Ivermectin under scrutiny: a systematic review and meta-analysis of efficacy and possible sources of controversies in COVID-19 patients

Table 2 Ivermectin compared to control for COVID-19 patients

Patient or population: COVID-19 Intervention: Ivermectin Comparison: Standard of care or Placebo
Outcomes	No of participants (studies) Follow up	Certainty of the evidence (GRADE)	Ref
Mortality	3472 (10 RCTs)	⨁◯◯◯ Very low^a,b	[19, 24, 34, 36,37,38,39, 41, 43, 47]
Progression to severe or critical state	3594 (9 RCTs)	⨁⨁◯◯ Low^a,b	[19, 24, 34, 36,37,38, 41, 44, 47]
Negative RT-PCR	2679 (9 RCTs)	⨁◯◯◯ Very low^a,b,c	[24, 33, 38, 41,42,43,44, 46]
Recovery	1125 (4 RCTs)	⨁⨁◯◯ Low^a,b	[19, 37, 38, 42]
Duration of hospitalization	908 (5 RCTs)	⨁◯◯◯ Very low^a,b,d	[19, 34, 36, 45, 47]
Time to negative RT-PCR	138 (3 RCTs)	⨁⨁◯◯ Low^a,e	[33, 40, 45]
Viral load	200 (2 RCTs)	⨁⨁◯◯ Low^b,e	[20, 42]

Explanations
GRADE Working Group grades of evidence
High certainty We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^aThe proportion of information from studies at high risk of bias is sufficient to affect the interpretation of results. Crucial limitation for one criterion, or some limitations for multiple criteria, sufficient to lower confidence in the estimate of effect. Downgraded one or two levels based on the number of high-risk of bias studies
^bWide confidence interval (uncertainty about magnitude of effect). Downgraded one level
^cModerate heterogeneity. Downgraded one level
^dHigh heterogeneity. Downgraded two level
^eSmall sample size. Downgraded one level

ISSN: 1743-422X