Ivermectin in the Prophylaxis and Treatment of Patients with SARS-CoV-2: A Living Systematic Review and Meta-Analysis

Abstract

Background: Finding an effective treatment for COVID-19 has been a paramount task. Ivermectin is an anti-parasitic drug that has gained interest among researchers due to its in vitro antiviral activity. Despite its novelty, its efficacy has not yet been proven. Therefore, we aim to conduct a living systematic review and meta-analysis to assess the effectiveness of ivermectin on adult patients with COVID-19.Methods: We performed a living systematic review and meta-analysis to assess the effectiveness of ivermectin on adult patients with SARS-CoV-2 infection. Six medical databases were searched for studies published from January 2019 to January 30, 2021. For meta-analyses, random-effects models were used to estimate outcome measures assuming high heterogeneity between studies. When a low-heterogeneity was expected, fixed-effects models were assessed. The study is registered with PROSPERO, CRD42021235402Findings: Ten trials including 1426 patients proved eligible. Pooled analysis in six studies (941 patients), with an overall high risk of bias, showed ivermectin to reduce mortality (OR 0.16; 95% CI 0.08 to 0.33; I 2=0%; p=0.81). Three studies reported time to viral clearance as outcome showing a statistically significant difference favoring the ivermectin group (MD - 3.83; 95% CI -5.43 to -2.22; I 2=81%; pInterpretation: The available body of evidence suggests ivermectin reduces mortality and time to viral clearance in adult patients with COVID-19. The evidence, however, is of low-quality which reduces the confidence of the results. There is no sufficient available data to suggest ivermectin has a prophylactic effect. Future studies should help us have a better perspective on its effect.Funding: NoneDeclaration of Interests: We declare no competing interests.