• Meta analysis using the most serious outcome reported shows 66% [52‑76%] and 86% [75‑92%] improvement for early treatment and prophylaxis, with similar results after exclusion based sensitivity analysis (which excludes all of the GMK/BBC team studies), with primary outcomes, and after restriction to peer-reviewed studies or Randomized Controlled Trials.• Statistically significant improvements are seen for mortality, ventilation, ICU admission, hospitalization, recovery, cases, and viral clearance. 30 studies show statistically significant improvements in isolation.• Results are very robust — in worst case exclusion sensitivity analysis 52 of 63 studies must be excluded to avoid finding statistically significant efficacy.• While many treatments have some level of efficacy, they do not replace vaccines and other measures to avoid infection. Only 24% of ivermectin studies show zero events in the treatment arm.• Multiple treatments are typically used in combination, and other treatments could be more effective, including monoclonal antibodies which may be available in countries not recommending ivermectin (sotrovimab, casirivimab/imdevimab, and bamlanivimab/etesevimab).• Elimination of COVID-19 is a race against viral evolution. No treatment, vaccine, or intervention is 100% available and effective for all variants. All practical, effective, and safe means should be used, including treatments, as supported by Pfizer [Pfizer, TrialSiteNews]. Denying the efficacy of treatments increases the risk of COVID-19 becoming endemic; and increases mortality, morbidity, and collateral damage.

	Studies	Prophylaxis	Early treatment	Late treatment	Patients	Authors
All studies	63	86% [75‑92%]	66% [52‑76%]	36% [21‑48%]	47,461	625
Peer-reviewed	44	86% [74‑93%]	71% [54‑82%]	38% [16‑55%]	17,126	466
With GMK/BBC exclusions	47	84% [69‑91%]	73% [63‑80%]	45% [22‑61%]	37,558	518
RCTs	30	84% [25‑96%]	62% [43‑75%]	20% [-6‑39%]	6,368	357
Percentage improvement with ivermectin treatment

• There is evidence of a negative publication bias, and the probability that an ineffective treatment generated results as positive as the 63 studies is estimated to be 1 in 122 billion.• Over 20 countries have adopted ivermectin for COVID-19. The evidence base is much larger and has much lower conflict of interest than typically used to approve drugs.• All data to reproduce this paper and sources are in the appendix. See [Bryant, Hariyanto, Kory, Lawrie, Nardelli] for other meta analyses with similar results confirming efficacy.

Evidence base used for other COVID-19 approvals
Medication	Studies	Patients	Improvement
Budesonide (UK)	1	1,779	17%
Remdesivir (USA EUA)	1	1,063	31%
Casirivimab/i.. (USA EUA)	1	799	66%
Ivermectin evidence	63	47,437	65% [57‑73%]