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

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.