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Letters to the Editor

Ivermectin, A Reanalysis of the Data

Marik, Paul E. MD, FCCM, FCCP1; Kory, Pierre MD2

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doi: 10.1097/MJT.0000000000001443
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To the Editor:

Our article entitled “Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19” was recently published in the American Journal of Therapeutics.1 Our article included randomized and observational trial meta-analyses on the efficacy of ivermectin for the prophylaxis and treatment of COVID-19. Recently, the study conducted by Elgazzar et al2 has come under scrutiny with accusations of scientific misconduct. His paper was apparently retracted without his knowledge and without giving him the opportunity to defend these serious claims. This situation is most unfortunate. While this issue is being resolved, we decided to redo the original meta-analyses excluding this study. The summary point estimates were largely unaffected when the study by Elgazzar et al was removed. The revised forest plots are provided below (Figures 1–3).

FIGURE 1.
FIGURE 1.:
Meta-analysis of ivermectin prophylaxis trials in COVID-19. Symbols: Squares indicate treatment effect of an individual study. Large diamond reflects summary of study design immediately above. Size of each symbol correlates with the size of the CI around the point estimate of treatment effect with larger sizes indicating a more precise CI. CI, confidence interval; OBS, observational study; RCT, randomized controlled trial.
FIGURE 2.
FIGURE 2.:
Meta-analysis of the outcome of time to clinical recovery from controlled trials of ivermectin treatment in COVID-19. Symbols: Squares indicate treatment effect of an individual study. Large diamond reflects summary of study design immediately above. Small diamond indicates sum effect of all trial designs. Size of each symbol correlates with the size of the CI around the point estimate of treatment effect with larger sizes indicating a more precise CI. CI, confidence interval.
FIGURE 3.
FIGURE 3.:
Meta-analysis of the outcome of mortality from controlled trials of ivermectin treatment in COVID-19. Symbols: Squares indicate treatment effect of an individual study. Large diamond reflects summary of study design immediately above. Small diamond indicates sum effect of all trial designs. Size of each symbol correlates with the size of the CI around the point estimate of treatment effect with larger sizes indicating a more precise CI. CI, confidence interval; OBS, observational study; RCT, randomized controlled trial.

REFERENCES

1. Kory P, Meduri GU, Iglesias J, et al. Review of the emerging evidence demonstrating the efficacy of ivermectin in the prophylaxis and treatment of COVID-19. Am J Ther. 2020;28:e299–e318.
2. Elgazzar A, Hany B, Youssef SA, et al. Efficacy and safety of ivermectin for treatment and prophylaxis of COVID-19 pandemic. Research Square. 2020.
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