Ivermectin's Role in the Prevention of COVID‐19: A Systematic Review and Meta‐Analysis

Abstract This systematic review was performed to determine the population that benefited from prophylactic ivermectin. Seven databases of health‐related studies were searched for eligible trials without language restrictions. Randomized controlled trials (RCTs) and cohort studies investigating ivermectin for coronavirus disease 2019 (COVID‐19) prevention were included. Data were pooled using a random‐effects model, and subgroups were analyzed by study type and the pre‐ or postexposure population. The certainty of the evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation approach. Furthermore, 4 RCTs and 4 cohort studies with a moderate to high risk of bias were included in the analysis. The prophylactic use of ivermectin significantly decreased the overall incidence of COVID‐19 (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.16‐0.44). Nevertheless, the positive result was not supported by the RCT. Ivermectin was associated with a lower risk of COVID‐19 (OR, 0.22; 95% CI, 0.12‐0.40) in the preexposure population, whereas no protective effect was observed in the postexposure population (OR, 0.39; 95% CI, 0.09‐1.67). In summary, prophylactic ivermectin did not prevent COVID‐19 in the postexposure population. Although the protective effect of ivermectin was shown in the overall and preexposure populations, the results were unreliable owing to poor‐quality evidence.