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Supplementary Data — Ivermectin for COVID-19: real-time meta analysis of 92 studies
Covid Analysis, Sep 23, 2022, Version 199V199
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0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg viral+ 0/60 2/56 OT​1​ CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Espitia-Hernandez 97% 0.03 [0.01-0.10] 12mg viral+ 0/28 7/7 CT​2​ Carvallo 85% 0.15 [0.02-1.28] 36mg death 1/32 3/14 CT​2​ Mahmud (DB RCT) 27% 0.73 [0.60-0.90] 12mg recov. time 183 (n) 180 (n) CT​2​ Szente Fonseca -14% 1.14 [0.75-1.66] 24mg hosp. 340 (n) 377 (n) Cadegiani 78% 0.22 [0.01-4.48] 42mg death 0/110 2/137 CT​2​ Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Chaccour (DB RCT) 8% 0.92 [0.77-1.09] 28mg viral+ 12 (n) 12 (n) Ghauri 92% 0.08 [0.01-0.88] 48mg no recov. 0/37 7/53 Babalola (DB RCT) 49% 0.51 [0.29-0.88] 24mg viral time 20 (n) 20 (n) OT​1​ Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 Mohan (DB RCT) 24% 0.76 [0.53-1.09] 28mg viral+ 21/40 31/45 Biber (DB RCT) 39% 0.61 [0.29-1.07] 36mg viral+ 13/47 21/42 Elalfy 87% 0.13 [0.06-0.27] 36mg viral+ 7/62 44/51 CT​2​ López-Me.. (DB RCT) 43% 0.57 [0.16-1.87] 84mg progression 4/200 7/198 Roy 6% 0.94 [0.52-1.93] n/a recov. time 14 (n) 15 (n) CT​2​ Chahla (CLUS. RCT) 87% 0.13 [0.03-0.54] 24mg no disch. 2/110 20/144 Mourya 89% 0.11 [0.05-0.25] 48mg viral+ 5/50 47/50 Loue (QR) 70% 0.30 [0.04-2.20] 14mg death 1/10 5/15 Merino (QR) 74% 0.26 [0.11-0.57] 24mg hosp. population-based cohort censored, see notes CS​5​ Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Krolewiecki (RCT) 66% 0.34 [0.10-1.16] 168mg decay rate 20 (n) 14 (n) Vallejos (DB RCT) 33% 0.67 [0.34-1.28] 24mg hosp. 14/250 21/251 Reis (DB RCT) 10% 0.90 [0.70-1.16] 84mg hosp./ER 100/679 111/679 Buonfrate (DB RCT) 31% 0.69 [0.46-1.03] 336mg viral load 30 (n) 29 (n) Mayer 55% 0.45 [0.32-0.63] 151mg death 3,266 (n) 17,966 (n) Borody 93% 0.07 [0.04-0.13] 96mg hosp. 5/600 70/600 CT​2​ SC​4​ Abbas (DB RCT) 31% 0.69 [0.46-1.05] 84mg recov. time 99 (n) 103 (n) de Jesús Ascenci.. 59% 0.41 [0.36-0.47] 12mg death/hosp. 7,898 (n) 20,150 (n) CT​2​ Manomai.. (DB RCT) 5% 0.95 [0.62-1.45] 48mg viral+ 19/36 20/36 Rocha (DB RCT) -187% 2.87 [0.12-67.5] 36mg misc. 1/30 0/26 Rezai (DB RCT) -5% 1.05 [0.07-16.7] 84mg death 1/268 1/281 Mirahma.. (DB RCT) 27% 0.73 [0.30-1.75] 24mg hosp. 8/130 11/130 Schilling (RCT) -9% 1.09 [0.88-1.27] 168mg viral rate 45 (n) 45 (n) Bramante (DB RCT) -4% 1.04 [0.81-1.31] 90mg progression 105/407 96/391 OT​1​ Tau​2​ = 0.30, I​2​ = 83.7%, p < 0.0001 Early treatment 55% 0.45 [0.36-0.57] 317/15,333 577/42,345 55% improvement Gorial 71% 0.29 [0.01-5.76] 14mg no recov. 0/16 2/71 Improvement, RR [CI] Dose (4d) Treatment Control Kishoria (RCT) -8% 1.08 [0.57-2.02] 12mg viral+ 11/19 7/13 Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Khan 87% 0.13 [0.02-1.00] 12mg death 1/115 9/133 Chachar (RCT) 10% 0.90 [0.44-1.83] 36mg no recov. 9/25 10/25 Soto-Becerra -39% 1.39 [0.88-2.22] 14mg death 47/203 401/2,630 Rajter (PSM) 67% 0.33 [0.12-0.84] 14mg death 26/173 27/107 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg death 0/59 6/70 CT​2​ Camprubí -25% 1.25 [0.43-3.63] 14mg viral+ 5/13 4/13 Spoorthi 21% 0.79 [0.64-0.98] n/a recov. time 50 (n) 50 (n) CT​2​ Budhiraja 99% 0.01 [0.00-0.15] n/a death 0/34 103/942 Okumuş (DB RCT) 16% 0.84 [0.55-1.30] 56mg no improv. 16/30 19/30 Shahbazn.. (DB RCT) 19% 0.81 [0.67-0.97] 14mg recov. time 35 (n) 34 (n) Lima-Morales 78% 0.22 [0.12-0.41] 12mg death 15/481 52/287 CT​2​ Beltran .. (DB RCT) -20% 1.20 [0.77-1.87] 12mg hosp. time 36 (n) 37 (n) Pott-Junior (RCT) -11% 1.11 [0.21-5.93] 14mg viral+ 10/27 1/3 censored, see notes Huvemek (DB RCT) 32% 0.68 [0.38-1.23] 84mg no improv. 13/50 19/50 Ahsan 50% 0.50 [0.28-0.90] 21mg death 17/110 17/55 CT​2​ Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg death 3/82 4/82 Hazan 93% 0.07 [0.00-1.02] 24mg hosp. 0/24 synthetic CT​2​ SC​4​ Elavarasi 20% 0.80 [0.61-1.06] n/a death 48/283 311/1,475 Rezk 80% 0.20 [0.01-4.13] 72mg death 0/160 2/160 Lim (RCT) -25% 1.25 [0.87-1.80] 112mg progression 52/241 43/249 Ozer 75% 0.25 [0.06-1.13] 28mg death 2/60 8/60 Ferreira -5% 1.05 [0.32-3.43] n/a death 3/21 11/81 Jamir (ICU) -53% 1.53 [0.88-2.67] n/a death 32/76 69/190 ICU patients Baguma 97% 0.03 [0.00-11.7] n/a death 7 (n) 474 (n) Mustafa 64% 0.36 [0.12-1.14] varies death 3/73 42/371 Shimizu 48% 0.52 [0.29-0.93] 14mg ventilation 39 (n) 49 (n) Zubair -9% 1.09 [0.33-3.64] 12mg death 5/90 5/98 Thairu (PSM) 88% 0.12 [0.01-2.14] 56mg death 0/21 4/26 Efimenko (PSM) 69% 0.31 [0.20-0.48] n/a death 1,072 (n) 40,536 (n) self-censored, see notes OT​1​ Soto -41% 1.41 [1.16-1.76] n/a death 280/484 374/934 Ravikirti 3% 0.97 [0.74-1.24] varies death 53/171 254/794 George (RCT) 30% 0.70 [0.25-1.93] 24mg death 5/35 8/39 Naggie (DB RCT) 7% 0.93 [0.85-1.04] 84mg no recov. 817 (n) 774 (n) Rezai (DB RCT) 31% 0.69 [0.35-1.39] 84mg death 13/311 18/298 Qadeer 58% 0.42 [0.31-0.56] 48mg viral+ 35/105 84/105 Aref (RCT) 74% 0.26 [0.12-0.55] n/a recov. time 49 (n) 47 (n) LONG COVID Tau​2​ = 0.17, I​2​ = 83.3%, p < 0.0001 Late treatment 31% 0.69 [0.57-0.83] 704/5,729 1,914/51,422 31% improvement Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Improvement, RR [CI] Dose (1m) Treatment Control Carvallo 96% 0.04 [0.00-0.63] 14mg cases 0/131 11/98 see notes CT​2​ Behera 54% 0.46 [0.29-0.71] 42mg cases 41/117 145/255 Carvallo 100% 0.00 [0.00-0.02] 48mg cases 0/788 237/407 see notes CT​2​ Hellwig (ECO.) 78% 0.22 [0.06-0.76] 14mg cases ecological Bernigaud 99% 0.01 [0.00-0.10] 84mg death 0/69 150/3,062 Alam 91% 0.09 [0.04-0.25] 12mg cases 4/58 44/60 IVERCOR PREP 73% 0.27 [0.15-0.48] 48mg cases 13/389 61/486 MD​3​ Chahla (RCT) 84% 0.16 [0.04-0.46] 48mg cases 4/117 25/117 CT​2​ Behera 83% 0.17 [0.12-0.23] 42mg cases 45/2,199 133/1,147 Tanioka (ECO.) 88% 0.12 [0.03-0.46] 14mg death ecological Seet (CLUS. RCT) 6% 0.94 [0.61-1.19] 12mg cases 398/617 433/619 OT​1​ Morgenstern (PSM) 74% 0.26 [0.10-0.71] 56mg cases 5/271 18/271 Mondal 88% 0.12 [0.01-0.55] n/a symp. case 128 (n) 1,342 (n) Samajdar 80% 0.20 [0.11-0.38] n/a cases 12/164 29/81 Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg death 25/3,034 79/3,034 Tau​2​ = 1.05, I​2​ = 95.3%, p < 0.0001 Prophylaxis 84% 0.16 [0.09-0.29] 562/8,285 1,424/11,080 84% improvement All studies 54% 0.46 [0.40-0.54] 1,583/29,347 3,915/104,847 54% improvement All 92 ivermectin COVID-19 primary outcome results ivmmeta.com Sep 2022 Tau​2​ = 0.31, I​2​ = 89.7%, p < 0.0001 Effect extraction pre-specified, see appendix ​1​ OT: ivermectin vs. other treatment​3​ MD: minimal detail available currently​5​ CS: preprint censored, see details ​2​ CT: study uses combined treatment​4​ SC: study uses synthetic control arm Favors ivermectin Favors control
Figure S1. Random effects meta-analysis for primary outcomes (as defined before the trial started).
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg hosp. 0/60 2/56 OT​1​ CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Espitia-Hernandez 70% 0.30 [0.16-0.55] 12mg recov. time 28 (n) 7 (n) CT​2​ Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg death 0/183 3/183 CT​2​ Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Chaccour (DB RCT) 96% 0.04 [0.00-1.01] 28mg symptoms 12 (n) 12 (n) Ghauri 92% 0.08 [0.01-0.88] 48mg no recov. 0/37 7/53 Babalola (DB RCT) 64% 0.36 [0.10-1.27] 24mg viral+ 40 (n) 20 (n) OT​1​ Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Mohan (DB RCT) 62% 0.38 [0.08-1.75] 28mg no recov. 2/40 6/45 Biber (DB RCT) 70% 0.30 [0.03-2.76] 36mg hosp. 1/47 3/42 Elalfy 87% 0.13 [0.06-0.27] 36mg viral+ 7/62 44/51 CT​2​ Mourya 89% 0.11 [0.05-0.25] 48mg viral+ 5/50 47/50 Loue (QR) 70% 0.30 [0.04-2.20] 14mg death 1/10 5/15 Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Krolewiecki (RCT) -152% 2.52 [0.11-58.1] 168mg ventilation 1/27 0/14 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg death 4/250 3/251 Mayer 55% 0.45 [0.32-0.63] 151mg death 3,266 (n) 17,966 (n) de Jesús Ascenci.. 59% 0.41 [0.36-0.47] 12mg death/hosp. 7,898 (n) 20,150 (n) CT​2​ Manomai.. (DB RCT) 43% 0.57 [0.20-1.46] 48mg no recov. 3/36 6/36 Mirahma.. (DB RCT) 67% 0.33 [0.03-3.14] 24mg ventilation 1/131 3/130 Bramante (DB RCT) -197% 2.97 [0.12-72.7] 90mg death 1/408 0/396 OT​1​ Tau​2​ = 0.07, I​2​ = 34.2%, p < 0.0001 Early treatment 67% 0.33 [0.26-0.42] 32/12,764 155/39,660 67% improvement Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Improvement, RR [CI] Dose (4d) Treatment Control Chachar (RCT) 10% 0.90 [0.44-1.83] 36mg no recov. 9/25 10/25 Rajter (PSM) 46% 0.54 [0.27-0.99] 14mg death 13/98 24/98 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg death 0/59 6/70 CT​2​ Camprubí 40% 0.60 [0.18-2.01] 14mg ventilation 3/13 5/13 Spoorthi 21% 0.79 [0.64-0.98] n/a recov. time 50 (n) 50 (n) CT​2​ Okumuş (DB RCT) 33% 0.67 [0.27-1.64] 56mg death 6/30 9/30 Shahbazn.. (DB RCT) -197% 2.97 [0.13-70.5] 14mg death 1/35 0/34 Lima-Morales 78% 0.22 [0.12-0.41] 12mg death 15/481 52/287 CT​2​ Pott-Junior (RCT) 85% 0.15 [0.01-1.93] 14mg ventilation 1/27 1/4 censored, see notes Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg death 3/82 4/82 Rezk 80% 0.20 [0.01-4.13] 72mg death 0/160 2/160 Lim (RCT) 69% 0.31 [0.09-1.11] 112mg death 3/241 10/249 Ozer 75% 0.25 [0.06-1.13] 28mg death 2/60 8/60 Jamir (ICU) -53% 1.53 [0.88-2.67] n/a death 32/76 69/190 ICU patients Shimizu 100% 0.00 [0.00-0.01] 14mg death 0/39 8/49 Efimenko (PSM) 69% 0.31 [0.20-0.48] n/a death 1,072 (n) 40,536 (n) self-censored, see notes OT​1​ George (RCT) 30% 0.70 [0.25-1.93] 24mg death 5/35 8/39 Aref (RCT) 74% 0.26 [0.12-0.55] n/a recov. time 49 (n) 47 (n) LONG COVID Tau​2​ = 0.39, I​2​ = 75.2%, p = 0.00014 Late treatment 52% 0.48 [0.33-0.69] 93/2,664 216/42,053 52% improvement Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Improvement, RR [CI] Dose (1m) Treatment Control Behera 54% 0.46 [0.29-0.71] 42mg cases 41/117 145/255 Bernigaud 99% 0.01 [0.00-0.10] 84mg death 0/69 150/3,062 Alam 91% 0.09 [0.04-0.25] 12mg cases 4/58 44/60 Chahla (RCT) 95% 0.05 [0.00-0.80] 48mg m/s case 0/117 10/117 CT​2​ Behera 83% 0.17 [0.12-0.23] 42mg cases 45/2,199 133/1,147 Seet (CLUS. RCT) 50% 0.50 [0.33-0.76] 12mg symp. case 32/617 64/619 OT​1​ Morgenstern (PSM) 80% 0.20 [0.01-4.15] 56mg hosp. 0/271 2/271 Mondal 88% 0.12 [0.01-0.55] n/a symp. case 128 (n) 1,342 (n) Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg death 25/3,034 79/3,034 Tau​2​ = 0.47, I​2​ = 86.0%, p < 0.0001 Prophylaxis 82% 0.18 [0.11-0.32] 162/6,813 686/10,008 82% improvement All studies 67% 0.33 [0.27-0.42] 287/22,241 1,057/91,721 67% improvement 51 ivermectin COVID-19 peer reviewed trials after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.31, I​2​ = 77.6%, p < 0.0001 Effect extraction pre-specified(most serious outcome, see appendix) ​1​ OT: ivermectin vs. other treatment​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S2. Random effects meta-analysis for peer-reviewed studies after exclusions. Effect extraction is pre-specified, using the most serious outcome reported, see the appendix for details.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg hosp. 0/60 2/56 OT​1​ CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg death 0/183 3/183 CT​2​ Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Chaccour (DB RCT) 96% 0.04 [0.00-1.01] 28mg symptoms 12 (n) 12 (n) Babalola (DB RCT) 64% 0.36 [0.10-1.27] 24mg viral+ 40 (n) 20 (n) OT​1​ Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 Mohan (DB RCT) 62% 0.38 [0.08-1.75] 28mg no recov. 2/40 6/45 Biber (DB RCT) 70% 0.30 [0.03-2.76] 36mg hosp. 1/47 3/42 Chahla (CLUS. RCT) 87% 0.13 [0.03-0.54] 24mg no disch. 2/110 20/144 Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Krolewiecki (RCT) -152% 2.52 [0.11-58.1] 168mg ventilation 1/27 0/14 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg death 4/250 3/251 Manomai.. (DB RCT) 43% 0.57 [0.20-1.46] 48mg no recov. 3/36 6/36 Rocha (DB RCT) -187% 2.87 [0.12-67.5] 36mg misc. 1/30 0/26 Mirahma.. (DB RCT) 67% 0.33 [0.03-3.14] 24mg ventilation 1/131 3/130 Bramante (DB RCT) -197% 2.97 [0.12-72.7] 90mg death 1/408 0/396 OT​1​ Tau​2​ = 0.00, I​2​ = 0.0%, p < 0.0001 Early treatment 65% 0.35 [0.26-0.47] 26/1,594 97/1,583 65% improvement Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Improvement, RR [CI] Dose (4d) Treatment Control Chachar (RCT) 10% 0.90 [0.44-1.83] 36mg no recov. 9/25 10/25 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg death 0/59 6/70 CT​2​ Okumuş (DB RCT) 33% 0.67 [0.27-1.64] 56mg death 6/30 9/30 Shahbazn.. (DB RCT) -197% 2.97 [0.13-70.5] 14mg death 1/35 0/34 Pott-Junior (RCT) 85% 0.15 [0.01-1.93] 14mg ventilation 1/27 1/4 censored, see notes Huvemek (DB RCT) 32% 0.68 [0.38-1.23] 84mg no improv. 13/50 19/50 Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg death 3/82 4/82 Lim (RCT) 69% 0.31 [0.09-1.11] 112mg death 3/241 10/249 George (RCT) 30% 0.70 [0.25-1.93] 24mg death 5/35 8/39 Naggie (DB RCT) -195% 2.95 [0.12-72.2] 84mg death 1/817 0/774 Aref (RCT) 74% 0.26 [0.12-0.55] n/a recov. time 49 (n) 47 (n) LONG COVID Tau​2​ = 0.06, I​2​ = 18.9%, p = 0.0032 Late treatment 39% 0.61 [0.44-0.85] 42/1,482 67/1,434 39% improvement Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Improvement, RR [CI] Dose (1m) Treatment Control Chahla (RCT) 95% 0.05 [0.00-0.80] 48mg m/s case 0/117 10/117 CT​2​ Seet (CLUS. RCT) 50% 0.50 [0.33-0.76] 12mg symp. case 32/617 64/619 OT​1​ Tau​2​ = 1.43, I​2​ = 93.0%, p = 0.02 Prophylaxis 84% 0.16 [0.04-0.75] 47/937 133/837 84% improvement All studies 60% 0.40 [0.29-0.55] 115/4,013 297/3,854 60% improvement 33 ivermectin COVID-19 Randomized Controlled Trials after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.38, I​2​ = 59.0%, p < 0.0001 Effect extraction pre-specified(most serious outcome, see appendix) ​1​ OT: ivermectin vs. other treatment​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S3. Random effects meta-analysis for RCT studies after exclusions. Effect extraction is pre-specified, using the most serious outcome reported, see the appendix for details.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg 0/183 3/183 CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg 0/55 4/57 Loue (QR) 70% 0.30 [0.04-2.20] 14mg 1/10 5/15 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg 4/250 3/251 Mayer 55% 0.45 [0.32-0.63] 151mg 3,266 (n) 17,966 (n) Bramante (DB RCT) -197% 2.97 [0.12-72.7] 90mg 1/408 0/396 OT​1​ Tau​2​ = 0.00, I​2​ = 0.0%, p < 0.0001 Early treatment 54% 0.46 [0.34-0.63] 6/4,172 15/18,868 54% improvement Gorial 71% 0.29 [0.01-5.76] 14mg 0/16 2/71 Improvement, RR [CI] Dose (4d) Treatment Control Khan 87% 0.13 [0.02-1.00] 12mg 1/115 9/133 Rajter (PSM) 46% 0.54 [0.27-0.99] 14mg 13/98 24/98 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg 0/59 6/70 CT​2​ Budhiraja 99% 0.01 [0.00-0.15] n/a 0/34 103/942 Okumuş (DB RCT) 33% 0.67 [0.27-1.64] 56mg 6/30 9/30 Shahbazn.. (DB RCT) -197% 2.97 [0.13-70.5] 14mg 1/35 0/34 Lima-Morales 78% 0.22 [0.12-0.41] 12mg 15/481 52/287 CT​2​ Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg 3/82 4/82 Rezk 80% 0.20 [0.01-4.13] 72mg 0/160 2/160 Lim (RCT) 69% 0.31 [0.09-1.11] 112mg 3/241 10/249 Ozer 75% 0.25 [0.06-1.13] 28mg 2/60 8/60 Jamir (ICU) -53% 1.53 [0.88-2.67] n/a 32/76 69/190 ICU patients Baguma 97% 0.03 [0.00-11.7] n/a 7 (n) 474 (n) Shimizu 100% 0.00 [0.00-0.01] 14mg 0/39 8/49 Efimenko (PSM) 69% 0.31 [0.20-0.48] n/a 1,072 (n) 40,536 (n) self-censored, see notes OT​1​ George (RCT) 30% 0.70 [0.25-1.93] 24mg 5/35 8/39 Naggie (DB RCT) -195% 2.95 [0.12-72.2] 84mg 1/817 0/774 Tau​2​ = 0.75, I​2​ = 73.1%, p = 0.00017 Late treatment 66% 0.34 [0.19-0.59] 82/3,457 314/44,278 66% improvement Bernigaud 99% 0.01 [0.00-0.10] 84mg 0/69 150/3,062 Improvement, RR [CI] Dose (1m) Treatment Control Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg 25/3,034 79/3,034 Tau​2​ = 6.33, I​2​ = 86.1%, p = 0.13 Prophylaxis 94% 0.06 [0.00-2.36] 25/3,103 229/6,096 94% improvement All studies 65% 0.35 [0.23-0.53] 113/10,732 558/69,242 65% improvement 26 ivermectin COVID-19 mortality results after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.48, I​2​ = 68.6%, p < 0.0001 ​1​ OT: ivermectin vs. other treatment​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S4. Random effects meta-analysis for mortality after exclusions.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Ravikirti (DB RCT) 79% 0.21 [0.03-1.72] 24mg 1/55 5/57 Improvement, RR [CI] Dose (4d) Treatment Control Krolewiecki (RCT) -152% 2.52 [0.11-58.1] 168mg 1/27 0/14 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg 4/250 3/251 Mirahma.. (DB RCT) 67% 0.33 [0.03-3.14] 24mg 1/131 3/130 Tau​2​ = 0.02, I​2​ = 2.0%, p = 0.5 Early treatment 30% 0.70 [0.25-1.95] 7/463 11/452 30% improvement Rajter (PSM) 64% 0.36 [0.12-1.10] 14mg 4/98 11/98 Improvement, RR [CI] Dose (4d) Treatment Control Camprubí 40% 0.60 [0.18-2.01] 14mg 3/13 5/13 Shahbazn.. (DB RCT) -94% 1.94 [0.18-20.4] 14mg 2/35 1/34 Lima-Morales 52% 0.48 [0.20-1.18] 12mg 8/434 11/287 CT​1​ Pott-Junior (RCT) 85% 0.15 [0.01-1.93] 14mg 1/27 1/4 censored, see notes Abd-Elsalam (RCT) 0% 1.00 [0.21-4.81] 36mg 3/82 3/82 Lim (RCT) 59% 0.41 [0.13-1.30] 112mg 4/241 10/249 Ozer 13% 0.87 [0.11-5.58] 28mg 3/60 2/60 Shimizu 48% 0.52 [0.29-0.93] 14mg 39 (n) 49 (n) Tau​2​ = 0.00, I​2​ = 0.0%, p = 0.00048 Late treatment 48% 0.52 [0.36-0.75] 28/1,029 44/876 48% improvement All studies 46% 0.54 [0.38-0.76] 35/1,492 55/1,328 46% improvement 13 ivermectin COVID-19 mechanical ventilation results after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.00, I​2​ = 0.0%, p = 0.00044 ​1​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S5. Random effects meta-analysis for mechanical ventilation after exclusions.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Ravikirti (DB RCT) 14% 0.86 [0.28-2.67] 24mg 5/55 6/57 Improvement, RR [CI] Dose (4d) Treatment Control Mayer 66% 0.34 [0.22-0.51] 151mg 3,266 (n) 17,966 (n) Tau​2​ = 0.24, I​2​ = 56.4%, p = 0.081 Early treatment 53% 0.47 [0.20-1.10] 5/3,321 6/18,023 53% improvement Khan 89% 0.11 [0.01-0.80] 12mg 1/115 11/133 Improvement, RR [CI] Dose (4d) Treatment Control Camprubí 33% 0.67 [0.13-3.35] 14mg 2/13 3/13 Pott-Junior (RCT) 85% 0.15 [0.01-1.93] 14mg 1/27 1/4 censored, see notes Lim (RCT) 22% 0.78 [0.27-2.20] 112mg 6/241 8/249 Ozer 49% 0.51 [0.09-2.50] 28mg 6/60 3/60 Shimizu 43% 0.57 [0.32-1.02] 14mg 39 (n) 49 (n) Tau​2​ = 0.00, I​2​ = 0.0%, p = 0.0054 Late treatment 46% 0.54 [0.35-0.83] 16/495 26/508 46% improvement All studies 54% 0.46 [0.33-0.64] 21/3,816 32/18,531 54% improvement 8 ivermectin COVID-19 ICU results after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.02, I​2​ = 8.4%, p < 0.0001 Favors ivermectin Favors control
Figure S6. Random effects meta-analysis for ICU admission after exclusions.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg hosp. 0/60 2/56 OT​1​ CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Biber (DB RCT) 70% 0.30 [0.03-2.76] 36mg hosp. 1/47 3/42 Merino (QR) 74% 0.26 [0.11-0.57] 24mg hosp. population-based cohort censored, see notes CS​3​ Vallejos (DB RCT) 33% 0.67 [0.34-1.28] 24mg hosp. 14/250 21/251 Mirahma.. (DB RCT) 46% 0.54 [0.21-1.42] 24mg hosp. 6/131 11/130 Tau​2​ = 0.00, I​2​ = 0.0%, p = 0.00048 Early treatment 54% 0.46 [0.30-0.71] 21/488 37/479 54% improvement Gorial 42% 0.58 [0.45-0.75] 14mg hosp. time 16 (n) 71 (n) Improvement, RR [CI] Dose (4d) Treatment Control Khan 40% 0.60 [0.44-0.81] 12mg hosp. time 115 (n) 133 (n) Spoorthi 16% 0.84 [0.74-0.96] n/a hosp. time 50 (n) 50 (n) CT​2​ Shahbazn.. (DB RCT) 15% 0.85 [0.74-0.97] 14mg hosp. time 35 (n) 34 (n) Lima-Morales 67% 0.33 [0.22-0.47] 12mg hosp. 44/481 89/287 CT​2​ Abd-Elsalam (RCT) 20% 0.80 [0.63-1.03] 36mg hosp. time 82 (n) 82 (n) Lim (RCT) -5% 1.05 [0.94-1.19] 112mg hosp. time 241 (n) 249 (n) Ozer -9% 1.09 [0.99-1.22] 28mg hosp. time 60 (n) 60 (n) Naggie (DB RCT) -5% 1.05 [0.43-2.58] 84mg hosp. 10/817 9/774 Tau​2​ = 0.07, I​2​ = 89.7%, p = 0.0048 Late treatment 24% 0.76 [0.63-0.92] 54/1,897 98/1,740 24% improvement Morgenstern (PSM) 80% 0.20 [0.01-4.15] 56mg hosp. 0/271 2/271 Improvement, RR [CI] Dose (1m) Treatment Control Kerr (PSM) 67% 0.33 [0.23-0.46] 56mg hosp. 44/3,034 99/3,034 Tau​2​ = 0.00, I​2​ = 0.0%, p < 0.0001 Prophylaxis 67% 0.33 [0.23-0.46] 44/3,305 101/3,305 67% improvement All studies 34% 0.66 [0.54-0.80] 119/5,690 236/5,524 34% improvement 16 ivermectin COVID-19 hospitalization results after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.10, I​2​ = 87.7%, p < 0.0001 ​1​ OT: ivermectin vs. other treatment​3​ CS: preprint censored, see details ​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S7. Random effects meta-analysis for hospitalization after exclusions.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 46% 0.54 [0.40-0.73] 14mg no recov. 27/60 47/56 OT​1​ CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Espitia-Hernandez 70% 0.30 [0.16-0.55] 12mg recov. time 28 (n) 7 (n) CT​2​ Mahmud (DB RCT) 94% 0.06 [0.04-0.09] 12mg no recov. 72/183 100/180 CT​2​ Ghauri 92% 0.08 [0.01-0.88] 48mg no recov. 0/37 7/53 Babalola (DB RCT) 41% 0.59 [0.33-1.05] 24mg ∆Spo2 38 (n) 18 (n) OT​1​ Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg no disch. 0/55 4/57 Mohan (DB RCT) 62% 0.38 [0.08-1.75] 28mg no recov. 2/40 6/45 Chahla (CLUS. RCT) 87% 0.13 [0.03-0.54] 24mg no disch. 2/110 20/144 Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Manomai.. (DB RCT) 43% 0.57 [0.20-1.46] 48mg no recov. 3/36 6/36 Mirahma.. (DB RCT) 39% 0.61 [0.26-1.42] 24mg no recov. 8/131 13/130 Tau​2​ = 0.78, I​2​ = 87.4%, p < 0.0001 Early treatment 70% 0.30 [0.17-0.53] 120/825 222/833 70% improvement Gorial 71% 0.29 [0.01-5.76] 14mg no recov. 0/16 2/71 Improvement, RR [CI] Dose (4d) Treatment Control Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Khan 87% 0.13 [0.02-1.00] 12mg no recov. 1/115 9/133 Chachar (RCT) 10% 0.90 [0.44-1.83] 36mg no recov. 9/25 10/25 Hashim (SB RCT) 41% 0.59 [0.46-0.77] 28mg recov. time 70 (n) 70 (n) CT​2​ Spoorthi 21% 0.79 [0.64-0.98] n/a recov. time 50 (n) 50 (n) CT​2​ Shahbazn.. (DB RCT) 32% 0.68 [0.47-1.00] 14mg recov. time 35 (n) 34 (n) Lima-Morales 59% 0.41 [0.30-0.55] 12mg no recov. 75/481 118/287 CT​2​ Rezk 33% 0.67 [0.35-1.27] 72mg no recov. 14/145 20/138 Lim (RCT) -2% 1.02 [0.85-1.23] 112mg no recov. 116/241 116/247 George (RCT) 19% 0.81 [0.52-1.27] 24mg recov. time 35 (n) 39 (n) Naggie (DB RCT) 24% 0.76 [0.55-1.00] 84mg clin. ord. 817 (n) 774 (n) Aref (RCT) 74% 0.26 [0.12-0.55] n/a recov. time 49 (n) 47 (n) LONG COVID Tau​2​ = 0.09, I​2​ = 74.3%, p = 0.0003 Late treatment 33% 0.67 [0.54-0.83] 215/2,111 275/1,945 33% improvement All studies 53% 0.47 [0.35-0.62] 335/2,936 497/2,778 53% improvement 25 ivermectin COVID-19 recovery results after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.36, I​2​ = 88.3%, p < 0.0001 ​1​ OT: ivermectin vs. other treatment​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S8. Random effects meta-analysis for recovery results only after exclusions.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Improvement, RR [CI] Dose (1m) Treatment Control Behera 54% 0.46 [0.29-0.71] 42mg cases 41/117 145/255 Bernigaud 55% 0.45 [0.22-0.91] 84mg cases 7/69 692/3,062 Alam 91% 0.09 [0.04-0.25] 12mg cases 4/58 44/60 Chahla (RCT) 84% 0.16 [0.04-0.46] 48mg cases 4/117 25/117 CT​2​ Behera 83% 0.17 [0.12-0.23] 42mg cases 45/2,199 133/1,147 Seet (CLUS. RCT) 50% 0.50 [0.33-0.76] 12mg symp. case 32/617 64/619 OT​1​ Morgenstern (PSM) 74% 0.26 [0.10-0.71] 56mg cases 5/271 18/271 Mondal 88% 0.12 [0.01-0.55] n/a symp. case 128 (n) 1,342 (n) Kerr (PSM) 44% 0.56 [0.53-0.58] 56mg cases population-based cohort Tau​2​ = 0.40, I​2​ = 92.6%, p < 0.0001 Prophylaxis 75% 0.25 [0.16-0.39] 153/3,779 1,180/6,974 75% improvement All studies 75% 0.25 [0.16-0.39] 153/3,779 1,180/6,974 75% improvement 10 ivermectin COVID-19 case results after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.40, I​2​ = 92.6%, p < 0.0001 ​1​ OT: ivermectin vs. other treatment​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S9. Random effects meta-analysis for COVID-19 case results after exclusions.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg viral+ 0/60 2/56 OT​1​ CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Espitia-Hernandez 97% 0.03 [0.01-0.10] 12mg viral+ 0/28 7/7 CT​2​ Mahmud (DB RCT) 39% 0.61 [0.44-0.83] 12mg viral+ 14/183 36/180 CT​2​ Ahmed (DB RCT) 76% 0.24 [0.07-0.91] 48mg viral+ 11/22 20/23 Chaccour (DB RCT) 95% 0.05 [0.01-0.50] 28mg viral load 12 (n) 12 (n) Babalola (DB RCT) 64% 0.36 [0.10-1.27] 24mg viral+ 40 (n) 20 (n) OT​1​ Ravikirti (DB RCT) -12% 1.12 [0.89-1.40] 24mg viral+ 42/55 39/57 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 Mohan (DB RCT) 24% 0.76 [0.53-1.09] 28mg viral+ 21/40 31/45 Biber (DB RCT) 62% 0.38 [0.14-0.90] 36mg viral+ 8/47 17/42 Elalfy 87% 0.13 [0.06-0.27] 36mg viral+ 7/62 44/51 CT​2​ Mourya 89% 0.11 [0.05-0.25] 48mg viral+ 5/50 47/50 Aref (RCT) 79% 0.21 [0.07-0.71] n/a viral+ 3/57 14/57 Krolewiecki (RCT) 66% 0.34 [0.10-1.16] 168mg decay rate 20 (n) 14 (n) Vallejos (DB RCT) -5% 1.05 [0.88-1.21] 24mg viral+ 137/250 131/251 Manomai.. (DB RCT) 5% 0.95 [0.62-1.45] 48mg viral+ 19/36 20/36 Rocha (DB RCT) 8% 0.92 [0.85-1.00] 36mg viral load 30 (n) 26 (n) Tau​2​ = 0.21, I​2​ = 87.7%, p < 0.0001 Early treatment 56% 0.44 [0.33-0.59] 271/1,033 433/972 56% improvement Khan 73% 0.27 [0.12-0.58] 12mg viral time 115 (n) 133 (n) Improvement, RR [CI] Dose (4d) Treatment Control Camprubí -25% 1.25 [0.43-3.63] 14mg viral+ 5/13 4/13 Okumuş (DB RCT) 80% 0.20 [0.05-0.81] 56mg viral+ 2/16 5/8 Pott-Junior (RCT) 1% 0.99 [0.04-26.3] 14mg viral+ 27 (n) 3 (n) censored, see notes Rezk 27% 0.73 [0.57-0.93] 72mg viral time 160 (n) 160 (n) Tau​2​ = 0.25, I​2​ = 61.2%, p = 0.064 Late treatment 43% 0.57 [0.32-1.03] 7/331 9/317 43% improvement All studies 53% 0.47 [0.37-0.61] 278/1,364 442/1,289 53% improvement 22 ivermectin COVID-19 viral clearance results after exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.19, I​2​ = 85.6%, p < 0.0001 ​1​ OT: ivermectin vs. other treatment​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S10. Random effects meta-analysis for viral clearance after exclusions.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Gorial 71% 0.29 [0.01-5.76] 14mg death 0/16 2/71 Improvement, RR [CI] Dose (4d) Treatment Control Espitia-Hernandez 70% 0.30 [0.16-0.55] 12mg recov. time 28 (n) 7 (n) CT​2​ Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Carvallo 85% 0.15 [0.02-1.28] 36mg death 1/32 3/14 CT​2​ Rajter (PSM) 46% 0.54 [0.27-0.99] 14mg death 13/98 24/98 Carvallo 96% 0.04 [0.00-0.63] 14mg cases 0/131 11/98 see notes CT​2​ Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg death 0/59 6/70 CT​2​ Camprubí 40% 0.60 [0.18-2.01] 14mg ventilation 3/13 5/13 Carvallo 100% 0.00 [0.00-0.02] 48mg cases 0/788 237/407 see notes CT​2​ Bernigaud 99% 0.01 [0.00-0.10] 84mg death 0/69 150/3,062 Chaccour (DB RCT) 96% 0.04 [0.00-1.01] 28mg symptoms 12 (n) 12 (n) Ghauri 92% 0.08 [0.01-0.88] 48mg no recov. 0/37 7/53 IVERCOR PREP 73% 0.27 [0.15-0.48] 48mg cases 13/389 61/486 MD​3​ Chahla (RCT) 95% 0.05 [0.00-0.80] 48mg m/s case 0/117 10/117 CT​2​ Okumuş (DB RCT) 33% 0.67 [0.27-1.64] 56mg death 6/30 9/30 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 Shahbazn.. (DB RCT) -197% 2.97 [0.13-70.5] 14mg death 1/35 0/34 Lima-Morales 78% 0.22 [0.12-0.41] 12mg death 15/481 52/287 CT​2​ Biber (DB RCT) 70% 0.30 [0.03-2.76] 36mg hosp. 1/47 3/42 Elalfy 87% 0.13 [0.06-0.27] 36mg viral+ 7/62 44/51 CT​2​ Beltran .. (DB RCT) 14% 0.86 [0.29-2.56] 12mg death 5/36 6/37 Huvemek (DB RCT) 32% 0.68 [0.38-1.23] 84mg no improv. 13/50 19/50 Chahla (CLUS. RCT) 87% 0.13 [0.03-0.54] 24mg no disch. 2/110 20/144 Seet (CLUS. RCT) 50% 0.50 [0.33-0.76] 12mg symp. case 32/617 64/619 OT​1​ Loue (QR) 70% 0.30 [0.04-2.20] 14mg death 1/10 5/15 Ahsan 50% 0.50 [0.28-0.90] 21mg death 17/110 17/55 CT​2​ Merino (QR) 74% 0.26 [0.11-0.57] 24mg hosp. population-based cohort censored, see notes CS​5​ Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg death 3/82 4/82 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Krolewiecki (RCT) -152% 2.52 [0.11-58.1] 168mg ventilation 1/27 0/14 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg death 4/250 3/251 Hazan 86% 0.14 [0.01-2.15] 24mg death 0/24 synthetic CT​2​ SC​4​ Buonfrate (DB RCT) -211% 3.11 [0.13-73.3] 336mg hosp. 1/28 0/31 Mayer 55% 0.45 [0.32-0.63] 151mg death 3,266 (n) 17,966 (n) Borody 92% 0.08 [0.01-0.79] 96mg death 0/600 6/600 CT​2​ SC​4​ Rezk 80% 0.20 [0.01-4.13] 72mg death 0/160 2/160 Ozer 75% 0.25 [0.06-1.13] 28mg death 2/60 8/60 Mustafa 64% 0.36 [0.12-1.14] varies death 3/73 42/371 Shimizu 100% 0.00 [0.00-0.01] 14mg death 0/39 8/49 Abbas (DB RCT) -4% 1.04 [0.07-16.4] 84mg death 1/99 1/103 Zubair -9% 1.09 [0.33-3.64] 12mg death 5/90 5/98 de Jesús Ascenci.. 59% 0.41 [0.36-0.47] 12mg death/hosp. 7,898 (n) 20,150 (n) CT​2​ Efimenko (PSM) 69% 0.31 [0.20-0.48] n/a death 1,072 (n) 40,536 (n) self-censored, see notes OT​1​ Rocha (DB RCT) -187% 2.87 [0.12-67.5] 36mg misc. 1/30 0/26 Naggie (DB RCT) -195% 2.95 [0.12-72.2] 84mg death 1/817 0/774 Rezai (DB RCT) 31% 0.69 [0.35-1.39] 84mg death 13/311 18/298 Rezai (DB RCT) -5% 1.05 [0.07-16.7] 84mg death 1/268 1/281 Mirahma.. (DB RCT) 67% 0.33 [0.03-3.14] 24mg ventilation 1/131 3/130 Bramante (DB RCT) -197% 2.97 [0.12-72.7] 90mg death 1/408 0/396 OT​1​ Qadeer 58% 0.42 [0.31-0.56] 48mg viral+ 35/105 84/105 Aref (RCT) 74% 0.26 [0.12-0.55] n/a recov. time 49 (n) 47 (n) LONG COVID Tau​2​ = 0.22, I​2​ = 63.4%, p < 0.0001 <8.1% 67% 0.33 [0.27-0.41] 228/19,615 1,043/88,653 67% improvement Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg hosp. 0/60 2/56 OT​1​ CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Kishoria (RCT) -8% 1.08 [0.57-2.02] 12mg no disch. 11/19 7/13 Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Khan 87% 0.13 [0.02-1.00] 12mg death 1/115 9/133 Chachar (RCT) 10% 0.90 [0.44-1.83] 36mg no recov. 9/25 10/25 Soto-Becerra 17% 0.83 [0.71-0.97] 14mg death 92/203 1,438/2,630 Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg death 0/183 3/183 CT​2​ Szente Fonseca -14% 1.14 [0.75-1.66] 24mg hosp. 340 (n) 377 (n) Behera 54% 0.46 [0.29-0.71] 42mg cases 41/117 145/255 Cadegiani 78% 0.22 [0.01-4.48] 42mg death 0/110 2/137 CT​2​ Spoorthi 21% 0.79 [0.64-0.98] n/a recov. time 50 (n) 50 (n) CT​2​ Budhiraja 99% 0.01 [0.00-0.15] n/a death 0/34 103/942 Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Alam 91% 0.09 [0.04-0.25] 12mg cases 4/58 44/60 Babalola (DB RCT) 64% 0.36 [0.10-1.27] 24mg viral+ 40 (n) 20 (n) OT​1​ Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Mohan (DB RCT) 62% 0.38 [0.08-1.75] 28mg no recov. 2/40 6/45 Behera 83% 0.17 [0.12-0.23] 42mg cases 45/2,199 133/1,147 López-Me.. (DB RCT) 67% 0.33 [0.01-8.11] 84mg death 0/200 1/198 Pott-Junior (RCT) 85% 0.15 [0.01-1.93] 14mg ventilation 1/27 1/4 censored, see notes Roy 6% 0.94 [0.52-1.93] n/a recov. time 14 (n) 15 (n) CT​2​ Mourya 89% 0.11 [0.05-0.25] 48mg viral+ 5/50 47/50 Morgenstern (PSM) 80% 0.20 [0.01-4.15] 56mg hosp. 0/271 2/271 Mondal 88% 0.12 [0.01-0.55] n/a symp. case 128 (n) 1,342 (n) Reis (DB RCT) 12% 0.88 [0.49-1.55] 84mg death 21/679 24/679 Elavarasi 20% 0.80 [0.61-1.06] n/a death 48/283 311/1,475 Lim (RCT) 69% 0.31 [0.09-1.11] 112mg death 3/241 10/249 Samajdar 80% 0.20 [0.11-0.38] n/a cases 12/164 29/81 Ferreira -5% 1.05 [0.32-3.43] n/a death 3/21 11/81 Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg death 25/3,034 79/3,034 Jamir (ICU) -53% 1.53 [0.88-2.67] n/a death 32/76 69/190 ICU patients Baguma 97% 0.03 [0.00-11.7] n/a death 7 (n) 474 (n) Manomai.. (DB RCT) 43% 0.57 [0.20-1.46] 48mg no recov. 3/36 6/36 Thairu (PSM) 88% 0.12 [0.01-2.14] 56mg death 0/21 4/26 Soto -41% 1.41 [1.16-1.76] n/a death 280/484 374/934 Ravikirti 3% 0.97 [0.74-1.24] varies death 53/171 254/794 George (RCT) 30% 0.70 [0.25-1.93] 24mg death 5/35 8/39 Schilling (RCT) 67% 0.33 [0.01-7.97] 168mg hosp. 0/45 1/45 Tau​2​ = 0.41, I​2​ = 88.6%, p < 0.0001 ≥8.1% 51% 0.49 [0.37-0.64] 696/9,684 3,140/16,196 51% improvement All studies 62% 0.38 [0.31-0.47] 924/29,299 4,183/104,849 62% improvement 90 ivermectin COVID-19 studies by strongyloides prevalence ivmmeta.com Sep 2022 Tau​2​ = 0.48, I​2​ = 86.9%, p < 0.0001 Effect extraction pre-specified, see appendix ​1​ OT: ivermectin vs. other treatment​3​ MD: minimal detail available currently​5​ CS: preprint censored, see details ​2​ CT: study uses combined treatment​4​ SC: study uses synthetic control arm Favors ivermectin Favors control
Figure S11. Random effects meta-analysis for studies grouped by strongyloides prevalence. Data is by country and from [Buonfrate]. Effect extraction follows the same pre-specified protocol as detailed in the appendix.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Chowdhury (RCT) 81% 0.19 [0.01-3.96] 14mg hosp. 0/60 2/56 OT​1​ CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg death 0/183 3/183 CT​2​ Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Chaccour (DB RCT) 96% 0.04 [0.00-1.01] 28mg symptoms 12 (n) 12 (n) Ghauri 92% 0.08 [0.01-0.88] 48mg no recov. 0/37 7/53 Babalola (DB RCT) 64% 0.36 [0.10-1.27] 24mg viral+ 40 (n) 20 (n) OT​1​ Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 Mohan (DB RCT) 62% 0.38 [0.08-1.75] 28mg no recov. 2/40 6/45 López-Me.. (DB RCT) 67% 0.33 [0.01-8.11] 84mg death 0/200 1/198 Faisal (RCT) 68% 0.32 [0.14-0.72] 48mg no recov. 6/50 19/50 Aref (RCT) 63% 0.37 [0.22-0.61] n/a recov. time 57 (n) 57 (n) Krolewiecki (RCT) -152% 2.52 [0.11-58.1] 168mg ventilation 1/27 0/14 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg death 4/250 3/251 Reis (DB RCT) 12% 0.88 [0.49-1.55] 84mg death 21/679 24/679 Buonfrate (DB RCT) -211% 3.11 [0.13-73.3] 336mg hosp. 1/28 0/31 Manomai.. (DB RCT) 43% 0.57 [0.20-1.46] 48mg no recov. 3/36 6/36 Rocha (DB RCT) -187% 2.87 [0.12-67.5] 36mg misc. 1/30 0/26 Rezai (DB RCT) -5% 1.05 [0.07-16.7] 84mg death 1/268 1/281 Mirahma.. (DB RCT) 67% 0.33 [0.03-3.14] 24mg ventilation 1/131 3/130 Schilling (RCT) 67% 0.33 [0.01-7.97] 168mg hosp. 0/45 1/45 Bramante (DB RCT) -197% 2.97 [0.12-72.7] 90mg death 1/408 0/396 OT​1​ Tau​2​ = 0.08, I​2​ = 13.6%, p < 0.0001 Early treatment 56% 0.44 [0.31-0.61] 46/2,694 108/2,684 56% improvement Gorial 71% 0.29 [0.01-5.76] 14mg death 0/16 2/71 Improvement, RR [CI] Dose (4d) Treatment Control Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Khan 87% 0.13 [0.02-1.00] 12mg death 1/115 9/133 Chachar (RCT) 10% 0.90 [0.44-1.83] 36mg no recov. 9/25 10/25 Soto-Becerra 17% 0.83 [0.71-0.97] 14mg death 92/203 1,438/2,630 Rajter (PSM) 46% 0.54 [0.27-0.99] 14mg death 13/98 24/98 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg death 0/59 6/70 CT​2​ Camprubí 40% 0.60 [0.18-2.01] 14mg ventilation 3/13 5/13 Spoorthi 21% 0.79 [0.64-0.98] n/a recov. time 50 (n) 50 (n) CT​2​ Budhiraja 99% 0.01 [0.00-0.15] n/a death 0/34 103/942 Okumuş (DB RCT) 33% 0.67 [0.27-1.64] 56mg death 6/30 9/30 Shahbazn.. (DB RCT) -197% 2.97 [0.13-70.5] 14mg death 1/35 0/34 Lima-Morales 78% 0.22 [0.12-0.41] 12mg death 15/481 52/287 CT​2​ Beltran .. (DB RCT) 14% 0.86 [0.29-2.56] 12mg death 5/36 6/37 Pott-Junior (RCT) 85% 0.15 [0.01-1.93] 14mg ventilation 1/27 1/4 censored, see notes Huvemek (DB RCT) 32% 0.68 [0.38-1.23] 84mg no improv. 13/50 19/50 Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg death 3/82 4/82 Elavarasi 20% 0.80 [0.61-1.06] n/a death 48/283 311/1,475 Rezk 80% 0.20 [0.01-4.13] 72mg death 0/160 2/160 Lim (RCT) 69% 0.31 [0.09-1.11] 112mg death 3/241 10/249 Ozer 75% 0.25 [0.06-1.13] 28mg death 2/60 8/60 Jamir (ICU) -53% 1.53 [0.88-2.67] n/a death 32/76 69/190 ICU patients Shimizu 100% 0.00 [0.00-0.01] 14mg death 0/39 8/49 George (RCT) 30% 0.70 [0.25-1.93] 24mg death 5/35 8/39 Naggie (DB RCT) -195% 2.95 [0.12-72.2] 84mg death 1/817 0/774 Rezai (DB RCT) 31% 0.69 [0.35-1.39] 84mg death 13/311 18/298 Qadeer 58% 0.42 [0.31-0.56] 48mg viral+ 35/105 84/105 Aref (RCT) 74% 0.26 [0.12-0.55] n/a recov. time 49 (n) 47 (n) LONG COVID Tau​2​ = 0.19, I​2​ = 71.3%, p < 0.0001 Late treatment 44% 0.56 [0.44-0.71] 301/3,562 2,206/8,032 44% improvement Shouman (RCT) 91% 0.09 [0.03-0.23] 36mg symp. case 15/203 59/101 Improvement, RR [CI] Dose (1m) Treatment Control Behera 54% 0.46 [0.29-0.71] 42mg cases 41/117 145/255 Bernigaud 99% 0.01 [0.00-0.10] 84mg death 0/69 150/3,062 Alam 91% 0.09 [0.04-0.25] 12mg cases 4/58 44/60 Chahla (RCT) 95% 0.05 [0.00-0.80] 48mg m/s case 0/117 10/117 CT​2​ Behera 83% 0.17 [0.12-0.23] 42mg cases 45/2,199 133/1,147 Seet (CLUS. RCT) 50% 0.50 [0.33-0.76] 12mg symp. case 32/617 64/619 OT​1​ Morgenstern (PSM) 80% 0.20 [0.01-4.15] 56mg hosp. 0/271 2/271 Mondal 88% 0.12 [0.01-0.55] n/a symp. case 128 (n) 1,342 (n) Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg death 25/3,034 79/3,034 Tau​2​ = 0.47, I​2​ = 86.0%, p < 0.0001 Prophylaxis 82% 0.18 [0.11-0.32] 162/6,813 686/10,008 82% improvement All studies 60% 0.40 [0.32-0.50] 509/13,069 3,000/20,724 60% improvement All 60 ivermectin COVID-19 studies after SSC exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.38, I​2​ = 79.1%, p < 0.0001 Effect extraction pre-specified(most serious outcome, see appendix) ​1​ OT: ivermectin vs. other treatment​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S12. Random effects meta-analysis with SSC exclusions. SSC has not reviewed late treatment and prophylaxis trials. SSC exclusions are from Nov 27, 2021.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Mahmud (DB RCT) 86% 0.14 [0.01-2.75] 12mg death 0/183 3/183 CT​2​ Improvement, RR [CI] Dose (4d) Treatment Control Szente Fonseca -14% 1.14 [0.75-1.66] 24mg hosp. 340 (n) 377 (n) Ahmed (DB RCT) 85% 0.15 [0.01-2.70] 48mg symptoms 0/17 3/19 Chaccour (DB RCT) 96% 0.04 [0.00-1.01] 28mg symptoms 12 (n) 12 (n) Ravikirti (DB RCT) 89% 0.11 [0.01-2.05] 24mg death 0/55 4/57 Bukhari (RCT) 82% 0.18 [0.07-0.46] 12mg viral+ 4/41 25/45 Mohan (DB RCT) 62% 0.38 [0.08-1.75] 28mg no recov. 2/40 6/45 Biber (DB RCT) 70% 0.30 [0.03-2.76] 36mg hosp. 1/47 3/42 López-Me.. (DB RCT) 67% 0.33 [0.01-8.11] 84mg death 0/200 1/198 Krolewiecki (RCT) -152% 2.52 [0.11-58.1] 168mg ventilation 1/27 0/14 Vallejos (DB RCT) -33% 1.33 [0.30-5.72] 24mg death 4/250 3/251 Reis (DB RCT) 12% 0.88 [0.49-1.55] 84mg death 21/679 24/679 Buonfrate (DB RCT) -211% 3.11 [0.13-73.3] 336mg hosp. 1/28 0/31 Mayer 55% 0.45 [0.32-0.63] 151mg death 3,266 (n) 17,966 (n) Manomai.. (DB RCT) 43% 0.57 [0.20-1.46] 48mg no recov. 3/36 6/36 Rocha (DB RCT) -187% 2.87 [0.12-67.5] 36mg misc. 1/30 0/26 Rezai (DB RCT) -5% 1.05 [0.07-16.7] 84mg death 1/268 1/281 Mirahma.. (DB RCT) 67% 0.33 [0.03-3.14] 24mg ventilation 1/131 3/130 Schilling (RCT) 67% 0.33 [0.01-7.97] 168mg hosp. 0/45 1/45 Bramante (DB RCT) -197% 2.97 [0.12-72.7] 90mg death 1/408 0/396 OT​1​ Tau​2​ = 0.17, I​2​ = 34.1%, p = 0.0036 Early treatment 43% 0.57 [0.39-0.83] 41/6,103 83/20,833 43% improvement Podder (RCT) 16% 0.84 [0.55-1.12] 14mg recov. time 32 (n) 30 (n) Improvement, RR [CI] Dose (4d) Treatment Control Soto-Becerra 17% 0.83 [0.71-0.97] 14mg death 92/203 1,438/2,630 Hashim (SB RCT) 92% 0.08 [0.00-1.44] 28mg death 0/59 6/70 CT​2​ Shahbazn.. (DB RCT) -197% 2.97 [0.13-70.5] 14mg death 1/35 0/34 Lima-Morales 78% 0.22 [0.12-0.41] 12mg death 15/481 52/287 CT​2​ Beltran .. (DB RCT) 14% 0.86 [0.29-2.56] 12mg death 5/36 6/37 Huvemek (DB RCT) 32% 0.68 [0.38-1.23] 84mg no improv. 13/50 19/50 Abd-Elsalam (RCT) 25% 0.75 [0.17-3.06] 36mg death 3/82 4/82 Elavarasi 20% 0.80 [0.61-1.06] n/a death 48/283 311/1,475 Rezk 80% 0.20 [0.01-4.13] 72mg death 0/160 2/160 Lim (RCT) 69% 0.31 [0.09-1.11] 112mg death 3/241 10/249 Ozer 75% 0.25 [0.06-1.13] 28mg death 2/60 8/60 Jamir (ICU) -53% 1.53 [0.88-2.67] n/a death 32/76 69/190 ICU patients Shimizu 100% 0.00 [0.00-0.01] 14mg death 0/39 8/49 George (RCT) 30% 0.70 [0.25-1.93] 24mg death 5/35 8/39 Naggie (DB RCT) -195% 2.95 [0.12-72.2] 84mg death 1/817 0/774 Rezai (DB RCT) 31% 0.69 [0.35-1.39] 84mg death 13/311 18/298 Qadeer 58% 0.42 [0.31-0.56] 48mg viral+ 35/105 84/105 Aref (RCT) 74% 0.26 [0.12-0.55] n/a recov. time 49 (n) 47 (n) LONG COVID Tau​2​ = 0.25, I​2​ = 76.8%, p = 0.00026 Late treatment 45% 0.55 [0.40-0.76] 268/3,154 2,043/6,666 45% improvement Seet (CLUS. RCT) 50% 0.50 [0.33-0.76] 12mg symp. case 32/617 64/619 OT​1​ Improvement, RR [CI] Dose (1m) Treatment Control Morgenstern (PSM) 80% 0.20 [0.01-4.15] 56mg hosp. 0/271 2/271 Kerr (PSM) 70% 0.30 [0.19-0.46] 56mg death 25/3,034 79/3,034 Tau​2​ = 0.04, I​2​ = 32.4%, p < 0.0001 Prophylaxis 61% 0.39 [0.26-0.59] 57/3,922 145/3,924 61% improvement All studies 46% 0.54 [0.43-0.67] 366/13,179 2,271/31,423 46% improvement All 42 ivermectin COVID-19 studies after GMK exclusions ivmmeta.com Sep 2022 Tau​2​ = 0.21, I​2​ = 66.4%, p < 0.0001 Effect extraction pre-specified(most serious outcome, see appendix) ​1​ OT: ivermectin vs. other treatment​2​ CT: study uses combined treatment Favors ivermectin Favors control
Figure S13. Random effects meta-analysis with GMK exclusions. Our main exclusion analyses already exclude all studies where the GMK team believes there are major data issues. This analysis corresponds with GMK's recommendation for meta analysis as of Oct 26, 2021. GMK excludes most non-RCT studies, with the notable exception of several studies with major issues that report negative or relatively poor results — [Szente Fonseca] which is likely affected by multicollinearity among treatments, [Elavarasi] which reports unadjusted results with no group details and is subject to confounding by indication, and [Soto-Becerra] which has several major issues described in the details.
Please send us corrections, updates, or comments. Vaccines and treatments are both valuable and complementary. All practical, effective, and safe means should be used. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. Denying the efficacy of any method increases mortality, morbidity, collateral damage, and the risk of endemic status. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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