Efficacy and safety of povidone-iodine compared to standard care/placebo

The information presented in the summary of findings table below comes from a living network meta-analysis that combines all the available evidence on prophylactic interventions for COVID-19. This statistical approach allows us to obtain estimates of effect for all potential comparisons, even those that have not been compared head-to-head in trials. We present the most trustworthy estimates of effect, based on the GRADE approach.

Comparison of povidone-iodine to standard care/placebo:

Summary of Findings Table

Population: People at risk of COVID-19

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OutcomeN studies / participants with direct evidenceRelative effect estimatesAbsolute effect estimatesCertainty of the EvidencePlain language summarySource of highest certainty estimate
Mortality
(closest to 90 days)		0 RCTs; 0 patientsN/ADifference: 2 fewer per 1000
(95% CI 31 fewer to 27 more)		VERY LOWDue to serious risk of bias, very serious imprecision, We are very uncertain about the effect of povidone-iodine on mortality compared to standard care/placeboNMA
Laboratory-confirmed SARS-CoV-2 infection0 RCTs; 0 patientsOdds Ratio: 0.84
(95% CI 0.3 - 2.07)		Difference: 6 fewer per 1000
(95% CI 45 fewer to 62 more)		VERY LOWDue to serious risk of bias, very serious imprecision, We are very uncertain about the effect of povidone-iodine on laboratory-confirmed infection compared to standard care/placeboNMA
Suspected, probable, or laboratory-confirmed SARS-CoV-2 infection
No data were reported for this outcome.
Admission to hospital (within 28 days)0 RCTs; 0 patientsN/ADifference: 3 fewer per 1000
(95% CI 36 fewer to 30 more)		VERY LOWDue to serious risk of bias, very serious imprecision, We are very uncertain about the effect of povidone-iodine on laboratory-confirmed infection compared to standard care/placeboNMA
Adverse events leading to discontinuation (within 28 days)0 RCTs; 0 patientsN/ADifference: 20 more per 1000
(95% CI 6 more to 33 more)		LOWDue to serious risk of bias, serious imprecision, Povidone-iodine may increase laboratory-confirmed infection compared to standard care/placeboNMA
Time to symptom(s) resolution (in days)
No data were reported for this outcome.

Abbreviations: AE, adverse events; 95% CI, 95% credible interval; NMA, network meta-analysis; N/A, not applicable; RCT, randomized control trial; SARS-CoV-2, severe acute respiratory syndrome–related coronavirus 2

GRADE Working Group grades of evidence

High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.

Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

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