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Evidence summaries

Continuous Terbinafine Compared with Intermittent Itraconazole in Treatment of Toenail Onychomycosis

Continuous terbinafine appears to be more effective than intermittent itraconazole for toenail onychomycosis. Level of evidence: "B"

496 patients were randomised to treatment with terbinafine 250 mg/d for 12 or 16 weeks (groups T12 and T16) or itraconazole 400 mg /d for one week every four weeks, for a total of 12 and 16 weeks (groups I3 and I4) 1. At week 72 the rate of mycological cure was 75.7% (81/107) in group T12 and 80.8% (80/99) in group T16, 38.3% (41/107) in group I3 and 49.1% (53/108) in group I4. In all comparisons the percentage of patients cured was greater in the groups receiving terbinafine (p<0.0001). The rates of clinical cure (100% clean toenail) was observed in 54%, 60%, 32%, and 32%, respectively.

Comment: The quality of evidence is downgraded by potential reporting bias (a thorough literature search was not performed).

    References

    • Evans EG, Sigurgeirsson B. Double blind, randomised study of continuous terbinafine compared with intermittent itraconazole in treatment of toenail onychomycosis. The LION Study Group. BMJ 1999 Apr 17;318(7190):1031-5. [PubMed]

Primary/Secondary Keywords