Investigational Treatment of Severe Ebola Virus Disease

Mary E. Wilson, MD

A patient with severe Ebola virus disease survived after treatment with FX06 as well as multiple other interventions and intensive supportive care.

Intensive treatment and monitoring of patients with severe Ebola virus disease in specialized units in Europe and the U.S. has yielded insights into the disease course and potential interventions. Now, investigators have described the care of an Ebola virus–infected 38-year-old male physician evacuated from Sierra Leone to Frankfurt, Germany.

After onset of symptoms, the patient self-treated with amiodarone and received oral rehydration solution; on day 6 of illness, he arrived in Germany for treatment under biosafety level 4 isolation conditions. He developed vascular leak syndrome and multiorgan failure, necessitating intubation, ventilatory support, and hemodiafiltration.

On day 11, because of worsening pulmonary vascular leak syndrome, he was given Bβ15-42 (FX06, provided by the manufacturer) — a fibrin-derived peptide under clinical development to treat vascular leak syndrome. The agent was administered intravenously as an initial slow bolus, followed by doses every 12 hours for 3 consecutive days. Partial doses of oral favipiravir, an RNA polymerase inhibitor, were given on days 8 and 9 and then discontinued because of nausea and renal failure. Additional therapies included multiple broad-spectrum antibiotics for possible bacterial infection, antifungal drugs, and platelet and red blood cell concentrates.

The patient's viremia level decreased after day 8, and his anti–Ebola virus IgG titers increased after day 9. He was extubated on day 22 and recovered completely.

Citation(s):

Wolf T et al. Severe Ebola virus disease with vascular leakage and multiorgan failure: Treatment of a patient in intensive care. Lancet 2014 Dec 19; [e-pub ahead of print].

Dunning J and Fischer W II.Ebola: The battle plan must include specific treatments. Lancet 2014 Dec 19; [e-pub ahead of print].