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

42 Pages Posted: 11 Mar 2021

See all articles by René Rodríguez-Gutiérrez

René Rodríguez-Gutiérrez

Universidad Autonoma de Nuevo Leon - Plataforma Invest KER México

Karina Raygoza-Cortez

Universidad Autonoma de Nuevo Leon - Plataforma Invest KER México

Mariana Garcia-Leal

Universidad Autónoma de Nuevo León (UANL) - Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico)

Melissa Sáenz-Flores

Universidad Autonoma de Nuevo Leon - Plataforma Invest KER México

Ricardo Cesar Solis

Universidad Autónoma de Nuevo León (UANL) - Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico)

Andrea Flores-Rodríguez

Universidad Autónoma de Nuevo León (UANL) - Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico)

Neri Álvarez-Villalobos

Universidad Autónoma de Nuevo León (UANL) - Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico)

José Gerardo González-González

Universidad Autonoma de Nuevo Leon - Plataforma Invest KER México

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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, CRD42021235402

Findings: 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%; p<0.01). No positive effect was found regarding ivermectin prophylaxis. As for the other outcomes, no statistically significant results were found. The global assessment of the quality of evidence exhibited very low confidence in the estimates of effect for ivermectin on several important and critical outcomes.

Interpretation: 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: None

Declaration of Interests: We declare no competing interests.

Keywords: SARS-CoV-2, COVID-19, Ivermectin, Prophylaxis, Treatment

Suggested Citation

Rodríguez-Gutiérrez, René and Raygoza-Cortez, Karina and Garcia-Leal, Mariana and Sáenz-Flores, Melissa and Solis, Ricardo Cesar and Flores-Rodríguez, Andrea and Álvarez-Villalobos, Neri and González-González, José Gerardo, Ivermectin in the Prophylaxis and Treatment of Patients with SARS-CoV-2: A Living Systematic Review and Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=3802499 or http://dx.doi.org/10.2139/ssrn.3802499

René Rodríguez-Gutiérrez

Universidad Autonoma de Nuevo Leon - Plataforma Invest KER México ( email )

Karina Raygoza-Cortez

Universidad Autonoma de Nuevo Leon - Plataforma Invest KER México ( email )

Mariana Garcia-Leal

Universidad Autónoma de Nuevo León (UANL) - Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico) ( email )

Dr. Carlos Canseco 110. Col. Mitras Centro. Monter
Monterrey, Nuevo Leon 64460
Mexico

Melissa Sáenz-Flores

Universidad Autonoma de Nuevo Leon - Plataforma Invest KER México

Ricardo Cesar Solis

Universidad Autónoma de Nuevo León (UANL) - Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico) ( email )

Dr. Carlos Canseco 110. Col. Mitras Centro. Monter
Monterrey, Nuevo Leon 64460
Mexico

Andrea Flores-Rodríguez

Universidad Autónoma de Nuevo León (UANL) - Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico) ( email )

Dr. Carlos Canseco 110. Col. Mitras Centro. Monter
Monterrey, Nuevo Leon 64460
Mexico

Neri Álvarez-Villalobos

Universidad Autónoma de Nuevo León (UANL) - Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico) ( email )

Dr. Carlos Canseco 110. Col. Mitras Centro. Monter
Monterrey, Nuevo Leon 64460
Mexico

José Gerardo González-González (Contact Author)

Universidad Autonoma de Nuevo Leon - Plataforma Invest KER México ( email )

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