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28 Jul, 4 tweets, 2 min read
Cochrane review on ivermectin just dropped. This is the current gold-standard summary:

"the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials."

cochranelibrary.com/cdsr/doi/10.10…
H/T @SGriffin_Lab, thanks for the tip!

Worth noting that the main finding of the review is that the available evidence is very low quality, and so low certainty that the impact of ivermectin could be anything from very protective to very detrimental to health (i.e. it could be saving lives or ending them)
Another interesting point - the Cochrane review authors addressed why their review disagrees with previous very positive studies on ivermectin. They were particularly pointed about the weird ivmmeta website

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More from @GidMK

Health Nerd Profile picture
28 Jul
Something that I keep seeing pop up is the idea that meta-analysis somehow eliminates issues with the underlying research

This is just confusingly incorrect
Meta-analysis really is just a simple statistical aggregation of results. Indeed, the most basic way to meta-analyze studies is just to use a mean or median of their point-estimates
But simple means/medians can be misleading - we don't really want a study of 10,000 to have the same weighting as a study of 10, but that's what a simple average provides
Read 10 tweets
Health Nerd Profile picture
27 Jul
Something worth noting - no matter how you look at it, the research community has royally fucked up when it comes to ivermectin
Yes, there are endless terrible trials, but we've had 18 months. WE COULD'VE RUN GOOD TRIALS

We didn't. That is woeful, and frankly inadequate
We spent endless billions researching hydroxychloroquine, and knew by August 2020 that it didn't work, but ivermectin which has been given to 100s OF MILLIONS OF PEOPLE...still no answer. Shameful
Read 4 tweets
Health Nerd Profile picture
27 Jul
Another day, another two ivermectin studies that have impossible values in their tables of results. Both included in meta-analyses (rated as high risk of bias this time)

This is getting truly insane
The entire ivermectin for COVID-19 literature is just...awash with this absolute trash. Studies that are pre-registered after publication. Tables of results that contradict the text. Percentages that are impossible
Endless examples of RCTs where the analysis plan is a single sentence long (we did chi-squared and some t-tests, p<0.05 was significant)
Read 5 tweets
Health Nerd Profile picture
26 Jul
People have claimed that ivermectin is 100% effective as a prophylactic for COVID-19 based on an observational trial of the drug

I'm extremely concerned about this trial. It definitely should not be used as evidence for anything 1/n
2/n The paper is here, and it's actually two studies - a pilot and a larger interventional trial where the authors gave ivermectin+carrageenan to one group of healthcare workers, and compared to a "matched" control media.marinomed.com/8b/7a/c7/nota-…
3/n The authors report that 0% of the people treated with ivermectin+carrageenan got COVID-19, while in the pilot 11% and in the full trial more than 50% of the control group got sick
Read 23 tweets
Health Nerd Profile picture
23 Jul
A fairly well-demonstrated fact about COVID-19 and lockdowns is that the more severe restrictions tend to have smaller marginal benefits once enacted
In practice, this means that the reduction in transmission for, say, limiting travel to 5km radius is probably quite small once you've already implemented other interventions such as stay-at-home orders
In other words, when we talk about 'hard' vs other lockdowns, the language often doesn't match the evidence. There's no strong reason to believe that adding small extra limits on behavior will have a large impact on the spread of COVID-19
Read 4 tweets
Health Nerd Profile picture
22 Jul
A large, well-done observational trial just found a big mortality benefit for ondansetron in the treatment of COVID-19

I think this is a fascinating case study in how we use observational research
academic.oup.com/ofid/article/8…
The authors used a huge database of people who'd been treated for COVID-19, and looked at the associations between mortality and 84 drugs or drug classes
They found that metformin, nicotine, fluticasone, SNRI, expectorants and ondasetron reduced the risk of death from COVID-19, but given the potential for residual confounding only focused on ondasetron
Read 10 tweets

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