Efficacy of ivermectin for malaria vector control: a systematic review and meta-analysis of randomized clinical trials

BACKGROUND: Despite global malaria control efforts, malaria continues to cause approximately 241-249 million cases and over 600,000 deaths annually. Ivermectin, a broad-spectrum antiparasitic drug with endectocidal activity against mosquitoes feeding on treated hosts, has been proposed as a potential malaria vector-control intervention. OBJECTIVE: To systematically evaluate the effectiveness of ivermectin in reducing malaria transmission outcomes in adult populations, including malaria incidence, prevalence, mosquito mortality, and safety outcomes. METHODS: Following PRISMA 2020 guidelines, we included randomized controlled trials (RCTs) and cluster-RCTs evaluating ivermectin compared with placebo, standard care, or non-ivermectin controls in adult populations. Outcomes included malaria incidence, prevalence, mosquito mortality, and adverse events. RESULTS: > 97%). Across studies, ivermectin was generally well tolerated, with no significant increase in adverse events. CONCLUSIONS: Current evidence does not demonstrate consistent reductions in malaria incidence or prevalence with ivermectin administration, although laboratory and experimental studies suggest mosquitocidal effects. Further large, well-designed cluster-randomized trials are required to determine whether ivermectin can contribute to malaria control strategies.