Network Meta-Analysis of Onychomycosis Treatments

Gupta, Aditya K.; Daigle, Deanne; Foley, Kelly A.

doi:10.1159/000433473

Cited by 34 publications

(15 citation statements)

References 27 publications

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“…PRO analyses of topical treatments are limited, likely in part because numerous studies have demonstrated the clinical superiority of oral medications [36,37]. Additionally, until recently, ciclopirox was the only topical drug approved for onychomycosis treatment in the US [36].…”

Section: Resultsmentioning

confidence: 99%

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Patient-Reported Outcomes in Onychomycosis: A Review of Psychometrically Evaluated Instruments in Assessing Treatment Effectiveness

Wang

Wiznia

Rieder

2017

Skin Appendage Disord

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Purpose: Onychomycosis is the most common nail disorder and causes morbidity and impaired quality of life (QOL). Patient-reported outcomes (PRO) are patients' assessment of their health status or treatment response. PROs help assess what is most bothersome to patients to identify targets for intervention. We sought to review the PRO instruments currently used to assess QOL and treatment response in onychomycosis patients. Procedures: A systematic review was performed by searching PubMed, Embase, CINAHL, and PsycINFO databases through December 31, 2016, to identify all English language literature on onychomycosis, PRO, and QOL. Results: Currently, 5 validated PRO instruments exist specifically for onychomycosis. Oral therapies were most extensively studied using PRO instruments. QOL data generally correlated with clinical change, although patients sometimes reported improvement without any clinically significant nail clearance. The only psychometrically validated PRO instrument used to evaluate treatment response is the OnyCOE-t™. Conclusions: Clinicians may underestimate the impact of onychomycosis on patients. With recent initiatives from health-care management organizations to improve patient experience and the recent approval of expensive and nonsuperior topical antifungal medications, PROs will be increasingly important in onychomycosis to assess patient priorities and optimize treatment. Future research should evaluate these instruments in special populations and fingernail disease.

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Section: Resultsmentioning

confidence: 99%

“…Additionally, until recently, ciclopirox was the only topical drug approved for onychomycosis treatment in the US [36]. With the approval of efinaconazole and tavaborole in 2014, more QOL studies are warranted given the high cost and nonsuperiority of these medications to oral antifungals [37]. …”

Section: Resultsmentioning

confidence: 99%

Patient-Reported Outcomes in Onychomycosis: A Review of Psychometrically Evaluated Instruments in Assessing Treatment Effectiveness

Wang

Wiznia

Rieder

2017

Skin Appendage Disord

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“…[ 20 ] There was no much difference between the efficacy of the pure medication in this study and that in literature. [ 21 22 ] The efficacy of the combination treatment was higher than that of the laser therapy only in the previous research. [ 1 10 12 ] In summary, combined laser and medicine treatment for onychomycosis is effective.…”

Section: Discussionmentioning

confidence: 90%

Self-controlled Study of Onychomycosis Treated with Long-pulsed Nd

Zhao

et al. 2016

Chinese Medical Journal

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Background:Onychomycosis is a fungal infection of the nail plate and subungual area. In this study, we examined the efficacy of laser treatment using self-controlled study programs involving a long-pulsed Nd:YAG 1064-nm laser combined with oral medication.Methods:Self-controlled strategies were followed in this study. The patients received treatment with oral itraconazole in conjunction with long-pulsed Nd:YAG 1064-nm laser treatment at the nails of the unilateral limb once a week for a total of four times. A total of 84 affected nails were divided into Group A (mild to moderate) and Group B (severe) according to disease severity. Affected nails with the same Scoring Clinical Index for Onychomycosis scores were selected to compare the therapeutic effects of the pure medication treatment group and the combination treatment group with a 24-week follow-up period.Results:In Group A, at the 8th, 16th, and 24th weeks of follow-up, the efficacies in the pure medication treatment group were 81.0%, 81.0%, and 90.5%, respectively, while those in the combination treatment group were 100%, 95.2%, and 90.5%, respectively. The differences between groups were not significant (8th week: χ2 = 4.421, P > 0.05; 16th week: χ2 = 2.043, P > 0.05; 24th week: χ2 = 0.00, P > 0.05). In Group B, at the 8th, 16th, and 24th weeks of follow-up, the efficacies in the pure medication treatment group were 61.9%, 66.7%, and 52.4%, respectively, while those in the combination treatment group were 95.2%, 90.5%, and 100%, respectively. The differences between groups at the 8th and 24th weeks of follow-up were statistically significant (8th week: χ2 = 6.929, P < 0.05; 24th week: χ2 = 13.125, P < 0.05).Conclusions:For patients with mild or moderate onychomycosis, we recommended a pure medication treatment or combination treatment with medication and laser. For those patients with severe onychomycosis, we recommended a combination of medication and laser therapy.

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“…Onychomycosis in children is rare, usually it comes from indirect environment contamination of trauma or dystrophic nails. 5,6 In addition there are other factors influencing as climate, prolonged use of occlusive footwear, repeated trauma to the nails, and genetic predisposition. 2,3,[7][8][9] Onychomycosis can cause cosmetic problem, pain, discomfort, and affect the emotional or psychosocial aspects of the patient, thus requiring optimal and total therapy.…”

Section: Kata Kunci: Antijamur Kombinasi Terapi Onikomikosis Efekmentioning

confidence: 99%

Combination Antifungal Therapy for Onychomycosis

Khamidah

Ervianti

2018

IJTID

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Onychomycosis is a fungal infection of the nail unit including the nail matrix, the nail bed and the nail plate by both dermatophyte and non-dermatophyte agents. It is disturbs not only cosmetic disfigurement, but also it may have an impact on patients’ emotional, social and occupational functioning, finally affecting the overall quality of life. The incidence rate tends to increase, management of onychomycosis is still challenging. Important problems regarding antifungal monotherapy have experienced many failures and recurrences. In general, pharmacological approaches for onychomycosis can be topical or oral antifungal. Antifungal monotherapies often lead to failure treatment, also high incidence of recurrence. One strategy for this problem is a combination antifungal therapy. In vitro studies show the synergistic effect of using combination two antifungals (both oral antifungal or combination topical and oral antifungal), hence it is mycologically or clinically expected to increase the success rate of onychomycosis therapy. This review tries to evaluate the previous study exploring the effectiveness of antifungal combination therapies on onychomycosis. Two oral antifungals usually used are terbinafine as fungicidal agent and itraconazole as fungistatic agent. There is combination between topical and oral antifungal such as itraconazole or terbinafine with amorolfine or ciclopirox, also other combination like griseofulvin and amorolfone or tioconazole. All the combination therapies show better result than monotherapy alone, but it is still difficult to conclude whether antifungal combinations in onychomycosis will increase effectiveness due to variations in therapeutic duration, result definition, and statistical evaluation on existing studies. Further research is required with longer duration of observation, uniform patient criteria and definition of success, random control and blinding to minimize bias.

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Network Meta-Analysis of Onychomycosis Treatments

Cited by 34 publications

References 27 publications

Patient-Reported Outcomes in Onychomycosis: A Review of Psychometrically Evaluated Instruments in Assessing Treatment Effectiveness

Patient-Reported Outcomes in Onychomycosis: A Review of Psychometrically Evaluated Instruments in Assessing Treatment Effectiveness

Self-controlled Study of Onychomycosis Treated with Long-pulsed Nd

Combination Antifungal Therapy for Onychomycosis

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