Anti-Ebola therapy for patients with Ebola virus disease: a systematic review.
Amides
/ therapeutic use
Amodiaquine
/ therapeutic use
Antibodies, Monoclonal
/ therapeutic use
Antiviral Agents
/ therapeutic use
Artemisinins
/ therapeutic use
Databases, Factual
Drug Combinations
Ebolavirus
/ isolation & purification
Hemorrhagic Fever, Ebola
/ drug therapy
Humans
Pyrazines
/ therapeutic use
Randomized Controlled Trials as Topic
Drug therapy
Ebola
Systematic review
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
02 May 2019
02 May 2019
Historique:
received:
15
08
2018
accepted:
11
04
2019
entrez:
4
5
2019
pubmed:
3
5
2019
medline:
19
6
2019
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 31046707
doi: 10.1186/s12879-019-3980-9
pii: 10.1186/s12879-019-3980-9
pmc: PMC6498552
doi:
Substances chimiques
Amides
0
Antibodies, Monoclonal
0
Antiviral Agents
0
Artemisinins
0
Drug Combinations
0
Pyrazines
0
ZMapp
0
amodiaquine, artesunate drug combination
0
Amodiaquine
220236ED28
favipiravir
EW5GL2X7E0
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
376Subventions
Organisme : Canadian Institutes of Health Research
ID : note that the grant recipients are Rob Fowler and Neill Adhikari
Pays : Canada
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