advertising
-
1
Elewski BE : The effect of toenail onychomycosis on patient quality of life. Int J Dermatol 36: 754, 1997.
-
2
Scher RK, Coppa LM: Advances in the diagnosis and treatment of onychomycosis. Hosp Med 34: 11, 1998.
-
3
Crissey JT : Common dermatophyte infections: a simple diagnostic test and current management. Postgrad Med 103: 191, 1998.
-
4
Piraccini BM, Sisti A, Tosti A: Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents. J Am Acad Dermatol 62: 411, 2010.
-
5
Gupta AK, Albreski D, Del Rosso JQ, et al: The use of the new oral antifungal agents, itraconazole, terbinafine, and fluconazole, to treat onychomycosis and other dermatomycoses. Curr Problems Dermatol 13: 213, 2001.
-
6
Jansen JP, Fleurence R, Devine B, et al: Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health 14: 417, 2011.
-
7
Gupta AK, Drummond-Main C, Paquet M: Evidence-based optimal fluconazole dosing regimen for onychomycosis treatment. J Dermatolog Treat 24: 75, 2013.
-
8
van Valkenhoef G, Tervonen T, Zwinkels T, et al: ADDIS: a decision support system for evidence-based medicine. Decis Support Syst 55: 459, 2013.
-
9
Gupta AK, Ryder JE, Bluhm R, et al: Onychomycosis: quality of studies. J Cutan Med Surg 7: 312, 2003.
-
10
Schulz KF, Altman DG, Moher D; for the CONSORT Group: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ 340: c332, 2010.
-
11
Higgins JPT, Green S (eds): Cochrane Handbook for Systematic Reviews of Interventions: Version 5.0.2 [updated September 2009], The Cochrane Collaboration, Oxford, England, 2009.
-
12
van Valkenhoef G, Lu G, de Brock B, et al: Automating network meta-analysis. Res Synthesis Methods 3: 285, 2012.
-
13
Gelman A, Rubin DB: Inference from iterative simulation using multiple sequences. Stat Sci 7: 457, 1992.
-
14
Brooks SP, Gelman A: General methods for monitoring convergence of iterative simulations. J Comput Graph Stats 7: 434, 1998.
-
15
Billstein S, Kianifard F, Justice A: Terbinafine vs. placebo for onychomycosis in black patients. Int J Dermatol 38: 377, 1999.
-
16
Brautigam M, Nolting S, Schopf RE, et al: German randomized double-blind multicentre comparison of terbinafine and itraconazole for the treatment of toenail tinea infection. Br J Dermatol 134 (suppl 46): 18, 1996.
-
17
De Backer M, De Keyser P, De Vroey C, et al: A 12-week treatment for dermatophyte toe onychomycosis terbinafine 250mg/day vs. itraconazole 200mg/day: a double-blind comparative trial. Br J Dermatol 134 (suppl 46): 16, 1996.
-
18
Drake L, Shear NH, Arlette JR, et al: Oral terbinafine in the treatment of toenail onychomycosis: North American multicenter trial. J Am Acad Dermatol 37: 740, 1997.
-
19
Elewski BE, Rich P, Pollak R, et al: Efinaconazole 10% solution in the treatment of toenail onychomycosis: two phase III multicenter, randomized, double-blind studies. J Am Acad Dermatol 68: 600, 2013.
-
20
Elewski BE, Ghannoum MA, Mayser P, et al: Efficacy, safety and tolerability of topical terbinafine nail solution in patients with mild-to-moderate toenail onychomycosis: results from three randomized studies using double-blind vehicle-controlled and open-label active-controlled designs. J Eur Acad Dermatol Venereol 27: 287, 2013.
-
21
Elewski BE, Scher RK, Aly R, et al: Double-blind, randomized comparison of itraconazole capsules vs. placebo in the treatment of toenail onychomycosis. Cutis 59: 217, 1997.
-
22
Goodfield MJD, Andrew L, Evans EGV: Short term treatment of dermatophyte onychomycosis with terbinafine. BMJ 304: 1151, 1992.
-
23
Gupta AK, Fleckman P, Baran R: Ciclopirox nail lacquer topical solution 8% in the treatment of toenail onychomycosis. J Am Acad Dermatol 43: S70, 2000.
-
24
Havu V, Brandt H, Heikkila H, et al: A double-blind, randomized study comparing itraconazole pulse therapy with continuous dosing for the treatment of toe-nail onychomycosis. Br J Dermatol 136: 230, 1997.
-
25
Ling MR, Swinyer L J, Jarratt MT, et al: Once-weekly fluconazole (450 mg) for 4, 6, or 9 months of treatment for distal subungual onychomycosis of the toenail. J Am Acad Dermatol 38: S95, 1998.
-
26
Scher RK, Breneman D, Rich P, et al: Once-weekly fluconazole (150, 300, or 450 mg) in the treatment of distal subungual onychomycosis of the toenail. J Am Acad Dermatol 38: S77, 1998.
-
27
ClinicalTrials.gov : Efficacy, safety, and tolerability of topical terbinafine in patients with mild to moderate toenail fungus of the big toenail. NCT00443820. http://www.clinicaltrials.gov/ct2/show/NCT00443820?term=NCT00443820&rank=1. Accessed March 25, 2013.
-
28
ClinicalTrials.gov : Efficacy, safety, and tolerability of topical terbinafine in patients with mild to moderate toenail fungus of the big toenail. NCT00443898. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00443898?term=NCT00443898&rank=1. Accessed March 25, 2013.
-
29
Viera AJ, Garrett JM: Understanding inter-observer agreement: the kappa statistic. Fam Med 37: 360, 2005.
Therapies for Onychomycosis
A Systematic Review and Network Meta-analysis of Mycological Cure
Search for other papers by Aditya K. Gupta in
Current site
Google Scholar
PubMed
Search for other papers by Deanne Daigle in
Current site
Google Scholar
PubMed
Search for other papers by Maryse Paquet in
Current site
Google Scholar
PubMed
New therapies for onychomycosis continue to be developed, yet treatments are seldom directly compared in randomized controlled trials. The objective of this study was to compare the rates of mycological cure for oral and topical onychomycosis treatments using network meta-analysis. A systematic review of the literature on onychomycosis treatments published before March 25, 2013, was performed, and data were analyzed using network meta-analysis. Terbinafine, 250 mg, therapy was significantly superior to all treatments except itraconazole, 400 mg, pulse therapy; itraconazole, 200 mg, therapy was significantly superior to fluconazole and the topical treatments; and fluconazole, efinaconazole, ciclopirox, terbinafine nail solution, and amorolfine treatments were significantly superior to only placebo. These results support the superiority of 12-week continuous terbinafine, 250 mg, therapy and itraconazole, 400 mg, pulse therapy (1 week per month for 3 months) while suggesting the equivalence of topical therapies. These results reflect findings from the literature and treatment efficacy observed in clinical practice.
- Supplemental File (PDF 2,897 KB)
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
advertising
