Comparative effectiveness of ivermectin versus permethrin for the treatment of scabies: an updated systematic review and meta-analysis

Abstract

BACKGROUND: Scabies is a highly contagious parasitic skin disease and a recognised neglected tropical disease with substantial global burden. Permethrin and ivermectin are widely used treatments, yet uncertainty remains regarding their comparative effectiveness. AIM: To systematically evaluate and compare the effectiveness of ivermectin versus permethrin for the treatment of scabies in humans. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies comparing ivermectin with permethrin were identified through searches of PubMed, Embase, Cochrane CENTRAL, Scopus, CINAHL, and ClinicalTrials.gov. Risk of bias was assessed using the updated Cochrane Risk of Bias tool (RoB 2). A random-effects meta-analysis was performed using RevMan version 5.4.1 Only peer-reviewed RCTs involving human participants with clinically diagnosed scabies were included. RESULTS: Seven studies involving 1,216 participants were included. Compared with permethrin, ivermectin was associated with a lower probability of clinical cure at final follow-up (RR = 0.93, 95% CI 0.86-0.99; I² = 61%) and a higher risk of treatment failure (RR = 1.52, 95% CI 1.06-2.20; I² = 0%). CONCLUSION: Permethrin demonstrates a modest advantage over ivermectin in achieving clinical cure and reducing treatment failure. Ivermectin remains a useful alternative where topical therapy is unsuitable, but optimised dosing regimens are essential. CLINICAL TRIAL NUMBER: Not applicable.