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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.
Ravuconazole
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Virginia Ramos-Martín, Li Min Ling, Monica A. Slavin
Overall, ravuconazole has in vitro activity against Aspergillus spp. The geometric mean (GM) MIC of ravuconazole for Aspergillus spp. of 1.71 µg/ml was slightly higher than that of itraconazole (GM MIC of 0.67 µg/ml) and amphotericin B (GM MIC of 0.63 µg/ml) (Moore et al., 2000). However, A. fumigatus was significantly more susceptible to ravuconazole than A. terreus and A. flavus with 96% of A. fumigatus strains inhibited at ≤ 1 µg/ml ravuconazole compared with 76% of non-fumigatus species (Moore et al., 2000; Messer et al., 2006). In one study, only 1.9% of A. fumigatus strains had a ravuconazole MIC ≥ 4 µg/ml, whereas the prevalence of in vitro resistance (MICs ≥ 4 µg/ml) among other Aspergillus spp. was 3% (Cuenca–Estrella et al., 2005). Recently, Aspergillus section Fumigati (previously all considered to be A. fumigatus) was shown to comprise a number of species by molecular analysis. Some of these species, such as A. lentulus, are more resistant to ravuconazole GM MIC ≥ 2 µg/ml as well as to the other mold-active azoles and amphotericin B (Alcazar-Fuoli et al., 2008).
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).
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
Laser therapy is approved by the FDA for ‘temporary increase in clear nail’ in patients with onychomycosis and may act as a cosmetic aid, rather than a true treatment modality for onychomycosis. While podiatrists have been using it to treat onychomycosis patients in clinic, the likelihood of successful eradication of fungal toenail onychomycosis is low. However, it is a promising alternative cosmetic option for patients whom systemic agents are contraindicated or in special populations having mobility and adherence issues with topical therapy. Further structured studies are required to explore the applicability of device modalities for the treatment of onychomycosis. Newer antifungal agents, such as voriconazole, posaconazole, albaconazole, and ravuconazole, need to be evaluated further for the management of onychomycosis. Managing onychomycosis is a long-term commitment for the patients and it is recommended to follow preventive measures to minimize recurrence.
Oxidative stress implications for therapeutic vaccine development against Chagas disease
Published in Expert Review of Vaccines, 2021
Subhadip Choudhuri, Lizette Rios, Juan Carlos Vázquez-Chagoyán, Nisha Jain Garg
The currently available benznidazole and nifurtimox drug therapies are effective against acute T. cruzi infection [14–16], and are recommended for the treatment of all infected children under 15 years of age and adults with recent infection [17]. While effective in parasite clearance in children, these drugs exhibit therapeutic failure and/or adverse events in adults and are not always recommended for patients with chronic infection [18–20]. Thus, new therapies to cure, eliminate, and eradicate T. cruzi are needed. However, clinical trials testing new chemotherapeutics against T. cruzi have not been very successful in identifying replacements for benznidazole and nifurtimox. Several drugs, such as ravuconazole and posaconazole exhibited promising, parasite-specific effects in pre-clinical studies but failed to surpass the efficacy of benznidazole in clinical studies. Fexinidazole, a drug in the same class as benznidazole and nifurtimox, has completed phase II clinical trial (clinical trial identifier NCT03587766). This drug has shown promise for treating the indeterminate phase of CD in experimental studies but currently outcomes of the clinical trial are publicly documented [21–25].