Fosravuconazole to treat severe onychomycosis in the elderly

Area of Science:

• Dermatology
• Pharmacology
• Mycology

Background:

• Fosravuconazole is a novel oral antifungal agent approved in Japan for treating tinea unguium.
• Its favorable pharmacokinetic profile allows for short treatment durations (3 months) and minimal drug interactions.
• The drug's mild cytochrome P450 inhibition profile suggests a favorable safety margin, particularly for polypharmacy in elderly populations.

Purpose of the Study:

• To evaluate the efficacy and safety of oral fosravuconazole in elderly patients with severe onychomycosis.
• To assess treatment outcomes in terms of nail involvement reduction and clinical cure rates.

Main Methods:

• Elderly patients (≥65 years) with severe onychomycosis (≥50% nail involvement) received oral fosravuconazole 100 mg daily for 12 weeks.
• Nail involvement, clinical efficacy, and cure rates were assessed.
• Adverse events, including liver enzyme levels, were monitored.

Main Results:

• Mean nail involvement decreased significantly from 86.6% to 28.1% (P < 0.01).
• Overall efficacy and cure rates were 83.8% and 29.7%, respectively.
• In the subgroup with thin nails (<3 mm), efficacy and cure rates were notably higher at 88.2% and 58.8%.

Conclusions:

• Oral fosravuconazole is effective and well-tolerated for treating severe onychomycosis in elderly patients.
• The treatment leads to substantial improvement in nail condition and high efficacy rates.
• Transient elevations in serum γ-glutamyltransferase were observed but resolved without intervention, indicating a good safety profile.