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Network Meta-Analysis of Onychomycosis Treatments
Aditya K Gupta1, Deanne Daigle2, Kelly A Foley2
1Department of Medicine, University of Toronto, Toronto, Ont., Canada; Mediprobe Research Inc., London, Ont., Canada.
Background:
Many onychomycosis treatments have not been directly compared in head-to-head clinical trials.
Objective:
To determine the relative efficacy of onychomycosis treatments using network meta-analysis (NMA).
Methods:
We conducted a systematic review and NMA of mycological cure rates.
Results:
Nineteen trials were included in the network. Terbinafine 250 mg was significantly superior to all treatments except itraconazole 400 mg pulse therapy. The itraconazole 400 mg pulse regimen was significantly superior to all topicals except efinaconazole 10% nail solution. Itraconazole 200 mg was significantly superior to all topical treatments, while fluconazole 150-450 mg, efinaconazole 10% nail solution, tavaborole 5% nail solution, ciclopirox nail lacquer 8%, terbinafine nail solution, and amorolfine 5% nail lacquer were significantly superior to placebo.
Conclusions:
Newly developed topicals have improved the odds ratios (ORs) of mycological cure, yet these ORs were not significantly greater than preexisting topical treatments. Further experience with these agents will reveal their clinical significance, and head-to-head trials are warranted. © 2015 S. Karger AG, Basel.
Insights
Terbinafine and itraconazole pulse therapy show superior efficacy for onychomycosis (fungal nail infection) compared to most other treatments. Newer topical antifungals offer benefits but require further study for definitive clinical significance.
Area of Science:
- Dermatology
- Mycology
- Pharmacology
Background:
- Direct comparative clinical trials for onychomycosis treatments are limited.
- Network meta-analysis (NMA) is crucial for comparing diverse treatment efficacies.
- Understanding relative treatment effectiveness is vital for clinical decision-making.
Purpose of the Study:
- To conduct a network meta-analysis (NMA) to determine the relative efficacy of various onychomycosis treatments.
- To compare mycological cure rates across different therapeutic interventions.
- To provide evidence-based insights into the comparative effectiveness of antifungal nail treatments.
Main Methods:
- Systematic review and network meta-analysis (NMA) of randomized controlled trials.
- Inclusion of 19 trials assessing mycological cure rates for onychomycosis.
- Statistical analysis to compare odds ratios (ORs) of cure between treatments.
Main Results:
- Terbinafine 250 mg demonstrated superior efficacy, surpassed only by itraconazole 400 mg pulse therapy.
- Itraconazole 400 mg pulse therapy was more effective than most topical treatments, with efinaconazole 10% being a notable exception.
- Several oral and topical agents, including fluconazole, efinaconazole, tavaborole, ciclopirox, terbinafine solution, and amorolfine lacquer, showed significant superiority over placebo.
Conclusions:
- Newer topical onychomycosis treatments show improved odds ratios for mycological cure.
- Current evidence does not demonstrate significantly greater efficacy for new topicals over established ones.
- Further research, including head-to-head trials, is necessary to establish the clinical significance of novel topical therapies.
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