214. Clinical Characteristics and Outcomes of Patients Treated with Tecovirimat for Mpox Disease: A Large Cohort in New York City

Abstract Background Clinical characteristics and outcomes in patients with mpox treated with tecovirimat are not well described. Methods We requested retrospective deidentified data from healthcare systems in New York City (NYC) with >50 tecovirimat prescriptions. Patients with probable or confirmed mpox initiating tecovirimat from May–December 2022 were included. We used a survey tool to extract demographic and clinical data from medical records. Patients reporting tecovirimat initiation at a different institution or with unknown HIV status were excluded. We used multivariable Poisson regression models with robust standard errors to examine factors associated with hospitalization and treatment delays. Results Of 751 eligible records, we excluded 41, leaving 708 patients in the analysis; median age was 36 years (IQR 31–43); 694 (98%) were assigned male at birth; 566 (80%) were cisgender men who have sex with men; 399 (56%) were living with HIV; and 232 (33%), 195 (28%), and 182 (26%) identified as Hispanic, non-Hispanic (NH) white, and NH Black, respectively. Reasons for treatment included proctitis (n=376, 53%), lesion type (confluent, location) (335, 47%), HIV (237, 33%), and bacterial superinfection (58, 8%). Side effects (100, 14%) and severe adverse events (7, 1%) were rare. The most common long-term sequela was scarring (69,10%) (Table 1). Of 100 (14%) hospitalized patients, reasons for hospitalization included pain (25%), bacterial superinfection (22%), and dysphagia (13%) (Table 2). Median delay from symptom onset to treatment initiation was 8 days (IQR 6–11). NH Black patients had higher risk of initiating ≥8 days after symptom onset (adjusted relative risk [aRR]=1.4, 95%CI: 1.2–1.7) and being hospitalized (aRR=2.2, 95%CI: 1.4–3.5) compared with Hispanic patients, adjusting for HIV and insurance status (Tables 3,4). Conclusion We described common reasons for tecovirimat initiation and hospitalization. There were racial and ethnic disparities in hospitalization and treatment delays that may have been due to late presentation to care or provider-related delayed testing. More research and focused efforts to mitigate these disparities are needed. These findings may better inform decisions for treatment initiation and hospitalization for mpox. Disclosures Ofole Mgbako, MD MS, Gilead: Advisor/Consultant