4/n So, here's the primary results from the Bryant et al meta-analysis of ivermectin that concluded "Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin"pic.twitter.com/CkCYWknA9X
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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
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
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
18/n Therefore, in my opinion, this means that excluding Elgazzar removes any certainty and a lot of significance from this analysis
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
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
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 
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
Two questions: - How is weight assigned? - Why say "absolutely no benefit" when there's clearly a trend toward benefit, just not meeting the arbitrary p < 0.05 / 95% CI cutoff?
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