Lamivudine in Ebola

On the internet, I came across a story that a doctor in Liberia who was desperate for Ebola treatments, tried lamivudine, an anti-viral used in hepatitis and HIV on 15 patients infected with Ebola. This caught my attention, as there’s currently no approved treatments for Ebola.

I checked the estimated death rates on the WHO Ebola Factsheet page. They have a table of the number of people infected with Ebola, and the number of subsequent deaths. Although there are lots of references to this table with an estimate of a 50% death rate, I calculate that there were 1590 deaths in 2387 Ebola cases, giving an estimated death rate of 67%.

The statistical analysis from this point is fairly easy – it’s a simple binomial distribution. If the “true” death rate is 67%, then the probability of seeing only 2 deaths or less out of 15 is 3.2 x 10^5, which would usually be represented as p<0.001. In other words, it would be extremely likely that the lamivudine is having a beneficial effect.

Another way of looking at the analysis is using a 2 by 2 table – whether the patients survive or not, and whether they received lamivudine or not. Using the previous Ebola outbreaks data (1590/2387), and carrying out a Fisher’s Exact test to see whether the lamivudine data come from the same underlying distribution, gives p<0.001. The odds ratio for surviving ebola is 13.0. Using the numbers from this outbreak (3865/8033), gives a Fisher’s Exact result of p=0.008 (odds ration 6.0).

If these results are confirmed, then it would appear that this is very strong evidence that lamivudine is helpful in saving lives in the fight against the Ebola virus, and should be investigated in further trials as a matter of urgency.

There has been a paper published in the Lancet online that details the reasons why randomised clinical trials, the usual gold standard for collecting medical evidence on the effectiveness of drugs, is difficult and potentially unethical in the current Ebola situation. Given this report of some effectiveness of lamivudine, I expect there will be other reports of success or failure of the treatment of patients with other drugs. It seems imperative that a global resource is set up to capture this information and ensure that each patient treated with Ebola contributes information and knowledge to the treatment of subsequent infected patients. A global registry of information on treatments given and survival outcome is needed as a matter of urgency.

Insider’s Guide to London for #PHUSE14

I’m excited that this year’s PhUSE conference is in my hometown of London. As I know there are lots of people coming from outside the city, I thought it would be helpful to give a few hints and tips from someone local of what you could do when not learning about the latest developments in pharmaceutical programming. If you have other tips, then please share them by commenting below, or on twitter using the conference hashtag #PHUSE14, where you can also find me @kevin2kane.

If you would like a nice walk, the South Bank of the river has been redeveloped in the last few decades and is bustling with activity. If you arrive early on the Sunday, cross over the river on Tower Bridge and turn right. You will pass many interesting sights – City Hall, home of the London’s Mayor office and the Shard, the tallest building in Western Europe, HMS Belfast, and Shakespeare’s Globe Theatre (unfortunately it looks like the shows are all sold out). When you get to the south side of London Bridge, pop in to Southwark Cathedral (click here to learn how to pronounce Southwark), which has been a place of worship since the year 606 AD, and has been used in a scene from Doctor Who. The Cathedral has a large stained glass window dedicated to William Shakespeare, depicting various scenes from his plays. You can stop at the Millennium Bridge to take a photo of St Paul’s Cathedral on the other side of the Thames. A little further along, there’s a replica of Sir Francis Drake’s ship, The Golden Hinde that he used to circumnavigate the globe in 1577-80. For the more active amongst you, there’s a bike hire place at Gabriel’s Wharf, which also has nice little cafés and art shops (the artist run print shop here is great value for money).

Lovely Sunny Day on the South Bank!

Lovely Sunny Day on the South Bank!

In the conference hotel, you are only 30 minutes walk from one of the biggest collections of contemporary art in the world – Tate Modern. I always think of it as a home for conceptual art, and it does have plenty of that, but it also has its fair share of figurative, although modern art as well. You’ll find Dali, Picasso, Ernst and Bacon here. You can also see Derek Jarman’s last movie, “Blue”, which is a 75 minute movie of a single monochromatic (blue) shot, inspired by Yves Klein painting IKN 79. Don’t miss the Mapplethorpe photographic portraits on the 6th floor, and of course, the view from the cafe’s balcony.

Don’t pay a fortune for a river tour. Instead, take one of the Transport For London (TFL)boats that travel regularly up and down the Thames for a fraction of the price. If you have an Oyster card, you can use that on-board. There’s a stop just in front of Tate Modern that will drop you at Embankment for an easy walk to Trafalgar Square, Leicester Square, Soho and Chinatown, or you can take the Tate Boat that will drop you at Tate Britain (where there’s more traditional British art, particularly Turner). The TFL website also has a great journey planner that will tell you how to get anywhere in London.

Bike Hire in Gabriel's Wharf

Bike Hire in Gabriel’s Wharf

If you have an hour to spare during the conference, the historic Leadenhall Market is a 12 minute walk from the hotel, and well worth a visit. The market dates back to the 14th century and was gifted to the City of London by the Lord Mayor “Dick” Whittington in 1441.

There are lots of bars and restaurants around St Katherine’s Docks, including the Dicken’s Inn that includes a traditional British pub and restaurant. Tom’s Kitchen in St Katherine’s Docks is owned by celebrity chef Tom Aitken, but would be a little more expensive and frankly, there are more interesting, quirky places to visit. For quirky, visit Les Trois Garçons, which has an interesting set of owners (check their website for more details). The food and wine is delicious, and the venue is beautiful, full of interesting and arty objects such as a stuffed giraffe to entertain you whilst eating. It’s a 20 minute walk from the hotel, but would only be a few pound in a black taxi. If you are looking for an Indian Curry, then I recommend Red Chilli on 137 Lehman Street, which is only a 3 minute walk from the hotel.

While you’re in St Katherine’s Docks, you’ll see HippopoThames, a giant floating hippopotamus sculpture created by Florentijn Hofman.

For beer drinkers, there’s a traditional local pub called the Oliver Conquest. They have draught ale on tap, and a huge gin selection. There’s a Bavarian beer house near the conference if you fancy a German selection. If you prefer cocktails, then my favourite cocktail bar is in trendy Shoreditch (as recommended by Hermann from Pro-Clinical). It’s called Lounge Lover and has a feel of being somewhere that only those in the know would go to. It’s owned by the same team as Les Trois Garçons. I wouldn’t recommend going in your business suit – that’s the least favoured outfit in this area. An ideal night might be to start at Lounge Lover, have dinner in Lew Trois Garcons, followed by a stroll around Shoreditch, investigating the many bars in the area – try Book Club, Callooh Callay or Bar Kick for a game of table football?