# Pocapavir for neonatal enteroviral sepsis: limitations of rapid viral sequencing on treatment decisions

## TL;DR

This paper discusses the challenges of using rapid viral sequencing to guide treatment decisions for a new antiviral drug in a neonatal enterovirus case.

## Contribution

Highlights the limitations of using genetic data to assess antiviral resistance in real-time clinical settings.

## Key findings

- Sequencing did not provide clear evidence of pocapavir resistance in the viral isolate.
- Clinical improvement could not be definitively linked to pocapavir treatment.
- The case illustrates difficulties in interpreting genomic data for treatment decisions.

## Abstract

Neonatal enterovirus infection can be severe and life-threatening, and there is ongoing interest in the development of antiviral compounds; however, their clinical efficacy has not been definitively proven.

We describe a case of neonatal enterovirus infection treated with the investigational therapeutic pocapavir, a viral capsid inhibitor. We describe the medical decision-making regarding the choice to offer pocapavir therapy. Because of clinical uncertainty about whether pocapavir contributed to clinical improvement, we performed sequencing of the viral genome and modeled the pocapavir pocket-binding site for evidence of genetic and protein changes before or after the initiation of pocapavir that might confer antiviral resistance.

This case and our findings reveal the challenges in interpreting sequence analysis of clinical enterovirus isolates to inform clinical decision-making regarding the use of pocapavir for the treatment of neonatal enterovirus.