Understanding Global Access to Topical Onychomycosis Therapy: A Systematic Review and Meta-Analysis

Area of Science:

• Dermatology and Infectious Diseases
• Pharmacoeconomics and Public Health

Background:

• Equitable access to medicines is vital for public health, yet challenging to measure for dynamic infections like onychomycosis.
• This study assesses access to topical onychomycosis medicines by integrating infection prevalence, drug efficacy, and regulatory availability.

Purpose of the Study:

• To evaluate global access to effective topical onychomycosis treatments.
• To identify factors contributing to access disparities, including pathogen prevalence and medicine availability.

Main Methods:

• A systematic literature review and meta-analysis of studies published between 1990-2019 from PubMed and Web of Science.
• Inclusion of human onychomycosis investigations utilizing Polymerase Chain Reaction (PCR) analysis.
• Meta-analysis employed a random-effects model with Freeman-Tukey transformation to determine global infection trends and regional pathogen differences.

Main Results:

• PCR confirmed onychomycosis in 55% of visually suspected cases across 26 studies.
• Dermatophytes were the most common pathogen (57%), but yeasts predominated in females, fingernail infections, and arid regions.
• Residents of 90% of assessed countries lacked access to the most efficacious topical product; 22% lacked access to any broad-spectrum agents, with Africa showing the poorest access.

Conclusions:

• Access to effective topical onychomycosis treatments is a significant global challenge.
• Under-representation of Candida infections in clinical studies may contribute to access issues.
• Further research, including head-to-head trials of agents like efinaconazole, is needed to improve treatment access.