Ebola Treatment in 2026: Inmazeb, Ebanga, and Supportive Care
A complete guide to approved Ebola treatments — Inmazeb (REGN-EB3) and Ebanga (ansuvimab) — including how they work, efficacy data from the PALM trial, and the role of supportive care.
The Breakthrough: From No Treatment to Two Approved Drugs
For nearly four decades after Ebola’s discovery in 1976, there was no approved treatment. Patients received only supportive care, and case fatality rates ranged from 25% to 90%. That changed dramatically between 2019 and 2020, when the US Food and Drug Administration (FDA) approved two targeted therapies based on data from the landmark PALM randomized controlled trial conducted during the 2018–2020 DRC Kivu outbreak.
Today, two monoclonal antibody therapies are FDA-approved for Zaire ebolavirus (the strain responsible for most outbreaks, including the 2026 DRC outbreak):
- Inmazeb (atoltivimab, maftivimab, odesivimab-ebgn) — approved October 2020
- Ebanga (ansuvimab-zykl) — approved December 2020
Inmazeb (REGN-EB3)
What It Is
Inmazeb is a cocktail of three human monoclonal antibodies developed by Regeneron Pharmaceuticals. It was previously known as REGN-EB3 during clinical development.
- Atoltivimab targets the Ebola glycoprotein (GP) base
- Maftivimab targets the GP receptor-binding domain
- Odesivimab targets a different epitope on the GP
By targeting three distinct sites, the combination provides a broader defence against potential viral escape mutations.
How It Is Given
Inmazeb is administered as a single intravenous (IV) infusion over 60–90 minutes. The dose is based on body weight.
Efficacy
In the PALM trial, 28-day mortality was 33.5% in the Inmazeb group, compared to 51% in the ZMapp control arm — a relative risk reduction of 35%. Among patients with low viral loads at enrolment, survival was markedly higher.
WHO issued an Emergency Use Listing for Inmazeb in October 2021, enabling its procurement by UN agencies for outbreak response.
Ebanga (Ansuvimab / mAb114)
What It Is
Ebanga is a single human monoclonal antibody derived from a B-cell of an Ebola survivor from the 1995 Kikwit outbreak. The antibody targets the Ebola virus glycoprotein receptor-binding domain, specifically blocking the virus’s ability to bind to its intracellular receptor NPC1 (Niemann-Pick C1 protein).
How It Is Given
Ebanga is administered as a single intravenous infusion.
Efficacy
In the PALM trial, 28-day mortality was 35.1% in the Ebanga group, compared to 49.7% in the ZMapp arm — a statistically significant improvement. Among patients with undetectable viral loads, survival approached 90%.
The PALM Trial: Why It Changed Everything
The PALM (Pamoja Tulinde Maisha — “Together Save Lives”) trial was a multi-arm randomised controlled trial conducted in DRC during the 2018–2020 Kivu outbreak. It compared four treatments:
| Treatment | 28-Day Mortality | Notes |
|---|---|---|
| ZMapp (control) | ~49–51% | Previous standard |
| Remdesivir | ~53% | Worse than ZMapp |
| Inmazeb (REGN-EB3) | 33.5% | FDA approved |
| Ebanga (mAb114) | 35.1% | FDA approved |
The trial was stopped early because the superiority of Inmazeb and Ebanga was so clear that continuing the ZMapp and remdesivir arms was considered unethical.
What About ZMapp?
ZMapp was a three-antibody cocktail developed by Mapp Biopharmaceutical that was given to American aid workers Thomas Eric Duncan and others under compassionate use in 2014. While it showed promise in non-human primates, the PREVAIL II trial was inconclusive (underpowered due to the epidemic ending), and PALM data showed it was inferior to the two approved alternatives.
ZMapp is no longer the standard of care.
Supportive Care: Still Essential
Even with approved antivirals, aggressive supportive care significantly improves survival:
- IV fluid resuscitation: correcting dehydration and electrolyte imbalances is one of the most effective interventions. Studies from West Africa showed that IV fluids alone substantially reduced CFR compared to oral rehydration only.
- Electrolyte replacement: Ebola causes severe potassium, magnesium, and phosphate losses
- Antipyretics: fever management (paracetamol preferred over NSAIDs)
- Antiemetics and antidiarrheals: reduce fluid loss
- Analgesics: pain management
- Nutritional support: adequate caloric and protein intake
- Treatment of secondary infections: bacterial sepsis is a common complication
The key principle is: the sooner treatment begins, the better the outcome. Patients who receive Inmazeb or Ebanga early, when viral loads are still low, have dramatically better survival rates.
Experimental Approaches
Convalescent Plasma
Plasma from Ebola survivors contains antibodies against the virus. However, the PALM trial included a convalescent plasma arm, and it did not demonstrate superiority over supportive care alone. It is not currently recommended.
Favipiravir
This broad-spectrum antiviral was tested in the JIKI trial during the 2014 West Africa epidemic. It showed benefit in patients with lower viral loads but no benefit in those with high viral loads. It is not FDA-approved for EVD.
Access and Deployment in 2026
For the current 2026 DRC outbreak, both Inmazeb and Ebanga are being deployed in MSF’s Ebola Treatment Unit in North Kivu. WHO has secured emergency stockpiles of both treatments through its Emergency Use Listing mechanism.
The key bottleneck is cold chain logistics: both drugs require refrigeration and IV administration infrastructure, making deployment challenging in remote areas without consistent electricity.
Key Takeaways
- Two FDA-approved targeted treatments exist for Zaire ebolavirus: Inmazeb and Ebanga
- Both are monoclonal antibody therapies shown to reduce 28-day mortality in the PALM trial
- Early treatment is critical — outcomes are far better with low viral loads
- Supportive care (IV fluids, electrolytes) remains essential alongside antivirals
- No approved treatment exists for Sudan ebolavirus (see our article on Sudan ebolavirus)