Adding these results into the meta-analytic model excluding Elgazzar and Niaee gives you an idea of the plausible benefit of ivermectin at this point (not great)pic.twitter.com/0l4NiVur6i
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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Adding these results into the meta-analytic model excluding Elgazzar and Niaee gives you an idea of the plausible benefit of ivermectin at this point (not great)pic.twitter.com/0l4NiVur6i
Worth waiting for the study to be published for any certainty, but at this point I'd say there's still a plausible minor benefit for ivermectin (on the order of 10% benefit) but any enormous benefits have been largely excluded by the data to date
In other words, it's still possible ivermectin helps a bit, but it is very unlikely that it is a "miracle drug" that everyone should be taking at this point
TOGETHER is the largest, most well-conducted ivermectin study to date, and it was in low-risk outpatients Which means the two main arguments from the ivermectin proponents simply no longer make any sense at all
Also, people are talking about minor dosing differences (0.4mcg/kg vs 0.6mcg/kg) as if that's meaningful which is HILARIOUS because the dosage used in TOGETHER is higher than most of the studies showing massive mortality benefits
Not a miracle drug. I think ultimately it will be shown to be a drug with an effect size and a massive number needed to harm. And according to WHO it should be considered as part of covid regimen for anyone in a strongyloides endemic region who's at risk of needing dexa.
At this point I would say that there's a plausible modest benefit, which could have a large impact at a population level. However, there's also a plausible modest detriment, which could similarly cause a lot of deaths
I think we should acknowledge this though https://www.who.int/news/item/17-12-2020-a-parasitic-infection-that-can-turn-fatal-with-administration-of-corticosteroids … I am troubled that WHO is telling countries endemic for strongyloides NOT to use IVM for covid (specifically for patients at risk to need steroids) when this is their official stance.
I think the WHO stance on ivm is the only responsible one to take at the moment - given that it could be helping or harming, the only ethical use is in clinical trials
In non strongyloides endemic regions sure. But for strongyloides endemic regions, different story. Ive discussed this with david boulware who's an expert in endemic parasitic diseases who agrees with me on this.
I can understand using treatment for COVID-19 as an opportunity to treat strongyloides, but that's not the same as advocating for mass use. Also, why limit it to COVID-19 in that case? @boulware_dr what is your take?
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