Use of tecovirimat for the treatment of mpox infection in a kidney transplant recipient

With the outbreak of mpox reaching a global spread, concerns about the possible effects of the infection on the population of immunocompromised patients—including solid organ transplant recipients—have increased. The antiviral drug tecovirimat—an inhibitor of the viral envelope protein p37—blocks the ability of mpox virus particles to be released from infected cells. In the study by Desai et al, 1 Desai A.N. Thompson G.R. Neumeister S.M. Arutyunova A.M. Trigg K. Cohen S.H. Compassionate use of tecovirimat for the treatment of monkeypox infection. JAMA. 2022; 328: 1348-1350https://doi.org/10.1001/jama.2022.15336 Crossref PubMed Scopus (51) Google Scholar 25 patients with confirmed mpox infection received tecovirimat as a compassionate use treatment; of them, 9 were positive for HIV; however, no transplant recipient was included. Transplant patients with mpox are expected to be particularly vulnerable to adverse events caused by potential interactions of tecovirimat—an inducer of cytochrome P450 3A—with immunosuppressants (eg, Mammalian target of rapamycin (mTOR) inhibitors and calcineurin inhibitors). 2 Summary of product characteristics. European Medicines Agency. Accessed December 10, 2022. https://www.ema.europa.eu/en/documents/product-information/tecovirimat-siga-epar-product-information_en.pdf. Google Scholar In this scenario, patients should be monitored closely for possible alterations in immunosuppression and the risk of organ rejection. Here we describe the safety of tecovirimat use in a kidney transplant recipient who developed a progressive mpox infection. Blood trough levels of tacrolimus were subsequently monitored.