Recent advances and perspectives in therapeutics for mpox

Mpox, a viral illness caused by the monkeypox virus (MPXV), has gained global attention due to its outbreaks worldwide in recent years. MPXV infections pose significant public health threats with notable transmission risks, yet specific antiviral treatments remain limited. Current therapeutic approaches primarily rely on smallpox vaccines and a limited number of broad-spectrum antiviral agents, such as tecovirimat, lacking specific drugs against MPXV. Thus, it remains a significant clinical need to develop anti-MPXV agents for the prevention and control of mpox outbreaks. In this review, we summarized the characteristics of MPXV in terms of viral structure, genome, and replication while reporting the recent progress in the development of small molecule anti-MPXV agents. Additionally, we discussed major obstacles in anti-MPXV drug development, including insufficient understanding of virus biology, the lack of reliable disease models, and limited resources for conducting large-scale clinical evaluations, and provided insights and perspectives for anti-MPXV therapies, with the aims of accelerating the development of effective treatments and contributing to preparedness against emerging orthopoxvirus threats.