The antiviral Tecovirimat (TPOXX) shows promise against monkeypox, but human data and supplies are limited
As supplies of vaccines against monkeypox remain constrained and the number of people contracting the disease continues to mount, physicians and researchers are looking to the drug tecovirimat for relief. In animals infected with monkeypox, the antiviral has been shown to lower the amount of virus in their bodies and reduce the number of fluid-filled ‘pox’ lesions forming on their skin.
What is tecovirimat, and how does it work? After the 2001 anthrax attacks in the United States, in which letters laced with spores of the lethal bacterium were sent to media organizations and politicians, the US National Institute of Allergy and Infectious Disease in Bethesda, Maryland, received a funding boost to develop treatments against pathogens with the potential to be used as bioweapons.
Is there any evidence that tecovirimat works against monkeypox? A 2018 trial in about 450 people, 90 of whom received a placebo, showed that the drug is safe and has few side effects. But demonstrating its efficacy against orthopoxviruses in humans has been less explored. The ongoing global monkeypox outbreak has so far provided only anecdotal evidence of tecovirimat’s effectiveness in people, says Daniel McQuillen, president of the Infectious Diseases Society of America, based in Arlington, Virginia. A couple of observational studies2,3 in a handful of people with monkeypox found that new lesions stopped forming within one day after physicians administered tecovirimat.
The paperwork required is an enormous burden for clinicians who have to juggle patients, says Amesh Adalja, an infectious-disease specialist at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. The CDC recently made some of the forms optional and has allowed physicians to submit them after administering the drug to people. It is also working with the FDA to further tweak the process, says Scott Pauley, a CDC spokesperson.
Hruby says that researchers plan to enrol people with mild cases of monkeypox. If they are hospitalized, participants will have the opportunity to receive the drug, even if they were part of the placebo group. He adds that he expects to see the first data in a matter of months.
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