Statin medications used to treat people with heart disease and diabetes may help fight Ebola, according to physicians writing an editorial in a recent edition of the New York Times. There are no medications approved to treat Ebola, and because of the seriousness of the infection, the World Health Organization recently came out in favor of using experimental drugs to treat it in some instances.
Experts have known for some time that Ebola has similar characteristics as bacterial sepsis, say the authors, David S. Fedson, MD, a retired professor of medicine at the University of Virginia, and Steven M. Opal, MD, a professor of medicine at Brown University. Both doctors have done research on medications to treat infectious diseases and sepsis, including statins.
Bacterial sepsis is a life-threatening systemic infection of the organs. Both Ebola and bacterial sepsis cause “severe dysfunction of the endothelial cells that line blood vessels through the body,” Fedson and Opal contend. This process causes problems with blood clotting, causing hemorrhaging and failure of internal organs such as the liver and kidneys. This often leads to death.
Researchers have found that the endothelial function and clotting problems respond to treatment with drugs such as statins used to treat high cholesterol in diabetics, for example, or drugs used in diabetics to prevent kidney disease, such as angiotensin converting enzyme (ACE) inhibitors, the physicians note.
Both types of drugs are used to treat heart disease and diabetes, and are called “immunomodulatory” medications. These drugs may help prevent complications from bacterial sepsis such as organ failure, the physicians contend.
One study indicated that treating patients who had bacterial sepsis with the statin drug atorvastatin (Lipitor) lowered the incidence of organ failure by 83 percent. Organ failure is a complication in Ebola that often kills people infected with it.
“Acute administration of atorvastatin in patients with sepsis may prevent sepsis progression. Further multi-centre trials are required to verify these findings,” Opal and Fedson write, adding that further research should be done to determine if statins should be used to treat sepsis – or Ebola.
There are advantages to statins. The drugs are already approved (albeit for other reasons) and are available as generics, which are less expensive than brand-name drugs.
“They are available to anyone who lives in a country with a basic health care system, and this includes the countries in West Africa that are struggling to cope with Ebola,” Opal and Fedson contend.
The physicians state that not all representatives from the World Health Organization have embraced their proposal. The WHO representatives are concerned that the drugs could increase “viral replication” and make patients sicker, state Opal and Fedson. (Viral replication is when viruses form inside “target host cells,” making the viral infection worse.) However, Opal and Fedson write that the opposite may be true, because some research indicates that statins may lower viral replication in other diseases such as hepatitis C.
“…[T]he best evidence we have suggests that Ebola patients and their doctors should be given a chance to consider the benefits as well as the risks that these drugs may offer,” they conclude. “Nothing should stop physicians from using them as long as they document the impact of treatment."