Evidence on other secondary outcomes was very low certainty. Severe adverse events were rare among treatment trials and evidence of no difference was assessed as low certainty. Low-certainty evidence suggested that there may be no benefit with ivermectin for “need for mechanical ventilation,” whereas effect estimates for “improvement” and “deterioration” clearly favored ivermectin use. Secondary outcomes provided less certain evidence. Low-certainty evidence found that ivermectin prophylaxis reduced COVID-19 infection by an average 86% (95% confidence interval 79%–91%). This was also robust against a trial sequential analysis using the Biggerstaff–Tweedie method. This result was confirmed in a trial sequential analysis using the same DerSimonian–Laird method that underpinned the unadjusted analysis. Meta-analysis of 15 trials found that ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19–0.73 n = 2438 I 2 = 49% moderate-certainty evidence).
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