I had a quick look and essentially it seems the latter found fewer studies (10 vs 19) and therefore fewer patients (1173 vs 2768)*
They have similar central estimates for RR of all cause mortality (0.37 vs 0.31) but due to having more patients the former has tighter CI (0.15 to 0.62) and concludes that there is an effect but the latter has wider CI (0.12 to 1.13) and concludes that there isn't an effect.
The latter could claim that there is as yet insufficient evidence of an effect based on the studies in their analysis but not that these isn't an effect. I especially take issue with the claim that "IVM is not a viable option for treating COVID-19 patients" when they themselves take such pains to talk about how low quality much of the evidence is!
The two meta-analyses also differ on their ratings of different papers - for instance the largest study (n=400, Lopez-Medina et al.) is rated as High quality (7 out of 7) in the former but at high risk of bias in the latter (due to deviations from intended interventions).
Scanning the paper there are a few issues. For the most part the problems are mitigated but there could still be issues:
- There was a period of 17 days where the placebo group were receiving ivermectin(!)
- The people from these 17 days were excluded from the primary analysis and additional subjects were enrolled
- The primary outcome was changed during the study
- This occurred ~30% through the study.
- The reasoning for changing from the old outcome seems reasonable
- It's hard to comment on whether the selection of the new outcome could have seen bias
- Placebo was changed during the study from dextrose water to something tasting more like ivermectin
- This was ~25% through the study
- Results did not differ much between the 2 placebo groups
- I don't feel like this would make a massive difference but I'm not sure
This paper is fairly typical of the quality of the studies (according to meta-analysis 2) or on the top end of study quality (according to meta-analysis 1) which causes me some concern.
In conclusion, if I was offered Ivermectin I would take it at this point (side effects seem to be small) and might even look to sign up to a trial if I had COVID - in the UK some people would be eligible for this one.
* 6 studies were common to both analyses.
Another meta-analysis (Bryant et al) has a very similar title but positive claims Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines.
The authors have put out an official rebuttal of the negative meta-analysis which is an interesting read and point to many of their perceived flaws.
The comments on the preprint of the negative study (Roman et al) are also interesting.
For instance:
And:
My current impression is that the negative study is not very high quality at the moment, for any reason among rush to publish, incompetence or malice.
For sake of argument I still have to look at what studies Roman et al did include that was omitted by Bryant et al and Hariyanto et al as that would reveal any pro-ivm biases.
Update:
A recent preprint compares Roman et al and Bryant et al: Bayesian Meta Analysis of Ivermectin Effectiveness in Treating Covid-19 Disease
Summary:
)
The two studies find similar
RR
(risk reduction asBryant found
RR = 0.38 [CI 95%: (0.19, 0.73)]
Roman found
RR = 0.37 [CI 95%: (0.12, 1.13)]
Roman et al should conclude there's not enough evidence because they can't rule out RR >= 1 at 95% confidence. Instead they conclude:
... (read more)