The
current monkeypox outbreaks during the COVID-19 pandemic
have
reignited interest in orthopoxvirus antivirals. Monkeypox belongs
to the Orthopoxvirus genus of the Poxviridae family,
which also includes the variola virus, vaccinia virus, and cowpox
virus. Two orally bioavailable drugs, tecovirimat and brincidofovir,
have been approved for treating smallpox infections. Given their human
safety profiles and in vivo antiviral efficacy in animal models, both
drugs have also been recommended to treat monkeypox infection. To
facilitate the development of additional orthopoxvirus antivirals,
we summarize the antiviral activity, mechanism of action, and mechanism
of resistance of orthopoxvirus antivirals. This perspective covers
both direct-acting and host-targeting antivirals with an emphasis
on drug candidates showing in vivo antiviral efficacy in animal models.
We hope to speed the orthopoxvirus antiviral drug discovery by providing
medicinal chemists with insights into prioritizing proper drug targets
and hits for further development.