Bayesian Hypothesis Testing and Hierarchical Modeling of Ivermectin Effectiveness

Abstract: e576 5. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. doi: 10.1136/bmj.n71. Available at: https://www.bmj.com/content/372/bmj. n71. Accessed August 9, 2021. 6. López-Medina E, López P, Hurtado IC. Effect of Ivermectin on time to resolution of symptoms among adults with mild COVID-19: a randomized clinical trial. J Am Med Assoc. 2021. doi: 10.1001/jama.2021.3071. 7. Scheim D, Hibberd JA, Chamie-Quintero J. Protocol violations in López-Medina et al.: 38 switched Ivermectin (IVM) and placebo doses, failure of blinding, widespread IVM sales OTC in Cali, and nearly identical AEs for the IVM and control groups. Open Sci Found Preprint. 2021. doi: 10.31219/osf.io/u7ewz. Available at: https://osf. io/u7ewz. Accessed August 9, 2021. 8. Hill A, Garratt A, Levi J, et al. Meta-analysis of randomized trials of Ivermectin to treat SARS-CoV-2 infection. Open Forum Infect Dis. 2021. doi: 10.1093/ofid/ofab358. Available Letters to the Editor 9. 10. 11. 12. at: https://academic.oup.com/ofid/advance-article/doi/ 10.1093/ofid/ofab358/6316214. Accessed August 9, 2021. World Health Organisation. Therapeutics and COVID-19: Living Guideline; 2021. Available at: https://www.who. int/publications/i/item/WHO-2019-nCoVtherapeutics-2021.2. Accessed July 22, 2021. Roman YM, Burela PA, Pasupuleti V, et al. Ivermectin for the treatment of COVID-19: a systematic review and meta-analysis of randomized controlled trials. Clin Infect Dis. 2021. doi: 10.1093/cid/ciab591. Neil M, Fenton NE. Bayesian meta analysis of Ivermectin effectiveness in treating covid-19 disease. Res Gate. 2021. doi: 10.13140/RG.2.2.31800.88323. Available at: https://doi.org/ 10.13140/RG.2.2.31800.88323. Accessed August 9, 2021. Neil, M. & Fenton, N. E. (2021). Bayesian meta-analysis of ivermectin effectiveness in treating Covid-19 (with sensitivity analysis to account for possibly flawed studies). Submitted to Am J Therapeutics. Available at: http:// dx.doi.org/10.13140/RG.2.2.19713.58723. Bayesian Hypothesis Testing and Hierarchical Modeling of Ivermectin Effectiveness To the Editor: A recent meta-analysis of the trials evaluating ivermectin that was published in AJT1 (referred to here as Bryant) was widely welcomed by those who argue that this antiparasitic drug is a cheap and effective treatment for COVID-19 infections. The study concluded: “Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the severe acute respiratory syndrome coronavirus 2 pandemic globally.” These conclusions stand in stark contrast to those of a later meta-analysis2 (referred to here as Roman) that looked at a subset of the trials. Roman concluded: “In comparison to standard of care or placebo, ivermectin (IVM) did not reduce all-cause mortality, length of stay, or viral clearance in randomized controlled trials in COVID19 patients with mostly mild disease. IVM did not have effect on adverse events or severe adverse events. IVM is not a viable option to treat COVID-19 patients.” Irrespective of the errors in the data and the analysis performed by Roman that were already highlighted by American Journal of Therapeutics (2021) 28(5) Crawford,3 we believe that this conclusion is not..