Antiviral Drugs for Treatment of Human Monkeypox: A Systematic Review/Meta-analysis

Background. On 23 July 2022, the World Health Organization declared a Public Health Emergency of International Concern. Monkeypox is a zoonotic viral disease caused by the monkeypox virus that is transmitted from animals to humans or from human to human. To date, treatment for human monkeypox is mostly symptomatic, as there is no specific standard antiviral treatment. Persons with severe symptoms and signs, immunocompromised patients, children younger than 8 years, and pregnant individuals should be considered for specific antiviral treatment. Objective. This study aims to assess effectiveness of antiviral drugs in treatment of human monkeypox. Methodology. Published clinical trials and cohort studies on the role of antivirals in the management of human monkeypox that were identified through a comprehensive search of electronic databases up to April 1, 2023. The patients included were children and adults confirmed with monkeypox. The diagnosis was based on PCR or clinical symptoms. The intervention was antivirals administration in human monkeypox patients, versus supportive treatment/placebo. Outcome measured include the duration of monkeypox until recovery, need for hospitalization, and ICU admission. Results. We included four completed studies with 195 participants assessing the safety, pharmacokinetics, and efficacy of antiviral treatments for human monkeypox compared to placebo. Three studies investigated Tecovirimat (st-246), and one investigated Brincidofovir. Both drugs were safe, tolerable, and effective with no serious adverse effects. The other 5 studies were not completed and are ongoing. Conclusion. There are currently no approved antivirals for the treatment of monkeypox; some medications could be authorized for outbreak use and are now under investigation, such as Tecovirimat, Cidofovir, and Brincidofovir.