David S. Fedson, MD
Sierra Leone Telegraph: 4 July 2015
More than 11,000 people in West Africa have died as a result of the Ebola outbreak in West Africa. Aside from conventional supportive care, there has been no specific treatment available.
In most treatment units, more than 50% of the patients have died. This needn’t have happened.
Patients who die of Ebola have elevated plasma levels of pro-inflammatory molecules (for example, cytokines). The same thing is seen in patients with sepsis.
In sepsis patients, these findings are associated with endothelial dysfunction and the loss of endothelial barrier integrity. (Endothelial cells line our blood vessels and form a barrier between what’s inside and what’s outside the blood stream.)
Careful studies of foreign healthcare workers who were infected with Ebola virus and evacuated from West Africa for medical care showed they had developed dramatic fluid losses.
These losses were due to a massive increase in vascular permeability, a direct effect of the loss of endothelial barrier integrity.
Cardiovascular scientists have known for many years that several common drugs, among them statins and angiotensin receptor blockers, have the ability to stabilize or restore endothelial barrier integrity.
Moreover, these drugs are safe when given to patients with acute critical illness, and clinical studies suggest they might improve survival in patients with sepsis, pneumonia and influenza.
For these reasons, in November local physicians in Sierra Leone treated consecutively approximately 100 Ebola patients with a combination of atorvastatin (40 mg orally /day) and irbesartan (150 mg orally/day).
Only two inadequately treated patients are known to have died. Unfortunately, there was no financial or logistical support to conduct a proper clinical trial.
Surprisingly, physicians and health officials in Sierra Leone have refused to release information on this treatment experience. Nonetheless, letters and memoranda they have exchanged provide good evidence that treatment brought about “remarkable improvement” in these patients.
Unlike other treatments (antiviral drugs, convalescent plasma) currently being tested in Ebola patients, the atorvastatin/irbesartan combination targets the host response to the infection, not the virus itself. By stabilizing endothelial function and restoring normal fluid balance, it allows patients to live long enough to develop immune responses of their own and get rid of the virus.
All physicians who treat patients with cardiovascular diseases are familiar with and most have used atorvastatin and irbesartan. These drugs are widely available as inexpensive generics in West Africa.
A 10-day course of treatment for an individual Ebola patient should cost only a few dollars.
Details on the Ebola patients who were treated need to be released, and they also need to be externally reviewed and validated. If cases of Ebola continue to occur, combination treatment should be tested in a proper clinical trial.
In the meantime, physicians should consider the possibility that this combination might be used to treat patients with any form of acute infectious disease, including pandemic influenza, in which a failure to overcome endothelial dysfunction often leads to multi-organ failure and death.