10/n The significance of the model entirely disappears. Now ivermectin shows no benefit for mortality at all, even in the overall analysispic.twitter.com/QH8tdyXi7U
Epidemiologist. Writer (Guardian, Observer etc). "Well known research trouble-maker". PhDing at @UoW Host of @senscipod Email gidmk.healthnerd@gmail.com he/him
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10/n The significance of the model entirely disappears. Now ivermectin shows no benefit for mortality at all, even in the overall analysispic.twitter.com/QH8tdyXi7U
11/n But wait, there's more! If you go back to that graph excluding Elgazzar, there's something odd. You see only one study finding a significant benefit for ivermectinpic.twitter.com/2VZvGDOetB
12/n In fact, it seems like the entire mortality benefit for ivermectin, once Elgazzar is excluded, comes down to this one study: Niaee et al
13/n If you look at the Niaee et al preprint, there are quite a number of issues. In fact, @K_Sheldrick noted that the results are worrying, and that the study "should not be included in meta-analyses" 

pic.twitter.com/mWV8BvccnJ
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
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
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