Outcome |
Relative effect (95% CI) |
Absolute effect (95% CI)1 |
Certainty of the Evidence (GRADE) |
Clinical improvement D28 |
Outcome not yet measured or reported
|
|
Clinical improvement D60 |
Outcome not yet measured or reported
|
|
WHO progression score (level 7 or above) D28 |
RR: * |
Zero events in both groups
|
Very low certainty
Reasons to downgrade
Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious single study from a single institution therefore results in this population might not be generalizable to other settings Imprecision: Very serious no events in both groups and low number of participants.
|
1 trials
Ahmed S, 2020
48 participants
|
|
Ivermectin+Doxycycline 0 per 1,000 ( - ) |
Standard care/Placebo 0 per 1,000 |
|
WHO progression score (level 7 or above) D60 |
Outcome not yet measured or reported
|
|
All-cause mortality D28 |
RR: 0.14 (0.01 - 2.75) |
12 fewer per 1000 (from 13 fewer to 23 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding missing data and slection of the reported results. Inconsistency: Not serious Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm and low number of events and participants
|
2 trials
Mahmud R, 2020; Ahmed S, 2020
448 participants
|
|
Ivermectin+Doxycycline 2 per 1,000 (0 - 37) |
Standard care/Placebo 13 per 1,000 |
|
All-cause mortality D60 |
RR: 0.33 (0.07 - 1.60) |
57 fewer per 1000 (from 80 fewer to 51 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Very serious Risk of bias downgraded by 2 levels: high risk of bias regarding adequate randomization, deviation from intended intervention and missing data and some concerns regarding selection of reported results Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm and low number of events and participants
|
1 trials
Hashim A, 2020
140 participants
|
|
Ivermectin+Doxycycline 28 per 1,000 (6 - 137) |
Standard care/Placebo 86 per 1,000 |
|
Viral negative conversion D7 |
RR: 1.65 (0.49 - 5.50) |
421 more per 1000 (from 330 fewer to 1000 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding missing data and selection of the reported results. Inconsistency: Not serious Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
|
2 trials
Mahmud R, 2020; Ahmed S, 2020
448 participants
|
|
Ivermectin+Doxycycline 1068 per 1,000 (317 - 1000) |
Standard care/Placebo 647 per 1,000 |
|
Adverse events
|
RR: 3.23 (0.23 - 45.46) |
189 more per 1000 (from 65 fewer to 1000 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding missing data and selection of reported results. Inconsistency: Serious I²=73% Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm and low number of events and participants
|
2 trials
Mahmud R, 2020; Ahmed S, 2020
448 participants
|
|
Ivermectin+Doxycycline 274 per 1,000 (20 - 1000) |
Standard care/Placebo 85 per 1,000 |
|
Serious adverse events
|
RR: 5.00 (0.24 - 103.49) |
Absolute effects were not calculated due to zero events in the control group
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding missing data and selection of reported results. Inconsistency: Not serious Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm and low number of events and participants
|
2 trials
Mahmud R, 2020; Ahmed S, 2020
448 participants
|
|
Ivermectin+Doxycycline 0 per 1,000 ( - ) |
Standard care/Placebo 0 per 1,000 |
|
1The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect