https://ivmmeta.com/
•100% of the
41 studies to date report positive effects.
Random effects meta-analysis for early treatment and pooled effects shows a reduction of 83%, RR
0.17
[0.11-0.28].
Prophylactic use shows a reduction of
89%, RR
0.11
[0.05-0.23].
Mortality results show 78% lower mortality, RR
0.22
[0.12-0.41] for all treatment delays, and
86% lower, RR
0.14
[0.03-0.62] for early treatment.
•100% of the
20 Randomized Controlled Trials (RCTs) report positive effects,
with an estimated reduction of
72%, RR
0.28
[0.17-0.47].
•The probability that an ineffective
treatment generated results as positive as the
41 studies to date is estimated to be 1 in
2 trillion (p = 0.00000000000045).
 |
Show forest plot for: |
| All studies | |
| With exclusions | |
| Mortality results | |
| Viral clearance | |
| Case results | |
| RCT mortality | |
| All RCTs |
| Early treatment | 83% improvement | RR 0.17 [0.11-0.28] |
| Late treatment | 52% improvement | RR 0.48 [0.35-0.64] |
| Prophylaxis | 89% improvement | RR 0.11 [0.05-0.23] |
| Total | 41 studies | 304 authors | 14,833 patients |
| RCT | 20 studies | 153 authors | 2,796 patients |
Figure 1. A. Random effects
meta-analysis excluding late treatment. Simplified dosages are shown for
comparison, these are the total dose in the first two 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 only, for COVID-19 case
results only, and for Randomized Controlled Trials (RCTs) only.
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.
Table 1 summarizes the results.
| Treatment time | Number of studies reporting positive results | Total number of studies | Percentage of studies reporting positive results | Probability of an equal or greater percentage of positive results from an ineffective treatment | Random effects meta-analysis results |
| Early treatment | 13 | 13 | 100% |
0.00012
0.00012
1 in 8 thousand |
83% improvement RR 0.17 [0.11‑0.28] p < 0.0001 |
| Late treatment | 17 | 17 | 100% |
0.0000076
7.6e-06
1 in 131 thousand |
52% improvement RR 0.48 [0.35‑0.64] p < 0.0001 |
| Prophylaxis | 11 | 11 | 100% |
0.00049
0.00049
1 in 2 thousand |
89% improvement RR 0.11 [0.05‑0.23] p < 0.0001 |
| All studies | 41 | 41 | 100% |
0.00000000000045
4.5e-13
1 in 2 trillion |
76% improvement RR 0.24 [0.18‑0.33] 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 frequency of
positive results occurred due to random chance from an ineffective
treatment.
Figure 5. Chronological history of prophylaxis results.
Figure 6. Random effects meta-analysis for all studies.
Figure 7. Random effects meta-analysis for
mortality results only.
Figure 8. Random effects meta-analysis for
COVID-19 case results only.
Figure 9. Random effects meta-analysis for
viral clearance results only.
Randomized Controlled Trials (RCTs)
Results restricted to Randomized Controlled Trials (RCTs) are
shown in Figure 10, 11, 12, and 13, and
Table 2. RCT results are similar to non-RCT results.
Evidence shows that non-RCT trials can also provide reliable results.
[Concato] find that well-designed observational studies do not
systematically overestimate the magnitude of the effects of treatment compared
to RCTs. [Anglemyer] summarized reviews comparing RCTs to
observational studies and found little evidence for significant differences in
effect estimates. [Lee] shows that only 14% of the guidelines of
the Infectious Diseases Society of America were based on RCTs. Evaluation of
studies relies on an understanding of the study and potential biases.
Limitations in an RCT can outweigh the benefits, for example excessive
dosages, excessive treatment delays, or Internet survey bias could have a
greater effect on results. Ethical issues may also prevent running RCTs for
known effective treatments. For more on issues with RCTs see
[Deaton, Nichol].
Figure 10. Randomized Controlled Trials. The
distribution of results for RCTs is similar to the distribution for all other
studies.
Figure 11. Random effects meta-analysis for
Randomized Controlled Trials only.
Figure 12. Random effects meta-analysis for
Randomized Controlled Trial mortality results only.
| Treatment time | Number of studies reporting positive results | Total number of studies | Percentage of studies reporting positive results | Probability of an equal or greater percentage of positive results from an ineffective treatment | Random effects meta-analysis results |
| Randomized Controlled Trials | 20 | 20 | 100% |
0.00000095
9.5e-07
1 in 1 million |
72% improvement RR 0.28 [0.17‑0.47] p < 0.0001 |
| Randomized Controlled Trials (excluding late treatment) | 11 | 11 | 100% |
0.00049
0.00049
1 in 2 thousand |
81% improvement RR 0.19 [0.11‑0.31] p < 0.0001 |
Table 2. Summary of RCT results.
Exclusions
To avoid bias in the selection of studies, we include all
studies in the main analysis. Here we show the results after excluding studies
with critical issues likely to alter results, non-standard studies, and
studies where very minimal detail is currently available.
[Soto-Becerra] is a database analysis covering anyone
with ICD-10 COVID-19 codes, which includes asymptomatic PCR+ patients.
Therefore many patients in the control group are likely asymptomatic with
regards to SARS-CoV-2, but in the hospital for another reason. For those that
had symptomatic COVID-19, there is also likely significant confounding by
indication. KM curves show that the treatment groups were in more serious
condition, with more than the total excess mortality at 30 days occurring on
day 1. All treatments are worse than the control group at 30 days, while at
the latest followup all treatments show lower mortality than control. The
machine learning system used also appears over-parameterized and likely to
result in significant overfitting and inaccurate results. There is also no
real control group in this study - patients receiving the treatments after 48
hours were put in the control group. Authors also state that outcomes within
24 hours were excluded, however the KM curves show significant mortality at
day 1 (only for the treatment groups). Note that this study provides both 30
day mortality and weighted KM curves up to day 43 for ivermectin, we use the
day 43 results as per our protocol.
There is no paper currently available for [Asghar].
[Vallejos] reports prophylaxis results, however only very minimal
details are currently available in a news report. We include these results for
additional confirmation of the efficacy observed in other trials, however this
study is excluded here. [Hellwig] provide an analysis of African
countries and COVID-19 cases as a function of whether widespread prophylactic
use of ivermectin is used for parasitic infections. Since this is a different
kind of study to the typical trial, it is excluded here. [Krolewiecki]
show a concentration dependent antiviral activity of ivermectin whereby the
viral decay rate for patients with ivermectin >160ng/mL was 0.64
log10 copies/reaction/day versus 0.13 for control. However, they do
not provide the results for the entire treatment group vs. control. Results
for [Raad, Rezai] are available in [Hill], however no paper is
currently available.
Summarizing, the studies excluded are as follows, and the
resulting forest plot is shown in Figure 14.
[Asghar], detail too minimal.
[Carvallo], control group formed from cases in the same hospital not in the study.
[Hellwig], not a typical trial, analysis of African countries that used or did not use ivermectin prophylaxis for parasitic infections.
[Raad], detail too minimal.
[Rezai], detail too minimal.
[Soto-Becerra], substantial unadjusted confounding by indication likely, includes PCR+ patients that may be asymptomatic for COVID-19 but in hospital for other reasons.
[Vallejos], detail too minimal.
Figure 14. Random effects meta-analysis
excluding studies with significant issues.
Discussion
Publishing is often biased towards positive results, which we
would need to adjust for when analyzing the percentage of positive results.
For ivermectin, there is currently not enough data to evaluate publication
bias with high confidence. One method to evaluate bias is to compare
prospective vs. retrospective studies. Prospective studies are likely to be
published regardless of the result, while retrospective studies are more
likely to exhibit bias. For example, researchers may perform preliminary
analysis with minimal effort and the results may influence their decision to
continue. Retrospective studies also provide more opportunities for the
specifics of data extraction and adjustments to influence results.
Figure 15 shows a scatter plot of results for prospective and
retrospective studies. The median effect size for prospective studies is
82% improvement, compared to
78% for retrospective studies, i.e.,
currently the prospective studies, which are less likely to exhibit a positive
publication bias, show more positive results.
Figure 15. Prospective vs. retrospective studies.
Typical meta analyses involve subjective selection criteria,
effect extraction rules, and study bias evaluation, which can be used to bias
results towards a specific outcome. In order to avoid bias we include all
studies and use a pre-specified method to extract results from all studies.
Every day that the approval of ivermectin is delayed results in thousands of
deaths, so it is important to consider all available data. We note that the
positive results to date are very consistent and are relatively insensitive to
potential selection criteria, effect extraction rules, and/or bias
evaluation.
Studies vary significantly in terms of treatment delay,
treatment regimen, patients characteristics, and (for the pooled effects
analysis) outcomes, as reflected in the high degree of heterogeneity. However
the results consistently show a positive effect of treatment, and with the
exception of some late treatment studies, the effect size is large.
Conclusion
Ivermectin is an effective treatment for COVID-19. The
probability that an ineffective treatment generated results as positive as the
41 studies to date is estimated to be 1 in
2 trillion (p = 0.00000000000045). As
expected for an effective treatment, early treatment is more successful, with
an estimated reduction of 83%
in the effect measured using a random effects meta-analysis, RR
0.17
[0.11-0.28].
Revisions
This paper is data driven, all graphs and numbers are
dynamically generated. We will update the paper as new studies are released or
with any corrections. Please
submit updates and corrections at https://ivmmeta.com/.
12/2: We added [Ahmed].
12/7: We added [Chaccour].
12/11: We added [Soto-Becerra].
12/16: We added [Afsar].
12/17: We added [Alam].
12/26: We added [Carvallo (C), Vallejos].
12/27: We added the total number of authors and patients.
12/29: We added meta analysis excluding late treatment.
12/31: We added additional details about the studies in the
appendix.
1/2: We added dosage information and we added the number of
patients to the forest plots.
1/5: We added direct links to the study details in the forest
plots.
1/6: We added [Babalola].
1/7: We added direct links to the study details in the
chronological plots.
1/9: We added [Kirti]. Due to the much larger size of
the control group in [Bernigaud], we limited the size of the control
group to be the same as the treatment group for calculation of the number of
patients.
1/10: We put all prophylaxis studies in a single group.
1/11: We added [Chala].
1/12: We added [Okumuş].
1/15: We added the effect measured for each study in the forest
plots.
1/16: We moved the analysis with exclusions to the main text,
and added additional commentary.
1/17: We added [Asghar].
1/25: We updated [Vallejos] with the recently released
results.
1/26: We updated [Shouman] with the journal version of
the article.
2/2: We added [Mohan].
2/5: We added [Bukhari].
2/10: We added [Lima-Morales].
2/11: We added more details on the analysis of prospective vs.
retrospective studies.
2/12: We added [Schwartz].
2/14: We added analysis restricted to COVID-19 case outcomes,
and we added additional results in the abstract.
2/15: We added [Behera].
2/16: We updated [Behera (B)] to the journal version of
the paper.
2/17: We added [Elalfy], and we added analysis
restricted to viral clearance outcomes, and mortality results restricted to
RCTs.
2/18: We updated [Babalola] to the journal version of
the paper.
We performed ongoing searches of PubMed, medRxiv,
ClinicalTrials.gov, The Cochrane Library, Google Scholar, Collabovid, Research
Square, ScienceDirect, Oxford University Press, the reference lists of other
studies and meta-analyses, and submissions to the site c19ivermectin.com, which regularly
receives submissions of studies upon publication.
Search terms were ivermectin and COVID-19 or SARS-CoV-2, or simply ivermectin.
Automated searches are performed every hour with notifications of new matches.
All studies regarding the use of ivermectin for COVID-19 that report an effect
compared to a control group are included in the main analysis. This is a
living analysis and is updated regularly.
We extracted effect sizes and associated data from all studies.
If studies report multiple kinds of effects then the most serious outcome is
used in calculations for that study. For example, if effects for mortality and
cases are both reported, the effect for mortality is used, this may be
different to the effect that a study focused on. If symptomatic results are
reported at multiple times, we used the latest time, for example if mortality
results are provided at 14 days and 28 days, the results at 28 days are used.
Mortality alone is preferred over combined outcomes. Outcomes with zero events
in both arms were not used. Clinical outcome is considered more important than
PCR testing status. For PCR results reported at multiple times, where a
majority of patients recover in both groups, preference is given to results
mid-recovery (after most or all patients have recovered there is no room for
an effective treatment to do better). When results provide an odds ratio, we
computed the relative risk when possible, or converted to a relative risk
according to [Zhang]. Reported confidence intervals and
p-values were used when available, using adjusted values when provided.
If multiple types of adjustments are reported including propensity score
matching (PSM), the PSM results are used. When needed, conversion between
reported p-values and confidence intervals followed
[Altman, Altman (B)], and Fisher's exact test was used to calculate
p-values for event data. If continuity correction for zero values is
required, we use the reciprocal of the opposite arm with the sum of the
correction factors equal to 1 [Sweeting]. Results are all expressed
with RR < 1.0 suggesting effectiveness. Most results are the relative risk of
something negative. If studies report relative times, results are expressed as
the ratio of the time for the ivermectin group versus the time for the control
group. Calculations are done in Python (3.9.1) with
scipy (1.5.4), pythonmeta (1.11), numpy (1.19.4), statsmodels (0.12.1), and plotly (4.14.1).
The forest plots are computed using PythonMeta
[Deng] with the DerSimonian and Laird random effects model (the
fixed effect assumption is not plausible in this case). The forest plots show
simplified dosages for comparison, these are the total dose in the first two
days for treatment, and the monthly dose for prophylaxis, for a 70kg person.
For full dosage details see below.
We received no funding, this research is done in our spare
time. We have no affiliations with any pharmaceutical companies or political
parties.
We have classified studies as early treatment if most patients
are not already at a severe stage at the time of treatment, and treatment
started within 5 days after the onset of symptoms, although a shorter time may
be preferable. Antivirals are typically only considered effective when used
within a shorter timeframe, for example 0-36 or 0-48 hours for oseltamivir,
with longer delays not being effective [McLean, Treanor].
Due to the much larger size of the control group in
[Bernigaud], we limit the size of the control group to be the same as
the treatment group for calculation of the number of patients.
A summary of study results is below. Please submit
updates and corrections at https://ivmmeta.com/.
Effect extraction follows pre-specified rules as detailed above
and gives priority to more serious outcomes. Only the first (most serious)
outcome is used in calculations, which may differ from the effect a paper
focuses on.
| [Afsar], 12/15/2020, retrospective, Pakistan, South Asia, preprint, 6 authors, dosage 12mg days 1-6. | risk of fever at day 14, 92.2% lower, RR 0.08, p = 0.04, treatment 0 of 37 (0.0%), control 7 of 53 (13.2%). |
| [Ahmed], 12/2/2020, Double Blind Randomized Controlled Trial, Bangladesh, South Asia, peer-reviewed, 15 authors, dosage 12mg days 1-5, ivermectin + doxycycline group took only a single dose of ivermectin. | risk of unresolved symptoms, 85.0% lower, RR 0.15, p = 0.09, treatment 0 of 17 (0.0%), control 3 of 19 (15.8%), day 7 fever ivermectin. |
| risk of unresolved symptoms, 62.7% lower, RR 0.37, p = 0.35, treatment 1 of 17 (5.9%), control 3 of 19 (15.8%), day 7 fever ivermectin + doxycycline. | |
| risk of no virological cure, 42.5% lower, RR 0.58, p = 0.01, treatment 11 of 22 (50.0%), control 20 of 23 (87.0%), day 7 ivermectin. | |
| risk of no virological cure, 20.0% lower, RR 0.80, p = 0.28, treatment 16 of 23 (69.6%), control 20 of 23 (87.0%), day 7 ivermectin + doxycycline. | |
| risk of no virological cure, 62.7% lower, RR 0.37, p = 0.02, treatment 5 of 22 (22.7%), control 14 of 23 (60.9%), day 14 ivermectin. | |
| risk of no virological cure, 35.7% lower, RR 0.64, p = 0.24, treatment 9 of 23 (39.1%), control 14 of 23 (60.9%), day 14 ivermectin + doxycycline. | |
| time to viral-, 23.6% lower, relative time 0.76, p = 0.02, ivermectin. | |
| time to viral-, 9.4% lower, relative time 0.91, p = 0.27, ivermectin + doxycycline. | |
| [Asghar], 1/16/2021, Randomized Controlled Trial, Pakistan, South Asia, preprint, 1 author, dosage 200μg/kg days 1, 8. | risk of no virological cure, 82.1% lower, RR 0.18, p < 0.001, treatment 50, control 50, day 7. |
| [Babalola], 1/6/2021, Double Blind Randomized Controlled Trial, Nigeria, Africa, peer-reviewed, baseline oxygen requirements 8.3%, 10 authors, dosage 12mg or 6mg q84h for two weeks. | adjusted risk of viral+ at day 5, 63.9% lower, RR 0.36, p = 0.11, treatment 40, control 20, adjusted per study. |
| risk of no virological cure, 58.0% lower, RR 0.42, p = 0.01, treatment 20, control 20, 12mg - Cox proportional hazard model. | |
| risk of no virological cure, 40.5% lower, RR 0.60, p = 0.12, treatment 20, control 20, 6mg - Cox proportional hazard model. | |
| time to viral-, 49.2% lower, relative time 0.51, treatment 20, control 20, 12mg. | |
| time to viral-, 34.4% lower, relative time 0.66, treatment 20, control 20, 6mg. | |
| [Cadegiani], 11/4/2020, prospective, Brazil, South America, preprint, 4 authors, dosage 200μg/kg days 1-3. | risk of death, 78.3% lower, RR 0.22, p = 0.50, treatment 0 of 110 (0.0%), control 2 of 137 (1.5%), control group 1. |
| risk of ventilation, 94.2% lower, RR 0.06, p = 0.005, treatment 0 of 110 (0.0%), control 9 of 137 (6.6%), control group 1. | |
| risk of hospitalization, 98.0% lower, RR 0.02, p < 0.001, treatment 0 of 110 (0.0%), control 27 of 137 (19.7%), control group 1. | |
| [Carvallo], 9/15/2020, prospective, Argentina, South America, preprint, 3 authors, dosage 36mg days 1, 8, dose varied depending on patient condition - mild 24mg, moderate 36mg, severe 48mg. | risk of death for hospitalized cases in study vs. cases in the same hospital not in the study, 87.9% lower, RR 0.12, p = 0.05, treatment 1 of 33 (3.0%), control 3 of 12 (25.0%), the only treatment death was a patient already in the ICU before treatment. |
| [Chaccour], 12/7/2020, Double Blind Randomized Controlled Trial, Spain, Europe, peer-reviewed, 23 authors, dosage 400μg/kg single dose. | risk of unresolved symptoms, 52.9% lower, RR 0.47, p < 0.05, treatment 12, control 12, relative probability of symptoms at day 28. |
| viral load, 94.6% lower, relative load 0.05, treatment 12, control 12, day 7 mid-recovery. | |
| [Elalfy], 2/16/2021, retrospective, Egypt, Middle East, peer-reviewed, 15 authors, dosage 18mg days 1, 4, 7, 10, 13, <90kg 18mg, 90-120kg 24mg, >120kg 30mg. | risk of no virological cure, 86.9% lower, RR 0.13, p < 0.001, treatment 7 of 62 (11.3%), control 44 of 51 (86.3%), day 15. |
| risk of no virological cure, 58.1% lower, RR 0.42, p < 0.001, treatment 26 of 62 (41.9%), control 51 of 51 (100.0%), day 7. | |
| [Espitia-Hernandez], 8/15/2020, retrospective, Mexico, North America, peer-reviewed, 5 authors, dosage 6mg days 1-2, 8-9. | risk of viral+ at day 10, 97.2% lower, RR 0.03, p < 0.001, treatment 0 of 28 (0.0%), control 7 of 7 (100.0%). |
| [Kirti], 1/9/2021, Double Blind Randomized Controlled Trial, India, South Asia, preprint, 11 authors, dosage 12mg days 1, 2. | risk of death, 88.7% lower, RR 0.11, p = 0.12, treatment 0 of 55 (0.0%), control 4 of 57 (7.0%). |
| risk of ventilation, 79.3% lower, RR 0.21, p = 0.09, treatment 1 of 55 (1.8%), control 5 of 57 (8.8%). | |
| risk of ICU admission, 13.6% lower, RR 0.86, p = 0.80, treatment 5 of 55 (9.1%), control 6 of 57 (10.5%). | |
| risk of no virological cure, 11.6% higher, RR 1.12, p = 0.35, treatment 42 of 55 (76.4%), control 39 of 57 (68.4%). | |
| [Mohan], 2/2/2021, Double Blind Randomized Controlled Trial, India, South Asia, preprint, 27 authors, dosage 400μg/kg single dose, 200μg/kg also tested. | risk of no discharge at day 14, 62.5% lower, RR 0.38, p = 0.27, treatment 2 of 40 (5.0%), control 6 of 45 (13.3%), ivermectin 24mg. |
| risk of no discharge at day 14, 43.8% lower, RR 0.56, p = 0.49, treatment 3 of 40 (7.5%), control 6 of 45 (13.3%), ivermectin 12mg. | |
| risk of no virological cure, 10.3% lower, RR 0.90, p = 0.65, treatment 20 of 36 (55.6%), control 26 of 42 (61.9%), ivermectin 24mg, day 7. | |
| risk of no virological cure, 3.2% higher, RR 1.03, p = 1.00, treatment 23 of 36 (63.9%), control 26 of 42 (61.9%), ivermectin 12mg, day 7. | |
| risk of no virological cure, 23.8% lower, RR 0.76, p = 0.18, treatment 21 of 40 (52.5%), control 31 of 45 (68.9%), ivermectin 24mg, day 5. | |
| risk of no virological cure, 5.6% lower, RR 0.94, p = 0.82, treatment 26 of 40 (65.0%), control 31 of 45 (68.9%), ivermectin 12mg, day 5. | |
| [Raad], 1/16/2021, Single Blind Randomized Controlled Trial, Lebanon, Middle East, preprint, 1 author, dosage 200μg/kg single dose. | risk of hospitalization, 85.7% lower, RR 0.14, p = 0.24, treatment 0 of 50 (0.0%), control 3 of 50 (6.0%). |
| risk of viral load, 59.0% lower, RR 0.41, p = 0.01, treatment 50, control 50, percentage relative improvement in Ct value with treatment at day 3. | |
| [Schwartz], 2/12/2021, Double Blind Randomized Controlled Trial, Israel, Middle East, preprint, 1 author, dosage 12mg days 1-3, 15mg for patients >= 70kg. | risk of hospitalization, 80.7% lower, RR 0.19, p = 0.23, treatment 0 of 49 (0.0%), control 2 of 45 (4.4%). |
| risk of no virological cure, 51.4% lower, RR 0.49, p = 0.01, treatment 16 of 49 (32.7%), control 25 of 45 (55.6%), adjusted per study, odds ratio converted to relative risk, multivariable logistic regression, day 6, Ct>30. | |
| risk of no virological cure, 54.1% lower, RR 0.46, p = 0.02, treatment 9 of 49 (18.4%), control 18 of 45 (40.0%), day 10, Ct>30. | |
| risk of no virological cure, 54.1% lower, RR 0.46, p = 0.02, treatment 10 of 49 (20.4%), control 20 of 45 (44.4%), day 8, Ct>30. | |
| risk of no virological cure, 41.2% lower, RR 0.59, p = 0.04, treatment 16 of 49 (32.7%), control 25 of 45 (55.6%), day 6, Ct>30. | |
| risk of no virological cure, 37.9% lower, RR 0.62, p = 0.09, treatment 11 of 26 (42.3%), control 15 of 22 (68.2%), day 4, Ct>30. |
Effect extraction follows pre-specified rules as detailed above
and gives priority to more serious outcomes. Only the first (most serious)
outcome is used in calculations, which may differ from the effect a paper
focuses on.
| [Budhiraja], 11/18/2020, retrospective, India, South Asia, preprint, 12 authors, dosage not specified. | risk of death, 99.1% lower, RR 0.009, p = 0.04, treatment 0 of 34 (0.0%), control 103 of 942 (10.9%). |
| [Bukhari], 2/5/2021, Randomized Controlled Trial, Pakistan, Middle East, preprint, 10 authors, dosage 12mg single dose. | risk of no virological cure, 82.4% lower, RR 0.18, p < 0.001, treatment 4 of 41 (9.8%), control 25 of 45 (55.6%), day 7. |
| risk of no virological cure, 38.7% lower, RR 0.61, p < 0.001, treatment 24 of 41 (58.5%), control 43 of 45 (95.6%), day 3. | |
| [Camprubí], 11/11/2020, retrospective, Spain, Europe, peer-reviewed, 9 authors, dosage 200μg/kg single dose. | risk of ICU admission, 33.3% lower, RR 0.67, p = 1.00, treatment 2 of 13 (15.4%), control 3 of 13 (23.1%), ICU at day 8. |
| risk of no improvement at day 8, 33.3% higher, RR 1.33, p = 1.00, treatment 4 of 13 (30.8%), control 3 of 13 (23.1%). | |
| [Chachar], 9/30/2020, Randomized Controlled Trial, India, South Asia, peer-reviewed, 6 authors, dosage 36mg, 12mg stat, 12mg after 12 hours, 12mg after 24 hours. | risk of no recovery at day 7, 10.0% lower, RR 0.90, p = 0.50, treatment 9 of 25 (36.0%), control 10 of 25 (40.0%). |
| [Elgazzar], 11/13/2020, Randomized Controlled Trial, Egypt, Africa, preprint, 6 authors, dosage 400μg/kg days 1-4. | risk of death, 91.7% lower, RR 0.08, p < 0.001, treatment 2 of 200 (1.0%), control 24 of 200 (12.0%). |
| risk of death, 88.9% lower, RR 0.11, p = 0.12, treatment 0 of 100 (0.0%), control 4 of 100 (4.0%), mild/moderate COVID-19. | |
| risk of death, 90.0% lower, RR 0.10, p < 0.001, treatment 2 of 100 (2.0%), control 20 of 100 (20.0%), severe COVID-19. | |
| [Gorial], 7/8/2020, retrospective, Iraq, Middle East, preprint, 9 authors, dosage 200μg/kg single dose. | risk of death, 71.0% lower, RR 0.29, p = 1.00, treatment 0 of 16 (0.0%), control 2 of 71 (2.8%). |
| hospitalization time, 42.0% lower, relative time 0.58, p < 0.001, treatment 16, control 71. | |
| [Hashim], 10/26/2020, Single Blind Randomized Controlled Trial, Iraq, Middle East, preprint, 6 authors, dosage 200μg/kg days 1-2, some patients received a third dose on day 8. | risk of death, 66.7% lower, RR 0.33, p = 0.27, treatment 2 of 70 (2.9%), control 6 of 70 (8.6%), all patients. |
| risk of death, 91.7% lower, RR 0.08, p = 0.03, treatment 0 of 59 (0.0%), control 6 of 70 (8.6%), excluding critical patients. | |
| [Khan], 9/24/2020, retrospective, Bangladesh, South Asia, preprint, median age 35.0, 8 authors, dosage 12mg single dose. | risk of death, 87.0% lower, RR 0.13, p < 0.05, treatment 1 of 115 (0.9%), control 9 of 133 (6.8%). |
| time to viral-, 73.3% lower, relative time 0.27, p < 0.001, treatment 115, control 133. | |
| [Lima-Morales], 2/10/2021, prospective, Mexico, North America, peer-reviewed, 9 authors, dosage 12mg single dose. | risk of death, 77.7% lower, RR 0.22, p < 0.001, treatment 15 of 481 (3.1%), control 52 of 287 (18.1%), adjusted per study, odds ratio converted to relative risk, multivariate. |
| risk of hospitalization, 67.4% lower, RR 0.33, p < 0.001, treatment 44 of 481 (9.1%), control 89 of 287 (31.0%), adjusted per study, odds ratio converted to relative risk, multivariate. | |
| risk of no recovery, 58.6% lower, RR 0.41, p < 0.001, treatment 75 of 481 (15.6%), control 118 of 287 (41.1%), adjusted per study, odds ratio converted to relative risk, recovery at day 14 after symptoms, multivariate. | |
| [Mahmud], 10/9/2020, Double Blind Randomized Controlled Trial, Bangladesh, South Asia, preprint, 1 author, dosage 12mg single dose. | risk of death, 85.7% lower, RR 0.14, p = 0.25, treatment 0 of 183 (0.0%), control 3 of 183 (1.6%). |
| risk of no recovery, 49.0% lower, RR 0.51, p < 0.004, treatment 42 of 183 (23.0%), control 67 of 180 (37.2%), adjusted per study. | |
| risk of disease progression, 55.0% lower, RR 0.45, p < 0.01, treatment 16 of 183 (8.7%), control 32 of 180 (17.8%), adjusted per study. | |
| risk of no virological cure, 42.0% lower, RR 0.58, p < 0.001, treatment 14 of 183 (7.7%), control 36 of 180 (20.0%), adjusted per study. | |
| [Niaee], 11/24/2020, Double Blind Randomized Controlled Trial, Iran, Middle East, preprint, mean age 56.0, 14 authors, dosage 400μg/kg single dose, dose varies in different groups. | risk of death, 81.8% lower, RR 0.18, p = 0.001, treatment 4 of 120 (3.3%), control 11 of 60 (18.3%), All IVM vs. all control. |
| risk of death, 94.3% lower, RR 0.06, p = 0.01, treatment 0 of 30 (0.0%), control 11 of 60 (18.3%), IVM single dose 200mcg/kg vs. all control. | |
| risk of death, 45.5% lower, RR 0.55, p = 0.37, treatment 3 of 30 (10.0%), control 11 of 60 (18.3%), IVM three dose 200mcg/kg vs. all control. | |
| risk of death, 94.3% lower, RR 0.06, p = 0.01, treatment 0 of 30 (0.0%), control 11 of 60 (18.3%), IVM single dose 400mcg/kg vs. all control. | |
| risk of death, 81.8% lower, RR 0.18, p = 0.06, treatment 1 of 30 (3.3%), control 11 of 60 (18.3%), IVM three dose 400/200/200mcg/kg vs. all control. | |
| [Okumuş], 1/12/2021, Double Blind Randomized Controlled Trial, Turkey, Middle East, preprint, 1 author, dosage 200μg/kg days 1-5, 36-50kg - 9mg, 51-65kg - 12mg, 66-79kg - 15mg, >80kg 200μg/kg. | risk of death, 33.3% lower, RR 0.67, p = 0.55, treatment 6 of 30 (20.0%), control 9 of 30 (30.0%). |
| risk of no improvement at day 5, 15.8% lower, RR 0.84, p = 0.60, treatment 16 of 30 (53.3%), control 19 of 30 (63.3%). | |
| [Podder], 9/3/2020, Randomized Controlled Trial, Bangladesh, South Asia, peer-reviewed, 4 authors, dosage 200μg/kg single dose. | recovery time from enrollment, 16.1% lower, relative time 0.84, p = 0.34, treatment 32, control 30. |
| [Rajter], 10/13/2020, retrospective, USA, North America, peer-reviewed, 6 authors, dosage 200μg/kg single dose. | risk of death, 46.0% lower, RR 0.54, p = 0.04, treatment 13 of 98 (13.3%), control 24 of 98 (24.5%), adjusted per study, odds ratio converted to relative risk, PSM. |
| risk of death, 66.9% lower, RR 0.33, p = 0.03, treatment 26 of 173 (15.0%), control 27 of 107 (25.2%), adjusted per study, odds ratio converted to relative risk, multivariate. | |
| [Rezai], 1/19/2021, Randomized Controlled Trial, Iran, Middle East, preprint, 1 author, dosage 200μg/kg single dose. | recovery time, 21.2% lower, relative time 0.79, p = 0.02, treatment 51, control 52. |
| hospitalization time, 17.9% lower, relative time 0.82, p = 0.01, treatment 51, control 52. | |
| [Soto-Becerra], 10/8/2020, retrospective, database analysis, Peru, South America, preprint, median age 59.4, 4 authors, dosage 200μg/kg single dose. | risk of death, 17.1% lower, RR 0.83, p = 0.01, treatment 92 of 203 (45.3%), control 1438 of 2630 (54.7%), IVM vs. control day 43 (last day available) weighted KM from figure 3, per the pre-specified rules, the last available day mortality results have priority. |
| risk of death, 39.0% higher, RR 1.39, p = 0.16, treatment 47 of 203 (23.2%), control 401 of 2630 (15.2%), adjusted per study, day 30, Table 2, IVM wHR. | |
| [Spoorthi], 11/14/2020, prospective, India, South Asia, peer-reviewed, 2 authors, dosage not specified. | recovery time, 21.1% lower, relative time 0.79, p = 0.03, treatment 50, control 50. |
| hospitalization time, 15.5% lower, relative time 0.84, p = 0.01, treatment 50, control 50. |
Effect extraction follows pre-specified rules as detailed above
and gives priority to more serious outcomes. Only the first (most serious)
outcome is used in calculations, which may differ from the effect a paper
focuses on.
| [Alam], 12/15/2020, prospective, Bangladesh, South Asia, peer-reviewed, 13 authors, dosage 12mg monthly. | risk of COVID-19 case, 90.6% lower, RR 0.09, p < 0.001, treatment 4 of 58 (6.9%), control 44 of 60 (73.3%). |
| [Behera], 2/15/2021, prospective, India, South Asia, preprint, 13 authors, dosage 300μg/kg days 1, 4. | risk of COVID-19 case, 83.0% lower, RR 0.17, p < 0.001, treatment 2199, control 1147, two doses. |
| risk of COVID-19 case, 4.0% higher, RR 1.04, p = 0.85, treatment 186, control 1147, patients only receiving the first dose. | |
| [Behera (B)], 11/3/2020, retrospective, India, South Asia, peer-reviewed, 13 authors, dosage 300μg/kg days 1, 4. | risk of COVID-19 case, 53.8% lower, RR 0.46, p < 0.001, treatment 41 of 117 (35.0%), control 145 of 255 (56.9%), adjusted per study, odds ratio converted to relative risk, model 2 2+ doses conditional logistic regression. |
| risk of COVID-19 case, 44.5% lower, RR 0.56, p < 0.001, treatment 41 of 117 (35.0%), control 145 of 255 (56.9%), odds ratio converted to relative risk, matched pair analysis. | |
| [Bernigaud], 11/28/2020, retrospective, France, Europe, peer-reviewed, 12 authors, dosage 200μg/kg days 1, 8, 15, 400μg/kg days 1, 8, 15, two different dosages. | risk of death, 99.4% lower, RR 0.006, p = 0.08, treatment 0 of 69 (0.0%), control 150 of 3062 (4.9%). |
| risk of COVID-19 case, 55.1% lower, RR 0.45, p = 0.01, treatment 7 of 69 (10.1%), control 692 of 3062 (22.6%). | |
| [Carvallo (B)], 11/17/2020, prospective, Argentina, South America, peer-reviewed, 4 authors, dosage 12mg weekly. | risk of COVID-19 case, 99.9% lower, RR 0.001, p < 0.001, treatment 0 of 788 (0.0%), control 237 of 407 (58.2%). |
| [Carvallo (C)], 10/19/2020, prospective, Argentina, South America, preprint, 1 author, dosage 1mg days 1-14. | risk of COVID-19 case, 96.3% lower, RR 0.04, p < 0.001, treatment 0 of 131 (0.0%), control 11 of 98 (11.2%). |
| [Chala], 1/11/2021, Randomized Controlled Trial, Argentina, South America, preprint, 1 author, dosage 12mg weekly. | risk of COVID-19 case, 94.7% lower, RR 0.05, p = 0.003, treatment 0 of 117 (0.0%), control 9 of 117 (7.7%), moderate/severe COVID-19. |
| risk of COVID-19 case, 84.0% lower, RR 0.16, p < 0.001, treatment 4 of 117 (3.4%), control 25 of 117 (21.4%), all cases. | |
| [Elgazzar (B)], 11/13/2020, Randomized Controlled Trial, Egypt, Africa, preprint, 6 authors, dosage 400μg/kg weekly. | risk of COVID-19 case, 80.0% lower, RR 0.20, p = 0.03, treatment 2 of 100 (2.0%), control 10 of 100 (10.0%). |
| [Hellwig], 11/28/2020, retrospective, multiple countries, Africa, peer-reviewed, 2 authors, dosage 200μg/kg, dose varied, typically 150-200μg/kg. | risk of COVID-19 case, 78.0% lower, RR 0.22, p < 0.02, African countries. |
| risk of COVID-19 case, 80.0% lower, RR 0.20, p < 0.001, worldwide. | |
| [Shouman], 8/28/2020, Randomized Controlled Trial, Egypt, Africa, peer-reviewed, 8 authors, dosage 18mg days 1, 3, dose varies depending on weight - 40-60kg: 15mg, 60-80kg: 18mg, >80kg: 24mg. | risk of symptomatic case, 91.3% lower, RR 0.09, p < 0.001, treatment 15 of 203 (7.4%), control 59 of 101 (58.4%), adjusted per study, multivariate. |
| risk of COVID-19 severe case, 92.9% lower, RR 0.07, p = 0.002, treatment 1 of 203 (0.5%), control 7 of 101 (6.9%), unadjusted. | |
| [Vallejos], 12/20/2020, retrospective, Argentina, South America, preprint, 1 author, dosage 12mg weekly. | risk of COVID-19 case, 73.6% lower, RR 0.26, p < 0.001, treatment 11 of 389 (2.8%), control 52 of 486 (10.7%). |
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