One week pulse therapy with itraconazole (200 mg day⁻¹) for onychomycosis. Evaluation of treatment results according to patient background

Abstract

We investigated background factors of patients that affect the response of onycomycosis to pulse therapy with itraconazole. The regimen used in this study involved administering 200 mg of itraconazole orally on a daily basis for 1 week as one pulse, which is half of the normally recommended dose. The number of pulses was fixed at one per month, and altered in accordance with improvements in the infected nails and/or the patients' request. Patient background (n = 63) including sex, age, occupation, duration of the disease, site of lesion (fingernail, toenail), number of affected nails, clinical types, severity of thickening, presence or absence of pathogens, the presence or absence of underlying diseases such as adult onset diseases, turbidity of the target nails before therapy and the number and duration of pulses was investigated. The efficacy of the therapy was evaluated after 12 months. A complete cure was judged to have taken place if an entirely healthy nail plate re-grew in place of the diseased nail, whereas lack of success was defined as the persistence of lesions beyond the designated time period. The average number and duration of pulses were 4.7 +/- 3.2 times over 5.6 +/- 4.3 months, respectively. The rate of complete cure was 62%. Factors in the patients' background that were judged to have an influence on treatment results were the relative duration of the disease, the number of affected nails, and severity of thickening. With regard to the efficacy of the therapy in terms of the number and duration of pulses, 78% of 23 patients who were given pulse therapy two to six times during a course of 2 to 6 months achieved total cure.

Topical efinaconazole: A promising therapeutic medication for tinea unguium

“…Treatment progress (improvement) was rated on a 5‐point scale based on the following definitions: (i) “cured”, complete replacement of the affected nail with a healthy nail; (ii) “markedly improved”, replacement of the affected nail with a healthy nail by at least 70%; (iii) “improved”, replacement of the affected nail by 40–70%; (iv) “slightly improved”, replacement of the affected nail by less than 40%; and (v) “no change”, no change or increase in the affected nail area.…”

Treatment of dermatophyte onychomycosis with three pulses of terbinafine (500 mg day−1 for a week)

“…The improved safety and efficacy profile of recently developed antifungal agents such as terbinafine and itraconazole has led to increased treatment of dermatophyte onychomycosis. More dosing options for oral administration have become available with the development of intermittent therapy (pulse therapy) and short‐duration therapy to replace long‐term continuous oral administration 1–3 …”

Combination of pulse therapy with terbinafine tablets and topical terbinafine cream for the treatment of dermatophyte onychomycosis: A pilot study

“…Treatment of dermatophyte onychomycosis has been done intensively due to the safety and efficacy of the recently developed new antifungal agents (terbinafine, itraconazole and fluconazole). Currently, more options have become available regarding the dosage regimen for oral administration, with the development of intermittent therapy (pulse therapy) and short‐duration therapy instead of long‐term continuous oral administration 1–2 . Terbinafine is an active allylamine derivative that inhibits squalene epoxidase in ergosterol biosynthesis, resulting in the accumulation of intracellular squalene, which is toxic to fungal cells.…”