Efficacy of Ivermectin in Covid-19: A Systematic Review of Randomised Controlled Trials

Ivermectin, an antiparasitic with a long safety record, was proposed early in the COVID-19 pandemic as a repurposed antiviral after it inhibited SARS-CoV-2 replication in cell culture. This review, which reports no new data, examines the published randomised controlled trials of ivermectin in COVID-19 together with the pharmacology, meta-analyses and safety literature. Small early trials gave mixed and sometimes favourable signals, whereas larger, better-designed placebo-controlled trials in outpatients found no clinically meaningful benefit on recovery, hospitalisation or death. Favourable pooled estimates depended heavily on low-quality or later discredited studies. Concentrations needed for antiviral effect are hard to reach at approved doses. Ivermectin cannot be recommended for COVID-19 outside trials.