Turns out the antiviral TPOXX (tecovirimat) doesn't work for mild/moderate Clade II #mpox ( #monkeypox) either, as previously shown for Clade I. Many treated people reported improvement, but symptoms typically resolve anyway -- that's why we need controlled trials. www.niaid.nih.gov/news-events/... - ThreadSky

lizhighleyman.bsky.social • 78 days ago

Turns out the antiviral TPOXX (tecovirimat) doesn't work for mild/moderate Clade II #mpox ( #monkeypox) either, as previously shown for Clade I. Many treated people reported improvement, but symptoms typically resolve anyway -- that's why we need controlled trials.

https://www.niaid.nih.gov/news-events/nih-study-finds-tecovirimat-was-safe-did-not-improve-mpox-resolution-or-pain

Comments

carlyhughes.bsky.social•78 days ago

📌

begrudginglyyeast.bsky.social•78 days ago

Does it reduce more severe outcomes in people without the ability to control it?

lizhighleyman.bsky.social•78 days ago

I haven't seen such a study. TPOXX was developed for smallpox & authorized for mpox based on animal data. @boghuma.bsky.social, @profchloeorkin.bsky.social, @taghivscience.bsky.social are you aware of any such research for severe mpox in people with or without HIV?

boghuma.bsky.social•78 days ago

30% of the the participants in STOMP were PWH and hopefully we will glean some information in the sub analyses when the paper is published. We did an observational analyses in our cohort of mpox in Atlanta which suggested benefit in advanced HIV. Trials are needed.
https://pubmed.ncbi.nlm.nih.gov/38190312/

lizhighleyman.bsky.social•78 days ago

Thanks for the quick response. I'll look forward to the HIV analysis.

begrudginglyyeast.bsky.social•78 days ago

I was just reminded of the Paxlovid situation where it is a godsend for the immunosuppressed and people with no immune memory, but doesn't do all that much for healthy people with functional immune systems and immune memory.

begrudginglyyeast.bsky.social•78 days ago

A situation like if your immune system can't control it a drug holds it down and lets you slowly beat it into submission, but doesn't appreciably speed that beating into submission by a working system. Especially with the long incubation and disease course here.

begrudginglyyeast.bsky.social•78 days ago

I could picture a world where such a drug works for smallpox because lots of people can't control that one, but we manage to control this one so you don't see the effect outside the risky people

lizhighleyman.bsky.social•78 days ago

In this trial (STOMP), people with severe mpox symptoms, pregnant women & immunocompromised people were all given TPOXX & none were assigned to the placebo group -- ethically the right thing to do -- so it couldn't make a comparison for that cohort.

drmichaelmarks.bsky.social•78 days ago

Not aware any trial data (nor forthcoming soon). Given multiple negative RCTs in moderate mpox think RCT in severe disease/immunocompromised justifiable. Takeaway esp. from DRC data was good general care = big impact & should focus on that as much as hoping TPOXX finds sub-group works in.

profchloeorkin.bsky.social•78 days ago

Agree with @drmichaelmarks.bsky.social and @boghuma.bsky.social. More research needed and results chime with PALM007.

lizhighleyman.bsky.social•78 days ago

Tecovirimat was developed for smallpox & received FDA authorization for mpox (a related virus) based on animal studies. Given it's safety & lack of good alternatives, it was reasonable to try it during the global outbreak while studies were underway.
https://www.nejm.org/doi/full/10.1056/NEJMp2210125

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