Emerging treatments

Vaccinia immune globulin (VIG)

Intravenous VIG (also known as VIGIV) 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. In the US, VIG can be used for the treatment of mpox under an expanded access protocol in the context of an outbreak. Patients who receive VIG typically also receive tecovirimat and either brincidofovir or cidofovir concomitantly. VIG can also be considered for postexposure prophylaxis to prevent mpox in an exposed person with severe immunocompromise or who has a contraindication to mpox vaccination. It is available upon clinical request to the Centers for Disease Control and Prevention (CDC) on a case-by-case basis.[231] 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.[316] 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.[317] Another small prospective clinical trial found that topical cidofovir appears to be most useful for lesions on the trunk and limbs.[318]​ Further research is required.

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