Onychomycosis Treatment Study

Onychomycosis is the most common infective nail disorder. Up to 50% of toenail abnormalities are due to onychomycosis. Terbinafine and itraconazole are the most commonly used oral antifungals to treat onychomycosis and superficial dermatomycoses.

However, a recent study suggests that posaconazole, fosravuconazole, voriconazole, and oteseconazole are superior to terbinafine and itraconazole in treating superficial fungal infection. The study findings were published in the International Journal of Dermatology on December 09, 2021.

Recent studies have shown that dermatophytes are being resistant or showing poor response to therapy with terbinafine and to a lesser extent to itraconazole. Therefore, Dr. Aditya K. Gupta and his team conducted a review on the most appropriate dosing regimens of posaconazole, fosravuconazole, voriconazole, and oteseconazole (VT-1161) to treat onychomycosis and superficial fungal infections.

The researchers searched on PubMed and Google Scholar and identified 463 records with 50 articles meeting the inclusion criteria for review. They noted that none of the new azoles is US FDA approved for onychomycosis treatment; however, an increasing number of studies have evaluated these agents.

Key findings of the study:

• Upon analysis, the researchers found that the efficacies (complete cure and mycologic cure) of the antifungal agents for dermatophyte great toenail onychomycosis treatment are:
  • Terbinafine (250 mg/day for 12 weeks, complete cure: 38.0%; mycological cure: 70.0%)
  • Itraconazole (200 mg/day for 12 weeks, complete cure: 14%; mycological cure: 54.0%)
• They also found that the complete cure rate and mycological cure rate were superior for all the alternative agents with ravuconazole (59.4%, 82.0%; 100 mg/day for 12 weeks) showing the most promising results.

The authors concluded, "In the course of treatment of onychomycosis and dermatomycoses, resistant to terbinafine and itraconazole (on-label) and flucanazole (Off-label) is being increasingly reported. In such scenarios, new azoles such as posaconazole, fosravuconazole, voriconazole, and oteseconazole are being considered for the treatment of superficial fungal infection."

For further information:

DOI: https://doi.org/10.1111/ijd.15999

Keywords:

azoles, onychomycosis, dermatomycoses, posaconazole, fosravuconazole, voriconazole, oteseconazole, superficial fungal infection, Antifungal resistance, Cure rate, mycological cure, alternative antifungal therapy, International Journal of Dermatology.