Kenya plans remdesivir for Ebola patients; Uganda case report did not show the drug caused recoveries

Kenya's Ministry of Health plans to give remdesivir, an antiviral made by Gilead Sciences, to Ebola patients under compassionate use. Director General for Health Patrick Amoth said on the evening of 18 October that "we hope to start the second part of the compassionate treatment using a medicine called Remdesivir tomorrow", Business Daily reported on 19 October.

Compassionate use means giving seriously ill patients a drug not approved for their disease when treatment options are limited. Remdesivir was most notably used in hospitalised Covid-19 patients. Its effectiveness against Bundibugyo virus, the cause of the Kenyan cases, has not been proven.

The ministry had confirmed eight Ebola cases, including one death, as of 19 October. All are linked to the first patient, a man who travelled from the Democratic Republic of Congo (DRC) through Uganda to Nairobi and died on 5 October. The eighth case, a 49-year-old support attendant at Nairobi Hospital, was the only positive result among 38 people tested on 18 October, the Kenyan current-affairs magazine Nairobi Law Monthly reported. Amoth said the team was preparing to start compassionate treatment for him.

Amoth said seven patients had received monoclonal antibodies (antibodies made in a laboratory) sourced from Rwanda. Kenya is working with the World Health Organization (WHO), Uganda and the DRC to evaluate remdesivir for relieving symptoms and improving outcomes. WHO's Africa office said on 16 October that there is no licensed vaccine or specific treatment for Bundibugyo Ebola.

The US Centers for Disease Control and Prevention (CDC) published a report in its Morbidity and Mortality Weekly Report on 10 September on 21 Bundibugyo patients in Uganda: 20 confirmed and one probable. Eighteen of the confirmed patients were treated at the Ebola treatment unit of Mulago National Referral Hospital, and all 18 received remdesivir under a compassionate-use protocol.

Eighteen of the 20 confirmed patients recovered. Two died, and the report says their infections were recognised late. Across all 21 cases, including the probable one, three patients died. In one patient, remdesivir was stopped after three days because of a severe skin rash and combined liver and kidney toxicity; the patient later recovered.

The report describes all 21 cases and has no comparison group: every patient treated in the unit received the drug. The authors wrote that the low fatality rate "might be a result of the patients who sought health care promptly", and that "Clinical trials of remdesivir for patients with BVD might be warranted." Business Daily said the report did not establish whether remdesivir was responsible for the recoveries.

The confirmed patients were 15 Congolese and five Ugandans, including four health workers. Their median age was 34 years, with a range of 1 to 59.

A WHO-supported trial in the DRC, called PARTNERS, is testing whether remdesivir and MBP134, a monoclonal antibody cocktail, alone or in combination, reduce deaths from Bundibugyo virus disease. When WHO announced the trial on 24 June, it said the United States and Gilead Sciences were donating all doses.

The ministry says there is no evidence of community transmission and that the risk to the public remains low. By 17 October, 128 of 130 identified contacts had been traced and placed under 21 days of monitoring. Health authorities say Ebola is not spread through the air but through direct contact with the blood or body fluids of an infected or dead person. Anyone with symptoms such as fever, vomiting, diarrhoea or unexplained bleeding is advised to seek care or call the ministry's toll-free line, 719.

Amoth said, as quoted by Business Daily: "We are cautiously optimistic, given the results we are seeing from our Ebola treatment unit today."