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Ivermectin for COVID-19: real-time meta analysis of 76 studies
https://ivmmeta.com/
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ All studies 65% 76 57,647 Improvement, Studies, Patients Relative Risk With exclusions 71% 51 44,741 Primary outcome 59% 76 57,700 Mortality 57% 37 44,932 Ventilation 46% 12 2,316 ICU admission 57% 7 21,857 Hospitalization 41% 20 11,380 Recovery 51% 24 3,866 Cases 78% 15 13,297 Viral clearance 57% 22 2,614 RCTs 57% 32 7,032 RCTs w/exc. 63% 25 4,423 Peer-reviewed 67% 55 25,228 Peer-rvw w/exc. 70% 41 21,188 Prophylaxis 83% 16 19,365 Early 66% 30 27,832 Late 39% 30 10,450 Ivermectin for COVID-19 ivmmeta.com Jan 26, 2022 Favors ivermectin Favors control
Statistically significant improvements are seen for mortality, ventilation, ICU admission, hospitalization, recovery, cases, and viral clearance. All remain significant after exclusions. 49 studies from 45 independent teams in 21 different countries show statistically significant improvements in isolation (37 primary outcome, 34 most serious outcome).
Meta analysis using the most serious outcome shows 66% [53‑75%] and 83% [74‑89%] improvement for early treatment and prophylaxis, with similar results after exclusion based sensitivity analysis (excluding all GMK/BBC team studies), for primary outcomes, for peer-reviewed studies, and for RCTs.
Results are very robust — in worst case exclusion sensitivity analysis 60 of 76 studies must be excluded to avoid finding statistically significant efficacy.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ All studies 65% 76 57,647 Improvement, Studies, Patients Relative Risk With exclusions 71% 51 44,741 Primary outcome 59% 76 57,700 Mortality 57% 37 44,932 Ventilation 46% 12 2,316 ICU admission 57% 7 21,857 Hospitalization 41% 20 11,380 Recovery 51% 24 3,866 Cases 78% 15 13,297 Viral clearance 57% 22 2,614 RCTs 57% 32 7,032 RCTs w/exc. 63% 25 4,423 Peer-reviewed 67% 55 25,228 Peer-rvw w/exc. 70% 41 21,188 Prophylaxis 83% 16 19,365 Early 66% 30 27,832 Late 39% 30 10,450 Ivermectin for COVID-19 ivmmeta.com Jan 26, 2022 Favors ivermectin Favors control
While many treatments have some level of efficacy, they do not replace vaccines and other measures to avoid infection. Only 25% of ivermectin studies show zero events in the treatment arm.
Multiple treatments are typically used in combination, which may be significantly more effective.
Elimination of COVID-19 is a race against viral evolution. No treatment, vaccine, or intervention is 100% available and effective for all variants. All practical, effective, and safe means should be used, including treatments, as supported by Pfizer [Pfizer, TrialSiteNews]. Denying the efficacy of treatments increases mortality, morbidity, collateral damage, and endemic risk.
Studies Prophylaxis Early treatment Late treatment PatientsAuthors
All studies 76 83% [74‑89%] 66% [53‑75%] 39% [23‑52%] 57,647 718
Peer-reviewedPeer-reviewed 55 83% [73‑90%] 68% [50‑80%] 41% [17‑58%] 25,228 558
With GMK/BBC exclusionsw/GMK/BBC exclusions 51 82% [68‑89%] 73% [64‑80%] 53% [29‑69%] 44,741 545
Randomized Controlled TrialsRCTs 32 84% [25‑96%] 62% [45‑74%] 23% [-1‑41%] 7,032 361
RCTs w/GMK/BBC exclusionsRCTs w/GMK/BBC exc. 25 84% [25‑96%] 69% [56‑77%] 26% [-2‑46%] 4,423 299
Percentage improvement with ivermectin treatment
There is evidence of a negative publication bias, and the probability that an ineffective treatment generated results as positive as the 76 studies is estimated to be 1 in 68 billion.
Over 20 countries have adopted ivermectin for COVID-19. The evidence base is much larger and has much lower conflict of interest than typically used to approve drugs.
All data to reproduce this paper and sources are in the appendix. See [Bryant, Hariyanto, Kory, Lawrie, Nardelli] for other meta analyses with similar results confirming efficacy.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Kory et al. 69% 0.31 [0.20-0.47] Improvement, RR [CI] Bryant et al. 62% 0.38 [0.19-0.73] Lawrie et al. 83% 0.17 [0.08-0.35] Nardelli et al. 79% 0.21 [0.11-0.36] Hariyanto et al. 69% 0.31 [0.15-0.62] WHO (OR) 81% 0.19 [0.09-0.36] ivmmeta 57% 0.43 [0.32-0.57] Ivermectin meta analysis mortality results ivmmeta.com Jan 26, 2022 Favors ivermectin Favors control
Evidence base used for other COVID-19 approvals
MedicationStudiesPatientsImprovement
Molnupiravir (UK)177550%
Budesonide (UK)11,77917%
Remdesivir (USA EUA)11,06331%
Casirivimab/i.. (USA EUA)179966%
Ivermectin evidence7657,623 65% [57‑72%]
    
  
A
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg hosp. 0/60 2/56 OT​1 CT​2 Improvement, RR [CI] Dose (4d) Treatment Control Espitia-Hernandez 70% 0.30 [0.16-0.55] 12mg recov. time 28 (n) 7 (n) CT​2 Carvallo 85% 0.15 [0.02-1.28] 36mg death 1/32 3/14 CT​2 Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg death 0/183 3/183 CT​2 Szente Fonseca -14% 1.14 [0.75-1.66] 24mg hosp. 340 (n) 377 (n) Cadegiani 78% 0.22 [0.01-4.48] 42mg death 0/110 2/137 CT​2 Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Chaccour (DB RCT) 96% 0.04 [0.00-1.01] 28mg symptoms 12 (n) 12 (n) Ghauri 92% 0.08 [0.01-0.88] 48mg no recov. 0/37 7/53 Babalola (DB RCT) 64% 0.36 [0.10-1.27] 24mg viral+ 40 (n) 20 (n) OT​1 Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 Mohan (DB RCT) 62% 0.38 [0.08-1.75] 28mg no recov. 2/40 6/45 Biber (DB RCT) 70% 0.30 [0.03-2.76] 36mg hosp. 1/47 3/42 Elalfy 87% 0.13 [0.06-0.27] 36mg viral+ 7/62 44/51 CT​2 López-Me.. (DB RCT) 67% 0.33 [0.01-8.11] 84mg death 0/200 1/198 Roy 6% 0.94 [0.52-1.93] n/a recov. time 14 (n) 15 (n) CT​2 Chahla (CLUS. RCT) 87% 0.13 [0.03-0.54] 24mg no disch. 2/110 20/144 Mourya 89% 0.11 [0.05-0.25] 48mg viral+ 5/50 47/50 Loue (QR) 70% 0.30 [0.04-2.20] 14mg death 1/10 5/15 Merino (QR) 74% 0.26 [0.11-0.57] 24mg hosp. population-based cohort Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Krolewiecki (RCT) -152% 2.52 [0.11-58.1] 168mg ventilation 1/27 0/14 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg death 4/250 3/251 Together.. (DB RCT) 18% 0.82 [0.44-1.52] 84mg death 18/677 22/678 Buonfrate (DB RCT) -211% 3.11 [0.13-73.3] 336mg hosp. 1/28 0/31 Mayer 55% 0.45 [0.32-0.63] 151mg death 3,266 (n) 17,966 (n) Borody 92% 0.08 [0.01-0.79] 96mg death 0/600 6/600 CT​2 SC​4 Abbas (DB RCT) -4% 1.04 [0.07-16.4] 84mg death 1/99 1/103 Tau​2 = 0.33, I​2 = 58.2%, p < 0.0001 Early treatment 66% 0.34 [0.25-0.47] 54/6,542 226/21,290 66% improvement Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Improvement, RR [CI] Dose (1m) Treatment Control Carvallo 96% 0.04 [0.00-0.63] 14mg cases 0/131 11/98 CT​2 Behera 54% 0.46 [0.29-0.71] 42mg cases 41/117 145/255 Carvallo 100% 0.00 [0.00-0.02] 48mg cases 0/788 237/407 CT​2 Hellwig (ECO.) 78% 0.22 [0.06-0.76] 14mg cases ecological Bernigaud 99% 0.01 [0.00-0.10] 84mg death 0/69 150/3,062 Alam 91% 0.09 [0.04-0.25] 12mg cases 4/58 44/60 IVERCOR PREP 73% 0.27 [0.15-0.48] 48mg cases 13/389 61/486 MD​3 Chahla (RCT) 95% 0.05 [0.00-0.80] 48mg m/s case 0/117 10/117 CT​2 Behera 83% 0.17 [0.12-0.23] 42mg cases 45/2,199 133/1,147 Tanioka (ECO.) 88% 0.12 [0.03-0.46] 14mg death ecological Seet (CLUS. RCT) 50% 0.50 [0.33-0.76] 12mg symp. case 32/617 64/619 OT​1 Morgenstern (PSM) 80% 0.20 [0.01-4.15] 56mg hosp. 0/271 2/271 Mondal 88% 0.12 [0.01-0.55] n/a symp. case 128 (n) 1,342 (n) Samajdar 80% 0.20 [0.11-0.38] n/a cases 12/164 29/81 Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg death 25/3,034 79/3,034 Tau​2 = 0.45, I​2 = 81.8%, p < 0.0001 Prophylaxis 83% 0.17 [0.11-0.26] 187/8,285 1,024/11,080 83% improvement All studies 75% 0.25 [0.19-0.33] 241/14,827 1,250/32,370 75% improvement Ivermectin COVID-19 early treatment and prophylaxis studies ivmmeta.com Jan 26, 2022 Tau​2 = 0.41, I​2 = 73.0%, p < 0.0001 Effect extraction pre-specified, see appendix 1 OT: ivermectin vs. other treatment3 MD: minimal detail available currently 2 CT: study uses combined treatment4 SC: study uses synthetic control arm Favors ivermectin Favors control
    
  
B
    
  
C
    
  
D
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 heterogeneity section. Effect extraction is pre-specified, using the most serious outcome reported. 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 details of effect extraction and full dosage information 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 or greater frequency of positive results were generated by 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, studies within each treatment stage, specific outcomes, peer-reviewed studies, 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, 9, 10, 11, 12, and 13 show forest plots for a random effects meta-analysis of all studies with pooled effects, and for studies reporting mortality results, ICU admission, mechanical ventilation, hospitalization, recovery, COVID-19 cases, and viral clearance results only. Figure 14 shows results for peer reviewed trials only, and the supplementary data contains peer reviewed and individual outcome results after exclusions. 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 25 30 83.3% 1 in 6 thousand 66% improvement
RR 0.34 [0.25‑0.47]
p < 0.0001
Late treatment 25 30 83.3% 1 in 6 thousand 39% improvement
RR 0.61 [0.48‑0.77]
p < 0.0001
Prophylaxis 16 16 100% 1 in 66 thousand 83% improvement
RR 0.17 [0.11‑0.26]
p < 0.0001
All studies 66 76 86.8% 1 in 68 billion 65% improvement
RR 0.35 [0.28‑0.43]
p < 0.0001
Table 1. Results by treatment stage.
    
  
Figure 3. Results by treatment stage.
    
  
    
  
Figure 4. Chronological history of early and late treatment results, with the probability that the observed or greater frequency of positive results were generated by an ineffective treatment.
Figure 5. Chronological history of prophylaxis results.
    
  
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg hosp. 0/60 2/56 OT​1 CT​2 Improvement, RR [CI] Dose (4d) Treatment Control Espitia-Hernandez 70% 0.30 [0.16-0.55] 12mg recov. time 28 (n) 7 (n) CT​2 Carvallo 85% 0.15 [0.02-1.28] 36mg death 1/32 3/14 CT​2 Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg death 0/183 3/183 CT​2 Szente Fonseca -14% 1.14 [0.75-1.66] 24mg hosp. 340 (n) 377 (n) Cadegiani 78% 0.22 [0.01-4.48] 42mg death 0/110 2/137 CT​2 Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Chaccour (DB RCT) 96% 0.04 [0.00-1.01] 28mg symptoms 12 (n) 12 (n) Ghauri 92% 0.08 [0.01-0.88] 48mg no recov. 0/37 7/53 Babalola (DB RCT) 64% 0.36 [0.10-1.27] 24mg viral+ 40 (n) 20 (n) OT​1 Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 Mohan (DB RCT) 62% 0.38 [0.08-1.75] 28mg no recov. 2/40 6/45 Biber (DB RCT) 70% 0.30 [0.03-2.76] 36mg hosp. 1/47 3/42 Elalfy 87% 0.13 [0.06-0.27] 36mg viral+ 7/62 44/51 CT​2 López-Me.. (DB RCT) 67% 0.33 [0.01-8.11] 84mg death 0/200 1/198 Roy 6% 0.94 [0.52-1.93] n/a recov. time 14 (n) 15 (n) CT​2 Chahla (CLUS. RCT) 87% 0.13 [0.03-0.54] 24mg no disch. 2/110 20/144 Mourya 89% 0.11 [0.05-0.25] 48mg viral+ 5/50 47/50 Loue (QR) 70% 0.30 [0.04-2.20] 14mg death 1/10 5/15 Merino (QR) 74% 0.26 [0.11-0.57] 24mg hosp. population-based cohort Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Krolewiecki (RCT) -152% 2.52 [0.11-58.1] 168mg ventilation 1/27 0/14 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg death 4/250 3/251 Together.. (DB RCT) 18% 0.82 [0.44-1.52] 84mg death 18/677 22/678 Buonfrate (DB RCT) -211% 3.11 [0.13-73.3] 336mg hosp. 1/28 0/31 Mayer 55% 0.45 [0.32-0.63] 151mg death 3,266 (n) 17,966 (n) Borody 92% 0.08 [0.01-0.79] 96mg death 0/600 6/600 CT​2 SC​4 Abbas (DB RCT) -4% 1.04 [0.07-16.4] 84mg death 1/99 1/103 Tau​2 = 0.33, I​2 = 58.2%, p < 0.0001 Early treatment 66% 0.34 [0.25-0.47] 54/6,542 226/21,290 66% improvement Gorial 71% 0.29 [0.01-5.76] 14mg death 0/16 2/71 Improvement, RR [CI] Dose (4d) Treatment Control Kishoria (RCT) -8% 1.08 [0.57-2.02] 12mg no disch. 11/19 7/13 Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Khan 87% 0.13 [0.02-1.00] 12mg death 1/115 9/133 Chachar (RCT) 10% 0.90 [0.44-1.83] 36mg no recov. 9/25 10/25 Soto-Becerra 17% 0.83 [0.71-0.97] 14mg death 92/203 1,438/2,630 Rajter (PSM) 46% 0.54 [0.27-0.99] 14mg death 13/98 24/98 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg death 0/59 6/70 CT​2 Camprubí 40% 0.60 [0.18-2.01] 14mg ventilation 3/13 5/13 Spoorthi 21% 0.79 [0.64-0.98] n/a recov. time 50 (n) 50 (n) CT​2 Budhiraja 99% 0.01 [0.00-0.15] n/a death 0/34 103/942 Okumuş (DB RCT) 33% 0.67 [0.27-1.64] 56mg death 6/30 9/30 Shahbazn.. (DB RCT) -197% 2.97 [0.13-70.5] 14mg death 1/35 0/34 Lima-Morales 78% 0.22 [0.12-0.41] 12mg death 15/481 52/287 CT​2 Gonzalez (DB RCT) 14% 0.86 [0.29-2.56] 12mg death 5/36 6/37 Pott-Junior (RCT) 85% 0.15 [0.01-1.93] 14mg ventilation 1/27 1/4 Huvemek (DB RCT) 32% 0.68 [0.38-1.23] 84mg no improv. 13/50 19/50 Ahsan 50% 0.50 [0.28-0.90] 21mg death 17/110 17/55 CT​2 Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg death 3/82 4/82 Hazan 86% 0.14 [0.01-2.15] 24mg death 0/24 synthetic CT​2 SC​4 Elavarasi 20% 0.80 [0.61-1.06] n/a death 48/283 311/1,475 Rezk 80% 0.20 [0.01-4.13] 72mg death 0/160 2/160 Malaysia M.. (RCT) 69% 0.31 [0.08-1.11] 112mg death 3/241 10/249 Ozer 75% 0.25 [0.06-1.13] 28mg death 2/60 8/60 Ferreira -5% 1.05 [0.32-3.43] n/a death 3/21 11/81 Jamir -53% 1.53 [0.88-2.67] n/a death 32/76 69/190 Baguma 97% 0.03 [0.00-11.7] n/a death 7 (n) 474 (n) Mustafa 64% 0.36 [0.12-1.14] varies death 3/73 42/371 Shimizu 100% 0.00 [0.00-0.01] 14mg death 0/39 8/49 Zubair -9% 1.09 [0.33-3.64] 12mg death 5/90 5/98 Tau​2 = 0.16, I​2 = 63.6%, p < 0.0001 Late treatment 39% 0.61 [0.48-0.77] 286/2,589 2,178/7,861 39% improvement Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Improvement, RR [CI] Dose (1m) Treatment Control Carvallo 96% 0.04 [0.00-0.63] 14mg cases 0/131 11/98 CT​2 Behera 54% 0.46 [0.29-0.71] 42mg cases 41/117 145/255 Carvallo 100% 0.00 [0.00-0.02] 48mg cases 0/788 237/407 CT​2 Hellwig (ECO.) 78% 0.22 [0.06-0.76] 14mg cases ecological Bernigaud 99% 0.01 [0.00-0.10] 84mg death 0/69 150/3,062 Alam 91% 0.09 [0.04-0.25] 12mg cases 4/58 44/60 IVERCOR PREP 73% 0.27 [0.15-0.48] 48mg cases 13/389 61/486 MD​3 Chahla (RCT) 95% 0.05 [0.00-0.80] 48mg m/s case 0/117 10/117 CT​2 Behera 83% 0.17 [0.12-0.23] 42mg cases 45/2,199 133/1,147 Tanioka (ECO.) 88% 0.12 [0.03-0.46] 14mg death ecological Seet (CLUS. RCT) 50% 0.50 [0.33-0.76] 12mg symp. case 32/617 64/619 OT​1 Morgenstern (PSM) 80% 0.20 [0.01-4.15] 56mg hosp. 0/271 2/271 Mondal 88% 0.12 [0.01-0.55] n/a symp. case 128 (n) 1,342 (n) Samajdar 80% 0.20 [0.11-0.38] n/a cases 12/164 29/81 Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg death 25/3,034 79/3,034 Tau​2 = 0.45, I​2 = 81.8%, p < 0.0001 Prophylaxis 83% 0.17 [0.11-0.26] 187/8,285 1,024/11,080 83% improvement All studies 65% 0.35 [0.28-0.43] 527/17,416 3,428/40,231 65% improvement All 76 ivermectin COVID-19 studies ivmmeta.com Jan 26, 2022 Tau​2 = 0.45, I​2 = 80.2%, p < 0.0001 Effect extraction pre-specified, see appendix 1 OT: ivermectin vs. other treatment3 MD: minimal detail available currently 2 CT: study uses combined treatment4 SC: study uses synthetic control arm Favors ivermectin Favors control
Figure 6. Random effects meta-analysis for all studies. This plot shows pooled effects, analysis for individual outcomes is below, and more details on pooled effects can be found in the heterogeneity section. Effect extraction is pre-specified, using the most serious outcome reported. 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 details of effect extraction and full dosage information see the appendix.
    
  
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Carvallo 85% 0.15 [0.02-1.28] 36mg 1/32 3/14 CT​1 Improvement, RR [CI] Dose (4d) Treatment Control Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg 0/183 3/183 CT​1 Cadegiani 78% 0.22 [0.01-4.48] 42mg 0/110 2/137 CT​1 Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg 0/55 4/57 López-Me.. (DB RCT) 67% 0.33 [0.01-8.11] 84mg 0/200 1/198 Loue (QR) 70% 0.30 [0.04-2.20] 14mg 1/10 5/15 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg 4/250 3/251 Together.. (DB RCT) 18% 0.82 [0.44-1.52] 84mg 18/677 22/678 Mayer 55% 0.45 [0.32-0.63] 151mg 3,266 (n) 17,966 (n) Borody 92% 0.08 [0.01-0.79] 96mg 0/600 6/600 CT​1 SC​2 Abbas (DB RCT) -4% 1.04 [0.07-16.4] 84mg 1/99 1/103 Tau​2 = 0.03, I​2 = 7.8%, p = 0.00011 Early treatment 51% 0.49 [0.35-0.70] 25/5,482 50/20,202 51% improvement Gorial 71% 0.29 [0.01-5.76] 14mg 0/16 2/71 Improvement, RR [CI] Dose (4d) Treatment Control Khan 87% 0.13 [0.02-1.00] 12mg 1/115 9/133 Soto-Becerra 17% 0.83 [0.71-0.97] 14mg 92/203 1,438/2,630 Rajter (PSM) 46% 0.54 [0.27-0.99] 14mg 13/98 24/98 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg 0/59 6/70 CT​1 Budhiraja 99% 0.01 [0.00-0.15] n/a 0/34 103/942 Okumuş (DB RCT) 33% 0.67 [0.27-1.64] 56mg 6/30 9/30 Shahbazn.. (DB RCT) -197% 2.97 [0.13-70.5] 14mg 1/35 0/34 Lima-Morales 78% 0.22 [0.12-0.41] 12mg 15/481 52/287 CT​1 Gonzalez (DB RCT) 14% 0.86 [0.29-2.56] 12mg 5/36 6/37 Ahsan 50% 0.50 [0.28-0.90] 21mg 17/110 17/55 CT​1 Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg 3/82 4/82 Hazan 86% 0.14 [0.01-2.15] 24mg 0/24 synthetic CT​1 SC​2 Elavarasi 20% 0.80 [0.61-1.06] n/a 48/283 311/1,475 Rezk 80% 0.20 [0.01-4.13] 72mg 0/160 2/160 Malaysia M.. (RCT) 69% 0.31 [0.08-1.11] 112mg 3/241 10/249 Ozer 75% 0.25 [0.06-1.13] 28mg 2/60 8/60 Ferreira -5% 1.05 [0.32-3.43] n/a 3/21 11/81 Jamir -53% 1.53 [0.88-2.67] n/a 32/76 69/190 Baguma 97% 0.03 [0.00-11.7] n/a 7 (n) 474 (n) Mustafa 64% 0.36 [0.12-1.14] varies 3/73 42/371 Shimizu 100% 0.00 [0.00-0.01] 14mg 0/39 8/49 Zubair -9% 1.09 [0.33-3.64] 12mg 5/90 5/98 Tau​2 = 0.30, I​2 = 71.0%, p < 0.0001 Late treatment 51% 0.49 [0.35-0.70] 249/2,373 2,136/7,676 51% improvement Bernigaud 99% 0.01 [0.00-0.10] 84mg 0/69 150/3,062 Improvement, RR [CI] Dose (1m) Treatment Control Tanioka (ECO.) 88% 0.12 [0.03-0.46] 14mg ecological