Therapies for onychomycosis a systematic review and network meta-analysis of mycological cure

Area of Science:

• Dermatology
• Mycology
• Pharmacology

Background:

• Onychomycosis treatments lack direct comparative studies in randomized controlled trials.
• Ongoing development of new therapies necessitates comparative efficacy data.
• Clinical practice and literature show variable treatment outcomes.

Purpose of the Study:

• To compare mycological cure rates for oral versus topical onychomycosis treatments.
• To evaluate the relative efficacy of different onychomycosis therapies using network meta-analysis.
• To provide evidence-based guidance for onychomycosis treatment selection.

Main Methods:

• Systematic literature review of onychomycosis treatments published before March 25, 2013.
• Network meta-analysis to compare multiple treatments simultaneously.
• Inclusion of oral and topical antifungal agents.

Main Results:

• Continuous oral terbinafine (250 mg) and pulse itraconazole (400 mg) were significantly superior to most other treatments.
• Itraconazole (200 mg) outperformed fluconazole and topical treatments.
• Fluconazole, efinaconazole, ciclopirox, terbinafine nail solution, and amorolfine showed superiority only over placebo.
• Topical therapies appeared to have equivalent efficacy.

Conclusions:

• 12-week continuous terbinafine and 3-month pulse itraconazole are highly effective oral treatments for onychomycosis.
• Topical onychomycosis treatments demonstrate comparable efficacy to each other.
• Findings align with existing literature and clinical observations.