3/n Judge for yourself whether it is fair to argue that removing Elgazzar largely eliminates the benefit for mortality here, the headline finding and the primary analysis of the paper
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14/n So, Step 4: Sensitivity Analysis Rerunning the original model excluding both Elgazzar and Niaee gives you this result Absolutely no benefit for ivermectin on mortality. CIs include both large benefit and large detrimentpic.twitter.com/tVKlmxJgpp
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15/n Worth noting that removing these two studies from the analysis takes the I squared statistic down to 0% - in other words, the remaining studies are all statistically consistent with each other
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16/n What does this all mean? In short - once Elgazzar is excluded, the results are incredibly uncertain, and any potential benefit rests entirely on the Niaee study, which at least one expert has argued should never be included in meta-analyses
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17/n Moreover, because the result is so marginally significant, including a ~single~ new piece of evidence also results in the benefit disappearing even if you still include Niaee in the model
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18/n Therefore, in my opinion, this means that excluding Elgazzar removes any certainty and a lot of significance from this analysis
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19/n In other words the conclusion - that moderate-certainty evidence found large reductions in death using ivermectin - is entirely reversed. The certainty is gone, and the reduction in death is likely to be very substantially smaller
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20/n Indeed, since the benefit now appears to rest entirely on one very worrisome trial, it is hard to see how we can justify any argument other than that we do not have sufficient information to make a conclusion about ivermectin at this pointpic.twitter.com/39xLhAewpi
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21/n I remain optimistic that ivermectin will indeed prove to be a "wonder drug" as Elgazzar claimed, but I simply don't think the evidence to date supports that assertion
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22/n With large randomized trials ongoing, we can only wait for them to finish before making a strong judgement as to whether ivermectin is beneficial It may yet turn out to be fantastic. We simply do not know
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End of conversation
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