13/n Technically there's no attrition bias because the authors report 100% follow-up data, but that in and of itself is weird. Usually you get at least a few dropouts!
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24/n There's a good reason the risk of bias for so many regions here is 'unclear' - the studies simply don't include enough information! Often the methods sections are 3-4 paragraphs long (v. short for an RCT)pic.twitter.com/8AP18DKtD2
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25/n Moreover, publication bias looks to be a bit of an issue, and it's not really addressed. Quite likely to be some null findings that are floating around but will be published eventually!
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26/n On top of this, if you only look at studies that the authors have rated as having a low risk of bias for all domains, the evidence is pretty much squarely null, although this is limited by the fact that there are only 3 good studies
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27/n I don't think that this study really supports the use of ivermectin as a treatment for COVID-19 outside of a clinical trial, which is a shame because it'd be fantastic to have another effective drug for the disease
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28/n The depressing thing is that 100s of millions of people, mostly in developing countries, have had ivermectin for COVID-19, and yet we've only got 3 low-risk studies with <700 participants total to use as good evidence


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29/n Oh, one other point is that the authors considered the Fonseca study an "outlier" because exclusion lowered the I^2, which I don't understand because excluding the Elgazzar study lowers the I^2 a lot as well
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30/n Also, I should reiterate that while I disagree with the conclusions, the study itself is pretty strong. The methodology was well constructed, I have few if any criticisms of the actual research the authors conducted
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End of conversation
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