By Kristina Fiore

Findings are positive, but critics still want a randomized controlled trial

Proponents of ivermectin for COVID-19 have long been talking about an expected review and meta-analysis led by Andrew Hill, PhD, of the University of Liverpool.

These results were finally published this week in Open Forum Infectious Diseases, and they’re positive — but they haven’t escaped criticism, and most researchers still want results from a randomized controlled trial.

The review and meta-analysis was conducted as part of the International Ivermectin Project Team from December 2020 to May 2021. Ivermectin proponents said Hill was conducting the analysis for the WHO, but MedPage Today was not able to confirm WHO involvement. Hill did not respond to an email request for comment.

Hill and colleagues assessed 24 randomized trials totaling 3,328 patients that involved some type of control, whether it was standard of care or another therapy. Sample sizes ranged from 24 to 400 participants. Eight of the studies had been published, nine were preprints, six were unpublished results shared for the analysis, and one was reported on a trial registry website.

In the 11 trials (totaling 2,127 patients) that focused on moderate or severe infection, there was a 56% reduction in mortality (relative risk [RR] 0.44, 95% CI 0.25-0.77, P=0.004), with 3% of patients on ivermectin dying compared with 9% of controls.

But the researchers noted that the total number of deaths was small (128) and there was no difference between ivermectin and controls in the subgroup with severe disease. As for moderate disease, they reported a 70% improvement in survival with ivermectin (RR 0.30, 95% CI 0.15-0.58, P=0.0004).

Use of ivermectin was also associated with a reduction in time to recovery of 1.58 days compared with controls (95% CI -2.8 to -0.35, P=0.01) and with a shorter duration of hospitalization (-4.27 days, 95% CI -8.6 to -0.06, P=0.05).

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