The current outbreak of Ebola virus disease (EVD) which began in August 2018 in North Kivu and Ituri provinces of the Democratic Republic of Congo (DRC) is the second largest recorded outbreak since the virus was first identified in 1976. Currently, more than 3,300 cases of EVD have been confirmed with a case-fatality rate of 66%. A new trial published in The New England Journal of Medicine, however, provides some room for optimism. Researchers from the DRC, the National Institutes of Health in the United States, and the World Health Organization successfully completed a randomized, controlled trial of four investigational therapies for EVD. In total, 673 patients with confirmed EVD were randomly assigned in a 1:1:1:1 ratio to receive either the triple monoclonal antibody ZMapp, which showed possible efficacy in a previous clinical trial (N=169; the control group), the antiviral agent remdesivir (N=175), MAb114 (N=174; a single monoclonal antibody derived from an Ebola survivor), or REGN-EB3 (N=155; a triple monoclonal antibody derived from immunizing mice). Mortality at 28 days was 50% in the ZMapp group, 53% in the remdesivir group, 35% in the MAb114 group, and 34% in the REGN-EB3 group during interim analysis in August 2019. Since MAb114 and REGN-EB3 were superior to ZMapp and remdesivir, the remainder of the trial will focus on MAb114 and REGN-EB3. Further data on efficacy against different viral strains and target populations in addition to safety of these two new EVD treatments are needed.
References:
- Mulangu S, Dodd LE, Davey Jr RT, Mbaya OT, et al for the PALM Consortium Study Team. A randomized, controlled trial of Ebola virus disease therapeutics. NEJM 2019; DOI:10.1056/NEJMoa1910993
- Levine MM. Monoclonal antibody therapy for Ebola virus disease. NEJM 2019; DOI:10.1056/NEJMe1915350
- WHO Health Emergency Update. Ebola in The Democratic Republic of the Congo. Accessed online December 2, 2019.
