| Bias | Author's judgement | Support for judgement |
| Confounding |
Serious |
Comment: The following review confounders (Age, Gender) comorbidities and severity but did not controlled for immunosuppression and ethnicity. No information for site-effects. The baseline characteristics presented are measured but not adjusted. Some potential confounders are unbalanced at baseline but were not controlled for like ethnicity ad immunosuppression. |
| Selection of participants into the study |
Serious |
Comment: It is unclear when the follow up of the patients started since participants exposure to treatment is at any time during hospitalization and analysis is performed after the completion of the study. In the control arm the baseline charecteristics are collected at admission or at treatment provision. Quote Baseline data was collected at the time of ivermectin administration for the ivermectin group; for the usual care group baseline was either at the time of administration of hydroxychloroquine or, if not used, at the time of admission. |
| Intervention classification |
Low |
Comment: Data were collected from health records. Treatment groups were classified using clearly defined criteria. Quote: Patients were categorized into two treatment groups based on whether they received ivermectin at any time during the hospitalization. Patients in the Ivermectin group received at least one oral dose of ivermectin at 200 micrograms/kilogram in addition to usual clinical care. The decision to prescribe ivermectin, hydroxychloroquine, azithromycin or other medications was at the discretion of the treating physicians, however hospital guidelines were established for the use of these agents |
| Deviation from intended intervention |
NI |
Comment: The information reported is inadequate to assess whether there are deviations from the intended intervention beyond what would be expected in usual practice. For example, the authors present only baseline data for the administration of co-interventions (hydroxychloroquine with or without azithromycin) an important number of patients receied thiese cointerventions in both arms however there is an imbalance between arms . It is unclear how many participants per arm received other co-interventions during follow-up. Inadequate information to assess risk for the outcomes: mortality and time to death |
| Missing data |
Low |
Comment: No missing data |
| Measurements of outcomes |
Low |
Comment: Observer-reported objective outcome (death). |
| Selection of the reported results |
Moderate |
Comment: The outcomes and analyses are clearly defined in the Methods section. There is no a-priori registered protocol or statistical analysis plan available. |