Intermittent pulse therapy with itraconazole for onychomycosis. Experience in Hong Kong Chinese

Abstract

Forty-four Hong Kong Chinese adults comprising 10 cases of fingernail and 42 cases of toenail onychomycosis were recruited for a 3-weekly itraconazole pulse therapy. Each pulse consisted of seven consecutive daily 400 mg doses with a 3-week interval between treatments. All patients in the fingernail group and 37 in the toenail group completed the study. The clinical cure, clinical response and mycological cure rates at week 36 were 70, 90 and 90% for fingernail and 35, 81 and 68% for toenail groups, respectively. Side-effects including biochemical abnormalities were minimal, and returned to normal upon cessation of treatment. We conclude that itraconazole pulse therapy is very effective, safe and well-tolerated for fingernail and toenail onychomycosis.

Cumulative meta-analysis of systemic antifungal agents for the treatment of onychomycosis

“…Thirty‐six studies were included in this meta‐analysis 6–41 . Forty‐seven studies were partially or completely excluded 8,9,12,13,15,16,24,27,32,33,36–38,40,42–74 Figures 1–5.…”

An exploration of the optimum dosage and number of cycles of itraconazole pulse therapy for severe onychomycosis

“…Mechanically, itraconazole has been reported to inhibit the activity of cytochrome P450 (CYP)3A4, resulting in impaired sterol synthesis in fungal cell membranes, therefore inhibiting fungal growth and eventually leading to cell death, Moreover, itraconazole pulse therapy was proven to be more effective and safer than continuous therapy . In addition, randomised controlled trials have shown that the cure rate for toenails varied among individuals with three pulses of itraconazole therapy, ranging from 35% to 100%, and the rates of severe onychomycosis were low . Furthermore, another study reported a complete cure rate of 53.1% for three pulses of itraconazole in patients with toenail onychomycosis whose average area of baseline toenail involvement was 74.1%, compared to an 83.3% complete cure rate for two pulses of itraconazole for patients with fingernail onychomycosis patients involving 78% of the fingernail plate, caused by candida, which was substantially higher (21%) than our results.…”