Abstract
BackgroundEmpiric antimalarial treatment is a component of protocol-based management of Ebola virus disease (EVD), yet this approach has limited clinical evidence for patient-centered benefits.MethodsThis retrospective cohort study evaluated the association between antimalarial treatment and mortality among patients with confirmed EVD. The data was collected from five International Medical Corps operated Ebola Treatment Units (ETUs) in Sierra Leone and Liberia from 2014 through 2015. The standardized protocol used for patient care included empiric oral treatment with combination artemether and lumefantrine, twice daily for three days; however, only a subset of patients received treatment due to resource variability. The outcome of interest was mortality, comparing patients treated with oral antimalarials within 48-h of admission to those not treated. Analysis was conducted with logistic regression to generate adjusted odds ratios (aORs). Multivariable analyses controlled for ETU country, malaria rapid diagnostic test result, age, EVD cycle threshold value, symptoms of bleeding, diarrhea, dysphagia and dyspnea, and additional standard clinical treatments.ResultsAmong the 424 cases analyzed, 376 (88.7%) received early oral antimalarials. Across all cases, mortality occurred in 57.5% (244). In comparing unadjusted mortality prevalence, early antimalarial treated cases yielded 55.1% mortality versus 77.1% mortality for those untreated (p = 0.005). Multivariable analysis demonstrated evidence of reduced aOR for mortality with early oral antimalarial treatment versus non-treatment (aOR = 0.34, 95% Confidence Interval: 0.12, 0.92, p = 0.039).ConclusionEarly oral antimalarial treatment in an EVD outbreak was associated with reduced mortality. Further study is warranted to investigate this association between early oral antimalarial treatment and mortality in EVD patients.
Highlights
The 2014–16 Ebola virus disease (EVD) epidemic in West Africa was the largest since the discovery of the virus in 1976 [1]
Given the frequent use of antimalarial medications in EVD treatment and the limited data on clinical impact, this study evaluated the association between early treatment with the oral antimalarial agent combination artemether-lumefantrine on mortality in patients with EVD using the multinational International Medical Corps (IMC) database
All patients admitted to the Ebola Treatment Units (ETUs), who had a final diagnosis of EVD and data on oral antimalarial treatment and mortality were eligible for inclusion
Summary
The 2014–16 Ebola virus disease (EVD) epidemic in West Africa was the largest since the discovery of the virus in 1976 [1]. Malaria, which is highly endemic in West Africa, can present with similar symptoms to EVD and was common among patients presenting to Ebola Treatment Units (ETUs), including among EVD-positive patients during the 2014–16 epidemic [1,2,3,4,5,6,7]. There exists limited clinical evidence for improvements in patient-centered outcomes with the use of empiric antimalarials in EVD care from outbreak settings [13, 23, 35]. Empiric antimalarial treatment is a component of protocol-based management of Ebola virus disease (EVD), yet this approach has limited clinical evidence for patient-centered benefits
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