抗天花病毒药物特考韦瑞(tecovirimat)的功效与作用及副作用？

Anti-smallpox virus drug-tecovirimat

It is an orthopoxvirus-specific antiviral drug jointly developed by SIGA Technologies and the Biomedical Advances Research and Development Administration of the U.S. Department of Health and Human Services.

In July 2018, oral tecovirimat was approved in the United States for the treatment of human smallpox disease caused by variola virus in adults and pediatric patients weighing ≥13 kg.

Tecovirimat is approved under the animal regulations of the U.S. Food and Drug Administration, where marketing approval is based on its efficacy in relevant animal models. In addition, an intravenous preparation of tecovirimat for the treatment of smallpox infection is also on the market.

Efficacy and role of tecovirimat

1. Prevent virus spread: Tecovirimat works by inhibiting the activity of orthopoxvirus VP37 envelope protein, thereby preventing the formation of enveloped virions with the ability to exit, which is crucial for the spread of the virus in the host.

2. Inhibition of envelope proteins: The only approved treatment for human smallpox disease in the EU is the oral administration of the small molecule tecovirimat, which inhibits the function of the main envelope protein required for extracellular virus production in orthopoxviruses.

3. Antiviral effect: Tecovirimat is an antiviral drug originally developed for smallpox virus (VARV) and is used to treat smallpox infection. Due to its mechanism of action, it is active against the orthopoxvirus family, including vaccinia and human monkeypox virus (HMPXV).

4. Relieve symptoms: Tecovirimat can block the spread of smallpox and relieve symptoms such as macules, papules, herpes, pustules, and fever caused by smallpox.

Tecovirimat side effects

1. Nausea, diarrhea, vomiting, dry mouth, abdominal pain, chapped lips, indigestion, fever, and abnormal oral sensation.

2. General and administration site: fever, headache, pain, chills, pain at the administration site, swelling at the administration site, irritation at the administration site, etc.

3. Musculoskeletal and connective tissue: joint pain, osteoarthritis.

4. Nervous system: migraine, attention disorder, taste disorder, and paresthesia.

5. Psychiatry: depression, irritability, irritability, panic attacks.

6. Respiratory, thoracic and mediastinal diseases: oropharyngeal pain.

7. Skin and subcutaneous tissue: palpable purpura, rash, facial redness, facial swelling, and itching.

Measures for dealing with side effects

1. Nausea: It is recommended that patients eat a light diet and avoid greasy food. At the same time, attention should be paid to maintaining a hygienic living environment to avoid odor stimulation and aggravating nausea.

2. Headache: Patients with headache should pay attention to rest, avoid overexertion, maintain adequate sleep, and use analgesics such as ibuprofen if necessary.

3. Vomiting: If the patient has vomiting symptoms, he should increase the amount of water he drinks to avoid dehydration. Antiemetic drugs can be used under the guidance of a doctor.

4. Abdominal pain: Avoid eating spicy, irritating, cold foods, and keep your abdomen warm to avoid aggravating abdominal pain symptoms.

The therapeutic effect of tecovirimat

Background: In May 2022, multiple non-endemic countries reported multi-country MPOX epidemics. The only licensed MPOX treatment in the EU is the oral small molecule tecovirat.

Methods: All MPOX patients who received tecovirmat in Germany during the outbreak from May 2022 to March 2023 were identified, and demographic and clinical characteristics were obtained through a standardized case report form.

Results: During the study period, a total of 12 MPOX patients in Germany received tecovirmat. All but one of the patients were identified as men who have sex with men, who likely contracted the MPOX virus through sexual contact. Eight of them were people living with HIV (PLWH), one of whom was newly diagnosed with HIV while receiving mpox, and four had CD4+ counts below 200.

Criteria for treatment with tecovirimat include severe immunosuppression, severe systemic and/or persistent symptoms, massive or increasing lesions, and the type and location of the lesions (e.g., facial or oral soft tissue involvement, impending epiglottitis, or tonsil swelling). Patients received tecovirmat for 6 to 28 days. Treatment was generally well tolerated, with all patients demonstrating clinical response.

Conclusion: In a cohort of 12 patients with severe MPOX, treatment with tecovirmat was well tolerated and all patients showed clinical signs.

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