A randomized controlled trial of tecovirimat, an antiviral originally developed for smallpox, demonstrated modest benefits in treating mpox patients. The study found that while the drug reduced lesion healing time by approximately 1-2 days compared to placebo, it did not significantly impact viral clearance or prevent disease progression in severe cases. This represents the first robust clinical evidence for any mpox therapeutic, yet highlights the ongoing challenge of developing effective treatments for orthopoxvirus infections. The findings are particularly relevant given mpox's emergence as a global health concern, with outbreaks affecting diverse populations worldwide. While tecovirimat's mechanism—blocking viral egress from infected cells—works well in laboratory settings, the real-world clinical benefit appears more limited than initially hoped. The study's design and statistical power provide solid evidence, but the marginal improvement raises questions about cost-effectiveness in resource-limited settings where mpox burden is highest. Future research may need to focus on combination therapies or novel antiviral targets, as monotherapy approaches seem insufficient for dramatic clinical improvement in most patients.