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Several pharmacoeconomic analyses of the various oral treatments used in dermatophyte onychomycosis have been published. These studies calculate the cost-effectiveness of each therapy on the basis of the efficacy results of multiple clinical trials. The two most cost-effective regimens for the treatment of onychomycosis are continuous terbinafine and pulse itraconazole.174,195-199

In certain nail presentations, response to therapy may be improved by combining oral antifungal

Table 33.7 Treatment of dermatophyte toenail onychomycosis using fluconazole therapy

Year

Authors

Study type

No. of

Regimen

Treatment

Follow up

Efficacy measure (%)

evaluable patients

duration

(post-treatment)

MC

CR CC

2000

Havu et al.162

Double-blind, double-placebo, randomised

43

12 wks

22/43

10/43 *

multicentre, comparative (continuous

41

150 mg/wk

24 wks

60 wks

(51)

(23), *

terblnaflne)

20/41

18/41

(49)

(44),

1998

Scher et al.34

Double-blind, randomised parallel,

73

150 mg/wk

Up to 12 months

6 months (only those

38/72

56/73 *

multicentre, placebo-controlled

patients that were

(53)

(77)

clinically cured or

Improved)

2002

Area et al.'63

Open, randomised comparative (pulse

16

150 mg/wk

3 months

6 months

5/16

5/16

Itraconazole, continuous terblnaflne)

(31)

(31)

See Table 33.1 for abbreviations

See Table 33.1 for abbreviations therapy with either an effective topical therapy or mechanical/chemical measures (for example mechanical avulsion, debridement or chemical avulsion). For example, when there is lateral onychomycosis, a dermatophytoma, severe onycholysis, a thickened nail or severe onychomycosis, it may be advantageous to consider a combination approach.42,59,68,200-202

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