The University of Oxford said on Wednesday it was testing anti-parasitic drug ivermectin as a possible treatment for COVID-19, as part of a British government-backed study that aims to aid recoveries in non-hospital settings.

mortality, in secondary outcomes, and in chemoprophylaxis, among people with, or at high risk of, COVID-19 infection. Data sources: We searched bibliographic databases up to April 25, 2021. Two review authors sifted for studies, extracted data, and assessed risk of bias. Meta-analyses were conducted and certainty of the evidence was assessed using the GRADE approach and additionally in trial sequential analyses for mortality. Twenty-four randomized controlled trials involving 3406 participants met review inclusion. Therapeutic Advances: Meta-analysis of 15 trials found that ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19–0.73; n = 2438; I2 = 49%; moderate-certainty evidence). This result was confirmed in a trial sequential analysis using the same DerSimonian–Laird method that underpinned the unadjusted analysis. This was also robust against a trial sequential analysis using the Biggerstaff–Tweedie method. Low-certainty evidence found that ivermectin prophylaxis reduced COVID-19 infection by an average 86% (95% confidence interval 79%–91%). Secondary outcomes provided less certain evidence. Low-certainty evidence suggested that there may be no benefit with ivermectin for “need for mechanical ventilation,” whereas effect estimates for “improvement” and “deterioration” clearly favored ivermectin use. Severe adverse events were rare among treatment trials and evidence of no difference was assessed as low certainty. Evidence on other secondary outcomes was very low certainty. Conclusions: Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally. Address for correspondence: Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, United Kingdom. E-mail: andy.bryant@ncl.ac.uk The preprint of this review received no funding. This updated version was funded by the crowdfunding initiative https://www.gofundme.com/f/help-us-get-lifesaving-drug-approved-for-covid19 The authors have no conflicts of interest to declare. T. A. Lawrie and A. Bryant cowrote the review; they also sifted the search and classified studies for inclusion and entered and checked the data in RevMan and performed analyses. Data extraction was divided among T. A. Lawrie, A. Bryant, and T. Dowswell. T. Dowswell and A. Bryant graded the evidence. E. J. Fordham prepared the text on ivermectin mechanisms, use in pregnancy, and among the elderly. S. R. Hill prepared the brief economic commentary. Clinicians S. Mitchell and T. C. Tham contributed to the interpretation of the evidence in the discussion and conclusions. All authors reviewed and approved the final version of the manuscript. This article discusses off-label use of the FDA-approved medication ivermectin against COVID-19. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved....

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By Meryl Nass, MD [Editor’s note: It should be noted that Dr Nass’s first objective has been achieved as following the publication of this article the WHO have halted these lethal trials.] Updates can be found here. The Solidarity Trial...

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