Publishing its first guideline for Ebola virus disease therapeutics, the World Health Organisation (WHO) has strongly recommended two monoclonal antibody treatments.
Ebola is a severe and fatal disease caused by the Ebola virus. Previous Ebola outbreaks and responses have shown that early diagnosis and treatment with optimized supportive care such as with fluid and electrolyte repletion and treatment of symptoms significantly improves survival. Following a systematic review and meta-analysis of randomized clinical trials of therapeutics for the disease, the WHO has now recommended monoclonal antibodies -- mAb114 (Ansuvimab; Ebanga) and REGN-EB3 (Inmazeb).
The clinical trials were conducted during Ebola outbreaks, with the largest trial conducted in the Democratic Republic of the Congo, demonstrating that the highest level of scientific rigour can be applied even during Ebola outbreaks in difficult contexts.
“It (guidance) will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs. From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible. As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible,” Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action.
The two recommended therapeutics have demonstrated clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth, the WHO said. Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis.
There is also a recommendation on therapeutics that should not be used to treat patients: these include ZMapp and remdesivir. All these recommendations only apply to Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus).
Although WHO was able to make strong recommendations for the use of two therapeutics, it said that there is a need for further research and evaluation of clinical interventions, as many uncertainties remain.