SynthesisJournal of clinical epidemiology2022
Bias as a source of inconsistency in ivermectin trials for COVID-19: A systematic review. Ivermectin's suggested benefits are mainly based on potentially biased results.
Synthesis in Journal of clinical epidemiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 6 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review.BMJ open · 2023Pooled it
- The relationship between pragmatism, timing, and study size on impact of randomized trials: a qualitative, hypothesis generating study of trials of systemic corticosteroids for COVID-19.Journal of clinical epidemiology · 2022Pooled it
- Efficacy and safety of nitazoxanide in treating SARS-CoV-2 infection: a systematic review and meta-analysis of blinded, placebo-controlled, randomized clinical trials.European journal of clinical pharmacology · 2022Pooled it
- Systematic review and meta-analysis of ivermectin for treatment of COVID-19: evidence beyond the hype.BMC infectious diseases · 2022Pooled it
- Ivermectin for preventing and treating COVID-19.The Cochrane database of systematic reviews · 2022Pooled it
- Ivermectin under scrutiny: a systematic review and meta-analysis of efficacy and possible sources of controversies in COVID-19 patients.Virology journal · 2022Pooled it
- Ivermectin for COVID-19 in adults in the community (PRINCIPLE): An open, randomised, controlled, adaptive platform trial of short- and longer-term outcomes.The Journal of infection · 2024Trial
- Impact of a Research Integrity Assessment (RIA) of Randomized Controlled Trials Included in Interventional COVID-19 Systematic Reviews: A Meta-Epidemiological Study.Cochrane evidence synthesis and methods · 2026Article
- Investigating the impact of trial retractions on the healthcare evidence ecosystem (VITALITY Study I): retrospective cohort study.BMJ (Clinical research ed.) · 2025Article
- Repurposed Drugs during the Outbreak of Pandemic COVID-19: A Mini-Review on Their Molecular Structures and Hit-and-Trial Results.ACS omega · 2024Review
- Why Certain Repurposed Drugs Are Unlikely to Be Effective Antivirals to Treat SARS-CoV-2 Infections.Viruses · 2024Article
- Designing, refining and reflecting on 3 years of daily evidence surveillance for Australia's living national COVID-19 guidelines.Cochrane evidence synthesis and methods · 2024Article
- The importance of meta-research in dentistry.Evidence-based dentistry · 2023Article
- Identifying and managing problematic trials: A research integrity assessment tool for randomized controlled trials in evidence synthesis.Research synthesis methods · 2023Article
- Treating COVID-19: Targeting the Host Response, Not the Virus.Life (Basel, Switzerland) · 2023Review
- A twisting tale of misinformation: should ivermectin be approved as a treatment for COVID-19 disease?Future virology · 2023Article
- An Overview of Repurposed Drugs for Potential COVID-19 Treatment.Antibiotics (Basel, Switzerland) · 2022Review
- Comparative Clinical Characteristics, Laboratory Findings, and Outcomes of Hypoxemic and Non-Hypoxemic Patients Treated at a Makeshift COVID-19 Unit in Bangladesh: A Retrospective Chart Analysis.Journal of clinical medicine · 2022Article
- Antiviral Activity of Repurposing Ivermectin against a Panel of 30 Clinical SARS-CoV-2 Strains Belonging to 14 Variants.Pharmaceuticals (Basel, Switzerland) · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe objective of this systematic review is to summarize the effects of ivermectin for the prevention and treatment of patients with COVID-19 and to assess inconsistencies in results from individual studies with focus on risk of bias due to methodological limitations.
methodsWe searched the L.OVE platform through July 6, 2021 and included randomized trials (RCTs) comparing ivermectin to standard or other active treatments. We conducted random-effects pairwise meta-analysis, assessed the certainty of evidence using the GRADE approach and performed sensitivity analysis excluding trials with risk of bias.
resultsWe included 29 RCTs which enrolled 5592 cases. Overall, the certainty of the evidence was very low to low suggesting that ivermectin may result in important benefits. However, after excluding trials classified as "high risk" or "some concerns" in the risk of bias assessment, most estimates of effect changed substantially: Compared to standard of care, low certainty evidence suggests that ivermectin may not reduce mortality (RD 7 fewer per 1000) nor mechanical ventilation (RD 6 more per 1000), and moderate certainty evidence shows that it probably does not increase symptom resolution or improvement (RD 14 more per 1000) nor viral clearance (RD 12 fewer per 1000).
conclusionIvermectin may not improve clinically important outcomes in patients with COVID-19 and its effects as a prophylactic intervention in exposed individuals are uncertain. Previous reports concluding important benefits associated with ivermectin are based on potentially biased results reported by studies with substantial methodological limitations. Further research is needed.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.