Terbinafine in the treatment of dermatophyte toenail onychomycosis: a meta-analysis of efficacy for continuous and intermittent regimens.
J Eur Acad Dermatol Venereol
; 27(3): 267-72, 2013 Mar.
Article
de En
| MEDLINE
| ID: mdl-22632057
ABSTRACT
OBJECTIVE:
To compare mycological and complete cures of terbinafine continuous and intermittent regimens in the treatment of toenail onychomycosis.METHODS:
The PubMed database was searched using the terms "terbinafine", "onychomycosis", "continuous" and "pulse(d)" or "intermittent". The inclusion criteria were head-to-head comparison of terbinafine pulse and continuous regimens for dermatophyte toenail infections. Risk ratios were calculated for intention-to-treat and evaluable patient analyses, when possible. Pooled estimates for total and subgroup analyses were calculated using a random effect model, Mantel-Haenszel method and their probabilities were calculated with z-statistics.RESULTS:
Nine studies from eight publications were included. Two continuous regimens and four intermittent regimens were investigated. A pooled risk ratio of 0.87 was obtained for intention-to-treat (95% CI 0.79-0.96, P = 0.004, n = 6) and evaluable patient (95% CI 0.80-0.96, P = 0.003, n = 8) analyses of mycological cure, favouring continuous terbinafine. For complete cure, pooled risk ratios of 0.97 (95% CI 0.77-1.23, P = 0.82, n = 7) for intention-to-treat and 0.93 (95% CI 0.76-1.13, P = 0.44, n = 9) for evaluable patient analyses showed equality of the two regimens. The pulse regimen that demonstrated consistently comparable results to the continuous terbinafine regimen was two pulses of terbinafine 250 mg/day for 4 weeks on/4 weeks off.CONCLUSIONS:
Meta-analysis of published studies of toenail onychomycosis showed that a continuous terbinafine regimen is generally significantly superior to a pulsed terbinafine regimen for mycological cure. In contrast, some pulse terbinafine regimens were as effective as continuous terbinafine regimens for complete cure.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Antifongiques
/
Onychopathies
/
Naphtalènes
Type d'étude:
Prognostic_studies
/
Systematic_reviews
Limites:
Humans
Langue:
En
Journal:
J Eur Acad Dermatol Venereol
Sujet du journal:
DERMATOLOGIA
/
DOENCAS SEXUALMENTE TRANSMISSIVEIS
Année:
2013
Type de document:
Article
Pays d'affiliation:
États-Unis d'Amérique