section name header

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