This "mini-review" into ivermectin for COVID-19 was recently published concluding that ivermectin is effective and should be used for the disease A brief peer-review 1/npic.twitter.com/KdxoQlqkXA
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3/n At the outset, I find the introduction and title very odd. Ivermectin has been honored by the Nobel committee for an ~entirely different purpose~ Other treatments that received Nobels include: - lobotomy - giving people malariapic.twitter.com/fBW4BWfk5P
4/n So it's an odd start, but overall I think the biggest weakness of this review is the issue with most reviews - the studies it relies on
5/n Firstly, the review cites the retracted and potentially fraudulent Elgazzar paper a number of times - in the abstract, and then at least twice in the discussion of RCTspic.twitter.com/xEAWEDSJri
6/n The review also talks about meta-analyses of RCTs for ivermectin, but as I've discussed when excluding the retracted Elgazzar study the results of these analyses look very different!pic.twitter.com/QzQAUS9Kk0
6.5/n One of the reviews that they cite as positive is being retracted and corrected due to the potential fraud in the literature as we speakhttps://twitter.com/GidMK/status/1425242452974133251?s=20 …
7/n Moreover, they reference "Cochrane analysis methodology" but fail to note that the Cochrane Collaboration has just published a review that: 1) found no benefit for ivermectin 2) pointed out that these reviews didn't actually use "Cochrane methodology"pic.twitter.com/WAG99U6LJW
8/n The review then moves on to argue that an observational analysis of Peru shows enormous benefits for ivermectin. I've talked about this ecological paper before, and why I think it is not very useful as evidence https://twitter.com/GidMK/status/1424525769242406915?s=20 …pic.twitter.com/isiLIa4SgL
9/n If nothing else, the graph in the paper is misleading - Peru officially authorized the use of ivermectin on May 5th 2020 and started distributing it en mass shortly afterpic.twitter.com/O3Xhq8RSTf
10/n The review also briefly discusses the biological plausibility of ivermectin use. This is pretty meagre, but the 2 studies cited don't seem to be terriblepic.twitter.com/VDkTQdS5bF
11/n Some of the issues above are definitely not the fault of the authors - for example, the Cochrane review came out after this paper had already been accepted - but they do make me disagree entirely with the conclusions of the paper
12/n I think that the Cochrane review into ivermectin remains solidly the best evidence around, arguing that we should only be using the drug in the context of a clinical trial until we have better evidencepic.twitter.com/PA5h7p5pTg
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