Roman et al., Clinical Infectious Diseases,
doi:10.1093/cid/ciab591 (preprint 5/25/21) (Peer Reviewed) (meta analysis)
Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials
Severely flawed meta analysis. An open letter signed by 40 physicians detailing errors and flaws, and requesting retraction, can be found at [1]. See also [2].
The authors state that they have no conflicts of interest on medRxiv, however Dr. Pasupuleti’s affiliation is Cello Health, whose website [3] says that they provide services such as “brand and portfolio commercial strategy for biotech and pharma”, and that their clients are "24 of the top 25 pharmaceutical companies”.
Authors cherry-pick to include only 4 studies reporting non-zero mortality and they claim a mortality RR of 1.11 [0.16-7.65]. However, they reported incorrect values for Niaee et al., claiming an RR of 6.51 [2.18-19.45]. The correct RR for Niaee et al. is 0.18 [0.06-0.55] (as below). After correction, their cherry-picked studies show >60% mortality reduction.
Similarly, for viral clearance and
NCT04392713, they report 20/41 treatment, 18/45 control, whereas the correct day 7 clearance numbers are 37/41 and 20/45 (sum of clearance @72hrs and @7 days), or 17/41 and 2/45 @72 hrs.
The duration of hospital stay for Niaee et al. is also incorrectly reported, showing a lower duration for the control group.
All of the errors are in one direction - incorrectly reporting lower than actual efficacy for ivermectin. Authors claim to include all RCTs excluding prophylaxis, however they only include 10 of the 24 non-prophylaxis RCTs (28 including prophylaxis). Authors actually reference meta analyses that do include the missing RCTs, so they should be aware of the missing RCTs.
The PubMed search strategy provided is syntactically incorrect.
For additional errors, see [4]. Also see [5].
Only one of these errors has been partially fixed as of 5/29 - the Niaee RR was corrected, but the associated conclusion was not. Other errors have not been corrected. Comments on this article appear to be censored, with zero comments posted as of July 5.
Roman et al., 6/28/2021, peer-reviewed, 6 authors.