Monkeypox treatment with tecovirimat in the Central African Republic under an Expanded Access Programme

BackgroundThere is currently no specific treatment recommended for monkeypox. This expanded access programme (EAP) aims to provide tecovirimat to patients with monkeypox and collect data on patient treatment, disease evolution and outcomes under a protocol to contribute to the evidence-base for the use of the drug for monkeypox. MethodsPatients with confirmed monkeypox received tecovirimat according to the recommended dosing. Data on clinical signs and symptoms were recorded daily during treatment and at follow-up visits. Blood or lesion samples were taken during treatment and at day 28 to assess viral presence of monkeypox by PCR. As tecovirimat is administered via an EAP, outcome measures were not predefined. Adverse events and clinical outcomes were monitored by evaluating the total number and location of lesions, temperature, degree of incapacity, presence of adverse events, patient survival, and viral presence throughout treatment and follow-up. ResultsWe report outcomes in 14 patients who were enrolled between December 2021 and February 2022. Muscle pain, headache, lymphadenopathy, lesions, fever, back pain, and upper respiratory symptoms were commonly reported at admission and during follow-up. The rate of appearance of active lesions gradually decreased throughout treatment, with the median time to no new lesions being 5 days following the start of treatment. No death attributable to monkeypox occurred in this cohort. ConclusionsData collected through this EAP can help improve our knowledge about the use of tecovirimat for monkeypox. We have been able to document systematically the presentation and clinical and virological evolution of monkeypox under treatment. Registration numberISRCTN43307947