Continuous terbinafine outperforms pulsed regimen for treatment of onychomycosis

Key takeaways:

• Treatment efficacy was achieved by 76.67% of the continuous regimen group vs. 26.67% of the pulsed group (P = .001).
• The authors recommended daily, continuous usage of terbinafine in this indication.

Terbinafine dosed daily and continuously for the treatment of onychomycosis in patients with skin of color may produce better outcomes than intermittent terbinafine, according to a study.

Terbinafine, one of the newest oral antifungals for the treatment of onychomycosis, has “higher cure rates, shorter treatment periods and fewer adverse reactions,” according to study author Muhammad Amer Saleem, MD, of the Rawalpindi Medical Center at Benazir Bhutto Hospital in Rawalpindi, Pakistan, and colleagues.

Regimens vary between continuous intake at lower doses or pulsed intake at higher doses. This is the first study to compare the outcomes of these dosage regimens of terbinafine exclusively in patients with skin of color, according to the authors.

In their study, Saleem and colleagues compared the continuous and pulsed dose regimens of 250 mg oral terbinafine among patients with Fitzpatrick skin types IV to VI with onychomycosis.

Sixty patients aged 15 to 65 years were randomly assigned to either the continuous (n = 30) or pulsed (n = 30) treatment group. The continuous treatment group received 250 mg of terbinafine once daily for 12 weeks, whereas the pulsed treatment group received the same dosage twice daily for 1 week followed by every 4 weeks until week 12.

Results showed the continuous treatment regimen significantly outperformed the pulsed regimen. Of the patients treated continuously, 76.67% (n = 23) achieved treatment efficacy, defined as nails appearing completely normal with no visible residual changes, compared with 26.67% (n = 8) of the pulsed group (P = .001).

Subgroup analyses of age groups also showed that, of those aged 41 to 65 years, 16 patients in the continuous treatment group achieved treatment efficacy compared with four in the pulsed group (P = .0001).

“This study concludes that the efficacy in terms of the clinical cure rate of continuous dose terbinafine at 250 mg has better treatment outcomes for onychomycosis compared with the pulse dose terbinafine regimen,” the authors concluded. “Thus, we recommend that the continuous dose terbinafine regimen should be used routinely in treating toenail onychomycosis to reduce disease morbidity and improve patient satisfaction.”