{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:46:48Z","timestamp":1785257208292,"version":"3.55.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"University of Toronto Emerging and Pandemic Infections Consortium"},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MRR-184812"],"award-info":[{"award-number":["MRR-184812"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","award":["CRC-950-232643"],"award-info":[{"award-number":["CRC-950-232643"]}],"id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tecovirimat is an antiviral drug that was used compassionately for treating mpox in high-income settings during the 2022 global outbreak. Randomized controlled trials of its efficacy have not yet been completed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To describe medication adherence, tolerability and clinical outcomes of adults receiving open-label tecovirimat for mpox infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a prospective observational study and a retrospective case series of adults with mpox cared for at three academic hospitals in Toronto, Canada, between May and August 2022. We present a descriptive analysis of those prescribed oral tecovirimat 600\u2005mg twice daily for 14\u2005days for the management of severe manifestations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 69 consenting participants, all were cisgender men, of whom 60 (87%) identified as gay, and 6 (9%) as bisexual. Nearly half (46%) were living with HIV, with a median (IQR) CD4 count of 468 (328\u2013678)\u2005cells\/mm3, among whom plasma HIV RNA was &amp;lt;20\u2005copies\/mL in 29 (91%) participants. One-third (33%) of participants received tecovirimat during the course of their illness. All participants experienced a decline in number of symptoms over time, but three treated participants initially experienced worsening symptoms despite therapy. Self-reported adherence to tecovirimat was excellent and tolerability was good.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our experience prescribing tecovirimat for mpox suggests it is safe and well tolerated, but the evolution of symptoms in some tecovirimat-treated patients underscores the ongoing uncertainty regarding its efficacy. In the context of considerable community demand for the drug, efforts should be made to connect mpox patients to rigorous randomized controlled trials, given this ongoing clinical equipoise.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkaf010","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T04:18:47Z","timestamp":1737433127000},"page":"935-940","source":"Crossref","is-referenced-by-count":5,"title":["Early clinical experience using tecovirimat during the 2022 mpox epidemic in Toronto underscores ongoing clinical equipoise and the need for randomized trials"],"prefix":"10.1093","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5674-677X","authenticated-orcid":false,"given":"Shreya S","family":"Khera","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, St. Michael\u2019s Hospital , 30 Bond St., Toronto, Ontario M5B 1W8 ,","place":["Canada"]},{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital, Li Ka Shing Knowledge Institute , 209 Victoria Street, 3rd floor, Toronto, Ontario M5B 1T8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmistha","family":"Mishra","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, St. Michael\u2019s Hospital , 30 Bond St., Toronto, Ontario M5B 1W8 ,","place":["Canada"]},{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital, Li Ka Shing Knowledge Institute , 209 Victoria Street, 3rd floor, Toronto, Ontario M5B 1T8 ,","place":["Canada"]},{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]},{"name":"Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto , 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 ,","place":["Canada"]},{"name":"Institute of Medical Science, University of Toronto , 6 Queen\u2019s Park Crescent, Suite 119, Toronto, Ontario M5S 3H2 ,","place":["Canada"]},{"name":"Institute for Clinical Evaluative Sciences , V1-06 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar Javier","family":"Pico Espinosa","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, St. Michael\u2019s Hospital , 30 Bond St., Toronto, Ontario M5B 1W8 ,","place":["Canada"]},{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital, Li Ka Shing Knowledge Institute , 209 Victoria Street, 3rd floor, Toronto, Ontario M5B 1T8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Gough","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, St. Michael\u2019s Hospital , 30 Bond St., Toronto, Ontario M5B 1W8 ,","place":["Canada"]},{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlie","family":"Tan","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, St. Michael\u2019s Hospital , 30 Bond St., Toronto, Ontario M5B 1W8 ,","place":["Canada"]},{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3959-5692","authenticated-orcid":false,"given":"Sharon","family":"Walmsley","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]},{"name":"Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto , 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 ,","place":["Canada"]},{"name":"Division of Infectious Diseases, Toronto General Hospital, University Health Network , 200 Elizabeth Street, Toronto, Ontario M5G 2C4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Zhabokritsky","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]},{"name":"Division of Infectious Diseases, Toronto General Hospital, University Health Network , 200 Elizabeth Street, Toronto, Ontario M5G 2C4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malika","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, St. Michael\u2019s Hospital , 30 Bond St., Toronto, Ontario M5B 1W8 ,","place":["Canada"]},{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3185-192X","authenticated-orcid":false,"given":"Adrienne K","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]},{"name":"Biological Sciences, Sunnybrook Research Institute, Sunnybrook Hospital , 2075 Bayview Ave., Toronto, Ontario M4N 3M5 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome A","family":"Leis","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]},{"name":"Biological Sciences, Sunnybrook Research Institute, Sunnybrook Hospital , 2075 Bayview Ave., Toronto, Ontario M4N 3M5 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myo Minn","family":"Oo","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital, Li Ka Shing Knowledge Institute , 209 Victoria Street, 3rd floor, Toronto, Ontario M5B 1T8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3069-2875","authenticated-orcid":false,"given":"Darrell H S","family":"Tan","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, St. Michael\u2019s Hospital , 30 Bond St., Toronto, Ontario M5B 1W8 ,","place":["Canada"]},{"name":"MAP Centre for Urban Health Solutions, St. Michael\u2019s Hospital, Li Ka Shing Knowledge Institute , 209 Victoria Street, 3rd floor, Toronto, Ontario M5B 1T8 ,","place":["Canada"]},{"name":"Department of Medicine, University of Toronto , C. David Naylor Building, 6 Queen\u2019s Park Crescent West, Third Floor, Toronto, Ontario M5S 3H2 ,","place":["Canada"]},{"name":"Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto , 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 ,","place":["Canada"]},{"name":"Institute of Medical Science, University of Toronto , 6 Queen\u2019s Park Crescent, Suite 119, Toronto, Ontario M5S 3H2 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"2025040208383485700_dkaf010-B1","doi-asserted-by":"publisher","first-page":"e0122622","DOI":"10.1128\/aac.01226-22","article-title":"New perspectives on antimicrobial agents: tecovirimat for treatment of human monkeypox virus","volume":"66","author":"DeLaurentis","year":"2022","journal-title":"Antimicrob Agents 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