Cochrane · systematic review · CD015017
Ivermectin for preventing and treating COVID‐19
Popp, M, Reis, S, Schießer, S, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
16
current version
GRADE rated
14
No studies
2
Included studies
NR
No studies 2 · 12.5%Ungraded 0 · 0%Very low 3 · 18.8%Low 8 · 50%Moderate 1 · 6.3%High 2 · 12.5%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySummary of findings table 1
Population: people with moderate to severe disease (WHO scale 4–9); all trials contributing results to the summary of findings table investigated people with moderate disease (WHO scale 4 or 5) only
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at day 28 | RR 0.6 [0.14, 2.51] | 3 studies · 230 participants | Very low Downgraded: risk of bias, imprecision |
Worsening of clinical status: participants with new need for invasive mechanical ventilation or death at day 28 | RR 0.82 [0.33, 2.04] | 2 studies · 118 participants | Very low Downgraded: risk of bias, imprecision |
Improvement of clinical status: participants discharged alive at day 28 | RR 1.03 [0.78, 1.35] | 1 study · 73 participants | Low Downgraded: risk of bias, imprecision |
QoL at longest | no estimate extracted | NR | No studies |
Serious adverse events during the trial period | RR 1.55 [0.07, 35.89] | 2 studies · 197 participants | Very low Downgraded: risk of bias, imprecision |
Any adverse events during the trial period | RR 1.04 [0.61, 1.79] | 3 studies · 228 participants | Low Downgraded: risk of bias, imprecision |
Viral clearance at day 7 | RR 1.12 [0.8, 1.58] | 3 studies · 231 participants | Low Downgraded: risk of bias, imprecision |
Summary of findings table 2
Population: all trials contributing results to the summary of findings table included people with mild disease (WHO scale 1 to 3)§
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality at day 28 | RR 0.77 [0.47, 1.25] | 6 studies · 2860 participants | Moderate Downgraded: imprecision |
Worsening of clinical status: admission to hospital or death within 28 days | RR 1.09 [0.2, 6.02] | 2 studies · 590 participants | Low Downgraded: inconsistency |
Improvement of clinical status: all initial symptoms resolved (asymptomatic) at day 14 | RR 0.9 [0.6, 1.36] | 2 studies · 478 participants | Low Downgraded: risk of bias, inconsistency |
Improvement of clinical status: time to symptom resolution | no estimate extracted | NR | No studies |
QoL (physical component) at up to 28 days, measured on the PROMIS Global‐10 scale and normalized to values from 16.2, low QoL, to 67.2, maximum QoL | MD 0 | 1 study · 1358 participants | High |
QoL (mental component) at up to 28 days, measured on the PROMIS Global‐10 scale and normalized to values from 21.2, low QoL, to 67.6, maximum QoL | MD 0 | 1 study · 1358 participants | High |
Serious adverse events during the trial period | RR 2.27 [0.62, 8.31] | 5 studies · 1502 participants | Low Downgraded: risk of bias, imprecision |
Any adverse events during the trial period | RR 1.24 [0.87, 1.76] | 5 studies · 1502 participants | Low Downgraded: risk of bias, inconsistency |
Viral clearance at day 7 | RR 1.01 [0.69, 1.48] | 2 studies · 331 participants | Low Downgraded: risk of bias, imprecision |
Ivermectin compared to placebo or standard of care for people with moderate‐to‐severe COVID‐19 treated in an inpatient setting
Population: people with moderate to severe disease (WHO scale 4–9); all studies contributing results to the summary of findings table included people with moderate disease (WHO scale 4 or 5)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality up to 28 days Ivermectin vs placebo or standard of care | RR 0.6 [0.14, 2.51] | 2 studies · 185 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Clinical worsening: need for invasive mechanical ventilation up to 28 days Ivermectin vs placebo or standard of care | RR 0.55 [0.11, 2.59] | 2 studies · 185 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Clinical worsening: need for oxygen by mask or nasal prongs up to 28 days, in people with WHO scale 4 at baseline Ivermectin vs placebo or standard of care | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Clinical improvement: participants discharged without respiratory deterioration or death up to 28 days  Ivermectin vs placebo or standard of care | RR 1.03 [0.78, 1.35] | 1 study · 73 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events (any grade) up to 28 days Ivermectin vs placebo or standard of care | RR 1.21 [0.5, 2.97] | 1 study · 152 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life up to 28 days Ivermectin vs placebo or standard of care | no estimate extracted | NR | No studies |
Duration of hospitalization Ivermectin vs placebo or standard of care | no estimate extracted | 1 study · 45 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Viral clearance at 7 days Ivermectin vs placebo or standard of care | RR 1.82 [0.51, 6.48] | 2 studies · 159 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Ivermectin compared to placebo or standard of care for people with mild COVID‐19 treated in an outpatient setting
Population: people with mild disease (WHO scale 1–3); all studies contributing results to the summary of findings table included people with mild disease (WHO scale 2 or 3)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality up to 28 days Ivermectin vs placebo or standard of care | RR 0.33 [0.01, 8.05] | 2 studies · 422 participants | Very low Downgraded: risk of bias, imprecision |
Clinical worsening: need for invasive mechanical ventilation up to 14 days  Ivermectin vs placebo or standard of care | RR 2.97 [0.12, 72.47] | 1 study · 398 participants | Very low Downgraded: risk of bias, imprecision |
Clinical worsening: need for non‐invasive mechanical ventilation or high flow up to 14 days  Ivermectin vs placebo or standard of care | no estimate extracted | 1 study · 398 participants | Very low Downgraded: risk of bias, imprecision |
Symptom resolution: participants with symptoms resolved up to 14 days  Ivermectin vs placebo or standard of care | RR 1.04 [0.89, 1.21] | 1 study · 398 participants | Low Downgraded: risk of bias, imprecision |
Symptom resolution: duration of symptom resolution  Ivermectin vs placebo or standard of care | no estimate extracted | NR | No studies |
Admission to hospital up to 14 days Ivermectin vs placebo or standard of care | no estimate extracted | NR | No studies |
Adverse events (any grade) up to 28 days Ivermectin vs placebo or standard of care | RR 0.95 [0.86, 1.05] | 2 studies · 422 participants | Low Downgraded: risk of bias, imprecision |
Quality of life up to 14 days Ivermectin vs placebo or standard of care | no estimate extracted | NR | No studies |
Viral clearance at 7 days Ivermectin vs placebo or standard of care | RR 3 [0.13, 67.06] | 1 study · 24 participants | Low Downgraded: risk of bias, imprecision |
Ivermectin compared to no treatment for prevention of SARS‐CoV‐2 infection
Population: people who were not infected with SARS‐CoV‐2, but were at high risk of developing the infection (e.g. after high‐risk exposure)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
SARS‐CoV‐2 infection (confirmed by RT‐PCR or antigen testing) at 14 days Ivermectin vs no treatment | no estimate extracted | NR | No studies |
Development of clinical COVID‐19 symptoms up to 14 days Ivermectin vs no treatment | no estimate extracted | NR | No studies |
Adverse events (any grade) up to 14 days Ivermectin vs no treatment | no estimate extracted | NR | No studies |
All‐cause mortality up to 28 days Ivermectin vs no treatment | no estimate extracted | 1 study · 304 participants | Very low Downgraded: risk of bias, imprecision |
Admission to hospital up to 14 days Ivermectin vs no treatment | no estimate extracted | NR | No studies |
Quality of life up to 14 days Ivermectin vs no treatment | no estimate extracted | NR | No studies |