The preliminary study shows that tecociramit is well tolerated by patients with monkeypox

In a recent study published in JAMAresearchers investigated the use of tecocirimate against monkeypox infections.

Background

A zoonotic orthopoxvirus belonging to the same genus as variola is monkeypox, which also causes smallpox. As of August 18, 2022, there have been over 39,000 reported cases resulting from a recent global outbreak. In previous outbreaks, monkeypox symptoms usually last between two and four weeks.

In a recent study, 13% of patients required hospitalization, indicating the need for effective therapy. The antiviral tecocirimate prevents the release of enveloped viruses, viral pathogenicity and viral spread by inhibiting p37 protein activity and shows a positive clinical safety profile.

About the research

In the current study, investigators evaluated adverse events and clinical remission of systemic symptoms and lesions in an uncontrolled cohort study of monkeypox-infected patients who received tecoxiramit as compassionate-use therapy.

After a polymerase chain reaction test confirming orthopoxvirus infection from skin lesions, patients were eligible for tecurimate treatment. The treatment was available to outpatients with lesions that had spread to delicate sites such as the face or vaginal area. For improved absorption, oral tecoxiramit therapy for adult patients is based on weight, administered every eight or 12 hours, and eaten within 30 minutes of a moderate- to high-fat meal.

The 14-day treatment period may be extended depending on the patient’s clinical condition. Clinical information was collected at the time of the initial in-person treatment assessment, as well as at 7 and 21 days after initiation of therapy by in-person or telephone interviews.

Results

A total of 25 individuals infected with monkeypox had completed their course of tequirimate treatment as of August 13, 2022. The mean age of the patients, who all self-identified as male, was 40.7 years. One patient reported receiving smallpox vaccine more than 25 years ago, four patients received one dose of JYNNEOS vaccine after symptom onset, and nine reported HIV.

Systemic signs, lesions, or both were present during treatment for an average of 12 days. 76% of patients had fever, 32% had headache, 28% had fatigue, 20% had chills, 12% had back pain, 8% had myalgia, 4% had nausea, and 4% had diarrhea. Additionally, 92% of subjects had genital and/or perianal problems, and 15% had fewer than ten lesions on their bodies.

While the other patients had only 14 days of treatment, one patient underwent 21 days of treatment. On day 7 of therapy, complete remission of lesions was observed in 40% of patients, while by day 21, complete disappearance of lesions and discomfort was documented in 92% of patients. No patient discontinued therapy while receiving tecorimate treatment, which was generally well tolerated. On the seventh day of therapy, the following side effects were most commonly reported: fatigue in 28% of patients, headache in 20%, nausea in 16%, pruritus in 8%, and diarrhea in 8% of patients.

Overall, the results of the study showed that all individuals with monkeypox infection tolerated oral tecocirimate with few side effects. Patient timelines for the development and presentation of symptoms vary. It is therefore important to proceed with caution when inferring the use of antivirals against the natural course of infection.