Expression of Concern for Bryant a, Lawrie TA, Dowswell T, Fordham EJ, Mitchell S, Hill SR, Tham TC. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. Am J Ther. 2021;28(4): e434-e460

Manu, Peter

doi:10.1097/mjt.0000000000001482

Cited by 8 publications

(7 citation statements)

References 3 publications

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“…There are some concerns regarding the accuracy of the results of previous studies that should be addressed. The most important concerns are several retractions of clinical trials [ 21 ], the availability of inaccurate or outdated meta-analyses [ 14 , 22 , 23 ], and three RCTs recently published in 2022 [ 19 , 20 , 24 ] which their final results were not included in previous meta-analyses. Considering these issues, we set out to conduct a comprehensive systematic review and meta-analysis of current peer-reviewed randomized controlled trials to assess the possible effect of ivermectin in patients with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Ivermectin under scrutiny: a systematic review and meta-analysis of efficacy and possible sources of controversies in COVID-19 patients

Shafiee

Athar

Gargari

et al. 2022

Virol J

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Background We conducted a systematic review and meta-analysis to evaluate the efficacy of ivermectin for COVID-19 patients based on current peer-reviewed RCTs and to address disputes over the existing evidence. Methods MEDLINE (Pubmed), Scopus, Web of Science, Cochrane library, Google scholar and Clinicaltrials.gov were searched for RCTs assessing the efficacy of Ivermectin up to 20 February 2022. A systematic review and meta-analysis of studies was performed based on the PRISMA 2020 statement criteria. Results 19 and 17 studies were included in this systematic review and meta-analysis, respectively. There was no significant difference in progression to severe disease (log OR − 0.27 [95% CI − 0.61 to 0.08], I2 = 42.29%), negative RT-PCR (log OR 0.25 [95% CI − 0.18–0.68], I2 = 58.73%), recovery (log OR 0.11 [95% CI − 0.22–0.45], I2 = 13.84%), duration of hospitalization (SMD − 0.40 [95% CI − 0.85–0.06], I2 = 88.90%), time to negative RT-PCR (SMD − 0.36 [95% CI − 0.89–0.17], I2 = 46.2%), and viral load (SMD -0.17 [95% CI -0.45 to 0.12], I^2 = 0%). It is worth noting that, based on low-certainty evidence, ivermectin may possibly reduce mortality (log OR − 0.67 [95% CI − 1.20 to − 0.13], I2 = 28.96%). However, studies with a higher risk of bias were more likely to indicate positive effects on the efficacy of this drug, according to our subgroup analyses based on study quality. Conclusion Ivermectin did not have any significant effect on outcomes of COVID-19 patients and as WHO recommends, use of ivermectin should be limited to clinical trials.

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Section: Introductionmentioning

confidence: 99%

Ivermectin under scrutiny: a systematic review and meta-analysis of efficacy and possible sources of controversies in COVID-19 patients

Shafiee

Athar

Gargari

et al. 2022

Virol J

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“…However, the impact may be significant in some cases, especially when retractions are due to problems with methods, data, or results. An expression of concern was published regarding one meta-analysis investigating the use of ivermectin in the prevention and treatment of COVID-19 after flaws in data collection and analysis were identified in two of the included studies [35]. Exclusion of those two studies from the meta-analysis invalidated the review's previous finding of decreased mortality.…”

Section: The Problemmentioning

confidence: 99%

Reducing the residue of retractions in evidence synthesis: Ways to minimize inappropriate citation and use of retracted data

Bakker¹,

Boughton²,

Faggion³

et al. 2022

Preprint

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The incorporation of publications that have been retracted is a risk in reliable evidence synthesis. Retraction is an important mechanism for correcting the literature and protecting its integrity. Within the medical literature, the continued citation of retracted publications occurs for a variety of reasons. Recent evidence suggests that systematic reviews and meta-analyses often unwittingly cite retracted publications which, at least in some cases, may significantly impact quantitative effect estimates in meta-analyses. There is strong evidence that authors of systematic reviews and meta-analyses may be unaware of the retracted status of publications and treat them as if they are not retracted. These problems are difficult to address for several reasons: identifying retracted publications is important but logistically challenging; publications may be retracted while a review is in preparation or in press; and problems with a publication may also be discovered after the evidence synthesis is published. We propose a set of concrete actions that stakeholders (e.g., scientists, peer-reviewers, journal editors) might take in the near-term, and that research funders, citation management systems, and databases and search engines might take in the longer term to limit the impact of retracted primary studies on evidence syntheses.

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“…44 In addition to antivirals, other medicines were selected, such as anthelmintics (ivermectin, nitazoxanide, or nicodamid), antimalarials (chloroquine or hydroxychloroquine), macrolide antibiotics (azithromycin), interferon, which showed the existence of antiviral activity in vitro tests and are effective and safe for COVID-19. [45][46][47][48] At one point, the plasma of convalescents from COVID-19 seemed to be a solution. 48 Widespread off-label prescribing and use 49 is most likely in contradiction with the principle of rational use of medicines, advanced by the WHO in 1985, 50 which states that the use of medicines is rational when "patients receive medicines appropriate to their clinical needs, in doses that meet their individual requirements, for an appropriate period of time and at the lowest cost to them and their community."…”

Section: Introductionmentioning

confidence: 99%

“…[45][46][47][48] At one point, the plasma of convalescents from COVID-19 seemed to be a solution. 48 Widespread off-label prescribing and use 49 is most likely in contradiction with the principle of rational use of medicines, advanced by the WHO in 1985, 50 which states that the use of medicines is rational when "patients receive medicines appropriate to their clinical needs, in doses that meet their individual requirements, for an appropriate period of time and at the lowest cost to them and their community." The concept is defeated by the ethical principle of compassion.…”

Section: Introductionmentioning

confidence: 99%

Against Authority: The Bioethics of Ivermectin Use for COVID-19 Infection

Astărăstoae

Rogozea

2023

American Journal of Therapeutics

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Background:The COVID-19 pandemic has brought new ethical challenges to both health care professionals and the general public. Among the ethical problems amplified during this period were the making of medical decisions to quickly introduce some drugs into therapeutic practice with unproven or insufficiently proven effects (such as ivermectin), the validity of drug testing, and the allocation of limited resources.Fields of Uncertainty:The COVID-19 pandemic brought to the attention of the entire scientific world a new problem, which exceeded the guidelines and rules known until then. Out of the desire to quickly solve this medical problem, a series of measures were taken, however not sufficiently validated in scientific terms; the recommendations regarding the use of drugs known for their properties to treat a greater number of conditions, such as ivermectin, was tried.Data Sources:A narrative review of the specialized literature was carried out using keywords such as COVID-19, ivermectin, ethics, and off-label medication from Scopus and Google Scholar but also of official documents developed at the international level (World Health Organization).Ethics and Therapeutic Advances:The off-label use of ivermectin alone or in combination with other medications during COVID pandemic raised problems related to the demonstration of its effectiveness, but also to ethics, starting from the expectations that both the medical staff and the population had of it. Ivermectin therapy was also evaluated by analyzing the behavior of ivermectin based on ethical principles (nonmaleficence, beneficence, and respect for one's autonomy) or on justice. Even in times of pandemic, exceptionalism must not triumph, and finding an effective treatment must be done through studies that respect ethical standard.Conclusions:The failures or rather lack of success in decision making during the pandemic showed that alongside scientific knowledge and the development of health policies, it is necessary to constantly evaluate the measures and decisions from an ethical point of view, and the prevention of slippages and abuses is not only necessary but even mandatory.

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Expression of Concern for Bryant a, Lawrie TA, Dowswell T, Fordham EJ, Mitchell S, Hill SR, Tham TC. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. Am J Ther. 2021;28(4): e434-e460

Cited by 8 publications

References 3 publications

Ivermectin under scrutiny: a systematic review and meta-analysis of efficacy and possible sources of controversies in COVID-19 patients

Ivermectin under scrutiny: a systematic review and meta-analysis of efficacy and possible sources of controversies in COVID-19 patients

Reducing the residue of retractions in evidence synthesis: Ways to minimize inappropriate citation and use of retracted data

Against Authority: The Bioethics of Ivermectin Use for COVID-19 Infection

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