Tuesday, December 23, 2014

Amiodarone against Ebola, what to do

Ebola outbreak is still ongoing in Africa.

In a treatment center in Sierra Leone, amiodarone, an anti-arrhythmic drug was newly introduced as a remedy against Ebola virus. However, some British doctors opposed to its use because clinical trials to evaluate its effectiveness had not been done, led to their strike. The Emergency, an Italian NGO participating the treatment has stopped its usage, accepting the request from British Department for International Development.

The Guardian: Untested Ebola drug given to patients in Sierra Leone causes UK walkout

It is common for physicians to test a conventional drug which has not fully proven to be effective on a particular disease. For example, many antipsychotics and antidepressants are given to patients with personality disorders or developmental disorders. They know FDA or other authorities have not permitted to prescribe such drugs to whom with other than indicated illnesses. Nonetheless, they can be a solution, or at least a temporary rescue, through mitigating their frustration, agony, and aggression. It is extremely difficult to prove the effect on them with clinical trials. Only medical practitioners and patients feel good at these means.

Ebola and amiodarone is different in the situation. First, amiodarone is targeting the heart directly. Thus its risk for fatality should be estimated more strictly than psychotropics. I can understand the hesitation of opposing doctors.

Second, however, it is obvious that the patients suffering from Ebola have no time to wait for the completion of clinical trials. In general, such patients are prioritized as a candidate of participants of the clinical trial. Yet, clinical trials regulate strict induction criteria. Many patients will be excluded from the subjects. Amiodarone is not a novel drug, but developed more than a half century ago. It should not be deemed as unethical to prescribe it to patients who want to take it.

The problem is that, we cannot explain whether it is truly beneficial.

I think it is inevitable to make some trial-and-errors in this extraordinary situation. Failure as a result should not be blamed, although needless to say that the victims are poor. Gathering clinical data is essential. Perhaps some innovative treatment will be born in the reckless attempts. It seems not sophisticated, but a real figure in the war against Ebola.

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