Emerging treatments

Ribavirin

A nucleoside analogue with broad-spectrum antiviral activity. It was used empirically in the Malaysian outbreak of Nipah virus (NiV) and in some cases of Hendra virus (HeV) infection.[50][29] Although outcomes were improved in patients who received ribavirin in Malaysia, this therapy occurred at the end of the outbreak when the patients may have received better supportive care.[50] The efficacy of ribavirin was challenged by subsequent animal studies.[34] In one report of the 2018 Kerala NiV outbreak, there were 20% fewer cases of encephalitis among patients who received ribavirin, but the difference was not statistically significant.[38] In the absence of other therapies, ribavirin may be considered in the treatment of henipavirus infection.[34] Further data need to become available to make recommendations for its use in henipavirus infection.

Human monoclonal antibodies

Passive immunotherapy with human monoclonal antibodies specific for viral glycoproteins may have a role in preventing infection in patients exposed to henipaviruses. In particular, the monoclonal antibody m102.4 has proven efficacy in post-exposure treatment in animal studies for both HeV or NiV and has been used in humans with high-risk exposures to HeV in Australia on compassionate grounds.[34] A phase 1 trial demonstrated that single and repeated dosing of m102.4 in healthy adults was safe and well tolerated, with no evidence of an immunogenic response.[51] An early phase human clinical trial of m102.4 is ongoing in Queensland, Australia.[52]

Chloroquine

Has shown promise in in vitro testing; however, animal studies and limited use in humans (one case of HeV alongside ribavirin) have been disappointing.[34]

Antithrombotic drugs

Aspirin and pentoxifylline have been used in some patients with NiV on the basis that arterial thrombosis may be a contributing factor; however, they were not given in a systematic fashion, making it impossible to assess their efficacy.[22]

Favipiravir

An investigational antiviral drug that inhibits RNA-dependent RNA polymerase. In one study, favipiravir was effective at preventing NiV infection in a hamster model.[53] However, there are no studies to confirm its efficacy against NiV or HeV in humans. 

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