School of Public Health and Community Medicine

West African Voices on Ebola 2: The case for Lamivudine for Ebola treatment

THE CASE FOR LAMIVUDINE IN THE TREATMENT OF EBOLA

By Walton Beckley

October 11 2014

THE CASE FOR LAMIVUDINE IN THE TREATMENT OF EBOLA

The United States Centres for Disease Control and Prevention (CDC), has projected that there could be as many as 1.4 million people infected with the Ebola virus in Sierra Leone and Liberia by the end of January 2015, if robust interventions aimed at controlling the current outbreak are not immediately put in place (CDC, 2014). As at 8th October 2014, the World Health Organisation reports that there are now 8399 cases and 4033 deaths from the disease, these figures in the midst of growing speculations of gross under reporting (WHO, 2014).

 There are no approved vaccines or cure for the Ebola Virus Disease (EVD) presently ravaging Sierra Leone, Guinea and Liberia (WHO, 2014).  Current management of patients in West Africa is mainly fluid and electrolyte replacement coupled with other symptomatic relief (WHO, 2014). Up to the time the first Americans got infected with the virus in Liberia in August 2014, little was known about experimental drugs that could be effective in treating the disease. However, the agent ZMapp came to the attention of the whole world when the 2 western aid workers who were indeed putting their lives at risk in the hot zone got infected. Subsequent treatment of the two Americans with ZMapp, resulted in their recovery and release from hospital (New York Times, 2014).  So far, a British nurse  (Dassanayeke, 2014), and two Liberian Health workers given the drug have also recovered from the disease. However, another Liberian health worker and a Spanish priest died (BBC, 2014; USA Today, 2014), even after receiving ZMapp, before the company manufacturing it announced it had run out of stock in August. Other experimental drugs that have been tried for Ebola include Brincidofoivir which was used on the Liberian Eric Duncan in Dallas and Faviripir which has been successfully tested on small laboratory animals in France (Oestereich et al., 2014) and given to a French nurse who contracted Ebola.

With the extreme humanitarian catastrophe currently unfolding in West Africa, it is quite understandable if unprecedented means are resorted to in order for lives to be saved, when no proven treatment or vaccines are available. When CNN reported on the 29th of September that a Liberian doctor, Gorbee Logan, working in the rural parts of his country, used the anti-retroviral drug Lamivudine to treat fifteen Ebola patients achieving full recovery in thirteen of them, it sure brought hope to the otherwise weary and hopeless population in these affected countries. Dr Logan told CNN that he got the idea from his personal research on how the Ebola virus replicated in the human body and finding out that it was similar to that of HIV. He then went on to first try another anti-viral, acyclovir, which on failing to produce a successful result, led him to use lamivudine (AllAfrica, 2014).  His results although achieved for a very small number of patients (and scientifically unproven) meant that the case fatality rate was drastically reduced from about 70% (WHO, 2014) to just 13%. The Director of the National Institute of Allergy and Infectious Diseases in the US, Dr Anthony Fauci, reportedly commented Dr Logan for his breakthrough, noting that similar classes of drugs (nucleoside analogs) were being looked at right now, for the treatment of Ebola (AllAfrica, 2014).

 Since Lamivudine is already used for the treatment of AIDS and hepatitis in humans and therefore medically safe (having undergone extensive clinical trials for safety), it was expected that more would have been done by global health authorities especially the WHO and CDC to scale up use of the drug for Ebola. Lamivudine is readily available, relatively cheap and does not need to go through the rigorous trials for safety that experimental drugs like ZMapp would have to go through. Although not previously used for Ebola, it would be of no loss if these agencies had supported and coordinated the use of lamivudine at a larger scale for now, whilst scientific trials and studies on its effectiveness for Ebola are ongoing. Lamivudine is a nucleoside analog (Lai et al., 1998) which is the same class of drugs which are being tested for Ebola. It is therefore plausible that there may be some effect on Ebola virus replication.  If ZMapp could be tried without even an established safety profile in humans, why not Lamivudine in West Africa?

In a situation as dire as the one currently occurring in West Africa, where health systems are completely incapable of responding and people die at hospital gates unattended, any intervention that save lives is very much welcome. It is clearly not the time to consider protocols. It is an issue of potentially saving lives where no other means are available. An estimated 5 people are getting infected every hour in Sierra Leone with far less than half of that number getting any form of medical attention and even with intervention the majority of that number eventually perish. The case fatality is estimated to be 70%.(Washington Post) If as has been declared, the epidemic is one of international public health concern and of significant security threat to the region, what could be stopping the WHO  and CDC to pay more attention to Dr Logan’s success and explore it further. Is it because this accidental discovery was made by a “rural African doctor”? Personally, it is disturbing that nothing has been heard of lamivudine and Ebola since Dr Logan’s breakthrough. It should be cheaper for an already approved drug to be tried on this disease than newer experimental ones. So what is responsible for the silence in this potential intervention?

The situation only serves to further fuel the suspicions already surrounding the origin and unprecedented devastating nature of the outbreak. Are there things we are not being told? Is there far more to this than just an epidemic that was transmitted to humans by fruit bats and monkeys? As the unfortunate people of West Africa continue to suffer and die in silence when a possibility with an already available and proven drug exists, one can only hope that humanity is put on the forefront and sincere efforts at containing this doomsday disease are immediately effected.

 

 

Walton Beckley is a Sierra Leonean currently pursuing a dual Master of International Health/Public Health in the University of New South Wales in Australia. A graduate pharmacist from the University of Sierra Leone, Walton started practicing pharmacy in his country before going in to work for the French Humanitarian Organisation Action Contre la Faim (ACF), as Head of Project for their Nutrition intervention in Moyamba, southern Sierra Leone. He is presently working as Nutrition Officer for UNICEF in Freetown.

 

References

AllAfrica, 2014. http://allafrica.com/stories/201409292050.html

British Broadcasting Cooperation, 2014.http://www.bbc.com/news/world-africa-28925491

Dassanayake, Dion (1 September 2014). "First British Ebola victim recovering 'pretty well' after being given experimental drug". Express (UK). Retrieved 2014-09-11.

Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. (2014). New England Journal Of Medicine, 140926130020005. doi:10.1056/nejmoa1411100

http://www.forbes.com/sites/davidkroll/2014/10/07/chimerixs-brincidofovir-given-to-dallas-nebraska-ebola-patients/?utm_content=buffer88cb4&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Lai, C., Chien, R., Leung, N., Chang, T., Guan, R., & Tai, D. et al. (1998). A One-Year Trial of Lamivudine for Chronic Hepatitis B. New England Journal Of Medicine, 339(2), 61-68. doi:10.1056/nejm199807093390201

New York Times, 2014. http://www.nytimes.com/2014/08/09/health/in-ebola-outbreak-who-should-get-experimental-drug.html?_r=0

Oestereich, L., Lüdtke, A., Wurr, S., Rieger, T., Muñoz-Fontela, C., & Günther, S. (2014). Successful treatment of advanced Ebola virus infection with T-705 (favipiravir) in a small animal model. Antiviral Research, 105, 17-21. doi:10.1016/j.antiviral.2014.02.014

The Local, Norway, 2014. http://www.thelocal.no/20141006/ebola-virus-victim-arrives-in-norway

The United States Centers for Disease Control and Prevention, 2014 http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-mmwr-estimating-future-cases.html

USA Today (August 12, 2014). "Spanish missionary doctor infected with Ebola dies

WHO Roadmap sitrep, 8th October 2014 http://apps.who.int/iris/bitstream/10665/136020/1/roadmapsitrep_8Oct2014_eng.pdf?ua=1

WHO, 2014. http://www.who.int/medicines/emp_ebola_q_as/en/

WHO, 2014. http://apps.who.int/iris/bitstream/10665/135765/1/roadmapupdate3oct14_eng.pdf

WHO, 2014. http://www.who.int/mediacentre/news/ebola/26-september-2014/en/

http://www.washingtonpost.com/national/health-science/the-ominous-math-of-the-ebola-epidemic/2014/10/09/3cad9e76-4fb2-11e4-8c24-487e92bc997b_story.html

 

 

 

Comments

This is very interesting. If it is biologically plausible that the lamivudine was a factor in the recovery, I'd agree that there is case to expand compassionate access for people with Ebola.

Given the current reduction in the number of new cases of Ebola in Liberia, I was wondering if this might be in part attributable to the use of Lamivudine in treating Ebola patients. Would anybody know?

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