The exponential increase in people infected with monkeypox in the last three months and a global scenario marked by a shortage of vaccines, guides scientists to seek therapeutic options for an antiviral treatment that relieves skin lesions and the pain it causes in the monkeypox patients.
In this framework, researchers Amanda Rojek, Jake Dunning and Piero Olliaro, from the International Consortium on Serious and Emerging Acute Respiratory Infections, from the Institute of Pandemic Sciences at the University of Oxford, recently published the article “Monkeypox: how will we know if the treatments work”, in the prestigious scientific journal The Lancet.
In the latest update on the disease, the US Centers for Disease Control and Prevention (CDC) noted that there are no specific treatments for monkeypox virus infections.
However, they clarified that because “monpox and smallpox viruses are genetically similar, antiviral drugs and vaccines developed to protect against smallpox could be used to prevent and treat monkeypox virus infections.”
It should be remembered that heMonkeypox is a zoonotic disease caused by an orthopoxvirus related to smallpox. The first human infection was discovered in 1970 in the Democratic Republic of the Congo and was later documented mainly in West and Central African countries. The current outbreak, which began in May this year, is the first known multinational outbreak among non-endemic countries.
Given this, CDC specialists pointed out that “se might recommend antivirals such as tecovirimat for people who are more likely to get seriously ill, such as patients with weakened immune systems.”
In the United States, they will apply a fifth of the dose of the monkeypox vaccine. It is an emergency use authorization from the FDA due to the high demand and shortage of immunizers.
“Antivirals such as tecovirimat might be recommended for people who are more likely to get seriously ill, such as patients with weakened immune systems,” the CDC specialists said.
On how tecovirimat works, the experts at the Center for Disease Control and Prevention indicated that It helps decrease the symptoms of smallpox such as fever, fatigue and reduce the severity and pain associated with skin lesions. Tecovirimat treatment consists of taking one pill twice a day for two weeks.
Once the monkeypox virus attacks a healthy cell, the virus copies its genetic information and begins to circulate throughout the body to infect other cells. The antiviral seeks to prevent the virus from replicating once it infects a host.
In other words, Tecovirimat can be considered as an experimental treatment for severe monkeypox patients or those at high risk of severe disease, who are people with weakened immune systems due to conditions such as HIV/AIDS, skin conditions such as eczema , children, pregnant women and people with other complications such as a bacterial skin infection.
The use of the antiviral drug tecovirimat was approved by the US Food and Drug Administration (FDA) in 2018 for the treatment of smallpox, although not yet for other orthopoxvirus infections, including monkeypox.
For their part, the Oxford experts indicated that “globally, we have a limited understanding of what typical monkeypox is: the common and most severe symptoms, the symptoms that cause the most distress to patients, the duration of the infectivity and possible complications.
Disease experience outside of Africa suggests a predominance of genital and perianal lesions, with new complications (such as proctitis), the Oxford infectious disease specialists said, noting that “the causes of milder disease need to be established and could be related to how the virus is transmitted.
Due to these differences, a current infection with a lower mortality rate, with milder but very painful symptoms, the Oxford researchers stated in The Lancet the need to “change the focus towards symptom relief, prevention of complications, reduction of the duration of patient isolation or prevention of the spread of the disease”.
In this sense, recent scientific evidence highlights that the way in which the disease presents in current cases differs from the traditional presentation that was known of monkeypox infection.
Since smallpox was eradicated worldwide, the antiviral was approved under the FDA’s “animal rule” regulation. TPOXX was approved for the treatment of smallpox based on efficacy data obtained from animal studies, specifically nonhuman primates infected with monkeypox virus and rabbits infected with rabbitpox virus.
However, this year the CDC produced guidance for its use under “expanded access” as an investigational drug.
Specialists stressed that they are working on clinical trials to evaluate the safety and efficacy of treatment for monkeypox
The Oxford specialists noted that clinical trials evaluating the safety and efficacy of treatment for monkeypox are being considered. Among the projects in progress, the PALM 007 randomized controlled trial of tecovirimat in the Democratic Republic of the Congo.
The study demonstrated in terms of pharmaceutical action, resolving “active lesions (presumably infectious) is an accurate measure.”
“This result was determined by analyzing several years of clinical data from patients in the Democratic Republic of the Congo with features of endemic disease in Africa and is appropriate for that context, but might be difficult to extrapolate to emerging disease phenotypes.” , clarified the researchers from the British university.
And they stressed that, even so, there is no consensus on when an injury is resolved; for example, if a scab must be present or has fallen off, or if the underlying skin or mucosa must be completely healed. Complete resolution of the lesion is essential because the prolonged presence of lesions could represent a bacterial superinfection for which antiviral treatment will not have a direct effect.
The experts said that the new trials require the scientific community to reach a consensus on important definitions that will help shape future research (such as what constitutes an active injury, a serious event, or a complication).
– missiononline.net (@misiononline) August 9, 2022