The antiviral drug tecovirimate may improve outcomes in people infected with monkeypox, according to a recent study in the UK.
The small retrospective observational study published in The Lancet Infectious Diseases includes 7 patients treated for monkeypox in high-impact infectious disease centers in the UK between 15 August 2018 and 10 September 2021 and aims to describe the clinical course of the disease and the response to new antiviral therapies.
“The biggest finding is the excellent clinical and virological response to oral antiviral tecovirymate in a monkey patient who received this agent,” lead author Hugh Adler, a doctor at Liverpool University Hospitals, told Contagion. “We definitely need well-driven, prospective studies to confirm this finding, but it’s a strong signal and could be helpful to clinicians treating monkey patients with the current outbreak in the Western Hemisphere.”
Three patients were treated with 200 mg brincidofovir weekly before developing elevated liver enzymes and completing treatment. One patient received 600 mg of tecovirimate twice daily for two weeks and had a shorter duration of illness and virus excretion.
The study included patients who tested positive after traveling from Nigeria, along with the transfer to a healthcare professional and in a family household. All seven of the patients in the study developed skin lesions and all fully recovered.
“We were surprised to find positive PCR results in monkeypox in blood and upper respiratory swabs, and especially surprised that throat swabs remain PCR positive long after the rash has resolved in some cases,” Adler said. “We still don’t know the consequences of infection control tips, etc. (After all, keep in mind that patients with COVID can remain PCR positive for weeks even though they are no longer contagious), but it deserves attention when managing patients in the current epidemic and requires specialized research (eg with viral culture) to solve the problem once and for all.
Three patients in the study spent more than three weeks in isolation due to prolonged positivity. The disease was mild in all patients included in the study, and no one had pneumonia or sepsis. Unexpected symptoms include a mild relapse six weeks after discharge in one patient and a deep tissue abscess that requires drainage in another. Isolation led to a bad mood of patients.
We wanted to draw attention to the long-term illness and hospitalization that our patients have experienced, even with ultimately “uncomplicated” monkeypox, so that healthcare providers can prepare to support psychological patients with this infection and politicians to consider whether self-isolation at home is an option for selected patients, “Adler said. “And most importantly, we want healthcare providers and readers everywhere to know that smallpox remains a significant public health problem in West and Central Africa, where there is an urgent unmet need for antiviral treatments, vaccines and more evidence-based protocols. to control infections.
Monkeypox is endemic to Africa, but global health officials are closely monitoring the recent outbreak outside Africa. About 300 cases of monkeypox have been reported in a dozen countries.
“Clinicians, including the author of this paper, continue to be involved in the clinical and public health response to the ongoing unprecedented monkeypox epidemic in the UK, Europe and beyond, and I am confident that this will be brought under control,” Adler said. “There are plans to undertake further research to explain our discovery of a positive PCR test for monkeypox virus in upper respiratory tract swabs and to understand the implications of controlling the infection. And internationally, I am pleased that there is a trial recruitment in the Democratic Republic of the Congo, which looks at the role of smallpox vaccination for healthcare professionals caring for monkeypox patients, and an expanded access program for tecovirimate in the Central African Republic.
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