Tecovirimat Use in Ambulatory and Hospitalized Patients With Monkeypox Virus Infection

Wu, En Ling; Osborn, Rebecca; Bertram, Christie M; Moore, W Justin; Galvin, Shannon; Bolon, Maureen K.; Masters, Mary Clare; Krueger, Karen

doi:10.1097/olq.0000000000001747

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…All the patients recovered. Participants reported improvement within two to 3 days (Wu et al, 2022). Two patients with concomitant HIV and anogenital and rectal mpox virus infection recovered with Frontiers in Pharmacology frontiersin.org tecovirimat (Beatty et al, 2022).…”

Section: Treatments and Vaccinesmentioning

confidence: 99%

“…Despite this different pattern of hepatic enzyme derangement, this was also only a transient rise (Nörz et al, 2022). Fatigue, headache, backache, and nausea are some of the other reported adverse events (Desai et al, 2022;O'Laughlin et al, 2022;Wu et al, 2022). Summing up, Tecovirimat is a promising option in terms of both efficacy and safety in worsening mpox virus disease.…”

Section: Treatments and Vaccinesmentioning

confidence: 99%

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Pharmacological treatment and vaccines in monkeypox virus: a narrative review and bibliometric analysis

et al. 2023

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Mpox (earlier known as monkeypox) virus infection is a recognized public health emergency. There has been little research on the treatment options. This article reviews the specific drugs used to treat mpox virus infection and the vaccines used here. Instead of focusing on the mechanistic basis, this review narrates the practical, real-life experiences of individual patients of mpox virus disease being administered these medicines. We conducted a bibliometric analysis on the treatment of the mpox virus using data from several databases like PubMed, Scopus, and Embase. The research on this topic has grown tremendously recently but it is highly concentrated in a few countries. Cidofovir is the most studied drug. This is because it is indicated and also used off-label for several conditions. The drugs used for mpox virus infection include tecovirimat, cidofovir, brincidofovir, vaccinia immune globulin, and trifluridine. Tecovirimat is used most frequently. It is a promising option in progressive mpox disease in terms of both efficacy and safety. Brincidofovir has been associated with treatment discontinuation due to elevated hepatic enzymes. Cidofovir is also not the preferred drug, often used because of the unavailability of tecovirimat. Trifluridine is used topically as an add-on agent along with tecovirimat for ocular manifestations of mpox virus disease. No study reports individual patient data for vaccinia immune globulin. Though no vaccine is currently approved for mpox virus infection, ACAM 2000 and JYNNEOS are the vaccines being mainly considered. ACAM 2000 is capable of replicating and may cause severe adverse reactions. It is used when JYNNEOS is contraindicated. Several drugs and vaccines are under development and have been discussed alongside pragmatic aspects of mpox virus treatment and prevention. Further studies can provide more insight into the safety and efficacy of Tecovirimat in actively progressing mpox virus disease.

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Section: Treatments and Vaccinesmentioning

confidence: 99%

Section: Treatments and Vaccinesmentioning

confidence: 99%

Pharmacological treatment and vaccines in monkeypox virus: a narrative review and bibliometric analysis

et al. 2023

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Effectiveness of Tecovirimat in Mpox Cases: A Systematic Review of Current Evidence

Shabil,

Khatib,

Ballal

et al. 2024

Journal of Medical Virology

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Mpox, formerly known as monkeypox, has re‐emerged as a significant global health concern, particularly during the widespread outbreak of 2022. As an orthopoxvirus related to the eradicated smallpox virus, mpox has been primarily managed with smallpox vaccines and treatments, including the antiviral agent Tecovirimat. This systematic review aims to evaluate the effectiveness and safety of Tecovirimat in treating mpox, focusing on its use during the 2022 outbreak, especially among high‐risk populations, including men who have sex with men and people living with HIV. We conducted a comprehensive search across databases, such as Embase, PubMed, and Web of Science, up to August 30, 2024. The selection involved a two‐stage review process utilizing the Nested Knowledge platform, which helped streamline the screening and data extraction. We included studies that focused on the clinical efficacy and safety of Tecovirimat in human patients with confirmed mpox infections. Our analysis mainly synthesized data narratively due to the heterogeneity of study designs and outcomes. Fifteen studies met the inclusion criteria, providing data on 1031 mpox cases. The preliminary analysis of the PALM 007 RCT indicated that tecovirimat did not significantly outperform placebo in lesion resolution for all patients. Lesions healed faster than expected, regardless of tecovirimat or placebo treatment. A lower mortality rate of 1.7% among those enrolled in the PALM 007 RCT was observed, compared to the general mpox mortality rate of 3.6% or higher in the DRC. Observational studies revealed that early administration of Tecovirimat, especially within the first week of symptom onset, significantly improves symptom resolution, reduces the severity of the disease, and decreases the likelihood of hospitalization and complications in observational studies. However, the impact on viral clearance was inconsistent, and some studies suggested limited efficacy in severely immunocompromised patients. Regarding safety, Tecovirimat was generally well‐tolerated as indicated by the RCT; however, mild adverse effects such as fatigue, headache, and nausea were commonly reported among observational studies. Serious adverse events were rare but included elevated liver enzymes and psychiatric symptoms, particularly in patients with pre‐existing conditions. Tecovirimat demonstrates some potential benefits in treating mpox, particularly when administered early. The PALM 007 RCT failed to meet the efficacy point. Tecovirimat is generally well‐tolerated with a favorable safety profile, although monitoring is advisable for those with existing liver or renal conditions. Despite promising results, further large‐scale randomized controlled trials are needed to fully ascertain the drug's effectiveness across diverse populations and to explore its impact on viral clearance and transmission dynamics.

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Mpox virus infection in women and outbreak sex disparities: A Systematic Review and Meta-analysis

Satapathy,

Shamim,

Padhi

et al. 2024

Commun Med

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Background Although the recent literature indicates that mpox (monkeypox) primarily affects men, there are also multiple reports in women. Estimates of the sex distribution of mpox patients and patterns will enable a better understanding of the ongoing mpox outbreak. Methods In this systematic review and meta-analysis, seven databases were searched for studies published in English up to January 4 th , 2023. The proportion of women with mpox was the primary outcome. A random-effects model was fitted for the primary outcome, and a sensitivity analysis was performed to check possible outliers in the studies. Results Here we screened 470 articles and included 60 studies for qualitative synthesis. 42 studies with 3125 women out of 47,407 confirmed cases were found suitable for meta-analysis. The pooled proportion of female patients is 17.22% (95% CI: 10.49-25.11; I 2 = 98.86%). Subgroup analyses reveal higher proportion before 2022 [44.09% (42.93–46.86] than 2022 onwards [2.40% (1.17–3.98)], and in endemic countries [43.13% (37.63–48.72)] than in nonendemic countries [6.15% (2.20–11.65)]. Conclusions There is considerable caseload (17.22%) amongst women, which must be seen in the context of a much higher proportion (44.09%) in studies prior to 2022 compared to 2.40% in the 2022 outbreak indicating an epidemiological shift. Data on disease characteristics among women with mpox disease are scarce. Further studies should focus on these aspects to better understand the disease in women and empower epidemiologists and clinicians to make evidence-based decisions for this vulnerable group.

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Tecovirimat Use in Ambulatory and Hospitalized Patients With Monkeypox Virus Infection

Cited by 5 publications

References 6 publications

Pharmacological treatment and vaccines in monkeypox virus: a narrative review and bibliometric analysis

Pharmacological treatment and vaccines in monkeypox virus: a narrative review and bibliometric analysis

Effectiveness of Tecovirimat in Mpox Cases: A Systematic Review of Current Evidence

Mpox virus infection in women and outbreak sex disparities: A Systematic Review and Meta-analysis

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