Opinion: An existing drug to assess in vivo for potential adjunctive therapy of Ebola virus disease and post-Ebola syndrome

Abstract

We currently have no approved drugs for the treatment of Ebola virus disease (EVD) or post-Ebola syndrome (PES). A substantial proportion of patients presenting for treatment die, including healthcare workers (HCWs) with hospital-acquired infections. More than 28,000 people were suspected or confirmed with EVD and 11,000 died in the West Africa outbreak during 2014-2016. A new EVD epicenter developed in the Democratic Republic of Congo in mid-2018, and it is likely that new outbreaks will occur in the future. The low survival rate discourages patients from presenting for treatment, and the occupational risk discourages HCWs from caring for highly infectious patients. A substantial proportion of survivors complain of chronic symptoms, such as eye problems (47%) and arthralgias (64%)-a condition that has been termed PES (Wilson et al., 2018). Inflammation may play a role in both the uveitis, which can result in blindness (Shantha et al., 2017) and in arthritis (Amissah-Arthur et al., 2017). Availability of an efficacious adjunctive treatment drug would save lives, increase the number of people presenting for treatment, and increase the willingness of HCWs to care for patients. An efficacious drug for adjunctive treatment of PES could decrease morbidity suffered by survivors. To date, most research efforts have focused on vaccine for prevention and either antivirals or antibody preparations for treatment. However, given the extensive inflammatory component of EVD, adjunctive therapy to decrease inflammation -but not globally downregulate the host immune response in a manner that could be detrimental (e.g., steroids)-may hold promise for better outcomes for those infected. Although drugs such as acetylsalicylic acid, ibuprofen, indomethacin, and celecoxib are also broadly anti-inflammatory, they all inhibit cyclooxygenase and can interfere with platelet aggregation-a characteristic that would be disqualifying for use with hemorrhagic fevers.