Efficacy and safety of ivermectin for COVID-19: A systematic review and meta-analysis

Objective: To critically evaluate the trials that have assessed the efficacy and safety of ivermectin COVID-19 and to validate the rationality of using this drug in the management of COVID-19 either as a prophylactic or therapeutic agent.Methods: The authors conducted a systematic search through various databases, i.e., Cochrane library, Pub Med, clincialtrials.gov, and preprint servers, for publications from 2020 to May 2021. The keywords used for the search were: "COVID-19 and ivermectin"(with filter set for "trials"). All the trials assessing efficacy in prophylaxis and treatment of COVID-19 were included for analysis. The primary outcome was the proportion of patients showing disease progression. Secondary outcomes were mean duration of hospitalization and resolution of symptoms, the proportion of patients testing positive on day 5-7, the mortality rate in severe cases, incidence of serious adverse events, and contacts of COVID-19 positive patients who turned RT-PCR positive after prophylaxis treatment. Results: A total of 17 clinical trials were included for the evaluation. Ivermectin proved to be a beneficial add-on therapy, as it reduced the risk of disease progression(OR 0.47, 95% CI 0.30-0.74, P=0.001), led to early resolution of symptoms(MD-1.16, 95% CI-1.52--0.81, P<0.001), and had less duration of hospitalization(MD-2.21, 95% CI-3.23--1.19, P<0.001). In addition, ivermectin was better in providing effective prophylaxis(OR 0.13, 95% CI 0.05-0.30, P<0.001). The incidence of serious adverse events was low.Conclusions: As an adjunct to standard care, ivermectin has shown its efficacy and safety in treating and prophylaxis in COVID-19 disease. These results should be interpreted cautiously as these trials had significant shortcomings.