The ongoing mpox outbreak in Central Africa has taken a troubling turn as a promising antiviral treatment, tecovirimat (TPOXX), has failed to deliver results in a significant clinical trial conducted in the Democratic Republic of the Congo (DRC). This trial, sponsored by the US National Institute of Allergy and Infectious Diseases (NIAID), was aimed at determining the drug’s effectiveness in alleviating symptoms associated with mpox. However, the initial findings, released earlier this month, revealed that tecovirimat did not reduce the severe blisterlike rash characteristic of the infection.

Urgency and Global Health Emergency
Lori Dodd, head of NIAID’s clinical trials research and statistics branch, emphasized the urgency of sharing these early results due to the critical need for scientific evidence in treating mpox. The World Health Organization’s (WHO) designation of the Central African mpox outbreak as a global health emergency on August 14 underscores the severity of the situation, marking the second such declaration in two years.

Escalating Crisis in Central Africa
The trial’s disappointing outcomes come as Central African nations grapple with rising mpox cases. As of August 25, 13 African countries have reported a total of 20,720 confirmed or suspected cases, resulting in 582 deaths, according to the Africa Centres for Disease Control and Prevention.

Strategic Plan to Combat Mpox
In response, the WHO has launched a six-month, $135 million strategic plan to curb the outbreak, focusing on enhancing surveillance, expanding access to testing, and improving vaccine distribution. WHO Director-General Tedros Adhanom Ghebreyesus expressed optimism, stating that the outbreaks in the DRC and neighboring countries can still be controlled.

Clinical Trial Results and Future Implications
The trial in the DRC involved nearly 600 participants who were randomly assigned to receive either tecovirimat or a placebo, with all patients receiving comprehensive supportive care. Despite the drug’s safety, it did not outperform the placebo in reducing lesions. Interestingly, overall mortality in the trial was lower than expected, with a 1.7% mortality rate among participants, compared to the 3.6% rate typically reported in the DRC.