Satisfaction with Onychomycosis Treatment

Abstract

The purpose of this study, which involved two dermatology clinics and two podiatric medical clinics, was to determine whether a difference exists in patient-reported satisfaction and compliance between continuous terbinafine therapy and pulse-dose itraconazole therapy for the treatment of toenail onychomycosis. Patients in this multicenter, open-label, cross-sectional study had previously completed treatment with either oral terbinafine or oral itraconazole for toenail onychomycosis. Patients were interviewed by telephone to assess clinical outcomes, compliance, and satisfaction with treatment; clinical data were collected by medical chart review. Patients reported significantly greater ease and convenience of treatment and higher overall satisfaction with continuous terbinafine therapy compared with pulse-dose itraconazole therapy.

Patient-Reported Outcomes in Onychomycosis: A Review of Psychometrically Evaluated Instruments in Assessing Treatment Effectiveness

“…Only 3 studies used a validated, onychomycosis-specific PRO instrument, the OnyCOE-t™ [31,33,34]. Four studies used instruments derived from previously validated questionnaires [27,28,29,30], 1 study used a validated instrument for podiatry-related QOL [32], and 2 studies used instruments of unclear origins [26,35]. There were 2,224 patients in 4 randomized controlled trials, 1,825 patients in 5 case series, and 142 patients in 1 cross-sectional study.…”

“…Eight studies describe baseline characteristics of onychomycosis patients using PRO instruments [10,11,12,13,14,15,16,17], while 8 other studies use nonvalidated instruments or instruments nonspecific to onychomycosis (Table 1) [7,18,19,20,21,22,23,24,25]. Ten studies used PRO instruments to evaluate onychomycosis treatments (Table 2) [26,27,28,29,30,31,32,33,34,35]. …”

“…Finally, Warshaw et al [30] developed a scale assessing treatment ease and convenience for a cross-sectional study, although a comprehensive onychomycosis instrument was not developed. Warshaw's instrument was valid and responsive with acceptable internal consistency but did not evaluate test-retest reliability.…”

“…The patient satisfaction study by Stier et al [27] demonstrated that treatment satisfaction was correlated with nail condition, although the content of the questionnaire was unclear. Warshaw et al [30] used the treatment satisfaction scale from Lubeck's questionnaire in their study of terbinafine versus pulsed-dose itraconazole in a multicenter, cross-sectional study with 142 patients. Subjects reported greater ease and satisfaction with terbinafine ( p = 0.008 and p = 0.003, respectively).…”

“…However, this core also has low sensitivity to group differences and clinical changes [10,12,15,17,18,19]. It also lengthens questionnaires, making clinical implementation less feasible [9], which may explain why Lubeck's and Drake's questionnaires have not been utilized in their entirety though selections from each have been appropriated [27,28,29,30]. To date, only the OnyCOE-t™ has been used in full [31,33,34].…”