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Tecovirimat does not accelerate clinical resolution of skin lesions or improve mortality in mpoxTrial data shows tecovirimat does not speed mpox recovery

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Key Takeaway
Note that tecovirimat does not accelerate clinical resolution of skin lesions or improve mortality in mpox patients.

This meta-analysis evaluated the efficacy of tecovirimat in 941 patients with laboratory-confirmed mpox compared to placebo or standard care. The analysis focused on primary outcomes including time to clinical resolution of skin lesions, lesion resolution by day 28-29, and 28-day all-cause mortality.

Key findings indicate that tecovirimat did not shorten the time to clinical resolution of skin lesions (HR 1.10; 95% CI 0.52-2.31). Additionally, tecovirimat did not increase the rate of lesion resolution by day 28-29 compared with placebo (RR 1.00; 95% CI 0.92-1.08). Mortality at day 28 was reported as rare in both trials, which precluded a meta-analysis for that specific outcome. Serious adverse events were reported as comparable between treatment groups.

The authors note that mortality at day 28 was rare in both trials, limiting the ability to synthesize data on mortality. Clinical evidence currently does not support the routine use of tecovirimat to accelerate clinical recovery or improve mortality rates in patients with mpox. Further evidence is needed to determine if specific high-risk populations might benefit from antiviral therapy.

How this fits prior evidence

This meta-analysis addresses a gap in clinical management by evaluating tecovirimat for mpox. While other reports have identified capmatinib as a promising candidate for repurposing against Mpox via in silico screening, this meta-analysis provides clinical data on tecovirimat. The findings suggest that tecovirimat does not currently offer a measurable advantage in accelerating clinical recovery or improving mortality rates in patients with mpox.

When people contract mpox, the skin lesions can be painful and slow to heal. This led researchers to look closely at tecovirimat, an antiviral drug, to see if it could speed up the recovery process for those infected.

By looking at data from 941 patients with laboratory-confirmed mpox, the analysis found that tecovirimat did not shorten the time it took for skin lesions to clear. It also did not increase the number of people whose lesions resolved by day 28 or 29 when compared to a placebo.

While the drug was found to be comparable in terms of serious side effects, the evidence suggests it is not currently supported for routine use to accelerate recovery. Because deaths were rare in the trials studied, researchers could not fully measure its impact on survival rates. More research is still needed to see if specific high-risk groups might benefit from antiviral treatments.

What this means for you:
Tecovirimat does not speed up the healing of skin lesions or improve survival rates for mpox patients.

Common questions

Does tecovirimat help skin lesions heal faster?

No, the data shows that tecovirimat did not shorten the time it took for skin lesions to clear compared to a placebo. It also did not increase the number of patients who saw their lesions resolve by day 28 or 29. Because of this, current evidence does not support using it to speed up recovery.

Is tecovirimat safe for people with mpox?

In the trials reviewed, serious adverse events were comparable between the groups that received tecovirimat and those that did not. While it was comparable in safety, it did not show a significant benefit in healing speed or survival rates for patients with laboratory-confirmed mpox.

Does tecovirimat improve survival rates for mpox?

Mortality at day 28 was rare in both trials studied. Because deaths were so rare in the groups, researchers could not perform a full analysis to see if the drug improved survival. More research is needed to see if high-risk populations might benefit from antiviral therapy.

Study Details

Study typeMeta analysis
Sample sizen = 941
EvidenceLevel 1
PublishedNov 2026
View Original Abstract ↓
Tecovirimat has been widely used for the treatment of mpox despite limited evidence supporting its efficacy. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of tecovirimat for this purpose. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to June 5, 2026 for RCTs comparing tecovirimat with placebo or standard care in patients with laboratory-confirmed mpox. Primary outcomes were time to clinical resolution of skin lesions, clinical resolution by day 28-29, and 28-day all-cause mortality. Hazard ratios (HRs) and risk ratios (RRs) were pooled using random-effects models with restricted maximum likelihood estimation and Hartung-Knapp-Sidik-Jonkman adjustment. Risk of bias was assessed using RoB 2 and certainty of evidence using GRADE. Two low-risk-of-bias RCTs involving 941 participants were included. Tecovirimat did not shorten the time to clinical resolution of skin lesions compared with placebo (HR 1.10, 95% CI 0.52-2.31, GRADE: moderate) or increase the lesion resolution by day 28-29 (RR 1.00, 95% CI 0.92-1.08, GRADE: high). No statistical heterogeneity was observed (I = 0% for both outcomes). Mortality at day 28 was rare in both trials, precluding meta-analysis. Virological clearance, pain-related outcomes, and serious adverse events were also comparable between treatment groups. In conclusion, current randomized evidence does not support routine tecovirimat use to accelerate clinical recovery or improve mortality rates in patients with mpox, while further evidence is needed to determine whether selected high-risk populations may benefit from antiviral therapy.
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