Emerging treatments

Vaccinia immune globulin (VIG)

Intravenous VIG is licensed in some countries for the treatment of complications due to vaccinia vaccination with first- or second-generation vaccines (i.e., eczema vaccinatum, progressive vaccinia, severe generalized vaccinia, vaccinia infection in people with skin conditions, aberrant infections induced by vaccinia virus). It is unknown whether people exposed to mpox or with severe mpox would benefit from VIG. It should be used only in a clinical research context with prospective data collection.[1] In the US, VIG can be used for the treatment of severe cases of mpox under an expanded access protocol in the context of an outbreak. It can also be considered for postexposure prophylaxis in an exposed person with severe immunodeficiency in T-cell function for which vaccination following exposure to mpox is contraindicated. It is available upon clinical request to the Centers for Disease Control and Prevention on a case-by-case basis.[229] VIG may be stockpiled in countries for use during an outbreak. 

NIOCH-14

NIOCH-14, an analog of tecovirimat, is an investigational oral antiviral agent with in vitro and in vivo activity against orthopoxviruses.[321] Animal challenge studies showed a significant reduction in virus production in the lungs of infected animals when compared with controls. However, the clinical efficacy for the treatment of mpox is uncertain.[1]​ NIOCH-14 is licensed in the Russian Federation for the treatment of mpox.

Topical cidofovir

Cidofovir is an antiviral agent used intravenously for the treatment of mpox. Topical cidofovir is being investigated as a potential treatment as it may avoid the adverse effects associated with systemic administration (e.g., nephrotoxicity). A small prospective clinical trial demonstrated a statistically significant reduction in the median time to resolution of skin lesions in patients treated with topical cidofovir (used on a compassionate use basis) compared with symptomatic treatment with analgesia. However, local adverse effects (e.g., irritation, erosions) were frequent, especially in the anogenital region.[322] Another small prospective clinical trial found that topical cidofovir appears to be most useful for lesions on the trunk and limbs.[323]​ Further research is required.

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