According to early-release case reports, treatment with oral tecovirimat rapidly alleviated rectal pain in 2 patients with monkeypox and severe proctitis with no serious adverse effects. The cases occurred in the District of Columbia, which has the highest rate of cases per capita in the U.S. One patient began oral tecovirimat 600 mg twice daily on the ninth day of symptoms. Pain improved within 36 hours with no adverse effects. The second patient began oral tecovirimat 600 mg twice daily on the 10th day of symptoms. Pain, which had required opioid therapy beginning on day 9, improved within 48 hours. Rectal symptoms “had almost resolved” by the fourth day of therapy. The patient reported mild, transient fatigue after beginning treatment.
The authors could not determine the direct effect of tecovirimat in rapidly alleviating the patients’ symptoms. Until results of randomized controlled trials of tecovirimat are available, the authors support early use of tecovirimat for patients with monkeypox and severe proctitis. “There is no approved antiviral for monkeypox, and optimal management has not been established,” the authors write. “However, antiviral agents approved for use against smallpox are expected to have activity against monkeypox. These include tecovirimat, cidofovir, and brincidofovir. Tecovirimat is a potent inhibitor of the VP37 orthopoxvirus protein, which mediates the formation and egress of enveloped virions. It is available from the Strategic National Stockpile. Current guidance from the Centers for Disease Control and Prevention recommends considering treatment in patients with severe monkeypox disease and those at risk for progression to severe disease.”
Source: Annals of Internal Medicine
