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Machado et al. planned a meta-analysis on the effectiveness and safety of ivermectin in the treatment of COVID-19 (coronavirus disease 2019) (1). Almost all of meta-analyses presented a lack of advantage in the effectiveness and safety of ivermectin for the treatment of COVID-19. In addition to insufficient evidence to support the use of ivermectin to treat or prevent COVID-19, there are potential toxic effects of ivermectin, including confusion, ataxia, seizures, and hypotension, which may be accelerated by inappropriate use (2). I have a comment about their study.
Hellwig and Maia reviewed the prophylactic effect of chemotherapy with and without ivermectin administration on incidence of COVID-19 by ecological procedure among the African countries and a worldwide, respectively (3). Although there was a significant decrease of incidence in countries with accepting ivermectin administration, ivermectin could be recommended for the treatment of patients with COVID-19 by the evidence from well-designed randomized controlled trials (RCTs) with appropriate doses and treatment period.
López-Medina et al. conducted a double-blind RCT to determine the effect of ivermectin in patients with mild COVID-19 (4). A total of 400 patients were randomized to receive ivermectin, 300 μg/kg of body weight per day for 5 days or placebo, and the authors followed symptoms for 3 weeks. The hazard ratio (95% confidence interval) of receiving ivermectin for the resolution of symptoms...
López-Medina et al. conducted a double-blind RCT to determine the effect of ivermectin in patients with mild COVID-19 (4). A total of 400 patients were randomized to receive ivermectin, 300 μg/kg of body weight per day for 5 days or placebo, and the authors followed symptoms for 3 weeks. The hazard ratio (95% confidence interval) of receiving ivermectin for the resolution of symptoms was 1.07 (0.87 to 1.32), although there was no specific adverse event by using ivermectin. In addition, Roman et al. conducted a meta-analysis of RCTs to evaluate the effectiveness and safety of ivermectin in patients with mostly mild COVID-19 (5). Ivermectin did not significantly reduce all-cause mortality, length of stay in hospital, and maintain viral clearance from the blood, although there was no significant difference of adverse events between ivermectin group and control group.
Taken together, there is a lack of evidence on the effectiveness of ivermectin for the treatment of COVID-19 by meta-analyses in the past.
1. Machado MLL, Souza ATB, Linhares PVA, et al. Effectiveness and safety of ivermectin in the treatment of COVID-19: protocol for a systematic review and meta-analysis. BMJ Open 2021;11(9):e050532.
2. Temple C, Hoang R, Hendrickson RG. Toxic effects from ivermectin use associated with prevention and treatment of Covid-19. N Engl J Med 2021 Oct 20. doi: 10.1056/NEJMc2114907.
3. Hellwig MD, Maia A. A COVID-19 prophylaxis? Lower incidence associated with prophylactic administration of ivermectin. Int J Antimicrob Agents 2021;57(1):106248.
4. López-Medina E, López P, Hurtado IC, et al. Effect of ivermectin on time to resolution of symptoms among adults with mild COVID-19: A randomized clinical trial. JAMA 2021;325(14):1426-35.
5. Roman YM, Burela PA, Pasupuleti V, et al. Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials. Clin Infect Dis 2021 Jun 28. doi: 10.1093/cid/ciab591.