The World Health Organization (WHO) on Friday published its first guideline for Ebola virus disease therapeutics, with new strong recommendations for the use of two monoclonal antibodies.
Ebola is a severe and too often fatal illness caused by the Ebola virus. According to the global health agency, previous Ebola outbreaks and responses have shown that early diagnosis and treatment with optimized supportive care —with fluid and electrolyte repletion and treatment of symptoms—significantly improve survival.
Now, after an analysis of randomised clinical trials of therapeutics for the disease, WHO has made strong recommendations for two monoclonal antibody treatments: mAb114 (Ansuvimab; Ebanga) and REGN-EB3 (Inmazeb).
The new guidance complements clinical care guidance that outlines the optimized supportive care Ebola patients should receive, from the relevant tests to administer, to managing pain, nutrition and co-infections, and other approaches that put the patient on the best path to recovery, WHO stated on Friday.
“This therapeutic guide is a critical tool to fight Ebola. It 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,” said 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 said in a statement.
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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. Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis, WHO said.
Meanwhile, 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).
“Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case. Provision of best supportive medical care to patients, combined with monoclonal antibody treatment—MAb114 or REGN-EB3—now leads to recovery for the vast majority of people,” said Dr Robert Fowler, University of Toronto, Canada and co-chair of the guideline development group in a statement.
“Access to both these treatments remains challenging, especially in resource-poor areas. These drugs should be where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely. WHO is ready to support countries, manufacturers and partners to improve access to these treatments, and to support national and global efforts to increase affordability of biotherapeutics and their corresponding similar biotherapeutic products, WHO published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to improve drug access for communities and countries affected by Ebola,” the health agency stated on Friday.
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Although WHO was able to make strong recommendations for the use of two therapeutics, there is a need for further research and evaluation of clinical interventions, as many uncertainties remain, it said.
