4 ms·

Doesn't bode well for the quality of evidence included in the meta-analysis.

by kuhewa 5y ago

lettergram 5y ago
Recommend watching the full video, basically meta-analysis are only as good as the underlying data. Because these studies test various protocols, it's likely you're going to underestimate the drugs effectiveness. (Later studies are more likely to have better protocols). In this case, the confidence interval drops, but the reduction in deaths and hospitalizations is still a very strong signal. However, the confidence interval has widened (note, the lower bound is still showing positive results).
- bb88 5y ago
  Sure, but it strikes me that people latched on to this drug as a miracle cure since this study stated that chance of dying with ivermectin was 90% less than compared with a placebo. It just strikes me that any subsequent studies should be viewed with the highest amount of skepticism. I think this epidemiologist provides a better argument than I will ever do on an online forum: https://gidmk.medium.com/is-ivermectin-for-covid-19-based-on-fraudulent-research-5cc079278602 https://gidmk.medium.com/is-ivermectin-for-covid-19-based-on... (TL;DR: efficacy goes to 0 when you add in a new study and remove an additional study that shouldn't have been in the meta-analysis) Also, let's not forget recent history: the EUA for Hydroxychloroquine as a treatment for covid got pulled by the FDA even though it was celebrated by many as the miracle cure for covid last year both on this site and in the media. https://www.fda.gov/media/138945/download https://www.fda.gov/media/138945/download
  - lettergram 5y ago
    Yeah, I don't think it's good to grab onto anything in particular. That being said, the risks with certain drugs are very low. Hydroxychloroquine has some serious side effects and appear to marginally improve results, hence they revoked the EUA. If you want to dive into the data, I recommend: https://c19early.com/ https://c19early.com/ A lot of the papers are sub-par (so are the COVID-19 spread, symptomology, PCR tests, etc). Even the CDC PCR testing protocol (shown to be erring in Nov 2020) is having its EUA revoked: https://www.cdc.gov/csels/dls/locs/2021/07-21-2021-lab-alert-Changes_CDC_RT-PCR_SARS-CoV-2_Testing_1.html https://www.cdc.gov/csels/dls/locs/2021/07-21-2021-lab-alert...
    - bb88 5y ago
      > Hydroxychloroquine has some serious side effects and appear to marginally improve results, hence they revoked the EUA. I agree. HCQ was neither safe, nor truly effective (though the NIH study showed no effectiveness even though the FDA left that question open when they revoked the EUA). If ivermectin were truly 90% effective as the original paper claimed, then it should be very easy to replicate it, at any sample size. (e.g. The effect of alcohol on humans can be seen on a sample size of one. HIV retroviral drug studies had 90% effectiveness, and could be quickly measured by the T-cell count in any infected person) Researchers are humans. I believe there's some kind of "heroic/hope bias" with covid studies that warrants that extra skeptical look. If ivermectin had marginally successful data, the authors (or one of them) might have "juiced" it up to make it more efficacious than it was. It doesn't make them evil, but it does make them untrustworthy. On the other hand, I also wasn't a doctor in an emergency room last year.
      - OrvalWintermute 5y ago
        All strong antivirals are likely to have some side effects. Almost every medical intervention has effects, the most common of which is a lighter wallet. I support Remdesivir/Veklury which is a potent IV antiviral. Likewise, it has the following side effects Hypersensitivity Including Infusion-Related and Anaphylactic Reactions Hypersensitivity reactions, including infusion-related and anaphylactic reactions, have been observed during and following administration of VEKLURY. Signs and symptoms may include hypotension, hypertension, tachycardia, bradycardia, hypoxia, fever, dyspnea, wheezing, angioedema, rash, nausea, diaphoresis, and shivering. Slower infusion rates, with a maximum infusion time of up to 120 minutes, can be considered to potentially prevent these signs and symptoms. Monitor patients under close medical supervision for hypersensitivity reactions during and following administration of VEKLURY. If signs and symptoms of a clinically significant hypersensitivity reaction occur, immediately discontinue administration of VEKLURY and initiate appropriate treatment. The use of VEKLURY is contraindicated in patients with known hypersensitivity to VEKLURY or any components of the product Increased Risk of Transaminase Elevations Transaminase elevations have been observed in healthy volunteers who received 200 mg of VEKLURY followed by 100 mg doses up to 10 days; the transaminase elevations were mild (Grade 1) to moderate (Grade 2) in severity and resolved upon discontinuation of VEKLURY. Transaminase elevations have also been reported in patients with COVID-19 who received VEKLURY. Because transaminase elevations have been reported as a clinical feature of COVID-19, and the incidence was similar in patients receiving placebo versus VEKLURY in clinical trials of VEKLURY, discerning the contribution of VEKLURY to transaminase elevations in patients with COVID-19 can be challenging
- kuhewa 5y ago
  What I'm saying is when the largest trial and the one with probably the most leverage in the meta-analysis included turns out to be completely fraudulent, it doesn't bode well for that not being the case for other included trials. This one was 'preregistered' after data was collected among other major red flags and shouldn't have passed QC. That is the type of bias/error that can't be accounted for in the analysis itself.

Doesn't bode well for the quality of evidence included in the meta-analysis.

by kuhewa 5y ago

Doesn't bode well for the quality of evidence included in the meta-analysis.

Recommend watching the full video, basically meta-analysis are only as good as the underlying data. Because these studies test various protocols, it's likely you're going to underestimate the drugs effectiveness. (Later studies are more likely to have better protocols). In this case, the confidence interval drops, but the reduction in deaths and hospitalizations is still a very strong signal. However, the confidence interval has widened (note, the lower bound is still showing positive results).

bb88 5y ago
Sure, but it strikes me that people latched on to this drug as a miracle cure since this study stated that chance of dying with ivermectin was 90% less than compared with a placebo. It just strikes me that any subsequent studies should be viewed with the highest amount of skepticism. I think this epidemiologist provides a better argument than I will ever do on an online forum: https://gidmk.medium.com/is-ivermectin-for-covid-19-based-on-fraudulent-research-5cc079278602 https://gidmk.medium.com/is-ivermectin-for-covid-19-based-on... (TL;DR: efficacy goes to 0 when you add in a new study and remove an additional study that shouldn't have been in the meta-analysis) Also, let's not forget recent history: the EUA for Hydroxychloroquine as a treatment for covid got pulled by the FDA even though it was celebrated by many as the miracle cure for covid last year both on this site and in the media. https://www.fda.gov/media/138945/download https://www.fda.gov/media/138945/download
- lettergram 5y ago
  Yeah, I don't think it's good to grab onto anything in particular. That being said, the risks with certain drugs are very low. Hydroxychloroquine has some serious side effects and appear to marginally improve results, hence they revoked the EUA. If you want to dive into the data, I recommend: https://c19early.com/ https://c19early.com/ A lot of the papers are sub-par (so are the COVID-19 spread, symptomology, PCR tests, etc). Even the CDC PCR testing protocol (shown to be erring in Nov 2020) is having its EUA revoked: https://www.cdc.gov/csels/dls/locs/2021/07-21-2021-lab-alert-Changes_CDC_RT-PCR_SARS-CoV-2_Testing_1.html https://www.cdc.gov/csels/dls/locs/2021/07-21-2021-lab-alert...
  - bb88 5y ago
    > Hydroxychloroquine has some serious side effects and appear to marginally improve results, hence they revoked the EUA. I agree. HCQ was neither safe, nor truly effective (though the NIH study showed no effectiveness even though the FDA left that question open when they revoked the EUA). If ivermectin were truly 90% effective as the original paper claimed, then it should be very easy to replicate it, at any sample size. (e.g. The effect of alcohol on humans can be seen on a sample size of one. HIV retroviral drug studies had 90% effectiveness, and could be quickly measured by the T-cell count in any infected person) Researchers are humans. I believe there's some kind of "heroic/hope bias" with covid studies that warrants that extra skeptical look. If ivermectin had marginally successful data, the authors (or one of them) might have "juiced" it up to make it more efficacious than it was. It doesn't make them evil, but it does make them untrustworthy. On the other hand, I also wasn't a doctor in an emergency room last year.
    - OrvalWintermute 5y ago
      All strong antivirals are likely to have some side effects. Almost every medical intervention has effects, the most common of which is a lighter wallet. I support Remdesivir/Veklury which is a potent IV antiviral. Likewise, it has the following side effects Hypersensitivity Including Infusion-Related and Anaphylactic Reactions Hypersensitivity reactions, including infusion-related and anaphylactic reactions, have been observed during and following administration of VEKLURY. Signs and symptoms may include hypotension, hypertension, tachycardia, bradycardia, hypoxia, fever, dyspnea, wheezing, angioedema, rash, nausea, diaphoresis, and shivering. Slower infusion rates, with a maximum infusion time of up to 120 minutes, can be considered to potentially prevent these signs and symptoms. Monitor patients under close medical supervision for hypersensitivity reactions during and following administration of VEKLURY. If signs and symptoms of a clinically significant hypersensitivity reaction occur, immediately discontinue administration of VEKLURY and initiate appropriate treatment. The use of VEKLURY is contraindicated in patients with known hypersensitivity to VEKLURY or any components of the product Increased Risk of Transaminase Elevations Transaminase elevations have been observed in healthy volunteers who received 200 mg of VEKLURY followed by 100 mg doses up to 10 days; the transaminase elevations were mild (Grade 1) to moderate (Grade 2) in severity and resolved upon discontinuation of VEKLURY. Transaminase elevations have also been reported in patients with COVID-19 who received VEKLURY. Because transaminase elevations have been reported as a clinical feature of COVID-19, and the incidence was similar in patients receiving placebo versus VEKLURY in clinical trials of VEKLURY, discerning the contribution of VEKLURY to transaminase elevations in patients with COVID-19 can be challenging
kuhewa 5y ago
What I'm saying is when the largest trial and the one with probably the most leverage in the meta-analysis included turns out to be completely fraudulent, it doesn't bode well for that not being the case for other included trials. This one was 'preregistered' after data was collected among other major red flags and shouldn't have passed QC. That is the type of bias/error that can't be accounted for in the analysis itself.