For the first time, a drug is showing promising signs of effectiveness in Ebola patients participating in a study. The medicine, which interferes with the virus’s ability to copy itself, seems to have halved mortality – to 15%, from 30% – in patients with low to moderate levels of Ebola in their blood, researchers have found. It had no effect in patients with more virus in their blood, who are more likely to die. The New York Times reports that the drug, favipiravir, approved as an influenza treatment in Japan last year, was generally well tolerated.
"The results are encouraging in a certain phase of the disease," Dr Sakoba Keita, director of disease control for the Guinean Ministry of Health, said. The drug is being tested in Guinea, one of the three West African countries most affected by the Ebola crisis.
Researchers and health authorities have been quietly debating whether and when to release the preliminary results of the study. The dilemmas they face echo those from the early years of the Aids epidemic. Because mortality was so high in a disease with no proven treatment, there was demand to provide experimental therapies to everyone.
The results for the drug favipiravir are based on an analysis of 69 patients older than 14 who have received it at two sites in Guinea since December. The survival rates of those with low to moderate levels of virus in their blood were significantly better than those of patients previously treated at a centre run by Doctors Without Borders in Guéckédou, Guinea.
In a typical drug study, participants would be randomly assigned to take the drug or not, and the outcomes would be compared to see if the drug made a difference. However, because Ebola is so deadly and there is no known treatment aside from supportive care, all patients in the study were provided with the treatment. Fluctuating death rates during the current epidemic have complicated researchers’ efforts to assess whether the new drug should be credited with the reduced mortality.
The drug was expected to be most effective in patients receiving it within two to three days of showing symptoms, similar to antiviral treatments for influenza. However, most study participants arrived at the Ebola treatment units later in their illnesses, a median of five days after their symptoms began, so results were analysed instead in terms of the approximate levels of virus in the blood.
Independent boards charged with monitoring the drug trial detected the encouraging findings and recommended that they be made public. Results were submitted for review to the Conference on Retroviruses and Opportunistic Infection, which will take place in Seattle at the end of the month.
Guinea's government has authorised the wider use of the drug, reports Reuters Health. The expansion of the treatment comes as the number of people with Ebola in Guinea has doubled in the past week, reversing a broader trend of decline across the three worst-hit West African states – Guinea, Liberia and Sierra Leone.
"We have decided to broaden the use of this drug. It will only be available in the Ebola treatment units, not the hospitals," Sakoba Keita, coordinator of Guinea's Ebola response, said. Keita said that after testing in Guéckédou and Nzerekore, favipiravir has been distributed to the town of Coyah and talks are underway start treatment in the capital, Conakry. "We are looking to see how we can get it to other parts of the country too," he said.
Guinea, where the outbreak began, has recorded over 1,900 dead from some 3,000 confirmed cases.
[link url="http://www.nytimes.com/2015/02/05/science/ebola-drug-has-encouraging-early-results-and-questions-follow.html?emc=edit_th_20150205&nl=todaysheadlines&nlid=60640071&_r=0"]Full report in The New York Times[/link]
[link url="http://www.reuters.com/article/2015/02/07/us-health-ebola-guinea-idUSKBN0LB0Q620150207"]Full Reuters Health report[/link]