Treatment
MPXV usually causes mild symptoms and most patients recover without treatment. However, in severe cases of MPX, supportive care, symptom management, and treatment of secondary bacterial infections remain the main recommendations [57]. No effective antiviral therapy has been identified yet, however, some antiviral drugs for Smallpox can also be used for MPX [7]. Tecovirimat (ST-246) was first proposed as an antiviral candidate for the treatment of orthopoxvirus infections in 2005 [67]. Studies have proven that treatment with Tecovirimat is effective in animal models and human cases, with a significant reduction in mortality [68,69]. Tecovirimat has been approved by the FDA for use in the treatment of MPX during outbreaks [70]. F13/VP37, the viral structural protein of MPXV, plays an essential role in the formation of cell-associated enveloped viruses prior to viral release. Tecovirimat inhibits the spread of the virus within the infected host by inhibiting F13/VP37 [71]. Some studies have now demonstrated the potential of drugs targeting inhibition of the MPXV-F13 protein for the successful treatment of MPXV, although additional in vitro and in vivo experiments are still necessary [72,73]. Cidofovir is a broad-spectrum antiviral drug effective against almost all DNA viruses, and its anti-MPXV activity in vivo has been demonstrated in different monkey infection models [74]. However, cidofovir is only effective in preventing death if given before the onset of the rash [75]. Because cidofovir causes significant nephrotoxicity and has limited efficacy data in human MPX, the use of this drug is likely to remain limited to the treatment of severe cases [27]. CMX001 and Brincindofovir, as cidofovir derivatives, block orthopoxvirus DNA polymerase-mediated viral DNA synthesis. These drugs have a better renal safety profile compared to cidofovir. A UK report found that seven patients recovered completely from MPX infection after treatment with Brincindofovir, although three of them developed elevated alanine transaminases [58]. Vaccinia Immune Globulin Intravenous can be used to treat MPX during outbreaks and complications due to vaccinia vaccination [7].