The WHO has just recommended the drugs Ebanga and Inmazeb to treat patients with Ebola but, because of its inaccessibility, invites manufacturers to invest in the production of these treatments.
The WHO issued "strong recommendations" on August 19 for the use of two drugs in the treatment of the virus disease Ebola (EVD).
It is on the one hand mAb114, also known under the names ofAnsuvimab andebanga, and on the other hand REGN-EB3, sold under the name ofInmazeb. These are two drugs from the category of monoclonal antibodies.
To justify this recommendation, WHO experts state in the document they produced on this occasion that compared to standard management, the absolute benefit of mAb114 on mortality is between 229 and 383 fewer deaths. per 1000 patients.
While that of REGN-EB3 is 237 to 396 fewer deaths per 1000 patients. Which, the organization judges, “is a significant reduction in mortality. »
“mAb114 and REGN-EB3 should not be administered together, and should be considered as alternatives. The choice to use mAb114 or REGN-EB3 depends on their availability", specifies the WHO while emphasizing that the recommendation of these treatments is only valid for the disease caused by the Zaire strain of the Ebola virus.
These two products are not new. For example, the conclusive clinical trial for Ebanga in DR Congo dates back to 2019, the approvals in Canada and the United States, in 2020.
But for Mulangu Sabue, supervisor of the immunology study group at INRB (Institut national de research biomedical) in Democratic Republic of Congo (DRC), these recommendations are a consecration.
"The WHO announcement further reinforces the discovery and reassures populations exposed to the virus in the DRC and everywhere else where the disease is endemic," he said.
However, whether for mAb114 or REGN-EB3, the WHO fears that the difficult access to drugs will lessen the impact of its new recommendations.
“Access to these treatments is difficult, and prices for future supply remain unknown, particularly in resource-limited settings,” warns the WHO GDG (Guideline Development Group).
To deal with this, the organization, which wishes to “mobilise all possible mechanisms aimed at improving global access to these treatments”, hopes to encourage more investment.
Thus, "on October 5, 2021, the WHO Prequalification Unit published the first invitation for manufacturers of therapeutic products against Ebola virus disease to submit an expression of interest", can we read in the document titled “Treatments for Ebola virus disease” published August 19, 2022.
Sixth epidemic
Currently in the grip of its sixth Ebola epidemic since 2018, the DRC is a country vulnerable to disease. Its huge forest houses the bat considered to be an EVD reservoir.
However, there is serenity among local experts: "Compared to access to anti-Ebola treatment, in particular Ebanga, the DRC is in a particularly favorable position", affirms Mulangu Sabue who had contributed to research work on this monoclonal.
The latter explains this serenity by a convention with Ridgeback Biotherapeutic, the American firm which holds the production license for mAb114 and which "guaranteed the DRC permanent access to Ebanga".
For his part, Billy Sivahera who previously headed the NGO ALIMA (Alliance for International Medical Action) and who knows the difficulties of the areas that have been affected by EVD, thinks that the effectiveness of the WHO recommendations depends closely on the système de health .
“So it will depend on the level of leadership and governance the health system, the quality and quantity of human resources, the funding of the health sector, the availability of medicines, the level of technologies, delivery of health care services and the commitment of the populations to support this recommendation”.
In the meantime, Mulangu Sabue prefers to point out the progress made: "Compared to the period 2008-2018, the DRC now has diagnostic and sequencing laboratories allowing the rapid confirmation of epidemics, to define the viral strain and to describe the relation to past epidemics”.
This immunologist concedes that the country is limited and cannot always organize the rapid response necessary to ensure the effectiveness of the response. “We need to ensure that we are able to get these treatments in time to those who need them the most… This requires logistical preparation in terms of the cold chain, for example, which has a significant financial cost,” says -he.
Billy Sivahera also believes that the investments of recent years in medical sciences (vaccines, treatments, equipment, etc.) have enabled a significant reduction in mortality linked to EVD.
“However, the same efforts with populations, health systems and other multisectoral actors will be conditional on their real effectiveness,” he suggests.
The doctor highlights the context of known or emerging multi-epidemics which can constitute an unfavorable factor while the WHO wants Ebola to be classified as an "acute and long-term disease".
This article was published on the French version of SciDev.net and is reproduced with their permission.