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Meta-analytic magic, ivermectin, and socially responsible reporting.

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  • 1Chair, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; Frere and Cecilia Makiwane hospitals, East London, South Africa. andygp@mweb.co.za.

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Clinicians prescribing ivermectin for COVID-19 face scrutiny. Evidence for its effectiveness is weak when high-risk studies are excluded, potentially causing harm and undermining trust in evidence-based medicine (EBM).

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Area of Science:

  • Medical Ethics
  • Infectious Diseases
  • Pharmacology

Background:

  • Ivermectin is prescribed for COVID-19 by some clinicians despite lacking support from South African professional bodies.
  • The argument for its use centers on acting on weak efficacy signals during clinical urgency when harm is perceived as unlikely.

Purpose of the Study:

  • To critically evaluate the evidence supporting ivermectin's use for COVID-19.
  • To assess the implications of relying on weak or biased evidence in clinical decision-making during a pandemic.
  • To emphasize the importance of evidence-based medicine (EBM) principles in medical practice.

Main Methods:

  • Systematic review and meta-analysis of existing studies on ivermectin for COVID-19.
  • Analysis of study bias and control types (active vs. placebo).
  • Assessment of statistical significance of pooled mortality effects.

Main Results:

  • Recent reviews including high-risk bias studies and active controls showed an apparent mortality benefit.
  • Excluding these biased studies rendered the pooled mortality effect statistically insignificant.
  • The evidence for ivermectin's benefit in treating COVID-19 is considered very weak.

Conclusions:

  • Relying on weak evidence for ivermectin could lead to clinical harm and fuel vaccine hesitancy.
  • Clinicians must ensure their guidance is legitimate and reliable, adhering to evidence-based medicine (EBM) principles.
  • Medical institutions should promote EBM as a lifelong learning process for consistent, evidence-based debate in clinical practice.