2/n Study is here, and generally it looks fine - search strategy was decent, they followed most guidelines (I.e. PRISMA), and overall the methodology was pretty reasonable for the stated purposehttps://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofab358/6316214#.YORtErIpyh8.twitter …
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13/n I could go on, but suffice to say that I genuinely do not understand how anyone could read these studies and consider them at a low risk of bias. Have a look for yourself, there are innumerable issues: https://www.researchsquare.com/article/rs-109670/v1 …https://www.researchsquare.com/article/rs-100956/v3 …
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14/n And guess what happens if you exclude these two studies from the mortality meta-analysis (RE/IV model in Stata) in this particular study? Suddenly, ivermectin has NO BENEFIT Againpic.twitter.com/OHjEaqYrEF
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15/n Indeed, the entirety of the ivermectin benefit across all of the literature appears to come down entirely to these two pretty low-quality pieces of researchpic.twitter.com/C5q5Kqtlwm
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16/n Now look, take this all with a pinch of salt, rating of bias is an inherently subjective thing and I might not be right That being said, it is extremely concerning that all of the benefit seen for ivermectin seems to come from just 2 studies
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17/n It is not a coincidence that out of the three (!) ivermectin meta-analyses to be published in the last 14 days, the two that included these studies found a benefit and the one that excluded Elgazzar did not
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18/n In the absence of new evidence (this meta-analysis doesn't really count), I reckon that the only reasonable stance is that we don't really know if ivermectin works, and probably should not be using it outside of clinical trials
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End of conversation
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