China
Africa
Explore chapters and articles related to this topic
Novel and emerging pharmacotherapy and device-based treatments for onychomycosis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Jose W. Ricardo, Shari R. Lipner
Ravuconazole is a triazole antifungal drug and fosravuconazole is one of its prodrugs that has undergone Phase III clinical trials. The most effective dose regimen for fosravuconazole was 100 mg/day, which resulted in 82% mycological cure rates at week 48.
Efinaconazole topical solution (10%) for the treatment of onychomycosis in adult and pediatric patients
Published in Expert Review of Anti-infective Therapy, 2022
Tracey C. Vlahovic, Aditya K. Gupta
Onychomycosis can be managed in several ways: pharmaceutically, mechanically (via nail debridement or laser therapy), and surgically. Compared to nail debridement and surgical avulsion of the nail, the pharmaceutical agents have robust data showing mycological cure. From a pharmaceutical perspective, oral or systemic antifungal options and topical options are available on the market. Systemic antifungals are currently assumed to be the most effective treatment for onychomycosis according to meta-analyses conducted [35]. Oral antifungal agents (e.g. terbinafine [an allylamine] and itraconazole [an imidazole]) are considered treatments of choice for onychomycosis because they can effectively reach the nail bed through systemic circulation [36]. However, these agents have limitations including: drug-drug interactions with agents that are metabolized by specific cytochrome P450 (CYP) enzymes (more often itraconazole), potential inhibition of certain CYP subtypes, and adverse effects such as congestive heart failure and hepatotoxicity, the latter of which requires liver functioning tests completed prior to initiation of therapy [29,30,36]. Itraconazole has boxed warnings of rare cases of serious hepatotoxicity with treatment, including liver failure and death. Even patients with no preexisting liver disease or serious underlying medical condition are at risk for hepatotoxicity as well as congestive heart failure [30]. Fosravuconazole (BFE1224) is an oral triazole antifungal agent approved for the treatment of onychomycosis in Japan [37], though it is not approved in the US.
Oral antifungal therapies for toenail onychomycosis: a systematic review with network meta-analysis toenail mycosis: network meta-analysis
Published in Journal of Dermatological Treatment, 2022
Maria L. D. Fávero, Aline F. Bonetti, Eric L. Domingos, Fernanda S. Tonin, Roberto Pontarolo
For the individual adverse events, the major findings were the following (Table 2):Gastrointestinal adverse events (19 studies; 5024 patients): itraconazole 400 mg and terbinafine 350 mg were less associated to these events (SUCRA around 19% and 21%, respectively), while albaconazole 400 mg and fosravuconazole 100 mg had higher probabilities of causing gastrointestinal effects (89% and 88%, respectively).Headache (13 studies; 4491 patients): ravuconazole 100 mg produced less headache (7%), while posaconazole 100 mg and terbinafine 250 mg presented the highest probability of causing this event (81% and 75%, respectively).Abnormal liver function (8 studies; 3149 patients): itraconazole 200 mg was more associated to this event (80%), while terbinafine 250 mg was safer (18%) (see complete analyses in the Supporting Information).
Emerging drugs for the treatment of onychomycosis
Published in Expert Opinion on Emerging Drugs, 2019
Fosravuconazole (F-RVCZ) is a prodrug of ravuconazole, which is a triazole that exerts broad and potent antifungal activity [37] (Table 1). The prodrug has improved hydrophilicity and oral absorbability, thus increasing bioavailability. A multicenter, double-blind, randomized study was completed in Japan to evaluate the efficacy and safety of F-RVCZ in patients with toenail clinical involvement of ≥25% of the nail plate area. Placebo or the drug was administered once daily for 12 weeks and complete and mycological cure were evaluated at 48 weeks. Complete cure was significantly higher with F-RVCZ than with placebo (59.4% vs. 5.8%, p < 0.001), as was mycological cure (82% vs. 20%, p < 0.001) [38].