WHO enrolled the first patient in a randomised Bundibugyo Ebola treatment trial in Ituri Province, eastern DR Congo, on Thursday 2 July1. It was the first time in this outbreak that anyone received an investigational drug under trial conditions, six weeks after the coalition running it was first named. Bundibugyo is a rare Ebola species, and until this week clinicians in Ituri could offer only supportive care: fluids, monitoring, and no drug licensed to fight the virus itself.
Patients are randomised to supportive care alone, to supportive care plus the antiviral remdesivir, to the engineered-antibody cocktail MBP134, or to both together, with a separate obeldesivir arm testing post-exposure prophylaxis, the preventive dosing given after a known exposure. Researchers set 28-day survival as the primary measure and estimate they need up to 1,000 participants across several months of enrolment. WHO runs the trial with DRC's national biomedical research institute (INRB), Oxford University and the Antwerp Institute of Tropical Medicine.
Dosing began only after DRC and Uganda regulators cleared the protocol, the approval pending since late May that had kept these same drugs out of patients' reach. That hold, rather than the science, is what left Ituri on supportive care through the weeks when the count climbed fastest. A supportive-care arm remains the trial's scientific control, and with case-fatality running near a third it will draw the objection the 2018 DRC PALM trial did, the design that let two of four Zaire-ebolavirus drugs win licences.
