Developments in the Treatment of Ebola—Commentary

The outbreak of Ebola disease in northeastern Democratic Republic of the Congo (DRC) is a significant concern. Containment of Ebola disease in the DRC is proving to be extraordinarily difficult, but there is a recent treatment development that may be helpful.

 The outbreak was first recognized in August of last year in North Kivu and Ituri provinces. It has subsequently spread to Goma, a city of over 1 million people and recently to South Kivu province. As of 23 August 2019, there have been 2950 cases and 69 percent of them have died. Because this is an area of over 1 million displaced people and borders on Uganda, South Sudan, and Rwanda, there is concern about local and international spread in this socially unstable population.

 Treatment centers have been set up and surveillance implemented that includes finding cases and their contacts and vaccinating them. Even with these measures in place, containment of the outbreak has not been successful for a variety of reasons. The main obstacle is distrust by local people of the effectiveness of DRC and foreign care givers and the care centers where they work and doubt that Ebola disease really exists.  This environment is complicated by the presence of many armed insurgent groups that have attacked Ebola care centers and field personnel.

 The very recent development of an effective treatment may help to foster the confidence and trust that is urgently needed. The preliminary results of a study with 499 participants indicated that those individuals receiving a cocktail of specific monoclonal antibodies (designated REGN-EB3 or mAb114) targeting the Ebola virus had about a 90 percent chance of survival if treated early during their infection and about a 70% chance regardless of when treatment began. This was in comparison to about 50% survival of people treated with the older antiviral drugs ZMAPP and remdesivir.

One hopes that these monoclonal antibody cocktails will demonstrate that the treatment centers can save lives and boost confidence in the centers and their staffs so that infected individuals will come in early. This will not solve all the barriers to containment of the outbreak, but it will help. These monoclonals will also be an effective treatment should infected individuals travel to large urban centers like Kinshasa or internationally.