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In the absence of an FDA-approved treatment specifically for mpox, clinicians have largely relied on tecovirimat, developed for smallpox. However, in a recent trial, this antiviral provided no clinical benefit to patients with clade I mpox. Now, investigators report on its efficacy against clade II mpox virus, the pathogen responsible for the 2022 global outbreak.
Approximately 340 immunocompetent patients with mild-to-moderate clade II mpox were randomized to receive tecovirimat or placebo for 14 days; those who developed severe disease or had severe pain at day 6 could switch to open-label drug. Enrolled participants were young (mean age, 34) and nearly all men. One quarter had symptoms for ≤5 days at enrollment, and 35% were living…