Mpox Information for Healthcare Providers

Treatment

Most people get well from mpox without needing any medicines or other treatment. There is no medicine that the FDA has approved for mpox treatment. However, Tecovirimat (TPOXX or ST-246) is an antiviral medication available through an Expanded Access Investigational New Drug (EA-IND) protocol for the treatment of mpox infection.

Background on Tecovirimat

Tecovirimat, also referred to as TPOXX, is an antiviral medication approved by the United States Food and Drug Administration (FDA) for the treatment of smallpox, and is now being used to treat mpox infection under an Expanded Access Investigational New Drug (IND) protocol from the Centers for Disease Control and Prevention (CDC). It is available for children and adults as an oral capsule and IV formulation. While data are not available on the effectiveness of TPOXX in treating mpox infections in people, animal studies have shown it is effective in treating disease and reducing the risk of death from Orthopoxviruses. Clinical trials in people have shown the drug is safe with only minor side effects. One case report describes a shortened duration of illness and viral shedding in a patient who received TPOXX (Adler, 2022).

Eligibility

Your patient may be eligible for TPOXX treatment if:

• Your patient is a confirmed or high suspect mpox case AND  
  • has severe disease (e.g. hospitalized, encephalitis, confluent lesions) OR  
  • is hospitalized for mpox or other co-morbidities OR
  • has a compromised immune system (e.g., HIV1, active cancer diagnosis/treatment, 
    immunotherapy) OR
  • is over 8 years of age OR
  • is pregnant or breastfeeding OR
  • has mucous membrane involvement (e.g., eyes, mouth, anus or genitals) OR
  • has significant facial lesions at-risk for permanent scarring OR
  • has secondary complications (e.g., bacterial infection, diarrhea, dehydration, concurrent 

    disease, severe pain)

Staging TPOXX

We have staged TPOXX supply at outpatient clinics that see high numbers of high-risk patients for mpox. TPOXX supply has also been staged at major healthcare systems across the county for both inpatient and outpatient prescribing. If you are a clinician who cares for high-risk patients and are affiliated with a large healthcare system, inquire internally regarding access to TPOXX prescribing.

Expanding TPOXX Consultation Capacity

In partnership with the Banner Poison and Drug Information Center (BPDIC), clinicians without access to staged TPOXX supply can now call BPDIC at 602-747-7111 to obtain TPOXX. BPDIC will review clinical eligibility based on CDC criteria with the prescribing clinician and when appropriate submit an order for dispensing to MCDPH. MCDPH will arrange for the TPOXX course to be delivered to the prescriber.

Streamlined EA-IND Process for Prescribers

The FDA and CDC have streamlined the process for ordering TPOXX. Prescribers must obtain informed consent, complete FDA form 1572 and complete the patient intake form. All required forms can be found on the CDC website. Interval follow-up and the clinical outcome form are no longer required.

Experience with Tecovirimat in Maricopa County

Approximately 20% of people diagnosed with mpox in Maricopa County in this outbreak have been treated with TPOXX. Frequent indications include painful oral, anal or penile lesions and bacterial superinfection. It has been prescribed for about 40 patients as of August 29, 2022, many of whom have reported significant improvement after just a few days of starting treatment. There have been delays getting tecovirimat to patients given the lack of providers and facilities willing and able to prescribe this medication.

Mpox is a painful, often debilitating illness. Prompt initiation of tecovirimat can lessen suffering and reduce the risk of complications. We urge facilities and providers to take steps to be able to prescribe tecovirimat to ensure timely treatment for their patients. 

For more information, including information about supportive care for mpox, we suggest that providers visit the NYC Health Department’s Mpox Information for Providers webpage.

back to top