Ebola: Drug Therapy Approaches
BY: MIYINGO Ivan, MPhil, B. Pharm, MPS
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Drug Treatment Approaches
Treatment of Ebola virus disease (EVD) is based on two major approaches: specific antiviral therapies using monoclonal antibodies (for certain strains) and intensive supportive care, which remains the most important life-saving component in most cases.
The only FDA-approved treatments currently available are used specifically for Zaire ebolavirus, the most studied Ebola strain.
These include Inmazeb (atoltivimab, maftivimab, and odesivimab) and Ebanga (ansuvimab).
Inmazeb is a combination of three monoclonal antibodies that work together to bind to the Ebola virus surface protein, blocking its ability to enter and infect human cells.
It is approved for both adults and children, including newborns of infected mothers.
Ebanga is a single monoclonal antibody that works in a similar way by neutralizing the virus and preventing it from attaching to human cells.
Both therapies have significantly improved survival rates in Zaire Ebola infections when given early.
However, these drugs are not a standalone cure for Ebola.
They must be used alongside aggressive supportive medical care, which is essential for patient survival.
Ebola causes severe fluid loss due to vomiting, diarrhea, fever, and bleeding, so patients require intravenous fluid replacement and electrolyte correction to prevent dehydration and organ failure.
Maintaining hydration and blood pressure is one of the most critical aspects of treatment.
In more severe cases, patients may develop bleeding disorders and shock.
This requires the use of blood transfusions and clotting support to manage hemorrhage and stabilize circulation.
When blood pressure drops dangerously and does not respond to fluids alone, vasopressor medications are used to maintain adequate blood flow to vital organs.
Respiratory complications can also occur, especially in advanced stages of disease, so patients may need oxygen therapy or ventilatory support.
In addition, because Ebola weakens the immune system, patients are at risk of secondary bacterial infections, which may require antibiotic treatment, along with medications to control pain and fever.
A key aspect of Ebola management is that all patients must be treated in strict isolation units with high-level infection control measures.
This is not only for the patient’s safety but also to protect healthcare workers and prevent further spread of the virus within hospitals and communities.
Ebola treatment is a combination of targeted monoclonal antibody therapy (for certain strains like Zaire ebolavirus) and comprehensive supportive hospital care.
While modern treatments have significantly improved survival outcomes, early detection and rapid medical intervention remain the most important factors in reducing mortality and controlling outbreaks.
EBANGA: Ansuvimab
Ebanga is a specialized monoclonal antibody medication developed for the treatment of Zaire ebolavirus infection, one of the deadliest Ebola virus species.
It is notable for being the only FDA-approved lyophilized (freeze-dried) Ebola treatment administered as a single one-hour intravenous infusion, making it particularly useful in outbreak settings where rapid preparation and transport are important.
The drug contains ansuvimab-zykl, a human monoclonal antibody designed to specifically target the glycoprotein on the surface of the Ebola virus.
By binding to this surface protein, the medication blocks the virus from attaching to and entering human cells, thereby limiting viral replication and spread inside the body.
EBANGA is approved for use in both adult and pediatric patients, including newborn babies born to mothers who test positive for Zaire ebolavirus by RT-PCR testing.
The medication is administered as a single dose of 50 mg/kg through IV infusion over approximately 60 minutes under strict medical supervision in specialized treatment settings.
The approval of EBANGA followed clinical studies conducted during the major Ebola outbreak in the Democratic Republic of Congo between 2018 and 2019.
In clinical trials, patients treated with EBANGA showed significantly improved survival rates compared to investigational control therapies.
However, EBANGA has important limitations. Its effectiveness has only been established against Zaire ebolavirus and not against other Ebola species such as:
- Bundibugyo ebolavirus
- Sudan ebolavirus
- Taï Forest virus
- or Marburg virus
This distinction is especially important in the current Central African outbreak involving the Bundibugyo strain, where approved therapies like EBANGA and some existing Ebola vaccines may not provide reliable protection or treatment benefit.
Like many monoclonal antibody therapies, EBANGA can cause side effects or infusion-related reactions.
Reported reactions include:
- fever,
- chills,
- vomiting,
- diarrhea,
- low blood pressure,
- rapid heartbeat,
- and breathing difficulties.
Healthcare workers must therefore monitor patients carefully during and after infusion. Severe allergic or hypersensitivity reactions, though uncommon, may require immediate discontinuation of treatment.
EBANGA represents a major milestone in Ebola medicine because it transformed Ebola treatment from purely supportive care toward targeted antiviral immunotherapy.
Together with intensive supportive treatment such as IV fluids, oxygen support, electrolyte correction, and infection control, monoclonal antibody therapies like EBANGA have significantly improved survival outcomes in Zaire Ebola outbreaks.
EBANGA: How It Works
EBANGA™ (ansuvimab-zykl, formerly known as mAb114) is a Zaire ebolavirus (EBOV) glycoprotein 1 (GP1)-directed recombinant, human Immunoglobulin G1 (IgG1) monoclonal antibody.
It is a specialized monoclonal antibody medication developed for the treatment of Zaire ebolavirus infection, one of the deadliest Ebola virus species.
EBANGA™ was isolated from a human survivor of the 1995 Ebola outbreak in Kikwit, in the DRC.
This human survivor maintained circulating antibodies against the Ebola virus surface glycoprotein for more than a decade after infection.
The antibody was developed by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), who discovered these Ebola virus antibodies in the blood samples from that survivor.
Investigators from the Institute for Research in Biomedicine in Switzerland isolated the specific antibodies to test for potential efficacy in treating Ebola virus infection.
NIAID and Dartmouth College researchers then studied how Ebanga™ (ansuvimab-zykl) neutralizes the Ebola virus and determined that it binds to the core of the Ebola glycoprotein, blocking its interaction with a receptor on human cells.
This area of the Ebola glycoprotein, called the receptor binding domain, was previously thought to be unreachable by antibodies because it is well-hidden by other parts of the virus, and only becomes exposed after the virus enters the inside of cells.
From that survivor of the 1995 Kikwit outbreak, monoclonal antibodies (mAbs) were isolated that neutralize recent and previous outbreak variants of the Ebola virus and mediate antibody-dependent cell-mediated cytotoxicity in vitro.
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