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Ivermectin for Prophylaxis and Treatment of COVID-19: A Systematic Review and Meta-Analysis

Background. Ivermectin has received particular attention as a potential treatment for COVID-19. However, the evidence to support its clinical efficacy is controversial. Objectives. We undertook a new systematic review of ivermectin for the treatment and prophylaxis of COVID-19, including new primary...

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Autores principales: Cruciani, Mario, Pati, Ilaria, Masiello, Francesca, Malena, Marina, Pupella, Simonetta, De Angelis, Vincenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470309/
https://www.ncbi.nlm.nih.gov/pubmed/34573986
http://dx.doi.org/10.3390/diagnostics11091645
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author Cruciani, Mario
Pati, Ilaria
Masiello, Francesca
Malena, Marina
Pupella, Simonetta
De Angelis, Vincenzo
author_facet Cruciani, Mario
Pati, Ilaria
Masiello, Francesca
Malena, Marina
Pupella, Simonetta
De Angelis, Vincenzo
author_sort Cruciani, Mario
collection PubMed
description Background. Ivermectin has received particular attention as a potential treatment for COVID-19. However, the evidence to support its clinical efficacy is controversial. Objectives. We undertook a new systematic review of ivermectin for the treatment and prophylaxis of COVID-19, including new primary studies, outcomes other than mortality, and grading the quality of the available evidence following the Cochrane guidance for methodology. Methods. We searched electronic databases, repository databases, and clinical trial registries (up to June 2021). The measure of treatment effect was risk difference (RD) with 95% confidence intervals (CIs). The GRADE system was used to assess the certainty of the evidence. Results. The review includes 11 RCTs (2436 participants). The certainty of the available evidence was quite low or very low due to risk of bias, inconsistency, and imprecision. When the analysis was limited to patients with baseline mild or moderate disease (8 reports, 1283 patients), there were no differences in mortality between ivermectin and control groups (low level of certainty); in patients with baseline severe diseases (3 reports, 304 patients), the use of ivermectin significantly decreased mortality compared to the controls (RD −0.17; 95% CIs, −0.24/−0.10; p = 0.00001; low level of certainty). In terms of disease progression (to severe pneumonia, admission to intensive care unit, and/or mechanical ventilation), the results were much the same. At day 14, the rate of patients with a negative RT-PCR test was 21% higher (from 5 to 36% higher) for ivermectin recipients than it was for the controls (low quality of evidence). Three studies (736 subjects) indicated that prophylaxis with ivermectin increased the likelihood of preventing COVID-19 compared to controls (low quality of evidence). Serious adverse events were rarely reported. Conclusions. There is limited evidence for the benefit of ivermectin for COVID-19 treatment and prophylaxis, and most of this evidence is of low quality. Further evidence is needed to fine-tune potential indications and optimal treatment protocols for ivermectin as a treatment for COVID-19.
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spelling pubmed-84703092021-09-27 Ivermectin for Prophylaxis and Treatment of COVID-19: A Systematic Review and Meta-Analysis Cruciani, Mario Pati, Ilaria Masiello, Francesca Malena, Marina Pupella, Simonetta De Angelis, Vincenzo Diagnostics (Basel) Systematic Review Background. Ivermectin has received particular attention as a potential treatment for COVID-19. However, the evidence to support its clinical efficacy is controversial. Objectives. We undertook a new systematic review of ivermectin for the treatment and prophylaxis of COVID-19, including new primary studies, outcomes other than mortality, and grading the quality of the available evidence following the Cochrane guidance for methodology. Methods. We searched electronic databases, repository databases, and clinical trial registries (up to June 2021). The measure of treatment effect was risk difference (RD) with 95% confidence intervals (CIs). The GRADE system was used to assess the certainty of the evidence. Results. The review includes 11 RCTs (2436 participants). The certainty of the available evidence was quite low or very low due to risk of bias, inconsistency, and imprecision. When the analysis was limited to patients with baseline mild or moderate disease (8 reports, 1283 patients), there were no differences in mortality between ivermectin and control groups (low level of certainty); in patients with baseline severe diseases (3 reports, 304 patients), the use of ivermectin significantly decreased mortality compared to the controls (RD −0.17; 95% CIs, −0.24/−0.10; p = 0.00001; low level of certainty). In terms of disease progression (to severe pneumonia, admission to intensive care unit, and/or mechanical ventilation), the results were much the same. At day 14, the rate of patients with a negative RT-PCR test was 21% higher (from 5 to 36% higher) for ivermectin recipients than it was for the controls (low quality of evidence). Three studies (736 subjects) indicated that prophylaxis with ivermectin increased the likelihood of preventing COVID-19 compared to controls (low quality of evidence). Serious adverse events were rarely reported. Conclusions. There is limited evidence for the benefit of ivermectin for COVID-19 treatment and prophylaxis, and most of this evidence is of low quality. Further evidence is needed to fine-tune potential indications and optimal treatment protocols for ivermectin as a treatment for COVID-19. MDPI 2021-09-08 /pmc/articles/PMC8470309/ /pubmed/34573986 http://dx.doi.org/10.3390/diagnostics11091645 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Cruciani, Mario
Pati, Ilaria
Masiello, Francesca
Malena, Marina
Pupella, Simonetta
De Angelis, Vincenzo
Ivermectin for Prophylaxis and Treatment of COVID-19: A Systematic Review and Meta-Analysis
title Ivermectin for Prophylaxis and Treatment of COVID-19: A Systematic Review and Meta-Analysis
title_full Ivermectin for Prophylaxis and Treatment of COVID-19: A Systematic Review and Meta-Analysis
title_fullStr Ivermectin for Prophylaxis and Treatment of COVID-19: A Systematic Review and Meta-Analysis
title_full_unstemmed Ivermectin for Prophylaxis and Treatment of COVID-19: A Systematic Review and Meta-Analysis
title_short Ivermectin for Prophylaxis and Treatment of COVID-19: A Systematic Review and Meta-Analysis
title_sort ivermectin for prophylaxis and treatment of covid-19: a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470309/
https://www.ncbi.nlm.nih.gov/pubmed/34573986
http://dx.doi.org/10.3390/diagnostics11091645
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