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MonkeypoxPhase 3UNITYNCT05597735

Assessment of the Efficacy and Safety of Tecovirimat in Patients With Monkeypox Virus Disease

A Phase 3 study testing Tecovirimat in people with Monkeypox and Mpox, run by ANRS, Emerging Infectious Diseases at 12 sites in 3 countries.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The overall purpose of this study is to evaluate whether tecovirimat is an efficient and safe antiviral in the treatment of monkeypox in adults and adolescents (14 years old and older). Read more about this study

Who is it for?
Ages 14 years and older
Conditions the study is for
Monkeypox, Mpox
What is being tested?
Tecovirimat
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
480 participants
Where
12 sitesin 3 countries
Study dates
3 Mar 2023to 30 Sep 2026
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 14 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Adults and adolescents (14 years old and older) with laboratory-confirmed (PCR if available) or highly suspected monkeypox virus infection of any duration
  • At least one visible active skin or mucosal lesion
  • Reachable via smartphone (for video calls) for outpatient participants
  • Signed informed consent

Who cannot join

  • Current or planned use of another investigational drug at any point during study participation.
  • Ongoing treatment which cannot be interrupted and for which a major interaction has been described with tecovirimat
  • Patients who, in the judgement of the investigator, will be at significantly increased risk as a result of participation in the study (for example: if the investigator judges that an antiviral treatment is indicated in the framework of compassionate therapeutic access in Switzerland).
  • Hypersensitivity to tecovirimat

Trial locations and contacts

12 sites in 3 countries.

12 sites in 3 countries

Brazil7 sites
  • Faculty of Medicine, Federal University of Minas Gerais

    Belo Horizonte

  • Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation-FIOCRUZ

    Rio de Janeiro

  • Federal Hospital for State Employees

    Rio de Janeiro

  • Nova Iguaçu General Hospital

    Rio de Janeiro

  • University Hospital Prof. Edgard Santos

    Salvador

  • Emílio Ribas Institute of Infectious Diseases

    São Paulo

  • STD/AIDS Reference and Training Center

    São Paulo

Other trials in Brazil

Switzerland4 sites
  • Hôpitaux Universitaires de Genève

    Geneva, Canton of Geneva, 1211

  • Pr Alexandra Calmy

    Geneva, Canton of Geneva, 1211

  • CHUV

    Lausanne, Canton of Vaud, 1010

  • Zürich checkpoint

    Zurich, Canton of Zurich

Other trials in Switzerland

Argentina1 site
  • Fundación Huésped

    Buenos Aires, C1204ABB

Other trials in Argentina

About this study

Official title: A Phase III, Multi-country, Randomized, Placebo-controlled, Double-blinded Trial to Assess the Efficacy and Safety of Tecovirimat Antiviral Treatment for Patients With Monkeypox Virus Disease

The overall purpose of this study is to evaluate whether tecovirimat is an efficient and safe antiviral in the treatment of monkeypox in adults and adolescents (14 years old and older).

The primary objective is to evaluate the clinical efficacy, as assessed by time to all visible lesion(s) resolution, of tecovirimat treatment + Standard of Care (SOC) compared to placebo + SOC for patients with monkeypox.

The secondary objective is to evaluate the clinical efficacy, as assessed by mortality, hospitalization, complications, duration of symptoms and virological shedding, and the safety of tecovirimat treatment + SOC compared to placebo + SOC in patients with monkeypox.

Read the detailed description

The study presented here is the Swiss-Brazil co-sponsored adaptation of the UNITY trial based on the WHO core protocol. It has an original governance to better respond to public health priorities, each country being its own sponsor, allowing for an easier scale-up of the trial and local adaptations of the protocol.

Background and rationale:

Monkeypox is an emerging viral zoonosis caused by a virus of the same name that is closely related to smallpox. It is usually endemic in central and West Africa but since May 2022, the virus has rapidly disseminated to Europe, North and South America, Africa and Australia, and has predominantly affected gay, bisexual and other men who have sex with men (MSM) with multiple partners. On 23 July 2022, the World Health Organization (WHO) declared that the monkeypox outbreak was an international public health emergency. In particular, the WHO called for the use of antivirals for the treatment of monkeypox cases. This declaration must therefore be translated not only into extraordinary public health measures but also as a call for greater investment in research.

This study proposal is a national adaptation for Switzerland and Brazil based on the 'CORE protocol' developed by the WHO. The research team would like to emphasize that this randomized trial is international in scope. Thus, they are joining forces to achieve a more effective and rapid response to important questions, with a harmonized follow-up and in a time frame that can be useful to the patients the medical staff have been caring for since the very beginning of this epidemic. Candidate antivirals are already available for testing in monkeypox. The first studied treatment in this adaptative trial is the antiviral tecovirimat. Tecovirimat (TPOXX®, SIGA Technologies Inc.) is a treatment for smallpox, monkeypox and cowpox. Tecovirimat is approved by the European Medicine Agency (EMA) for this indication for adults and children weighing at least 13 kg, as well as by the United States Food and Drugs Administration (FDA) under expanded access investigational new drug protocol, but it is not yet approved in Switzerland and Brazil.

Objectives:

This study aims to evaluate whether tecovirimat is an efficient and safe antiviral in the treatment of monkeypox in adults and adolescents (14 years old and over).

The primary objective is to evaluate the clinical efficacy of tecovirimat treatment + standard of care (SOC) compared to placebo + SOC for patients with monkeypox as assessed by time to visible lesion(s) resolution. The secondary objectives are to evaluate the clinical efficacy and safety of tecovirimat treatment + SOC compared to placebo + SOC in patients with monkeypox as assessed by mortality, hospitalization, complications, duration of symptoms and virological shedding.

Methods:

This study will include adult and adolescent patients aged ≥14 years with a confirmed or highly suspected monkeypox virus infection and with at least one visible active skin or mucosal lesion. Individuals with a known hypersensitivity to tecovirimat, who are taking medications which cannot be interrupted and for which a major interaction has been described or who, in the judgement of the investigator, will be at significantly increased risk as a result of participation in the study will not be included. Randomization will be in a ratio of 1:1 to either tecovirimat treatment combined with SOC or to placebo combined with SOC. All participants will be followed-up until day 29 and additionally at day 60 for those who accept this last optional follow-up visit.

Outcome:

The primary outcome is the time for all visible lesions (skin, mucosal) to heal with a new fresh layer of skin re-epithelialization (i.e. resurfacing of a wound with a new epithelium layer).

Expected results:

The hypothesis is that prompt oral treatment with tecovirimat will result in a reduction of the duration of illness in patients with monkeypox that may correlate with the duration of contagiousness. It is expected that tecovirimat will be well tolerated and acceptable for these patients.

Conditions
Monkeypox, Mpox
Being tested
Tecovirimat, Placebo
Keywords
Tecovirimat, Antiviral agent
Medical subject headings
Mpox, Monkeypox

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TecovirimatDrug

    The experimental intervention is tecovirimat, available as immediate-release capsules containing tecovirimat monohydrate, equivalent to 200 mg of tecovirimat. The route of administration of tecovirimat is oral. Tecovirimat treatment will be initiated as soon as possible after diagnosis.

    The international recommended doses will be followed:

    • 25 kg to less than 40 kg: 400 mg (two tecovirimat 200 mg capsules) every 12 hours for 14 consecutive days.
    • 40 kg and above: 600 mg (three tecovirimat 200 mg capsules) every 12 hours for 14 consecutive days.
  • PlaceboDrug

    The control intervention is a placebo and its route of administration will be identical to the experimental intervention administration to allow treatment arm blinding.

Study groups in NCT05597735
Study groupRoleWhat they receive
TecovirimatExperimentalNot described
Receives: Drug: Tecovirimat
PlaceboPlacebo comparatorNot described
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time to all visible lesion(s) resolution

    Time for all visible lesions (skin, mucosal) to heal with a new fresh layer of skin re-epithelialization (i.e resurfacing of a wound with a new epithelium layer). For skin lesions, typically this means the lesion has scabbed, desquamated and new layer of skin has been formed. For mucosal lesions, the phase of scabbing and desquamation is absent, and healing with new layer of skin ensues.

    Measured: 28 days

Secondary outcomes (6)
  1. All-cause mortality within the first 28 days (applied to all patients)

    All-cause mortality is more reliably measured than monkeypox-specific mortality. It is easy to measure and is reliable.

    Measured: 28 days

  2. All-cause unplanned admission to hospital within first 28 days (applies to outpatients)

    Most patients will be managed at home or in community and this outcome is an important patient-centered and health system outcome. All-cause is easier to measure than monkeypox specific and will ease data burden.

    Measured: 28 days

  3. Occurrence of patients with a complication within first 28 days (applies to all patients who did not already have a complication at baseline)

    Complications include secondary bacterial skin infection (cellulitis, abscess, necrotizing fasciitis, need for antibiotics), severe pain, ocular impairment (e.g. keratitis), neurologic impairment (e.g. encephalitis) or mental health disturbance, confusion, cardiac impairment (e.g. cardiomyopathy, myocarditis), severe dehydration, and genitourinary complications as urinary retention. Progression to complications is an important patient-centered outcome and an important health system outcome to prepare and anticipate clinical services for monkeypox cases. It is easy to measure, as long as definitions are clear, and the relevant staff is trained. Complications will be differentiated based on drug-related complications and disease-related complications.

    Measured: 28 days

  4. Time to resolution of symptoms and signs within first 28 days (applies to all patients)

    Symptoms include fatigue, malaise, nausea, vomiting, abdominal pain, anorexia, cough, dysphagia, odynophagia, fever, headache, oral pain, pain with urination, rectal/anal pain. Signs include lymphadenopathy, ocular lesions, pharyngitis, urethritis, and proctitis. Collection of symptoms and signs can be useful to understand the clinical characterization.

    Measured: 28 days

  5. Viral clearance up to 28 days after randomization

    Occurrence of negative oropharyngeal , rectal swab, and skin swab PCR results, respectively, 7, 14, 21 days and 28 days after randomization. Viral clearance assessment is important to evaluate whether treatment is also a route for reducing transmission.

    Measured: 28 days

  6. Frequency of adverse events (AEs) and serious adverse events (SAEs) for specific therapeutics (applies to all patients)

    The collection of standardized data of adverse events is of importance in order to increase the understanding of safety and tolerability of the treatment.

    Measured: 60 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Oct 2022
  2. Study start3 Mar 2023
  3. Primary completion30 Sep 2026 (estimated)
  4. Study completion30 Sep 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized, Placebo-controlled, Double-blinded Trial
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
480 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05597735
Sponsor's protocol ID
2022-01579
Acronym
UNITY
Status last verified
May 2026
First submitted
27 Oct 2022
Last updated
26 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, Palich R, Nori A, Reeves I, Habibi MS, Apea V, Boesecke C, Vandekerckhove L, Yakubovsky M, Sendagorta E, Blanco JL, Florence E, Moschese D, Maltez FM, Goorhuis A, Pourcher V, Migaud P, Noe S, Pintado C, Maggi F, Hansen AE, Hoffmann C, Lezama JI, Mussini C, Cattelan A, Makofane K, Tan D, Nozza S, Nemeth J, Klein MB, Orkin CM; SHARE-net Clinical Group. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022 Aug 25;387(8):679-691. doi: 10.1056/NEJMoa2207323. Epub 2022 Jul 21.

    PubMed 35866746
  • Girometti N, Byrne R, Bracchi M, Heskin J, McOwan A, Tittle V, Gedela K, Scott C, Patel S, Gohil J, Nugent D, Suchak T, Dickinson M, Feeney M, Mora-Peris B, Stegmann K, Plaha K, Davies G, Moore LSP, Mughal N, Asboe D, Boffito M, Jones R, Whitlock G. Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis. Lancet Infect Dis. 2022 Sep;22(9):1321-1328. doi: 10.1016/S1473-3099(22)00411-X. Epub 2022 Jul 1.

    PubMed 35785793
  • Siegrist EA, Sassine J. Antivirals With Activity Against Mpox: A Clinically Oriented Review. Clin Infect Dis. 2023 Jan 6;76(1):155-164. doi: 10.1093/cid/ciac622.

    PubMed 35904001
  • Smith SK, Self J, Weiss S, Carroll D, Braden Z, Regnery RL, Davidson W, Jordan R, Hruby DE, Damon IK. Effective antiviral treatment of systemic orthopoxvirus disease: ST-246 treatment of prairie dogs infected with monkeypox virus. J Virol. 2011 Sep;85(17):9176-87. doi: 10.1128/JVI.02173-10. Epub 2011 Jun 22.

    PubMed 21697474
  • O'Laughlin K, Tobolowsky FA, Elmor R, Overton R, O'Connor SM, Damon IK, Petersen BW, Rao AK, Chatham-Stephens K, Yu P, Yu Y; CDC Monkeypox Tecovirimat Data Abstraction Team. Clinical Use of Tecovirimat (Tpoxx) for Treatment of Monkeypox Under an Investigational New Drug Protocol - United States, May-August 2022. MMWR Morb Mortal Wkly Rep. 2022 Sep 16;71(37):1190-1195. doi: 10.15585/mmwr.mm7137e1.

    PubMed 36107794
  • Desai AN, Thompson GR 3rd, Neumeister SM, Arutyunova AM, Trigg K, Cohen SH. Compassionate Use of Tecovirimat for the Treatment of Monkeypox Infection. JAMA. 2022 Oct 4;328(13):1348-1350. doi: 10.1001/jama.2022.15336.

    PubMed 35994281
  • Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM; NHS England High Consequence Infectious Diseases (Airborne) Network. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022 Aug;22(8):1153-1162. doi: 10.1016/S1473-3099(22)00228-6. Epub 2022 May 24.

    PubMed 35623380
  • Carvalho T. The unknown efficacy of tecovirimat against monkeypox. Nat Med. 2022 Nov;28(11):2224-2225. doi: 10.1038/d41591-022-00094-0. No abstract available.

    PubMed 36100750
  • Merchlinsky M, Albright A, Olson V, Schiltz H, Merkeley T, Hughes C, Petersen B, Challberg M. The development and approval of tecoviromat (TPOXX(R)), the first antiviral against smallpox. Antiviral Res. 2019 Aug;168:168-174. doi: 10.1016/j.antiviral.2019.06.005. Epub 2019 Jun 7.

    PubMed 31181284

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Tecovirimat in people with Monkeypox and Mpox, run by ANRS, Emerging Infectious Diseases at 12 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 26 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 12 sites in Brazil, Switzerland, Argentina. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to all visible lesion(s) resolution (time frame: 28 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05597735, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 May 2026.

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