Monkeypox medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Bassel Almarie M.D.[2]

## Overview

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Currently, there is no proven, safe treatment for monkeypox. To contain the outbreak, the CDC advises using smallpox vaccine, cidofovir, ST-246, and vaccinia immune globulin. Vaccines are not available to public as for now but in an event of larger outbreak, the CDC will establish guidelines on who to receive the vaccine.

## Medical therapy

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* JYNNEOSTM, also known as Imvamune or Imvanex, is an FDA approved vaccine to prevent monkeypox and smallpox in adults 18 years of age and older determined to be at high risk for smallpox or monkeypox infection_FDA-1|[1].

* ACAM2000 is an FDA approved active immunization against smallpox disease for persons determined to be at high risk for smallpox infection. It may be used following exposure to monkeypox under compassionate-use protocol_FDA-2|[2].

* Cidofovir is an antiviral agent that has proven activity against poxviruses such as smallpox and monkeypox in invitro and animal studies. No data are available on the drug’s effectiveness to treat humans cases of monkeypox[3].

* Tecovirimat (ST-246) is an antiviral agent with activity against orthopoxvirus. In phase I and phase II trials, no serious adverse events were observed or reported. Since smallpox has been eradicated, the drug was tested only on healthy individuals. Antiviral efficacy of the drug was based on its efficacy in relevant animal models. No data are available on the effectiveness of the drug to treat humans cases of monkeypox[4][5]. The FDA granted the drug a fast track and priority review designation as a measure of biosecurity preparedness[6], followed by an official approval on July 13, 2018.

* Vaccinia Immune Globulin (VIG) can be used as prophylaxis in patients for whom smallpox vaccine is contraindicated e.g. immunocompromised. Data are lacking to support the effectiveness of VIG in treatment of monkeypox complications[7].

## References

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1. _FDA_1-0|↑ "JYNNEOS | FDA". Retrieved 2022-06-16.
2. _FDA_2-0|↑ "ACAM2000 | FDA". Retrieved 2022-06-16.
3. ↑ De Clercq E (2002). "Cidofovir in the treatment of poxvirus infections". Antiviral Res. 55 (1): 1–13. doi:10.1016/s0166-3542(02)00008-6. PMID 12076747.
4. ↑ Jordan R, Tien D, Bolken TC, Jones KF, Tyavanagimatt SR, Strasser J; et al. (2008). "Single-dose safety and pharmacokinetics of ST-246, a novel orthopoxvirus egress inhibitor". Antimicrob Agents Chemother. 52 (5): 1721–7. doi:10.1128/AAC.01303-07. PMC 2346641. PMID 18316519.CS1 maint: Multiple names: authors list (link)
5. ↑ Chinsangaram J, Honeychurch KM, Tyavanagimatt SR, Leeds JM, Bolken TC, Jones KF; et al. (2012). "Safety and pharmacokinetics of the anti-orthopoxvirus compound ST-246 following a single daily oral dose for 14 days in human volunteers". Antimicrob Agents Chemother. 56 (9): 4900–5. doi:10.1128/AAC.00904-12. PMC 3421894. PMID 22777041.CS1 maint: Multiple names: authors list (link)
6. ↑ Russo AT, Grosenbach DW, Chinsangaram J, Honeychurch KM, Long PG, Lovejoy C; et al. (2021). "An overview of tecovirimat for smallpox treatment and expanded anti-orthopoxvirus applications". Expert Rev Anti Infect Ther. 19 (3): 331–344. doi:10.1080/14787210.2020.1819791. PMID 32882158 Check `|pmid=` value (help).CS1 maint: Multiple names: authors list (link)
7. ↑ Wittek R (2006). "Vaccinia immune globulin: current policies, preparedness, and product safety and efficacy". Int J Infect Dis. 10 (3): 193–201. doi:10.1016/j.ijid.2005.12.001. PMID 16564720.