Topical efinaconazole: A promising therapeutic medication for tinea unguium

We evaluated the efficacy of efinaconazole 10% topical solution in long‐term use, for up to 72 weeks, for onychomycosis, including severe cases. Among 605 participants, 219 patients diagnosed as having onychomycosis were evaluated for the efficacy of efinaconazole. The treatment success rate (<10% clinical involvement of the target toenail) at the final assessment time point was 56.6%, the complete cure rate was 31.1% and the mycological cure rate was 61.6%, all of which increased over time, demonstrating that continuous application contributed to the improvement of cure rate. Even in severe cases, reduction of the affected nail area was observed, showing the potential efficacy of the treatment. Responses to a quality of life questionnaire among patients with onychomycosis, OnyCOE‐t, suggested that efinaconazole treatment improved the patients’ quality of life. The incidence of adverse drug reaction in the patients eligible for the assessment was 6.3%, and this developed only in the administration site in all cases. No systemic adverse event was observed. In addition, no increase in the incidence of adverse drug reaction due to long‐term use was found. Efinaconazole therapy was proved to exhibit excellent balance between efficacy and safety, and thus may serve as a useful treatment option for onychomycosis.

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Efficacy of long‐term treatment with efinaconazole 10% solution in patients with onychomycosis, including severe cases: A multicenter, single‐arm study

Iozumi

Abe²,

Ito

et al. 2019

“…A phase 3 trial reported efficacy and cure rates of 94.4% (84/89) and 59.4% (60/101), respectively, and more severe conditions, including an older age (78.1 vs 58.4 years old) and larger affected areas (86.6% vs 54.5%), delayed the treatment effect. On investigating severe onychomycosis cases (66.7 years old, 77.6% affected area) with topical efinaconazole for 38.1 weeks (mean), the efficacy and cure rates were 65.4% (34/52) and 5.8% (3/52), respectively 11 . Taken together, these findings suggest that fosravuconazole should be more effective than topical efinaconazole therapy for severe onychomycosis.…”

Section: Discussionmentioning

confidence: 83%

“…The normal average toenail thickness is 1.65 ± 0.43 mm in men and 1.38 ± 0.20 mm in women 11 . The nail plate thickness changes with age 12 .…”

Section: Discussionmentioning

confidence: 96%

Fosravuconazole to treat severe onychomycosis in the elderly

Noguchi

Matsumoto

Kimura

et al. 2020

Self Cite

Fosravuconazole is a novel oral antifungal drug developed in Japan and used to treat tinea unguium since 2018. Its excellent oral absorbability and systemic bioavailability has enabled short‐duration therapy of 3 months. Furthermore, no concomitant drugs are contraindicated due to the presence of the mild inhibitor of cytochrome P450 enzyme which is responsible for polypharmacy adverse effects. Therefore, it can be safely administrated to elderly patients. Elderly patients (≥65 years old) with severe onychomycosis (≥50% nail involvement) were treated with oral fosravuconazole 100 mg once daily for 12 weeks. The rate of involvement improved from 86.6% to 28.1% (P < 0.01). The efficacy (i.e. percentage of those rated as “improved” and better) and cure rate was 83.8% (31/37) and 29.7% (11/37), respectively. Furthermore, when focusing on the thin nail group (<3 mm), the efficacy and cure rate was 88.2% (15/17) and 58.8% (10/17), respectively. Although the serum γ‐glutamyltransferase levels increased in 21.6% (8/37), all patients recovered without any specific treatments.

“…The complete cure rate at the final evaluation was 31.1%. 10 In another study, Noguchi et al 11 reported an efficacy rate of 65.4% in patients with an infected area exceeding 50%. In 2020, randomized controlled trials 7 , 12 of EFCZ with a high level of evidence were cited in the review of local treatment and device treatment for onychomycosis in the Cochrane Library.…”

Section: Discussionmentioning

confidence: 95%

Clinical effectiveness of efinaconazole 10% solution for treatment of onychomycosis with longitudinal spikes

Watanabe

Iozumi

Abe³

et al. 2021

Onychomycosis with longitudinal spikes in the nail plate has been reported to be refractory to oral drugs as with dermatophytoma. We evaluated the efficacy of 10% efinaconazole solution in the treatment of onychomycosis with longitudinal spikes. Of the 223 subjects who were enrolled in a previous study, a post‐hoc analysis of 82 subjects with longitudinal spikes was performed in this study. The opacity ratio of longitudinal spikes was decreased over time from 8.1 to 0.9 at the final assessment. In addition, the longitudinal spike disappearance rate increased early after the application to 81.7% at the final assessment. Therefore, 10% efinaconazole solution can be a first‐line drug for longitudinal spikes, which have been regarded as refractory to oral drugs.