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Monotherapy for toenail onychomycosis: a systematic review and network meta-analysis

Gupta, A. K., Foley, K. A., Mays, R. R., Shear, N. H. and Piguet, V. 2020. Monotherapy for toenail onychomycosis: a systematic review and network meta-analysis. British Journal of Dermatology 182 (2) , pp. 287-299. 10.1111/bjd.18155

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Background Onychomycosis is a fungal infection of the nail caused by dermatophytes, yeasts and non‐dermatophyte moulds that accounts for approximately 50% of all nail related disease. Objectives This study aims to assess the effectiveness and safety of monotherapy and combination treatments for toenail onychomycosis using a network meta‐analysis (NMA). Methods Quality of evidence was assessed using Cochrane‐compliant rules and the Grading of Recommendations, Assessment, Development and Evaluations approach. Efficacy and safety outcomes were compared using a random‐effects network meta‐analysis to estimate pooled odds ratios (ORs) of direct and indirect comparisons amongst oral and topical treatments (PROSPERO 2015: CRD42018086912). There were not enough eligible combination and device‐based therapy trials to include in the NMA. Results Of 77 randomised controlled trials, 26 were included in the network meta‐analysis (8,136 patients). There were no significant inconsistencies between the direct and indirect evidence. Relative effects show that odds of mycological cure with continuous terbinafine 250 mg or continuous itraconazole 200 mg are significantly greater than topical treatments. Fluconazole, pulse regimens of terbinafine and itraconazole, and topical treatments did not differ significantly in odds of achieving mycological cure. The odds ratios of adverse events occurring with oral or topical treatments were not significantly different from each other. For mycological cure, evidence was of moderate or high quality while evidence ranged from very low to high quality for adverse events. Conclusions Our review suggests that oral and topical treatments for toenail onychomycosis are safe and effective in producing mycological cure.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Wiley
ISSN: 0007-0963
Last Modified: 17 Feb 2020 12:25

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