As governments and health authorities rush to meet the moment of a worsening Ebola outbreak in central Africa, Merck & Co. is considering dusting off its antiviral molnupiravir, which saw use as a treatment for COVID-19 under an emergency use authorization during the pandemic.
The New Jersey pharma giant is now in talks with multiple global health authorities about making the pill, also known as Lagevrio, available as an Ebola treatment, Eliav Barr, M.D., chief medical officer at Merck Research Laboratories, told Reuters at the ASCO conference in Chicago this past weekend.
"Molnupiravir is a non-specific RNA virus drug,” Barr told the publication. “We're thinking about how we could use that,” he said, adding that Merck is “talking a lot with different parties about this.”
"Merck has a longstanding history of responding to disease outbreaks and remains committed to public health and vaccine innovation," a company spokesperson told Fierce in an emailed statement confirming the strategy.
"We are exploring how we can support response efforts to the Ebola Bundibugyo outbreak in the DRC and Uganda," the spokesperson added, "including potential collaborations with global health and research organizations on treatment and prevention research and/or vaccine development."
Importantly, while "molnupiravir has antiviral activity in preclinical, in-vitro studies against a range of viruses, including Ebola Zaire and Sudan, we do not currently have any data to support the use of molnupiravir to treat or prevent Ebola Bundibugyo virus," the spokesperson said.
But based on the drug's mechanism of action, it may have activity against other Ebola virus strains and Merck noted that it's now "pursuing in-vitro studies to assess this for the Bundibugyo strain."
Molnupiravir hasn't been used or recommended in response to the current or previous Ebola outbreaks, but should there be a recommendation or need, "our company has available inventory," the spokesperson pointed out.
Merck is also weighing whether it could use the technology behind its existing Ebola vaccine, Ervebo—used to prevent a different and more common strain of the Ebola virus—to develop a new shot against the current outbreak, Barr said in an interview with Reuters.
The Bundibugyo species virus responsible for the current Ebola outbreak in the Democratic Republic of the Congo and Uganda has resulted in some 906 suspected cases and 223 deaths among suspected cases in the first country, and a total of 134 confirmed cases overall as of May 29, including nine in Uganda, according to the World Health Organization (WHO).
As infections continue to climb and health workers struggle to fight back the virus, organizations and drugmakers alike are scanning their clinical and commercial armamentariums for potential tools against Ebola.
In May, the U.S. Department of Health and Human Services (HHS) confirmed to Fierce that it was working with a small biotech, Mapp Biopharmaceutical, to secure access to doses of an experimental antibody for potential use against Ebola in high-risk individuals.
The antibody was developed in collaboration with the Biomedical Advanced Research and Development Authority for Sudan virus, a species of ebolavirus separate from the Bundibugyo species.
Coded MBP134, the asset has shown potential in laboratory studies against Bundibugyo too, an HHS spokesperson said last month, adding that any potential use of the treatment would be coordinated by the FDA, the Department of State and the Administration for Strategic Preparedness and Response in a “whole-of-government approach.”
WHO has also singled out Mapp’s drug, alongside antiviral treatments from Regeneron and Gilead Sciences, as prime candidates to be tested in patients infected with the Bundibugyo form of Ebola, outlets like Pharmaphorum and Stat News have reported.
Other companies like RedHill Biopharma are seeking to step up to the plate, too. On Tuesday, the Tel Aviv-headquartered company said it was in talks on potential collaborations to advance its investigational oral medicine opaganib against the Bundibugyo ebolavirus subtype.
RedHill is leveraging data on its SPHK2 inhibitor when added to Gilead’s remdesivir and corticosteroids in a late-stage severe COVID-19 trial in its bid.
On the prophylactic front, the Coalition for Epidemic Preparedness Innovations (CEPI) said Monday that it will “urgently accelerate” the development of three investigational vaccines targeting Bundibugyo ebolavirus developed by IAVI, Moderna and the University of Oxford in partnership with the Serum Institute of India, the world’s largest vaccine maker by volume. CEPI said it is looking for additional candidates beyond those initial three.
For its part, Merck’s molnupiravir got its initial moment in the spotlight during the COVID pandemic, winning an emergency nod (PDF) to treat mild-to-moderate COVID-19 in certain adults at high risk for progressing to severe COVID.
The drug did not subsequently pick up a full FDA nod, and Merck and its Lagevrio partner Ridgeback Biotherapeutics withdrew their COVID marketing authorization bid for the antiviral in the European Union in 2023.
Editor's note: This story has been updated with a statement from Merck & Co.