Tecovirimat for Mpox —Promise and Limitations

In this issue of JAMA Internal Medicine, Aldred et al report on a critical clinical question amid the recent mpox outbreak: does early tecovirimat treatment improve outcomes in people with HIV? The authors conducted a matched case-cohort study in 4 hospitals in Atlanta, Georgia. The exposed group included those who received tecovirimat within 7 days of diagnosis, and the unexposed group were those who did not receive tecovirimat or received it after 7 days. Roughly 5.4% of the 56 treated and 26.8% of the 56 untreated or late-treated patients progressed, representing an odds ratio of 11.0 (95% CI, 1.4-85.1) for progression among the no/late-treated population compared with early. Progression was defined as developing at least 1 severe mpox criterion after day 7 of symptoms. While the findings are promising from an efficacy standpoint, the authors ’ conclusion advocating for using tecovirimat in all persons with HIV as soon as mpox is suspected may be premature and should be tempered given the observational nature of the evidence and the limitations of tecovirimat availability.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research