I would argue that we actually *do* know, with approximately as much certainty as we had a year ago for #HydroxyChloroquine, that #Ivermectin almost certainly doesn’t work. Low prior probability + equivocal clinical trials = doesn’t work.
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Replying to @gorskon
Sure, but we could've easily had a large trial really testing the idea by now. If we'd rolled it into RECOVERY or SOLIDARITY, it might've prevented (or caused) literally millions of people to get the drug
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We're still arguing about awful, low-quality evidence, but as a global research community that is a choice. We could definitely have tested this properly by now, and we really dropped the ball
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At some point isn't it unethical to try something you don't think will work just to shut people up?
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That is my issue as well. But it is tricky. Ivermectin has a good safety in a reasonable treatment regime, this makes the testing less problematic. Plus there are some studies, mostly pretty poor but I guess it may be seen as giving it some plausibility.
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Here's what made me rate the prior plausibility of
#ivermectin as a treatment for#COVID19 to be very low. The in vitro experiments that showed antiviral activity used concentrations several times what is achievable in the blood with normal dosing. That's a huge red flag.1 reply 11 retweets 34 likes -
That's why I keep saying about
#ivermectin: Low prior plausibility/probability + equivocal clinical trials = almost certainly doesn't work.1 reply 0 retweets 4 likes -
Let's crank it up to an extreme example to show you what I mean. Homeopathy has in essence, no prior plausibility from basic science; yet there are quite a few equivocal trials of homeopathy that seem to show a benefit, even meta-analyses that claim to find a benefit.
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Do these equivocal clinical trials overcome the low prior plausibility of homeopathy? Of course not. No, I'm not saying the prior plausibility of
#ivermectin is homeopathy-level, but the same principle applies, just to a less extreme extent.2 replies 0 retweets 1 like -
Yes, it's possible that
#ivermectin might have a therapeutic benefit vs.#COVID19, but, again, its low prior plausibility plus equivocal and low quality clinical trials *strongly* suggest that it probably does not.1 reply 0 retweets 1 like
My prediction for #ivermectin is thus the same as it was for #HydroxyChloroquine a year ago. It's highly unlikely that it works against #COVID19. However, if a therapeutic effect is seen in large randomized trials, it will almost certainly be weak, far less than a "miracle cure."
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