Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Ivermectin vs Standard care/Placebo

This comparison will not be updated. Last search date 28 Feb, 2022.

Study Samaha A, Viruses 2021 has been retracted on October 26, 2021. The study was excluded from the analysis and grade assessment by December 17 the latest.

Study Pott-Junior H, 2021 (Toxicology Reports) retracted on May 11, 2022.

Outpatients

Forest plots
(last update: 2022-06-02)

Summary of findings
(last update: 2022-06-03)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Ivermectin
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.05 (0.93 - 1.19)	33 more per 1000 (from 46 fewer to 124 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: high risk regarding adequate randomization and some concerns regarding outcome measurement and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
2 trials Khan Chachar AZ, 2020; Lopez-Medina E, 2021 526 participants		Ivermectin 683 per 1,000 (605 - 774)	Standard care/Placebo 650 per 1,000
Clinical improvement D60	Outcome not yet measured or reported
Hospitalisation or death	RR: 0.67 (0.35 - 1.29)	28 fewer per 1000 (from 54 fewer to 24 more)		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 due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Vallejos J, 2021 501 participants		Ivermectin 56 per 1,000 (29 - 108)	Standard care/Placebo 84 per 1,000
WHO progression score (level 7 or above) D28	RR: 1.43 (0.55 - 3.72)	6 more per 1000 (from 6 fewer to 38 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
3 trials Chaccour C, 2021; Lopez-Medina E, 2021; Vallejos J, 2021 1001 participants		Ivermectin 20 per 1,000 (8 - 52)	Standard care/Placebo 14 per 1,000
WHO progression score (level 7 or above) D60	RR: 2.00 (0.37 - 10.82)	8 more per 1000 (from 5 fewer to 83 more)		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 due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Lopez-Medina E, 2021 476 participants		Ivermectin 17 per 1,000 (3 - 91)	Standard care/Placebo 8 per 1,000
All-cause mortality D28	RR: 1.05 (0.27 - 4.02)	0 fewer per 1000 (from 5 fewer to 19 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
4 trials Chaccour C, 2021; Lopez-Medina E, 2021; Chahla R, 2021; Vallejos J, 2021 1255 participants		Ivermectin 7 per 1,000 (2 - 25)	Standard care/Placebo 6 per 1,000
All-cause mortality D60	RR: 2.00 (0.18 - 21.91)	4 more per 1000 (from 3 fewer to 88 more)		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 due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Lopez-Medina E, 2021 476 participants		Ivermectin 8 per 1,000 (1 - 92)	Standard care/Placebo 4 per 1,000
Viral negative conversion D7	RR: 1.10 (0.92 - 1.33)	54 more per 1000 (from 43 fewer to 177 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding adequate randomization, deviation from intended intervention, missing data and selection of the reported results Inconsistency: Serious Inconsistency downgraded by 1 level: I²=:63.1% Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect and low number of participants. Not downgraded a further level, as already downgraded for inconsistency, which would have contributed to the impresicion.
6 trials Aref ZF, 2021; Biber A, 2021; Khan Chachar AZ, 2020; Chaccour C, 2021; Vallejos J, 2021; Podder C, 2020 938 participants		Ivermectin 589 per 1,000 (492 - 712)	Standard care/Placebo 535 per 1,000
Adverse events	RR: 0.96 (0.85 - 1.08)	14 fewer per 1000 (from 54 fewer to 29 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Despite concerns with adequate randomisation, outcome measurement, and selection of the reported results not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
5 trials Khan Chachar AZ, 2020; Chaccour C, 2021; Lopez-Medina E, 2021; Biber A, 2021; Vallejos J, 2021 1167 participants		Ivermectin 345 per 1,000 (305 - 388)	Standard care/Placebo 359 per 1,000
Serious adverse events	RR: 1.00 (0.14 - 7.04)	0 fewer per 1000 (from 3 fewer to 21 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Despite concerns with adequate randomisation, outcome measurement, and selection of the reported results not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
5 trials Khan Chachar AZ, 2020; Chaccour C, 2021; Lopez-Medina E, 2021; Biber A, 2021; Vallejos J, 2021 1167 participants		Ivermectin 3 per 1,000 (0 - 24)	Standard care/Placebo 3 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

Hospitalized patients

Forest plots
(last update: 2023-01-27)

Summary of findings
(last update: 2023-04-20)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Ivermectin
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.00 (0.90 - 1.11)	0 fewer per 1000 (from 75 fewer to 83 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, outcome measurement and selection of reported results. Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
4 trials Mohan A, 2021, Beltran-Gonzalez J, 2021; Kishoria N, 2020; Ravikirti R, 2021 373 participants		Ivermectin 752 per 1,000 (676 - 834)	Standard care/Placebo 752 per 1,000
Clinical improvement D60	Outcome not yet measured or reported
WHO progression score (level 7 or above) D28	RR: 1.55 (0.07 - 35.89)	Absolute effects were not calculated due to zero events in the control group		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm and low number of participants and events.
4 trials Ahmed S, 2020; Mohan A, 2021; Krolewiecki A, 2020; Manomaipiboon A, 2022 320 participants		Ivermectin 0 per 1,000 (1 - 36)	Standard care/Placebo 0 per 1,000
WHO progression score (level 7 or above) D60	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 Pott-Junior H, 2021 32 participants		Ivermectin 0 per 1,000 (* - *)	Standard care/Placebo 0 per 1,000
All-cause mortality D28	RR: 0.46 (0.22 - 0.95)	26 fewer per 1000 (from 38 fewer to 2 fewer)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, missing data and selection of reported results. Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
10 trials Lim SCL, 2022; Ahmed S, 2020;Manomaipiboon A, 2022; Mohan A, 2021; Krolewiecki A, 2020; Ravikirti R, 2021; Beltran-Gonzalez J, 2021; Shahbaznejad L, 2021; Abd-Elsalam S, 2021; Niaee MS, 2021 1425 participants		Ivermectin 23 per 1,000 (11 - 46)	Standard care/Placebo 49 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
All-cause mortality D60	RR: 0.56 (0.22 - 1.38)	132 fewer per 1000 (from 234 fewer to 114 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: high risk of bias regarding adequate randomization and some concerns with deviation from intended intervention. 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 participants and events.
1 trials Okumus N, 2021 66 participants		Ivermectin 168 per 1,000 (66 - 414)	Standard care/Placebo 300 per 1,000
Viral negative conversion D7	RR: 1.17 (0.92 - 1.51)	54 more per 1000 (from 26 fewer to 163 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding adequate randomization, deviation from intended intervention, missing data, and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for no effect and low number of participants
7 trials Kishoria N, 2020; Shah Bukari KH, 2021; Ahmed S, 2020; Manomaipiboon A, 2022; Mohan A, 2021; Ravirti R, 2021; Okumus N, 2021, 454 participants		Ivermectin 374 per 1,000 (294 - 482)	Standard care/Placebo 319 per 1,000
Adverse events	RR: 1.30 (0.75 - 2.27)	30 more per 1000 (from 25 fewer to 128 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level:some concerns or high risk regarding adequate randomization, deviation from intended intervention, outcome measurement and selection of reported results. Inconsistency: Serious Inconsistency downgraded by 1 level: I²=:54.9% Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
7 trials Lim SCL, 2022; Ahmed S, 2020; Manomaipiboon A, 2022; Mohan A, 2021; Krolewiecki A, 2021; Beltran-Gonzalez J, 2021; Okumus N, 2021 959 participants		Ivermectin 131 per 1,000 (76 - 229)	Standard care/Placebo 101 per 1,000
Serious adverse events	RR: 2.94 (0.78 - 11.07)	9 more per 1000 (from 1 fewer to 45 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level:high risk or some concerns regarding adequate randomisation, deviation from intended intervention, outcome measurement and selection of reported results. Inconsistency: Not serious Indirectness: Not serious We presume that the adverse event rates and the corresponding relative risks, are similar across diverse settings, therefore not downgraded for indirectness Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
7 trials Lim SCL, 2022; Ahmed S, 2020; Manomaipiboon A, 2022; Mohan A, 2021; Krolewiecki A, 2021, Okumus N, 2021; Beltran-Gonzalez J, 2021 959 participants		Ivermectin 13 per 1,000 (3 - 50)	Standard care/Placebo 4 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

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click here for Outpatients
click here for Hospitalized patients

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=36

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
N/A Manomaipiboon A, Research square, 2022 Full text Commentary Commentary	Public/non profit	Ivermectin	Placebo	RCT	Patients with confirmed COVID-19 (mild-moderate) admitted to a single center in Thailand.	N=74	Some concerns Details	Full description
NCT04920942 I-TECH Lim SCL, JAMA Intern Med, 2022 Full text Commentary Commentary	Not reported/unclear	Ivermectin	Standard care	RCT	Patients with confirmed COVID-19 (mild) admitted to 21 centers in Malaysia.	N=500	Some concerns Details	Full description
NCT04529525 IVERCOR-COVID19 Vallejos J, BMC Infect Dis, 2021 Full text Commentary	No specific funding	Ivermectin	Placebo	RCT	Outpatients with confirmed COVID-19 (asymptomatic-mild) treated by a single center in Argentina	N=501	Low Details	Full description
NCT04716569 Aref ZF, Int J Nanomed, 2021 Full text Commentary	Public/non profit	Ivermectin	Standard care	RCT	Outpatients with confirmed COVID-19 (mild, symptomatic) treated at a single center in Egypt.	N=114	Some concerns Details	Full description
NCT04784481 Chahla R, Research Square, 2021 Full text Commentary	Public/non profit	Ivermectin	Standard care	RCT	Outpatients with confirmed COVID-19 (mild) treated by multiple centers in Argentina.	N=254	Some concerns Details	Full description
NCT04429711 Biber A, medRxiv, 2021 Full text Commentary Commentary	No specific funding	Ivermectin	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated by multiple centers in Israel	N=116	Some concerns Details	Full description
NCT04403555 Abd-Elsalam S, J Med Virol, 2021 Full text Commentary	Not reported/unclear	Ivermectin	Standard care	RCT	Patients with confirmed COVID-19 admitted to 2 centers in Egypt	N=164	Some concerns Details	Full description
IRCT20111224008507N3 Shahbaznejad L, Clin Ther, 2021 Full text Commentary	No specific funding	Ivermectin	Standard care	RCT	Patients with suspected or confirmed COVID-19 (moderate-critical) admitted to 2 centers in Iran.	N=73	Some concerns Details	Full description
N/A Kishoria N, PIJR, 2020 Full text Commentary	Not reported/unclear	Ivermectin	Standard care	RCT	Patients with confirmed COVID-19 (mild/asymptomatic) admitted to a single center in India.	N=32	Some concerns Details	Full description
NCT04391127 Beltran-Gonzalez J, medRxiv, 2021 Full text Commentary Commentary	Public/non profit	Hydroxychloroquine Ivermectin Hydroxychloroquine	Placebo Placebo Ivermectin	RCT	Patients with suspected or confirmed COVID-19 (moderate/severe) admitted to a single center in Mexico	N=106	Some concerns Details	Full description
NCT04405843 Lopez-Medina E, JAMA, 2021 Full text Commentary Commentary	Mixed	Ivermectin	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated by a single center in Colombia	N=476	Some concerns Details	Full description
NCT04392713 Shah Bukhari K H, medRxiv, 2021 Full text Commentary Commentary	Not reported/unclear	Ivermectin	Standard care	RCT	Patients with confirmed COVID-19 (mild) admitted to a single center in Pakistan	N=100	High Details	Full description
CTRI/2020/06/026001 RIVET-COV Mohan A, J Infect Chemother, 2021 Full text Full text Commentary	Mixed	Ivermectin 12 mg Ivermectin 24 mg Ivermectin 12 mg	Placebo Placebo Ivermectin 24 mg	RCT	Patients with confirmed COVID-19 (asymptomatic-mild-moderate) admitted to a single center in India	N=157	Some concerns Details	Full description
IRCT20200408046987N1 Niaee MS, Asian Pac J Trop Med, 2021 Full text Commentary Commentary	Mixed		Placebo Standard care Placebo Standard care Placebo Standard care Placebo Standard care	RCT	Patients with CT or PCR confirmed COVID-19 (unclear severity) admitted to 5 centers in Iran.	N=60	Some concerns Details	Full description
NCT04739410 Khan Chachar AZ, Int J Sci, 2020 Full text Commentary	No specific funding	Ivermectin	Standard care	RCT	Outpatients with confirmed COVID-19 (symptomatic-mild) treated at a single center in Pakistan	N=50	High Details	Full description
CTRI/2020/08/027225 Ravikirti R, J Pharm Pharm Sci, 2021 Full text Full text Commentary Commentary Commentary	Mixed	Ivermectin	Placebo	RCT	Patients with COVID-19 (mild-severe) admitted to a single center in India	N=115	High Details	Full description
NCT04390022 SAINT Chaccour C, EClinicalMedicine, 2021 Full text Commentary	Mixed	Ivermectin	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) attending the emergency room at a single center in Spain	N=24	Some concerns Details	Full description
NCT04407130 Ahmed S, Int J Infect Dis, 2020 Full text 32506-6/fulltext Commentary	Private	Ivermectin+Doxycycline Ivermectin Ivermectin	Placebo	RCT	Patients with confirmed COVID-19 (mild) admitted to hospital in Bangladesh.	N=72	Some concerns Details	Full description
NCT04381884 Krolewiecki A, EClinicalMedicine, 2021 Full text Full text Commentary Commentary	Mixed	Ivermectin	Standard care	RCT	Patients with confirmed COVID-19 (mild-moderate) admitted to 4 centers in Argentina	N=45	Some concerns Details	Full description
N/A Podder C, IMC J Med Sci, 2020 Full text	No specific funding	Ivermectin	Standard care	RCT	Outpatients with confirmed COVID-19 (mild-moderate) treated at a single center in Bangladesh	N=62	High Details	Full description
NCT04438850 COVER Buonfrate D, Int J Antimicrob Agents, 2022 Full text Full text Commentary Commentary Commentary	Public/non profit	Ivermectin 600	Ivermectin 600	RCT	Outpatients with confirmed COVID 19 (asymptomatic/mild) treated by 4 centers in Italy.	N=93	Some concerns Details	Full description
NCT04646109 Okumus N, BMC Infectious Disea, 2021 Full text Commentary Commentary	Public/non profit	Ivermectin	Standard care	RCT	Patients with confirmed COVID-19 (severe) admitted to four centers in Turkey	N=66	High Details	Full description