Ebola virus disease managed with blood product replacement and point of care tests in Sierra Leone

Nicholson-Roberts, T C; Fletcher, Tom; Rees, Paul; Dickson, Stuart; Hinsley, D E; Bailey, Margaret; Lamb, Lucy; Ardley, Christian

doi:10.1093/qjmed/hcv092

Cited by 5 publications

(12 citation statements)

References 2 publications

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“…This resulted in 11 drug screening,23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 17 preclinical studies,34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 and 9 clinical studies 51, 52, 53, 54, 55, 56, 57, 58, 59…”

Section: Resultsmentioning

confidence: 99%

“…These include 3 case reports,52, 53, 54 1 case series, 55 and 5 nonrandomized cohort studies 51, 56, 57, 58, 59. Convalescent blood products were included in the treatment regimen in a total of 6 studies 52, 53, 54, 55, 57, 59. Finally, the only end point extracted was the mortality rate because it was the only adequately documented end point shared by all studies.…”

Section: Resultsmentioning

confidence: 99%

“…Mortality was 91% (95% CI, 78.8% to 91.1%) for cycle threshold < 20, compared with 85% in pretrial populationBai et al 58 2016 Sierra Leona/ChinaRetrospective case series for the treatment of patients with favipiravir compared with control group39 patients in treatment group, 85 control groupFavipiravir 800 BID on Day 1, then 600 mg BID on Day 2, then at least 5 d of standard therapy3-11 d or until discharge85 patients receiving standard careHigher survival rate for treatment group compared with control (56.4% vs 35.3%; P = 0.027). All treated patients had medium to high viral loadBorobia et al 52 2015 SpainCase report on a single case of Ebola infection in Spain treated with a combination of convalescent plasma and favipiravir1 patientConvalescent plasma, favipiravir (loading dose of 50 mg/kg BID, maintenance dose of 25 mg/kg TID)11 d from Day 9NonePatient survivedNicholson-Roberts et al 53 2015 United Kingdom/Sierra LeoneCase report on management of a severe case of EVD with supportive care and convalescent whole blood1 male patientConvalescent whole blood (500 mL over 2 d)2 dNonePatient survivedFlorescu et al 54 2015 United StatesCase report on the management of a case of EVD with supportive care, convalescent plasma, and an experimental drug brincidofovir1 male patient200 mg brincidofovir PO on Day 6, followed by 100 mg doses on Day 9, 13, and 16. On Day 8, 3 U convalescent plasma were givenConvalescent plasma: 1 dNonePatient survivedMupapa et al 55 1999 Democratic Republic of CongoObservational study on 8 patients with confirmed EVD receiving treatment with convalescent blood transfusions8 female patientsConvalescent blood, variable quantityVariable durationNo direct control, overall case fatality rate of the Ebola epidemic in Kikwit2 out 9 patients died (12.5% Mortality compared with 80% overall case fatality rate)Gignoux et al 56 2016 Liberia/FranceRetrospective analysis of relative risk of mortality for treatment with 2 different antimalarial drugs, using adjusted and unadjusted regression models381 in total, divided into 4 groupsArtesunate-amodiaquine (dose according to age)3-d courseGroup receiving artemether-lumefantrine50.7% (36 out of 71) mortality rate for artesunate-amodiaquine group compared to 64.4% (125 out of 194) for the artemether-lumefantrine groupVan Griensven et al 57 2016 Guinea/BelgiumNonrandomized, comparative trial including 84 patients treated with up to 500 mL convalescent plasma with Unknown levels of neutralizing antibodies84 patients in treatment group 57% female2 U ABO-compatible convalescent plasma, 200ã 250 mL eachTransfusion on day of diagnosis or up to 2 d later…”

Section: Resultsmentioning

confidence: 99%

“…Of the 4 case studies, 2 studies52, 53 were judged to have poor reporting quality, 1 study 55 was judged to have fair reporting quality, and the last study 54 had good reporting quality. All the nonrandomized cohort studies51, 56, 57, 58, 59 were found to have a low risk of bias.…”

Section: Resultsmentioning

confidence: 99%

“…Our search yielded 3 single case reports of foreign patients who contracted EVD during their stay in western Africa and survived following transfusion therapy 52, 53, 54. An additional potential therapeutic agent was administered in 2 cases 52, 54.…”

Section: Discussionmentioning

confidence: 99%

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Repurposed Therapeutic Agents Targeting the Ebola Virus: A Systematic Review

Sweiti

Ekwunife

Jaschinski

et al. 2017

Current Therapeutic Research

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BackgroundThe Ebola virus has been responsible for numerous outbreaks since the 1970s, with the most recent outbreak taking place between 2014 and 2016 and causing an international public health emergency. Ebola virus disease (EVD) has a high mortality rate and no approved targeted treatment exists to date. A number of established drugs are being considered as potential therapeutic agents for the treatment of EVD.ObjectiveWe aimed to identify potential drug repositioning candidates and to assess the scientific evidence available on their efficacy.MethodsWe conducted a systematic literature search in MEDLINE, Embase, and other relevant trial registry platforms for studies published between January 1976 and January 2017. We included drug screening, preclinical studies, and clinical studies on repurposed drugs for the treatment of EVD. The risk of bias for animal studies and nonrandomized clinical studies was assessed. The quality of reporting for case series and case reports was evaluated. Finally, we selected drugs approved by established regulatory authorities, which have positive in vitro study outcomes and at least one additional animal or clinical trial.ResultsWe identified 3301 publications, of which 37 studies fulfilled our inclusion criteria. Studies were highly heterogeneous in terms of study type, methodology, and intervention. The risk of bias was high for 13 out of 14 animal studies. We selected 11 drugs with potential anti-EVD therapeutic effects and summarized their evidence.ConclusionsSeveral established drugs may have therapeutic effects on EVD, but the quality and quantity of current scientific evidence is lacking. This review highlights the need for well-designed and conducted preclinical and clinical research to establish the efficacy of potential repurposed drugs against EVD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Repurposed Therapeutic Agents Targeting the Ebola Virus: A Systematic Review

Sweiti

Ekwunife

Jaschinski

et al. 2017

Current Therapeutic Research

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Ebola Virus Disease in the Obstetric Population

Brown

Garde

Headrick

et al. 2018

Ebola Virus Disease

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The clinical management of Ebola created a significant challenge during the outbreak in West Africa, due to the paucity of previous research conducted into the optimum treatment regimen. That left many centres, to some extent, having to ‘work out’ best practice as they went along, and attempting to conduct real time prospective research. Médecins Sans Frontières (MSF) [1] were the only organization to have provided relatively in depth practical guidance prior to the outbreak and this manual was the basis of further planning between the WHO, national Ministry of Health and Sanitation in Sierra Leone, and other relevant stakeholders. Additionally, guidance changed over the epidemic as experience grew. This chapter will describe four key areas in the management of Ebola in West Africa. Firstly, it outlines the most recent WHO guidance; secondly, it looks back at how Ebola was managed in differing low and high resource settings; thirdly it outlines possible and optimal options for managing complications, paying particular attention to some of the controversies faced; fourthly it describes recent and ongoing studies into potential novel therapies that may shape future practice.

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