How Often Does Oral Treatment of Toenail Onychomycosis Produce a Disease-Free Nail?

Abstract

To analyze studies on oral treatment of toenail onychomycosis so as to aid clinicians and patients in making informed decisions. Data Sources: Studies dealing with treatment of toenail onychomycosis were identified by means of 2 MEDLINE search strategies. One was a title search using the word "toenail"; the other search used the combined Medical Subject Headings "onychomycosis" and "therapy." Study Selection: Articles were read to ascertain that they (1) described results in toenails, (2) used both culture and microscopy, and (3) included a clinical evaluation. Not included were case reports, series of fewer than 15 subjects, reports that combined fingernail onychomycosis and toenail onychomycosis in their statistics, and articles reporting only the total number of toenails cured without providing data as to how many subjects were cured. Data Extraction: This elimination process left 26 articles , which were then analyzed by means of a checklist that included a morphologically normal nail, mycological findings, and methodological items including recurrence rate, intent-to-treat analysis, placebo group, and whether terms were defined. Data Synthesis: When there was sufficient data, the frequency with which the treatment achieved normal mycological results, a clinically normal nail, and a disease-free nail (normal-appearing nail plus normal mycological results) was calculated. Confidence intervals were calculated for disease-free nail results. Conclusions: Standard courses of terbinafine achieved a disease-free nail in approximately 35% to 50% of patients. For itraconazole, the relevant disease-free nail rate was about 25% to 40%. Disease reappearance is an important issue; unfortunately data are lacking as to its frequency.

VT-1161 Dosed Once Daily or Once Weekly Exhibits Potent Efficacy in Treatment of Dermatophytosis in a Guinea Pig Model

“…Although allylamines and azoles are efficacious for a large number of dermatophyte infections, there remains room for improvement in efficacy and safety, particularly for more difficult-totreat infections such as onychomycosis. In randomized controlled trials of onychomycosis, complete cure rates reflecting both mycological and clinical cures for terbinafine and itraconazole range from approximately 35 to 50% (10). Moreover, both drug classes carry safety warnings pertaining to liver toxicity (11,12) and drug-drug interactions (13), with a small but significant percentage of more serious side effects (14)(15)(16).…”

Long-term Effectiveness of Treatment With Terbinafine vs Itraconazole in Onychomycosis

“…9,10 While both itraconazole and terbinafine have proven to be effective against onychomycosis, very little is known about the long-term maintenance of cure and relapse rates observed with both drugs. 11 The objective of the present study was to examine long-term mycological and clinical cure rates after treatment with terbinafine and itraconazole for onychomycosis. Similarly, mycological and clinical relapse rates were examined.…”

Aktuelle Behandlungsoptionen der Onychomykose

“…Die hiermit zu erzielenden Heilungsraten variieren in den einzelnen Studien [12,13]. Epstein [14] gibt für 35-50 % der mit Terbinafin behandelten Patienten, und für 25-40 % der mit Itraconazol behandelten Patienten eine komplette Heilung der betroffenen Nägel an.…”