Re: “Commentary” by Rothrock et al. “Meta-Analyses Did Not Establish Improved Mortality With Ivermectin Use in COVID-19”

Abstract

The "Commentary" by Rothrock et al 1 includes a critique of our Systematic Review 2 and Letter. 3 They also introduce a misleading account of ivermectin safety and proposals for individual participant data (IPD) in meta-analysis that are impractical in a health emergency. We respond to the various matters in turn.

Meta-Analyses Do Not Establish Improved Mortality With Ivermectin Use in COVID-19

“…We thank Bryant et al 1 for their reply and appreciate their intent to study an inexpensive drug with potential to be repurposed during this pandemic. We recognize their self-published protocol and attempt to register with the Cochrane Collaboration.…”

“…The authors seem to be mistaken about media reports within our commentary. 1 Our citations regarding off-label ivermectin use only included the New England Journal of Medicine, the Center for Disease Control Health Advisory Network, the National Institutes of Health, and the Food and Drug Administration. [3][4][5] These acknowledgments aside, Bryant's letter serves as an opportunity to highlight important and potentially controversial considerations when performing meta-analyses.…”

Ivermectin for COVID-19: The 2022 Update

“…3 In 2021, the American Journal of Therapeutics hosted a vigorous debate regarding the quality of the primary data used by systematic reviewers to justify the therapeutic use of ivermectin for COVID-19. [5][6][7][8][9][10][11] We indicated at the time that the value of ivermectin for COVID-19 remained to be established by carefully designed and executed randomized, double-blinded, placebo-controlled trials. 12 To follow up on our suggestion, we searched Medline on September 15, 2022 using the key words "ivermectin", "controlled trials" and COVID-19 and identified six reports of such trials [13][14][15][16][17][18] (Table 1).…”

“…In 2021, the American Journal of Therapeutics hosted a vigorous debate regarding the quality of the primary data used by systematic reviewers to justify the therapeutic use of ivermectin for COVID-19. 5–11 We indicated at the time that the value of ivermectin for COVID-19 remained to be established by carefully designed and executed randomized, double-blinded, placebo-controlled trials. 12…”

Re: 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. Am J Ther. 2022;29:e232.

“…We have already responded to the criticisms made by Rothrock et al 2 in a separate letter. 6 Concerning the disputed study, 5 the preprint server Research Square posted a notice that concerns expressed by undisclosed complainants were “under formal investigation.” Enquiry of the Egyptian Ministry of Education has been acknowledged but without substantive report; at this time, we have no further information.…”