From the Guidelines
Treatment Options for Monkeypox
Monkeypox treatment primarily involves antiviral medications, with Cidofovir and ST-246 (Tecovirimat) being notable options 1.
- ST-246 (Tecovirimat) is an orally bioavailable anti-viral agent that targets the F13L gene product required for production of extracellular virus, showing promise in treating orthopoxviruses, including monkeypox, with a potential dose of 600mg twice daily for 14 days 1.
- Cidofovir is currently the only licensed anti-viral drug approved by the US FDA to treat infections caused by variola and other ortho-poxviruses, although it may cause nephrotoxicity and is not orally bioavailable 1.
Additional Considerations
- Supportive care such as pain management, wound care, and hydration is crucial in managing symptoms.
- Vaccination against smallpox, such as ACAM2000, may also be considered for post-exposure prophylaxis, especially in severe cases or for individuals with weakened immune systems 1.
- Vaccinia immune globulin (VIG) can be used for treating specific complications of smallpox vaccination and may be considered in the treatment of monkeypox under certain conditions 1. It is essential to consult a healthcare professional for personalized treatment and care, as the severity of the disease and the patient's health status can influence the choice of treatment.
From the FDA Drug Label
The effectiveness of TPOXX for treatment of smallpox disease was established based on results of adequate and well-controlled animal efficacy studies of non-human primates and rabbits infected with non-variola orthopoxviruses. Efficacy studies were conducted in cynomolgus macaques infected with monkeypox virus, and New Zealand white (NZW) rabbits infected with rabbitpox virus. The primary efficacy endpoint for these studies was survival In non-human primate studies, cynomolgus macaques were lethally challenged intravenously with 5 x 107 plaque-forming units of monkeypox virus; tecovirimat was administered orally once daily at a dose level of 10 mg/kg for 14 days, starting at Day 4,5 or 6 post-challenge
Treatment options for Monkeypox (Orthopoxvirus) include:
- Tecovirimat (TPOXX): administered orally once daily at a dose level of 10 mg/kg for 14 days, starting at Day 4,5 or 6 post-challenge, as shown in animal efficacy studies with cynomolgus macaques infected with monkeypox virus 2
- TPOXX injection: supplied in a 30 mL single-dose vial as a clear, colorless to pale yellow solution for intravenous administration containing 200 mg/20 mL (10 mg/mL) of tecovirimat 2
From the Research
Treatment Options for Monkeypox
The treatment options for Monkeypox (Orthopoxvirus) include:
- Antiviral medications such as tecovirimat, brincidofovir, and cidofovir 3, 4, 5
- Vaccinia immune globulin intravenous (VIGIV) 5
- Supportive care for mild cases 5
- Combination therapy of direct-acting and host-targeted antivirals, such as tecovirimat with mycophenolate mofetil (MMF) or the N-myristoyltransferase (NMT) inhibitor IMP-1088, to prevent the emergence and spread of TPOXX-resistant MPXV variants 6
Candidate Therapies
The candidate therapies for the management of Monkeypox include:
- Tecovirimat, which has favorable clinical efficacy, safety, and side effect profile and can be considered as first-line treatment for Monkeypox 3, 4, 7
- Brincidofovir, which has been studied for smallpox treatment and may also be effective against Monkeypox 5, 7
- Cidofovir, which is an antiviral medication that can be used to treat Monkeypox, but its safety and efficacy are not as well established as tecovirimat 3, 5
Special Considerations
Special considerations for the treatment of Monkeypox include:
- Severe disease, where antivirals such as tecovirimat may be considered 5
- Immunocompromised patients, where antivirals such as tecovirimat may be considered 5
- Pediatrics, pregnant and breastfeeding women, and patients with complicated lesions, where antivirals such as tecovirimat may be considered 5
- The risk of resistance to tecovirimat, which should be considered in patients who fail to respond to treatment 7