Treatment Outcome with Fosravuconazole for Onychomycosis

Abstract

Fosravuconazole L-lysine ethanolate (F-RVCZ), a ravuconazole prodrug, is a newly available agent with high expectations for e cacy in the treatment of onychomycosis. However, clinical data regarding the e cacy of F-RVCZ are limited because the drug was launched only in Japan in 2018. Therefore, we analyzed the outcome of F-RVCZ therapy in the treatment of onychomycosis at outpatient dermatology clinics in Japan. We examined data for 109 patients (68 male, 41 female) with varying clinical type, including total dystrophic onychomycosis and dermatophytoma, and a wide range of age groups, including the elderly. The complete cure rate at 12 weeks was 6.4% (7/109) and 67.9% (74/109) at the last visit (mean time to last visit: 32±14.2 weeks). Mean rate of improvement in the affected nail area was 49.1±23.3% at 12 weeks and 86.8±22.4% at the last visit. E cacy at 12 weeks and the last visit, respectively, was as follows: none, 4 cases and 1 case; slight, 35 cases and 4 cases; moderate, 51 cases and 21 cases; signi cant, 12 cases and 9 cases; complete cure, 7 cases and 74 cases. There were no serious adverse events. This retrospective survey was the rst large-scale analysis of actual clinical practice outcomes and had minimal exclusions. Compared to previous reports, our results demonstrated excellent e cacy of F-RVCZ therapy in a variety of patients. Considering our results and the ease of oral administration (1 capsule/day for 12 weeks) and few adverse events, F-RVCZ therapy appears to be a useful option for the treatment of onychomycosis.

Mycetoma: Development of Diagnosis and Treatment

“…Ravuconazole was recently shown to be effective against M. mycetomatis in an in vitro study [ 33 ]. Fosravuconazole was developed to treat onychomycosis [ 69 , 70 ]. It can rapidly convert to ravuconazole in the body once taken orally.…”

Dermatophytomas: Clinical Overview and Treatment

“…Fosravuconazole L-lysine ethanolate (F-RVCZ is a pro-drug that is metabolized into the triazole antifungal ravuconazole. F-RVCZ has significantly increased bioavailability and efficacy compared to the ravuconazole structure, with fewer drug interactions than standard oral treatments [ 42 ]. F-RVCZ is currently only approved for onychomycosis in Japan, but available data indicates it may be a suitable alternative for dermatophytomas where oral therapy is desired.…”

“…In the study by Shimoyama, 109 patients with onychomycosis of varying types were treated with fosravuconazole one capsule per day (equivalent to 100 mg of ravuconazole for 12 weeks ( Table 1 ) [ 42 ]. Dermatophytomas were present in 21 patients based on a retrospective photo review of the treated subjects.…”

“…The adverse events improved following the discontinuation of therapy. The mean administration period in the patients who discontinued therapy was 6.3 ± 2.0 weeks [ 42 ].…”

Dermatophytoma caused by terbinafine‐resistant Trichophyton rubrum treated with fosravuconazole

“…Although continuous water-soluble fosravuconazole is used offlabel, it could be effective for terbinafine-resistant dermatophytoma. 5…”