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Antivirals including tecovirimat, cidofovir, brincidofovir, trifluridine, and vaccinia immune globulin, have been utilized to treat human monkeypox virus infection (MPXV), according to the first systematic study of the topic. The most widely utilized of these is tecovirimat, which has proven beneficial with no significant safety risks.

The World Health Organization recently designated the human monkeypox viral infection to be a  public health emergency of international concern (PHEIC). Unfortunately, the use of antivirals in monkeypox virus infection is only briefly covered in the literature. 

Initial studies that discussed the use of antivirals in patients with monkeypox virus infection and mentioned specific patient data were reviewed in a recent systematic review. A thorough analysis gathered all data on the effectiveness, safety, and mechanisms of action of numerous antivirals.

Eighteen studies totaling 71 subjects were included out of the 487 non-duplicate studies, in total. Tecovirimat was used in 61 patients, cidofovir (CDV) in seven, and brincidofovir (BCV) in three. In addition to tecovirimat, topical trifluridine was administered in four ophthalmic instances. 

Of the total, 59 (83.1%) reportedly had complete symptom relief, one experienced waxing and waning symptoms, one (1.8%) died, and the remaining subjects were experiencing resolution of symptoms. The instance of death was not believed to be related to the use of tecovirimat. All patients treated with BCV (which resulted in treatment cessation) and five tecovirimat-treated patients had elevated liver panels.

The most widely used drug is tecovirimat, which has shown benefits in several patients with monkeypox. Tecovirimat produced encouraging results in patients with progressive disease and had a better safety profile than other medications. In addition to tecovirimat, topical trifluridine has been employed as adjuvant therapy for ocular lesions associated with monkeypox. 

In some cases, brincidofovir or cidofovir may be used. However, brincidofovir was linked to treatment discontinuation due to negative side effects. More research is needed to evaluate the effectiveness and safety of these antivirals. 

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Shamim, M. A., Padhi, B. K., Satapathy, P., Veeramachaneni, S. D., Chatterjee, C., Tripathy, S., Akhtar, N., Pradhan, A., Dwivedi, P., Mohanty, A., Rodriguez-Morales, A. J., Sah, R., Ala’a, A. T., Al-Tawfiq, J., Behdin Nowrouzi, K., & Chattu, V. K. (2022). The Use of Antivirals in the Treatment of Human Monkeypox Outbreaks: A Systematic Review: Antivirals in treatment of monkeypox: systematic review. Int J Infect Dis. https://doi.org/10.1016/j.ijid.2022.11.040