Emerging treatments

Current 2026 Ebola outbreak: candidate therapeutics

The World Health Organization (WHO) has recommended prioritizing three therapeutic candidates for evaluation and research in clinical trials during the current 2026 Ebola outbreak caused by the Bundibugyo virus. MBP-134 (a cocktail of two broadly neutralizing human monoclonal antibodies) has demonstrated efficacy against Bundibugyo virus in a preclinical study in six nonhuman primates, and was administered during the 2022 Sudan virus outbreak in Uganda under a compassionate use protocol, but clinical efficacy was not determined. Maftivimab has broad activity in vitro against Bundibugyo virus but there are no human efficacy data available. It is currently licensed (as part of a three monoclonal antibody cocktail) for the treatment of disease caused by Orthoebolavirus zairense. The antiviral remdesivir is also being considered as a therapeutic candidate either as monotherapy or in combination with monoclonal antibodies (see below).[186]​ Trials are in progress.[187]

Remdesivir

A prodrug of adenine nucleotide analog that has potent activity against a variety of filoviruses in primate cell infection models. Initial studies have demonstrated excellent effectiveness as a treatment in nonhuman primates.[176]  The PALM trial found that remdesivir was inferior to atoltivimab/maftivimab/odesivimab, ansuvimab, and ZMapp at reducing mortality.[184] The WHO suggests against treatment with remdesivir as the effects on mortality and serious adverse events remains very uncertain.[183] Remdesivir is being evaluated as a potential therapeutic for use during the current 2026 Ebola outbreak caused by the Bundibugyo virus.[186]

ZMapp

An experimental combination of three humanized monoclonal antibodies targeted at three Orthoebolavirus zairense glycoprotein epitopes, engineered for expression in tobacco plants.[197][198][199]​​​ ZMapp was found to be protective when administered to nonhuman primates 24-48 hours after infection. Another study showed that the drug was able to rescue nonhuman primates when treatment is initiated up to 5 days after infection.[200] The PALM trial found that ZMapp was inferior to both atoltivimab/maftivimab/odesivimab and ansuvimab at reducing mortality.[184] The WHO suggests against treatment with ZMapp as the evidence is very uncertain regarding any true benefits or harms.[183]

Favipiravir

Favipiravir is an experimental antiviral drug that selectively inhibits viral RNA-dependent RNA polymerase. It is active against influenza viruses, West Nile virus, yellow fever virus, foot-and-mouth disease virus, as well as other flaviviruses, arenaviruses, bunyaviruses, and alphaviruses. The drug is currently approved in Japan for influenza pandemics, but has been found to be effective against orthoebolaviruses in mouse models.[201] Human phase 2 trials in Guinea used a higher dose than that used for influenza. The JIKI trial, a multicenter nonrandomized trial undertaken in Guinea in 2014-2015, suggested good tolerability at a higher dose in a low-resource setting, as well as a potential benefit in patients with low viral loads.[202]

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