“…From 11,257 citations and studies listed in trial registries, 55 studies were selected for full-text review, of which 35 met eligibility criteria (Fig. 1): 1 RCT [24], 8 non-randomized intervention and cohort studies [25–32], 9 case series [11, 33–40], and 17 case reports published in 16 citations [10, 13, 41–54]. These 35 studies collectively examined 21 anti-Ebola agents, including 9 antivirals, 6 blood- or blood component-based therapies, 3 monoclonal antibody treatments, 2 vascular leak syndrome treatments (previously described for other indications [55, 56]), and 1 antimalarial drug, which we included because of the possibility of anti-Ebola virus effects [57].…”
Section: Resultsmentioning
confidence: 99%
“…These 35 studies collectively examined 21 anti-Ebola agents, including 9 antivirals, 6 blood- or blood component-based therapies, 3 monoclonal antibody treatments, 2 vascular leak syndrome treatments (previously described for other indications [55, 56]), and 1 antimalarial drug, which we included because of the possibility of anti-Ebola virus effects [57]. Thirty-one eligible studies, published in 30 citations, were conducted during the 2014–2016 West African outbreak [10, 11, 13, 24–32, 36–40, 42–54] and reported on 4.8% (1377/28616) of all patients with a diagnosis of EVD.Fig. 1Flow of studies through the systematic review…”
Background
Management of Ebola virus disease (EVD) has historically focused on infection prevention, case detection and supportive care. Several specific anti-Ebola therapies have been investigated, including during the 2014–2016 West African outbreak. Our objective was to conduct a systematic review of the effect of anti-Ebola virus therapies on clinical outcomes to guide their potential use and future evaluation.
Methods
We searched PubMed, EMBASE, Global Health, Cochrane Library, African Index Medicus, WHOLIS (inception-9 April 2018), and trial registries for observational studies or clinical trials, in any language, that enrolled patients with confirmed EVD who received therapy targeting Ebola virus and reported on mortality, symptom duration, or adverse effects.
Results
From 11,257 citations and registered trials, we reviewed 55 full-text citations, of which 35 met eligibility criteria (1 randomized clinical trial (RCT), 8 non-randomized comparative studies, 9 case series and 17 case reports) and collectively examined 21 anti-Ebola virus agents. The 31 studies performed during the West African outbreak reported on 4.8% (1377/28616) of all patients with Ebola. The only RCT enrolled 72 patients (0.25% of all patients with Ebola) and compared the monoclonal antibody ZMapp vs. standard care (mortality, 22% vs. 37%; 95% confidence interval for risk difference, − 36 to 7%). Studies of convalescent plasma, interferon-β-1a, favipiravir, brincidofovir, artesunate-amodiaquine and TKM-130803 were associated with at least moderate risk of bias.
Conclusions
Research evaluating anti-Ebola virus agents has reached very few patients with EVD, and inferences are limited by non-randomized study designs. ZMapp has the most promising treatment signal.
Electronic supplementary material
The online version of this article (10.1186/s12879-019-3980-9) contains supplementary material, which is available to authorized users.
“…From 11,257 citations and studies listed in trial registries, 55 studies were selected for full-text review, of which 35 met eligibility criteria (Fig. 1): 1 RCT [24], 8 non-randomized intervention and cohort studies [25–32], 9 case series [11, 33–40], and 17 case reports published in 16 citations [10, 13, 41–54]. These 35 studies collectively examined 21 anti-Ebola agents, including 9 antivirals, 6 blood- or blood component-based therapies, 3 monoclonal antibody treatments, 2 vascular leak syndrome treatments (previously described for other indications [55, 56]), and 1 antimalarial drug, which we included because of the possibility of anti-Ebola virus effects [57].…”
Section: Resultsmentioning
confidence: 99%
“…These 35 studies collectively examined 21 anti-Ebola agents, including 9 antivirals, 6 blood- or blood component-based therapies, 3 monoclonal antibody treatments, 2 vascular leak syndrome treatments (previously described for other indications [55, 56]), and 1 antimalarial drug, which we included because of the possibility of anti-Ebola virus effects [57]. Thirty-one eligible studies, published in 30 citations, were conducted during the 2014–2016 West African outbreak [10, 11, 13, 24–32, 36–40, 42–54] and reported on 4.8% (1377/28616) of all patients with a diagnosis of EVD.Fig. 1Flow of studies through the systematic review…”
Background
Management of Ebola virus disease (EVD) has historically focused on infection prevention, case detection and supportive care. Several specific anti-Ebola therapies have been investigated, including during the 2014–2016 West African outbreak. Our objective was to conduct a systematic review of the effect of anti-Ebola virus therapies on clinical outcomes to guide their potential use and future evaluation.
Methods
We searched PubMed, EMBASE, Global Health, Cochrane Library, African Index Medicus, WHOLIS (inception-9 April 2018), and trial registries for observational studies or clinical trials, in any language, that enrolled patients with confirmed EVD who received therapy targeting Ebola virus and reported on mortality, symptom duration, or adverse effects.
Results
From 11,257 citations and registered trials, we reviewed 55 full-text citations, of which 35 met eligibility criteria (1 randomized clinical trial (RCT), 8 non-randomized comparative studies, 9 case series and 17 case reports) and collectively examined 21 anti-Ebola virus agents. The 31 studies performed during the West African outbreak reported on 4.8% (1377/28616) of all patients with Ebola. The only RCT enrolled 72 patients (0.25% of all patients with Ebola) and compared the monoclonal antibody ZMapp vs. standard care (mortality, 22% vs. 37%; 95% confidence interval for risk difference, − 36 to 7%). Studies of convalescent plasma, interferon-β-1a, favipiravir, brincidofovir, artesunate-amodiaquine and TKM-130803 were associated with at least moderate risk of bias.
Conclusions
Research evaluating anti-Ebola virus agents has reached very few patients with EVD, and inferences are limited by non-randomized study designs. ZMapp has the most promising treatment signal.
Electronic supplementary material
The online version of this article (10.1186/s12879-019-3980-9) contains supplementary material, which is available to authorized users.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
