Nipah Virus Therapeutics: A Systematic Review to Support Prioritisation for Clinical Trials

Nipah virus disease is a bat-borne zoonosis with person-to-person transmission, a case fatality rate of 38-75%, and recognised pandemic potential. The first reported outbreak occurred in Malaysia and Singapore in 1998, since followed by multiple outbreaks in Bangladesh and India. No therapeutics or vaccines have been licensed to date, and only few candidates are in development. This systematic review aimed to assess the evidence for the safety and efficacy of therapeutic options (monoclonal antibodies and small molecules) for Nipah virus and other henipaviral diseases in order to support candidate prioritisation for further evaluation in clinical trials. At present, there is sufficient evidence to trial only m102.4 and remdesivir (singly and/or in combination) for prophylaxis and early treatment of Nipah virus disease. In addition to well-designed clinical efficacy trials, in vivo pharmacokinetic-pharmacodynamic studies to optimise selection and dosing of therapeutic candidates in animal challenge and natural human infection are needed.