Researchers running the PALM trial in the Democratic Republic of the Congo randomly assigned patients during the 2018-2019 outbreak to one of four treatments, comparing two antibody drugs, mAb114 and REGN-EB3, against the older ZMapp and the antiviral remdesivir.
An independent board stopped the trial early once mAb114 and REGN-EB3 clearly outperformed the other two arms, with mortality near 34 to 35 percent versus roughly 50 percent for ZMapp and remdesivir. Among patients treated early, before the virus had spread far in their blood, mortality with the antibody drugs fell to as low as 6 to 11 percent.
The results turned Ebola, for patients who could reach treatment early, from a disease with grim odds into one with real survival prospects, and both antibody drugs went on to receive regulatory approval. Reaching patients early remained the limiting factor, since survival dropped sharply the later treatment started, and outbreak response in remote areas still determines how many people get that chance.
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Early treatment turned the odds from grim to good.
Source
- Mulangu, S., Dodd, L. E., Davey, R. T., Tshiani Mbaya, O., Proschan, M., Mukadi, D., Lusakibanza Manzo, M., Nzolo, D., Tshomba Oloma, A., Ibanda, A., Ali, R., Coulibaly, S., Levine, A. C., Grais, R., Diaz, J., Lane, H. C., & Muyembe-Tamfum, J.-J. (2019). A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. New England Journal of Medicine, 381(24), 2293–2303. https://doi.org/10.1056/NEJMoa1910993