Antivirals With Activity Against Mpox: A Clinically Oriented Review

Abstract

Monkeypox virus is an emergent human pathogen. While it is less lethal than smallpox, it can still cause significant morbidity and mortality. In this review, we explore three antiviral agents with activity against monkeypox and other orthopoxviruses: cidofovir, brincidofovir, and tecovirimat. Cidofovir, and its prodrug brincidofovir, are inhibitors of DNA replication with a broad spectrum of activity against multiple families of double-stranded DNA viruses. Tecovirimat has more specific activity against orthopoxviruses, and inhibits the formation of the extracellular enveloped virus necessary for cell-to-cell transmission. For each agent, we review basic pharmacology, data from animal models and reported experience in human patients.

Clinical Use of Tecovirimat (Tpoxx) for Treatment of Monkeypox Under an Investigational New Drug Protocol — United States, May–August 2022

“…The preliminary safety reporting with tecovirimat use under the EA-IND is consistent with data from the healthy human tecovirimat safety studies (SIGA-246–001). §§§§ Two other investigational treatments for orthopoxviruses, cidofovir and brincidofovir, have demonstrated substantial toxicity with limited efficacy data ( 6 ).…”

Monkeypox: An Emerging Global Public Health Emergency

“…BLACK BOX WARNING: Prolonged use may increase the risk of mortality due to the drug overdosage. The prescribing information contains no contraindications [ 8 , 10 , 52 ].…”

“…Most monkeypox patients have a mild version of the disease and can be managed with supportive treatment [ 9 ]. There are currently no approved treatments for monkeypox virus infection; however, several antiviral drugs originally designed for the treatment of smallpox and other viral infections are available [ 10 ].…”

Pharmaceutical Treatment of Monkeypox Virus: A Narrative Review and Bibliometric Analysis

“…Some of the common associated adverse events are headaches, gastrointestinal disturbances, and injection site complaints such as pain, swelling, erythema, and extravasation. (6,10) There are some case reports and case studies on the use of Tecovirimat in monkeypox disease in humans. It has been effective in arresting the aggravation of the condition.…”

“…This paper briefly analyses past literature on the pharmaceutical treatment of the disease and the drugs administered. This review provides detailed information on the clinical orientation of the antivirals administered: tecovirimat (TPOXX), cidofovir, brincidofovir, and Vaccinia Immune Globulin which would be essential to improve the treatment protocol and increase the treatment efficacy of the disease treatment (6).…”