Some antivirals may be effective against Monkeypox virus Lancet

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London, May 25

A team of researchers have found that some antiviral medications might have the potential to shorten symptoms and reduce the amount of time a patient is contagious with Monkeypox virus.

In the paper published in The Lancet Infectious Diseases journal, researchers described a retrospective study of seven patients diagnosed with Monkeypox in the UK between 2018 and 2021. It also reported the first off-label use of two different antiviral medications – brincidofovir and tecovirimat – to treat the disease.

The study found little evidence that brincidofovir was of clinical benefit but concluded that further research into the potential of tecovirimat would be warranted.

The team from Liverpool University Hospitals also report detection of monkeypox virus in blood and throat swabs.

"As public health officials are trying to understand what is causing the May 2022 Monkeypox outbreaks in Europe and North America – which have affected several patients who reported neither travel nor an identified link to a previously known case – our study offers some of the first insights into the use of antivirals for the treatment of Monkeypox in humans," said lead author Dr. Hugh Adler from the Hospital.

The initial three patients were treated with brincidofovir seven days after the initial onset of the rash. Brincidofovir was not observed to have any convincing clinical benefit in treating Monkeypox and alterations in liver blood tests were observed.

The researchers note that it is not known whether brincidofovir administration earlier in the course of the disease or at a different dosing schedule would have yielded different clinical outcomes. Despite this, all three patients, plus the fourth hospital transmission patient, made a full recovery.

Of the three further cases of Monkeypox reported in the UK in 2021, one was treated with tecovirimat and experienced a shorter duration of symptoms and upper respiratory tract viral shedding than the other cases in this cluster.

All patients experienced mild disease and were treated in a hospital setting for infection control purposes and not due to the severity of the infection.

No patients experienced the commonly recognised severe complications of monkeypox such as pneumonia or sepsis, however, one patient experienced a mild relapse six weeks following hospital discharge, and another patient developed a deep tissue abscess that required drainage. Patients were also found to experience low mood, likely stemming from isolation.

However, since conclusions are unable to be drawn on antiviral effectiveness against Monkeypox in such a small cohort, the team have called for further research into antivirals to treat this neglected tropical disease.

"During previous outbreaks of Monkeypox, patients were considered infectious until all lesions crusted over. In these seven UK cases, viral shedding was observed for at least three weeks following infection. However, data on infectivity remains limited, and is an important area for future study," said Dr. Catherine Houlihan, of the UK Health Security Agency and University College London.


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