Antifungal pulse therapy for onychomycosis. A pharmacokinetic and pharmacodynamic investigation of monthly cycles of 1-week pulse therapy with itraconazole

Doncker, P. De; Decroix, J.; Pierard, Gérald; Roelant, Dirk; Woestenborghs, Robert; Jacqmin, Philippe; Odds, Frank C.; Heremans, Annie; Dockx, P.; Roseeuw, Diane

doi:10.1001/archderm.132.1.34

Cited by 116 publications

(68 citation statements)

References 40 publications

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“…De Doncker et al 20 evaluated 2 different intermittent schedules of itraconazole of 3 and 4 months (400 mg/d; 1:4 weeks) and found that the cure rates at 24 weeks were 64% for patients who received the shorter treatment and 72% for those who received 4 months of treatment. 20 The trial had a small number of patients (N = 50), and no significant difference was detected between the treatments. Shemer et al 10 also did not find that a higher longterm cure rate was associated with a 200-mg/d continuous regimen of itraconazole compared with either of the 2 intermittent regimens (1:4 weeks) for 12 or 16 weeks (N=64).…”

Section: Discussionmentioning

confidence: 98%

Oral Treatments for Toenail Onychomycosis

Crawford

Young²,

Godfrey³

et al. 2002

Arch Dermatol

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Section: Discussionmentioning

confidence: 98%

Oral Treatments for Toenail Onychomycosis

Crawford

Young²,

Godfrey³

et al. 2002

Arch Dermatol

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“…Itraconazole also has a very long residence time in nails after the cessation of therapy (122). Maximal concentrations of itraconazole in fingernails and toenails are 0.95 g/g and 1.5 g/g, respectively, 4 and 6 months after cessation of pulse therapy (222). The concentration of posaconazole within the human dermis is comparable to that in plasma (59).…”

Section: Skin and Nailsmentioning

confidence: 99%

Tissue Penetration of Antifungal Agents

Troke²,

2014

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SUMMARY Understanding the tissue penetration of systemically administered antifungal agents is critical for a proper appreciation of their antifungal efficacy in animals and humans. Both the time course of an antifungal drug and its absolute concentrations within tissues may differ significantly from those observed in the bloodstream. In addition, tissue concentrations must also be interpreted within the context of the pathogenesis of the various invasive fungal infections, which differ significantly. There are major technical obstacles to the estimation of concentrations of antifungal agents in various tissue subcompartments, yet these agents, even those within the same class, may exhibit markedly different tissue distributions. This review explores these issues and provides a summary of tissue concentrations of 11 currently licensed systemic antifungal agents. It also explores the therapeutic implications of their distribution at various sites of infection.

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“…The new systemic antifungals itraconazole and terbinafine have been proven effective and safe by a large number of open and controlled trials [1, 2, 3]. However, there are only a few studies that evaluate the long-term outcome of patients who have been successfully treated [4, 5, 6, 7, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

Relapses of Onychomycosis after Successful Treatment with Systemic Antifungals: A Three-Year Follow-Up

et al. 1998

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Background: Data about relapses of onychomycosis after treatment with the new systemic antifungals vary among the different studies, with figures ranging from 3 to 20% for terbinafine and from 21 to 27% for itraconazole, depending on the follow-up duration. Objective: To determine the prevalence of relapses of onychomycosis cured by terbinafine compared with that of onychomycosis cured by itraconazole. Methods: We followed up 47 patients whose toenail onychomycosis had been mycologically cured in an open randomized study comparing intermittent itraconazole treatment with continuous terbinafine treatment and intermittent terbinafine therapy. Patients were examined every 3 months for up to 3 years after the end of therapy. At each visit clinical and mycologic (direct microscopy and cultures) evaluations were performed. Results: Eight of the 36 patients (22.2%) who completed the study had a relapse of onychomycosis during the follow-up period, including 2 patients of the terbinafine 250 mg group, 2 patients of the terbinafine 500 mg group and 4 patients in the itraconazole 400 mg group. As the original infection, the relapse was caused in all cases by Trichophyton rubrum. Conclusions: This study shows that 22.2% of patients with onychomycosis successfully treated with systemic antifungals experienced a relapse. The relapse rate increased from 8.3% at month 12 to 19.4% at month 24 and to 22.2% at month 36. Relapses were more common in patients treated with pulse itraconazole (4/11) than in patients treated with continuous (2/12) or intermittent (2/13) terbinafine. Statistical analysis did not reveal any significant difference between relapse rates in the three groups.

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Antifungal pulse therapy for onychomycosis. A pharmacokinetic and pharmacodynamic investigation of monthly cycles of 1-week pulse therapy with itraconazole

Cited by 116 publications

References 40 publications

Oral Treatments for Toenail Onychomycosis

Oral Treatments for Toenail Onychomycosis

Tissue Penetration of Antifungal Agents

Relapses of Onychomycosis after Successful Treatment with Systemic Antifungals: A Three-Year Follow-Up

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