Tecovirimat may be preferred treatment for mpox

Key takeaways:

• Tecovirimat decreased hospitalization time and duration in patients with mpox better than other antivirals.
• The most common cutaneous manifestations of mpox are pustular.

In the treatment of mpox, tecovirimat demonstrates superior toleration compared with other antivirals and may be the preferred treatment option for this disease, according to a study.

The cutaneous manifestations of mpox have made it relevant in the dermatology community. While no treatments have been approved, three antivirals — brincidofovir, cidofovir and tecovirimat — have been utilized.

“The objective of our study was twofold,” Madiha Khan, BA, a fourth-year medical student at the New York Institute of Technology College of Osteopathic Medicine, and colleagues wrote. “Our first aim was to study the antiviral efficacy in treating [mpox]. Our second aim was to investigate common cutaneous manifestation of [mpox] among human patients to increase physician awareness about presentation.”

Antiviral efficacy

The researchers utilized PubMed and SCOPUS databases to identify studies that utilized brincidofovir, cidofovir or tecovirimat for the treatment of mpox in humans.

Six articles consisting of 36 patients total were used to evaluate the efficacy of these antivirals. Of the 36 patients, 32 were treated with tecovirimat, three with brincidofovir and one with cidofovir.

Results showed that 28 of tecovirimat-treated patients and all of the patients treated with the other antivirals achieved complete resolution.

However, all patients treated with brincidofovir developed elevated liver enzymes which required treatment cessation. As a result, the authors emphasized that patients with hepatic pathologies should avoid this treatment option.

In contrast, tecovirimat was well tolerated with the most common adverse effect being fatigue, which was reported in 25% of the patients. Additional benefits of tecovirimat include decreased hospitalization time compared with brincidofovir (10 vs. 29 days) and increased time to recovery compared with cidofovir. Of the tecovirimat-treated patients, 29 recovered in less than 21 days, with 45% recovering within 1 week. The cidofovir-treated patient took 6 weeks to recover.

While the small pool of patients was considered a study limitation, the authors suggest that the evidence from this study provides slightly more insight into antiviral efficacy than before.

“Our study suggests that tecovirimat therapy had the best result out of the antiviral options as it was the most studied and reported to be well tolerated,” they wrote.

Common cutaneous manifestations

Results from the second aim of the study, comprised of 859 patients, concluded that the majority of patients with mpox were men (96%), specifically men who self-reported as men who have sex with men (82%). Additionally, 32% of the pooled patients were HIV positive and 22% were on pre-exposure prophylaxis therapy, according to the researchers.

Cutaneous manifestations were most commonly pustular (32%) followed by vesicular (25%) or papular (18%). Lesions were primarily located in the genital area (37%), trunk (20%) and limbs (19%).

“Overall, we found that best patient outcomes included nitrating antiviral therapy with tecovirimat in more severe cases to decrease hospitalization time and duration of disease burden,” the authors concluded.

In the treatment of mpox, tecovirimat demonstrates superior toleration compared with other antivirals and may be effective for future treatment of the disease.