COVID-19 : une analyse Cochrane révèle des données probantes limitées en faveur de l’ivermectine

• Popp M & al.
•  Cochrane Database Syst Rev
•  28 juil. 2021
• Par Liz Scherer
•  Clinical Essentials
•  6 août 2021

À retenir

• Les données probantes actuelles ne soutiennent pas l’utilisation de l’ivermectine pour le traitement ou la prévention de la maladie à coronavirus 2019 (COVID-19) à la suite d’un contact à haut risque.

Pourquoi est-ce important ?

• Des études sont en cours et les données probantes pourraient évoluer, mais aucune donnée probante de haute qualité ne soutient actuellement le traitement par ivermectine.

Principaux résultats

• 14 études, 1 678 participants.
• Risques relatifs (RR ; IC à 95 %) avec l’ivermectine, par rapport au placebo ou au traitement standard pour les patients hospitalisés :
  • Mortalité : 0,60 (0,14–2,51).
  • Aggravation clinique jusqu’au jour 28, ventilation artificielle : 0,55 (0,11–2,59).
  • Événements indésirables (EI) : 1,21 (0,50–2,97).
  • Clairance virale, jour 7 : 1,82 (0,51–6,48).
  • Amélioration clinique jusqu’au jour 28 : 1,03 (0,78–1,35).
  • Par ailleurs, pour la durée d’hospitalisation, la différence moyenne était de -0,10 jour (-2,43 à 2,23).
• RR (IC à 95 %) pour les patients ambulatoires :
  • Réduction/Augmentation de la mortalité jusqu’au jour 28 : 0,33 (0,01–8,05).
  • Aggravation clinique jusqu’au jour 14 : 2,97 (0,12–72,47).
  • Clairance virale au jour 7 : 3,00 (0,13–67,06).
  • Résolution des symptômes jusqu’au jour 14 : 1,04 (0,89–1,21).
  • EI jusqu’au jour 28 : 0,95 (0,86–1,05).

Méthodologie

• Une revue de l’intervention Cochrane a évalué l’efficacité et la sécurité d’emploi de l’ivermectine pour le traitement du COVID-19, par rapport à l’absence de traitement, au traitement standard, au placebo, à tout traitement éprouvé ou à une prophylaxie post-exposition.
• Financement : ministère fédéral de l’Éducation et de la Recherche.

Limites

• Données probantes de faible certitude.
• IC étendus.
• Biais de publication.

• Voir l’abstract 
• Voir l’article Full text (gratuit)

Popp M, Stegemann M, Metzendorf MI, Gould S, Kranke P, Meybohm P, Skoetz N, Weibel S. Ivermectin for preventing and treating COVID-19. Cochrane Database Syst Rev. 2021;7:CD015017. doi: 10.1002/14651858.CD015017.pub2. PMID: 34318930

Conclusions sur l’abstract:

Main results: We found 14 studies with 1678 participants investigating ivermectin compared to no treatment, placebo, or standard of care. No study compared ivermectin to an intervention with proven efficacy. There were nine studies treating participants with moderate COVID-19 in inpatient settings and four treating mild COVID-19 cases in outpatient settings. One study investigated ivermectin for prevention of SARS-CoV-2 infection. Eight studies had an open-label design, six were double-blind and placebo-controlled. Of the 41 study results contributed by included studies, about one third were at overall high risk of bias. Ivermectin doses and treatment duration varied among included studies. We identified 31 ongoing and 18 studies awaiting classification until publication of results or clarification of inconsistencies. Ivermectin compared to placebo or standard of care for inpatient COVID-19 treatment We are uncertain whether ivermectin compared to placebo or standard of care reduces or increases mortality (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.14 to 2.51; 2 studies, 185 participants; very low-certainty evidence) and clinical worsening up to day 28 assessed as need for invasive mechanical ventilation (IMV) (RR 0.55, 95% CI 0.11 to 2.59; 2 studies, 185 participants; very low-certainty evidence) or need for supplemental oxygen (0 participants required supplemental oxygen; 1 study, 45 participants; very low-certainty evidence), adverse events within 28 days (RR 1.21, 95% CI 0.50 to 2.97; 1 study, 152 participants; very low-certainty evidence), and viral clearance at day seven (RR 1.82, 95% CI 0.51 to 6.48; 2 studies, 159 participants; very low-certainty evidence). Ivermectin may have little or no effect compared to placebo or standard of care on clinical improvement up to 28 days (RR 1.03, 95% CI 0.78 to 1.35; 1 study; 73 participants; low-certainty evidence) and duration of hospitalization (mean difference (MD) -0.10 days, 95% CI -2.43 to 2.23; 1 study; 45 participants; low-certainty evidence). No study reported quality of life up to 28 days. Ivermectin compared to placebo or standard of care for outpatient COVID-19 treatment We are uncertain whether ivermectin compared to placebo or standard of care reduces or increases mortality up to 28 days (RR 0.33, 95% CI 0.01 to 8.05; 2 studies, 422 participants; very low-certainty evidence) and clinical worsening up to 14 days assessed as need for IMV (RR 2.97, 95% CI 0.12 to 72.47; 1 study, 398 participants; very low-certainty evidence) or non-IMV or high flow oxygen requirement (0 participants required non-IMV or high flow; 1 study, 398 participants; very low-certainty evidence). We are uncertain whether ivermectin compared to placebo reduces or increases viral clearance at seven days (RR 3.00, 95% CI 0.13 to 67.06; 1 study, 24 participants; low-certainty evidence). Ivermectin may have little or no effect compared to placebo or standard of care on the number of participants with symptoms resolved up to 14 days (RR 1.04, 95% CI 0.89 to 1.21; 1 study, 398 participants; low-certainty evidence) and adverse events within 28 days (RR 0.95, 95% CI 0.86 to 1.05; 2 studies, 422 participants; low-certainty evidence). None of the studies reporting duration of symptoms were eligible for primary analysis. No study reported hospital admission or quality of life up to 14 days. Ivermectin compared to no treatment for prevention of SARS-CoV-2 infection We found one study. Mortality up to 28 days was the only outcome eligible for primary analysis. We are uncertain whether ivermectin reduces or increases mortality compared to no treatment (0 participants died; 1 study, 304 participants; very low-certainty evidence). The study reported results for development of COVID-19 symptoms and adverse events up to 14 days that were included in a secondary analysis due to high risk of bias. No study reported SARS-CoV-2 infection, hospital admission, and quality of life up to 14 days.

Authors’ conclusions: Based on the current very low- to low-certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID-19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID-19 outside of well-designed randomized trials.