Sai Yengu Nithin, Raheem Abdul, Pons Andrea Gómez, Ho Wing Lam, Ali Syed Muhammad Sinaan, Haseeb Abdul, Fadlalla Ahmad Tagwa Kalool, Mustafa Muhammad Saqlain
Dr Pinnamaneni Siddhartha Institute of Medical Sciences, Vijayawada, India.
Baqai Medical University, Karachi, Pakistan.
Ann Med Surg (Lond). 2025 Jan 7;87(2):809-829. doi: 10.1097/MS9.0000000000002762. eCollection 2025 Feb.
The COVID-19 pandemic, resulting in approximately seven million deaths globally, underscores the urgency for effective treatments. Ivermectin, among several repurposed drugs, garnered interest due to its antiviral properties. However, conflicting evidence from observational studies and randomized controlled trials raised questions about its efficacy and safety.
This systematic review and meta-analysis followed MOOSE and PRISMA guidelines. Comprehensive searches were conducted in databases including Scopus, Embase, PubMed, and Web of Science up to April 2024. Data were extracted independently by two reviewers and analyzed using Comprehensive Meta-Analysis V3 software.
Across 33 studies encompassing 15,376 participants, ivermectin showed no significant impact on critical outcomes such as mortality [risk ratio (RR) 0.911, 95% confidence intervals (CI) 0.732-1.135], mechanical ventilation (RR 0.727, 95% CI 0.521-1.016), polymerase chain reaction conversion (RR 1.024, 95% CI 0.936-1.120), ICU admissions (RR 0.712, 95% CI 0.274-1.850), or hospitalization rates (RR 0.735, 95% CI 0.464-1.165) compared to controls. However, it significantly reduced time to symptom alleviation (standardized mean difference -0.302, 95% CI -0.587 to -0.018) and sustained symptom relief (RR 0.897, 95% CI 0.873-0.921). Adverse event (AE) rates were similar between the ivermectin and control groups (RR 0.896, 95% CI 0.797-1.007). Meta-regression indicated older age and diabetes as predictors of AEs.
Despite its observed benefits in symptom management, ivermectin did not significantly influence critical clinical outcomes in COVID-19 patients. These findings highlight the importance of continued research to identify effective treatments for COVID-19, emphasizing the need for high-quality studies with robust methodology to inform clinical practice and public health policy effectively.
新冠疫情在全球导致约700万人死亡，凸显了有效治疗方法的紧迫性。伊维菌素作为几种重新利用的药物之一，因其抗病毒特性而受到关注。然而，观察性研究和随机对照试验得出的相互矛盾的证据引发了对其疗效和安全性的质疑。
本系统评价和荟萃分析遵循MOOSE和PRISMA指南。截至2024年4月，在包括Scopus、Embase、PubMed和Web of Science在内的数据库中进行了全面检索。由两名审阅者独立提取数据，并使用Comprehensive Meta-Analysis V3软件进行分析。
在涵盖15376名参与者的33项研究中，与对照组相比，伊维菌素对死亡率[风险比（RR）0.911，95%置信区间（CI）0.732 - 1.135]、机械通气（RR 0.727，95%CI 0.521 - 1.016）、聚合酶链反应转阴（RR 1.024，95%CI 0.936 - 1.120）、入住重症监护病房（RR 0.712，95%CI 0.274 - 1.850）或住院率（RR 0.735，95%CI 0.464 - 1.165）等关键结局没有显著影响。然而，它显著缩短了症状缓解时间（标准化均差 -0.302，95%CI -0.587至 -0.018）并延长了症状持续缓解时间（RR 0.897，95%CI 0.873 - 0.921）。伊维菌素组和对照组的不良事件（AE）发生率相似（RR 0.896，95%CI 0.797 - 1.007）。Meta回归表明年龄较大和患有糖尿病是不良事件的预测因素。
尽管伊维菌素在症状管理方面有一定益处，但它对新冠患者的关键临床结局没有显著影响。这些发现凸显了持续开展研究以确定新冠有效治疗方法的重要性，强调需要采用稳健方法进行高质量研究，以便为临床实践和公共卫生政策提供有效信息。
