Prognostic factors negatively affecting onchomycosis cure revealed
MedWire News: Patients with onchomycosis treated with terbafine are less likely to reach a complete clinical cure if they have a history of prior infection, are male, or are older, report researchers.
In addition, matrix or lateral involvement, slow nail growth, or presence of dermatophytoma also had a negative effect on complete and mycological cure rates.
Bardur Sigurgeirsson (University of Iceland, Reykjavik) recruited 199 patients from the Icelandic arm of a trial comparing continuous (350 mg/day) with intermittent (250 mg/day) terbinafine treatment for onchomycosis to take part in an additional observational follow-up study to try and determine factors predicting clinical cure.
For the purposes of this study all the patients were combined and considered to have been treated with terbinafine. In the original trial patients were followed-up to week 48, in this study the follow-up was extended to week 72.
In addition to standard demographic factors, Sigurgeirsson assessed type of onchomycosis, percentage nail involvement, nail thickness, presence of a dermatophytoma or spikes, matrix involvement, and presence of exclusive lateral edge involvement at baseline of the original study. These factors were then related to degree of clinical cure at 72 weeks.
Mycological cure was defined as negative microscopy and culture, clinical cure as resulting in a nail with no sign of onchomycosis, and complete cure as a combination of the two.
Complete cure was less likely to be achieved in patients with matrix or lateral involvement and with poor nail growth between screening and baseline (4–6 weeks). Thick nail plate also negatively influenced cure, but this was not statistically significant.
Mycological cure was negatively affected by the same factors as complete cure, with the addition of presence of a dermatophytoma.
Additional factors negatively affecting clinical cure were having a history of prior infection, being male, or being over the age of 65 years.
“The results of this study can be important for both clinical research and clinical practice,” concludes Sigurgeirsson in the Journal of the European Academy of Dermatology and Venereology.
He adds: “This finding merits a large study on prognostic outcome factors in onychomycosis.”
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By Helen Albert