Improved Ebola survival rates with study treatments raise hopes, challenges

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Announcing favorable results from two of four Ebola treatment candidates being used in a randomized clinical trial among patients in the ongoing Democratic Republic of Congo outbreak, officials from the National Institute of Allergy and Infectious Diseases, the World Health Organization, and a veteran Democratic Republic of Congo researcher today heralded preliminary data as yielding hope for improved survival and control of the virus.

Data indicating greater survival rates among patients given one of the drugs, REGN-EB3, caused an independent trial monitoring and safety board to recommend that the trial in its current form be ended with two of the other drugs no longer offered. Data on survival rates among on the second drug that will continue to be offered, known as mAB114, were close to those of REGN-EB3.

ZMapp, a drug linked to better, but not significantly higher rates of survival in 2016 when used among patients who became sick during the West Africa outbreak, was a control drug in this trial and is one of the two drugs that will no longer be used.

Officials, who included NIAID Director Dr. Anthony Fauci, WHO Emergencies Program Director Dr. Michael Ryan, and Dr. Jean Jacques Muyembe-Tamfum, who has researched the virus through 10 outbreaks in his country, indicated the findings represent a meaningful step forward for efforts to control the spread and impacts of the disease.

“We do now have treatment for a disease, which, a short time ago we didn’t have,”  Dr. Fauci said, while Dr. Ryan said, “The news today is fantastic.”

Their language was largely cautious, though, as Dr. Fauci called the “bottom line,” the narrowing of candidates to the two drugs, which were linked to survival rates several times higher, particularly with early treatment than with the other drugs.

Dr. Ryan cited “tragedy linked to this success,” with “too many people still not being treated, still staying away.” He emphasized that a successful treatment will continue to be just one component to controlling the current and future outbreaks. Also needed, he noted will be good surveillance, good community engagement, and vaccination campaigns that can reach all of those at risk.

The PALM trial, named for the Swahili Pamoja Tulinde Maisha — “Together Saves Lives” — trial of the treatments began in November 2018, with the aim of testing the treatments on about 700 patients, and the anticipation that would need to take place over the course of multiple outbreaks in multiple countries. The trial curtailed Friday, though had enrolled more than 681 patients in the single ongoing outbreak in northwestern DRC, where the spread of disease continues to elude control.

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