thousandFeb 23 p<0.00011 in 10 thousand
Figure 4. Chronological history of early and late treatment results, with the probability that the observed frequency of positive results occurred due to random chance from an ineffective treatment.
100+ 75 50 25 25 50 75 100 Shoumansymp. case, p<0.001Carvallocases, p<0.0001Beheracases, p<0.0001Elgazzarcases, p=0.03Carvallocases, p<0.0001Hellwigcases, p<0.02Bernigauddeath, p=0.08Alamcases, p<0.0001Vallejoscases, p<0.0001Chahlacases, p=0.002Beheracases, p<0.001Taniokadeath, p=0.002Seetsevere case, p=0.01Morgensternhosp., p=0.50Prophylaxis% Lower Risk% Increased Riskivmmeta.com 4/20/21Probability results fromineffective treatmentNov 17 p<0.051 in 20Nov 28 p<0.011 in 100Jan 11 p<0.0011 in 1 thousandApr 16 p<0.00011 in 10 thousand
Figure 5. Chronological history of prophylaxis results.
    
  
00.250.50.7511.251.51.752+Chowdhury (RCT)0.19[0.01-3.96]14mghosp.0/602/56OT​1 CT​2RRCIDose (4d)TreatmentControlEspitia-Hernandez0.03[0.01-0.11]12mgviral+0/287/7CT​2Carvallo0.12[0.01-1.06]36mgdeath1/333/12CT​2Cadegiani0.22[0.01-4.48]42mgdeath0/1102/137Ahmed (DB RCT)0.15[0.01-2.70]48mgsymptoms0/173/19Chaccour (DB RCT)0.47[0.19-1.16]28mgsymp. prob.1212Afsar0.08[0.00-1.32]48mgsymptoms0/377/53Babalola (DB RCT)0.36[0.10-1.27]24mgviral+4020OT​1Kirti (DB RCT)0.11[0.01-2.05]24mgdeath0/554/57Bukhari (RCT)0.18[0.07-0.46]12mgviral+4/4125/45Raad (SB RCT)0.14[0.01-2.70]14mghosp.0/503/50MD​3Mohan (DB RCT)0.38[0.08-1.75]28mgno recov.2/406/45Schwartz (DB RCT)0.19[0.01-3.92]36mghosp.0/492/45Elalfy0.13[0.06-0.27]36mgviral+7/6244/51CT​2López-Me.. (DB RCT)0.33[0.01-8.11]84mgdeath0/2001/198Roy0.94[0.52-1.93]n/arecov. time1415CT​2Chahla (CLUS. RCT)0.11[0.02-0.52]24mgno disch.2/1108/62Mourya0.11[0.05-0.25]48mgviral+5/5047/50Tau​2 = 1.52; I​2 = 85.0%Early treatment0.19[0.09-0.38]21/1,008164/93481% improvementGorial0.29[0.01-5.76]14mgdeath0/162/71RRCIDose (4d)TreatmentControlKishoria (RCT)1.08[0.57-2.02]12mgno disch.11/197/13Podder (RCT)0.84[0.55-1.12]14mgrecov. time3230Khan0.13[0.02-1.01]12mgdeath1/1159/133Chachar (RCT)0.90[0.44-1.83]36mgno recov.9/2510/25Soto-Becerra0.83[0.71-0.97]14mgdeath92/2031,438/2,630Mahmud (DB RCT)0.14[0.01-2.75]12mgdeath0/1833/183CT​2Rajter (PSM)0.54[0.27-0.99]14mgdeath13/9824/98Hashim (SB RCT)0.33[0.07-1.60]28mgdeath2/706/70CT​2Camprubí0.67[0.13-3.35]14mgICU2/133/13Elgazzar (RCT)0.08[0.02-0.35]112mgdeath2/20024/200OT​1Spoorthi0.79[0.62-1.01]n/arecov. time5050CT​2Budhiraja0.01[0.00-0.15]n/adeath0/34103/942Niaee (DB RCT)0.18[0.06-0.55]28mgdeath4/12011/60Okumuş (DB RCT)0.67[0.27-1.64]56mgdeath6/309/30Rezai (DB RCT)0.79[0.63-0.98]14mgrecov. time5152MD​3Lima-Morales0.22[0.12-0.41]12mgdeath15/48152/287CT​2Beltran-.. (DB RCT)0.86[0.29-2.56]12mgdeath5/366/37Pott-Junior (RCT)0.15[0.01-1.93]14mgICU1/271/4Huvemek (DB RCT)0.68[0.38-1.23]84mgno improv.13/5019/50Tau​2 = 0.13; I​2 = 65.6%Late treatment0.57[0.44-0.73]176/1,8531,727/4,97843% improvementShouman (RCT)0.09[0.03-0.23]36mgsymp. case15/20359/101RRCIDose (1m)TreatmentControlCarvallo0.04[0.00-0.63]14mgcases0/13111/98CT​2Behera0.46[0.29-0.71]42mgcases41/117145/255Elgazzar (RCT)0.20[0.04-0.89]112mgcases2/10010/100Carvallo0.00[0.00-0.02]48mgcases0/788237/407CT​2Hellwig (ECO.)0.22[0.05-0.89]14mgcasesecologicalBernigaud0.01[0.00-0.10]84mgdeath0/69150/3,062Alam0.09[0.04-0.24]12mgcases4/5844/60Vallejos0.27[0.15-0.48]48mgcases13/38961/486MD​3Chahla (RCT)0.05[0.00-0.80]48mgcases0/11710/117CT​2Behera0.17[0.12-0.23]42mgcases45/2,199133/1,147Tanioka (ECO.)0.12[0.03-0.51]14mgdeathecologicalSeet (CLUS. RCT)0.50[0.33-0.76]12mgsevere case32/61764/619OT​1Morgenstern (PSM)0.20[0.01-4.15]56mghosp.0/2712/271Tau​2 = 0.58; I​2 = 83.8%Prophylaxis0.15[0.09-0.25]152/5,059926/6,72385% improvementAll studies0.28[0.22-0.36]349/7,9202,817/12,63572% improvementAll 52 ivermectin COVID-19 studiesivmmeta.com 4/20/211 OT: ivermectin vs. other treatment2 CT: study uses combined treatment3 MD: minimal detail available currentlyTau​2 = 0.47; I​2 = 87.2%; Z = 9.62 (p < 0.0001)Lower RiskIncreased Risk
Figure 6. Random effects meta-analysis for all studies.
    
  
00.250.50.7511.251.51.752+Carvallo0.12[0.01-1.06]36mg1/333/12CT​2RRCIDose (4d)TreatmentControlCadegiani0.22[0.01-4.48]42mg0/1102/137Kirti (DB RCT)0.11[0.01-2.05]24mg0/554/57López-Me.. (DB RCT)0.33[0.01-8.11]84mg0/2001/198Tau​2 = 0.00; I​2 = 0.0%Early treatment0.16[0.04-0.63]1/39810/40484% improvementGorial0.29[0.01-5.76]14mg0/162/71RRCIDose (4d)TreatmentControlKhan0.13[0.02-1.01]12mg1/1159/133Soto-Becerra0.83[0.71-0.97]14mg92/2031,438/2,630Mahmud (DB RCT)0.14[0.01-2.75]12mg0/1833/183CT​2Rajter (PSM)