Both oral and topical treatments appear to be safe and effective for treating toenail onychomycosis, according to the results of a recently published systematic review and network meta-analysis (NMA).
To better understand the safety and efficacy of various therapeutic options for toenail onychomycosis, study authors conducted a literature search for randomized controlled trials (RCTs) that included patients ≥18 years old where oral (fluconazole, itraconazole, terbinafine), topical (ciclopirox, efinaconazole, tavaborole), or device-based treatments were used both as monotherapy and in combination with other therapies. Efficacy outcomes included mycological cure, complete cure, treatment success, adverse events, and quality of life, while safety was evaluated by determining the number of patients who experienced at least 1 adverse event.
In order to assess these outcomes, a random-effects NMA was utilized to approximate pooled odds ratios (ORs) of both direct as well as indirect comparisons of oral and topical therapies. “There were not enough eligible combination and device-based therapy trials to include in the NMA,” the authors explained.
A total of 26 RCTs with 8136 patients were included in the NMA. Results of the study showed that compared with topical agents, continuous treatment with terbinafine 250mg (daily for 12-16 weeks) or itraconazole 200mg (daily for 12 weeks) was associated with significantly greater odds ratios of achieving mycological cure. Additionally, no significant difference in achieving mycological cure was observed between patients treated with pulse regimens (1 week on, then 3 weeks off for 12-16 weeks) of terbinafine and itraconazole, fluconazole, and topical therapy.
Analysis of the data also found no significant difference in the occurrence of adverse events in patients treated with oral vs topical therapy. “The risk of adverse events is similar across treatments with a caveat for clinicians to consult product inserts for warnings and precautions and choose the treatment that best suits their patients’ needs,” the authors noted.
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