TrumpLyftAlles | 20 points
Ivermectin is effective for COVID-19: analysis of 19 studies (World, found 2020-11-26) Has a great chart summarizing ivermectin trialsLooking at their HCQ page, its seems the authors don't recognize the biases inherent in retrospective and non-randomized studies.
I happen to believe believe a meta-analysis restricted to randomized, placebo controlled studies would still find a benefit to IVM (which isn't the case IMO with HCQ).
But this page reminds me too much of the politically motivated lists supporting HCQ, which ignored the reality that in the best designed studies, effects were negligible or slightly negative. Randomized, placebo controlled trials will (and should) upstage any number of retrospective studies.
[-] Haitchpeasauce | 1 points
Hopefully now there is enough to truly warrant proper large RCTs. Through this pandemic I have come to learn that without corporate/government support the pyramid of evidence has to be slowly built from the ground up, one step at a time.
But this page reminds me too much of the politically motivated lists supporting HCQ, which ignored the reality that in the best designed studies, effects were negligible or slightly negative.
Agreed. This one purports to be more objective and methods based and should stand out as such. The HCQ page makes no mention, but even considering the inherent biases the signal is nowhere near as positive.
is there any reason to suspect the ivermectin studies are politically motivated or influenced by $
I haven't seen an influential microbiologist (like Didier Raoult), a political advisor (like Peter Navarro) or a national leader (like DJT) push ivermectin, nor have I seen ivermectin dominate drug studies to great opportunity cost. It seems just a more organic investigation of a generic drug on the WHO Model List of Essential Medicines, that happens to have broad anti-viral activity in vitro. There's no money to be made in this generic, and there aren't any politicians to provide political cover for.
I really really wish the UK Recovery trial had considered ivermectin for one of its arms, rather than one of the lower impact therapies its looked at (or is looking at), like Lopinavir–ritonavir or aspirin.
[-] TrumpLyftAlles | 4 points
[-] Ok-Film-9049 | 1 points
Paul Marik thinks HCQ may have benefit early on only. The problem with HCQ is that it might take 4 days to be effective. IVM works very quickly. So if you take both only when symptomatic IVM would have a massive advantage, even if they were both equally efficacious. That window when you are looking for anti viral properties is quite small. Unless you want to be on either drugs for months IVM is the only one I would take for post symptomatic stage. I have both as well as famotadine and a whole bunch of other contenders. Thinking logically, why wouldn't you take IVM after infection? It is safer that paracetamol and very likely effective. It is quite perverse that doctors refuse to prescribe itt.
[-] Haitchpeasauce | 6 points | Nov 27 2020 00:49:56
This is a very important resource. Their search is automated and analysis is impartial - negative findings will not be filtered out, and efforts are made to compensate for publication bias:
Discussion
Publishing is often biased towards positive results, which we would need to adjust for when analyzing the percentage of positive results. For ivermectin, there is currently not enough data to evaluate publication bias with high confidence. One method to evaluate bias is to look at prospective vs. retrospective studies. Prospective studies are likely to be published regardless of the result, while retrospective studies are more likely to exhibit bias. For example, researchers may perform preliminary analysis with minimal effort and the results may influence their decision to continue. Retrospective studies also provide more opportunities for the specifics of data extraction and adjustments to influence results. While some effects are not statistically significant when considered alone, currently all ivermectin studies report positive effects. We note that 12 of the 19 studies are prospective studies.
Typical meta analyses involve subjective selection criteria, effect extaction rules, and study bias evaluation, which can be used to bias results towards a specific outcome. In order to avoid bias we include all studies and use a pre-specified method to extract results from all studies. We note that currently for ivermectin, it would take an extreme form of cherry-picking via selection criteria, effect extraction rules, and/or bias evaluation in order to avoid a statistically significant positive result.
Their methods listed in Appendix 1 are worth noting:
Appendix 1. Methods and Study Results
We performed ongoing searches of PubMed, medRxiv, ClinicalTrials.gov, The Cochrane Library, Google Scholar, Collabovid, Research Square, ScienceDirect, Oxford University Press, the reference lists of other studies and meta-analyses, and submissions to the site c19ivermectin.com, which regularly receives submissions of both positive and negative studies upon publication. Search terms were ivermectin and COVID-19 or SARS-CoV-2, or simply ivermectin. Automated searches are performed every hour with notifications of new matches. All studies regarding the use of ivermectin for COVID-19 that report an effect compared to a control group are included in the main analysis. This is a living analysis and is updated regularly.
We extracted effect sizes and associated data from all studies. If studies report multiple kinds of effects then the most serious outcome is used in calculations for that study. For example, if effects for mortality and cases are both reported, the effect for mortality is used, this may be different to the effect that a study focused on. If symptomatic results are reported at multiple times, we used the latest time, for example if mortality results are provided at 14 days and 28 days, the results at 28 days are used. Mortality alone is preferred over combined outcomes. Outcomes with zero events in both arms were not used. Clinical outcome is considered more important than PCR testing status. For PCR results reported at multiple times, preference is given to results mid-recovery (after most or all patients have recovered there is no room for an effective treatment to do better). When results provide an odds ratio, we computed the relative risk when possible, or converted to a relative risk according to [Zhang]. Reported confidence intervals and p-values were used when available, using adjusted values when provided. If multiple types of adjustments are reported including propensity score matching (PSM), the PSM results are used. When needed, conversion between reported p-values and confidence intervals followed [Altman, Altman (B)], and Fisher's exact test was used to calculate p-values for event data. If continuity correction for zero values are required, we use the reciprocal of the opposite arm with the sum of the correction factors equal to 1 [Sweeting]. Results are all expressed with RR < 1.0 suggesting effectiveness. Most results are the relative risk of something negative. If studies report relative times, results are expressed as the ratio of the time for the ivermectin group versus the time for the control group. Calculations are done in Python (3.8.5) with scipy (1.3.3), pythonmeta (1.11), numpy (1.19.1), statsmodels (0.12.0), and plotly (4.10.0). The forest plots are computed using PythonMeta [Deng] with the DerSimonian and Laird random effects model (the fixed effect assumption is not plausible in this case). We received no funding, this research is done in our spare time. We have no affiliations with any pharmaceutical companies or political parties.
I appreciate their efforts and the quality of the analysis.
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[-] TrumpLyftAlles | 6 points | Nov 27 2020 00:55:37
Thanks for this.
I never do this, maybe I should do it more -- but I tweeted this chart to the FDA, CDC, NIH and our in-coming President.
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[-] LinkifyBot | 1 points | Nov 27 2020 00:50:11
I found links in your comment that were not hyperlinked:
I did the honors for you.
^delete ^| ^information ^| ^<3
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