Groundbreaking Clinical Trial Confirms Effectiveness and Safety of New Treatments for Bubonic Plague

Researchers from the United Kingdom and Madagascar have conducted the world’s first comprehensive clinical trial to assess treatments for bubonic plague. This significant study involved collaboration with Madagascar’s health authorities and national plague program, and it marks a historic advancement in plague management. The trial, known as IMASOY, offers robust evidence supporting the efficacy and safety of two treatment regimens, including a 10-day oral course of ciprofloxacin, an antibiotic that can be administered at home, as a viable alternative to traditional treatments requiring hospitalization.

Despite its long history of causing devastating outbreaks, bubonic plague remains a persistent threat due to its wide animal reservoirs and potential use as a bioweapon. While cases are declining globally, Madagascar reports approximately 80% of cases worldwide annually. The disease can be deadly, with mortality rates ranging from 15% to 25%. The recent trial’s findings, published in the New England Journal of Medicine, come after five years of research conducted in rural Madagascar, involving over 450 patients across 47 sites.

The study compared two treatment options: a 10-day oral regimen of ciprofloxacin and a combination of three days of injectable gentamicin followed by seven days of ciprofloxacin. Patients were randomly assigned to these regimens, which were found to have about a 90% success rate and a mortality rate of around 4%. The oral treatment offers numerous advantages including reduced healthcare burden, lower costs, and greater feasibility for remote areas.

The trial faced logistical challenges due to the remote nature of many participants and the unpredictability of outbreaks. However, with the dedication of local healthcare workers, the study successfully enrolled and treated a diverse patient population. Experts now hope the results will influence updates to international guidelines, facilitating broader adoption of these treatments to save lives.

Professor Piero Olliaro from the University of Oxford emphasized that this research provides crucial actual-world data on effective treatment options for bubonic plague, moving beyond prior reliance on animal studies. Malagasy physician Mihaja Raberahona highlighted the benefits of the oral regimen in rural settings, noting its affordability and ease of administration. Epidemiologist Rindra Vatosoa Randremanana praised the extensive operational effort behind the trial and expressed gratitude to communities involved.

This pioneering trial underscores a major step forward in combating a disease with centuries of history, offering a more accessible and cost-effective treatment method while enhancing readiness for future outbreaks.