In August, as a new outbreak of the Ebola virus flared in the Democratic Republic of the Congo (DRC), the World Health Organization (WHO) announced that two new agents are proving to be effective in reducing mortality. "From now on, we will no longer say that Ebola is incurable," said Jean-Jacques Muyembe Tamfum, director-general of the National Institute for Biomedical Research and professor of microbiology at Kinshasa University Medical School in the DRC.
In November 2018, as part of the emergency response to an outbreak of 2,800 Ebola cases in the eastern DRC, the WHO, with the DRC's National Institute for Biomedical Research and other organizations, began PALM, a randomized controlled trial of four drugs. PALM stands for Pamoja Tulinde Maisha, which is Swahili for "together save lives." Untreated, those infected with Ebola have a mortality rate as high as 75%.
By August, with 681 patients enrolled in the trial, researchers had found that those treated with the investigational monoclonal antibodies (MABs) REGN-EB3 and mAb114 had a significantly lower mortality rate (29% and 34%, respectively) than those treated with ZMapp (49%), an older MAB, and remdesivir (53%), a nucleoside analog. Following trial protocol for early termination, the trial was ended and REGN-EB3 and mAb114 became the recommended agents for treatment of Ebola disease.
Because Ebola is so lethal and misunderstanding about treatment is prevalent in afflicted regions, many people have been reluctant to seek treatment. Delay in seeking treatment, even for a few days, significantly affects survival. In this trial, for example, those who were treated early with REGN-EB3 after Ebola exposure had a mortality rate of only 6%. WHO experts emphasized that the findings, although strong, are preliminary; a final analysis of the data is expected later this year.
The outcome of the trial was announced at a press conference on August 12 by the WHO and the National Institute of Allergy and Infectious Diseases. Listen to the telebriefing at https://activecho.cit.nih.gov/node_share_links/3198?token=5553cb72-77c1-4bde-a16.-Frank Brodhead