Efinaconazole Topical Solution, 10%: Factors Contributing to Onychomycosis Success

Abstract

To provide an adequate therapeutic effect against onychomycosis, it has been suggested that topical drugs should have two properties: drug permeability through the nail plate and into the nail bed, and retention of their antifungal activity in the disease-affected areas. Only recently has the importance of other delivery routes (such as subungual) been discussed. Efinaconazole has been shown to have a more potent antifungal activity in vitro than the most commonly used onychomycosis treatments. The low keratin affinity of efinaconazole contributes to its effective delivery through the nail plate and retention of its antifungal activity. Its unique low surface tension formulation provides good wetting properties affording drug delivery both through and under the nail. High antifungal drug concentrations have been demonstrated in the nail of onychomycosis patients, and effectiveness of efinaconazole topical solution, 10% confirmed in two large well-controlled multicenter Phase 3 clinical studies in patients with mild-to-moderate disease.

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

“…Among the FDA‐approved topical antifungals for onychomycosis, efinaconazole 10% solution may provide enhanced nail penetration due to decreased water solubility and keratin affinity 66,113 . Drug delivery into the nail unit is further improved by the low surface tension of the formulation, which allows it to spread around the nail, under the cuticle, and through the hyponychium 114 . Moreover, efinaconazole has demonstrated the ability to reduce the density and thickness of T .…”

“…66,113 Drug delivery into the nail unit is further improved by the low surface tension of the formulation, which allows it to spread around the nail, under the cuticle, and through the hyponychium. 114 Moreover, efinaconazole has demonstrated the ability to reduce the density and thickness of T. rubrum biofilms in vitro, 115 which may provide greater access to the site of infection in onychomycosis.…”

Dermatophytomas: Clinical Overview and Treatment

“…The efficacy of the efinaconazole solution may be related to the high degree of penetration through the transungual route. There is also evidence of the spread of drugs through the subungual route [ 46 , 47 , 48 ]. This results in a high fungicidal concentration of the drug at the site of the dermatophytoma.…”

Formulation and Evaluation of Voriconazole Loaded Nanoemulgel for the treatment of Onychomycosis

“…Topical therapy gives fewer side effect and also deliver the drug on a specific site. Controlling onychomycosis has shown one or more omissions like low cure rates from amorolfine nail lacquer, ciclopirox nail lacquer, nail paint, efinaconazole solution, tavaborole solution [8][9][10][11][12]. Voriconazole show the 52% success rate in the primary therapy.…”