Evaluation of Hepatic and Renal Function Algorithms for Fosravuconazole in Real-World Clinical Practice

Oral antifungal therapy is the standard treatment for onychomycosis. However, many physicians still prefer topical agents because of concerns about adverse effects.

This study evaluated changes in hepatic and renal function parameters during fosravuconazole therapy and assessed the utility of an algorithmic approach for interpreting these abnormalities.

Laboratory parameters including aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ glutamyltransferase (γ-GTP), serum creatinine (sCr), and estimated glomerular filtration rate (eGFR) were compared between baseline and follow-up. Fold changes were calculated, and γ-GTP was classified according to the LiverTox database. Each parameter was assessed using an algorithm for managing hepatic and renal side effects.

A total of 128 cases were analyzed. Median baseline values were AST 22 U/L, ALT 19 U/L, γ-GTP 25 U/L, sCr 0.75 mg/dL, and eGFR 74.9 mL/min/1.73 m². At follow-up, values were AST 22 U/L, ALT 22 U/L, γ-GTP 51.5 U/L, sCr 0.86 mg/dL, and eGFR 67.1 mL/min/1.73 m². γ-GTP showed significantly greater fold changes than other parameters (p < 0.001). Thresholds for discontinuation were met in 3 hepatic (2.3%) and 5 renal (3.9%) cases. No patient developed clinical symptoms, and only one discontinued treatment.

Algorithm-based monitoring enabled safe fosravuconazole administration. This practical approach may help clinicians adopt oral antifungal therapy more confidently as first-line treatment for onychomycosis.