Terbinafine Versus Itraconazole For Treatment Of Onychomycosis: A Meta-analysis

ObjectiveOur aim is to access the difference of the efficacy between terbinafine and itraconazole in the treatment of onychomycosis.Materials and MethodsLiterature search The Medline,Science Direct On Site(SDOS) and Springer database were using the headings 'onychomycosis','tinea unguium','terbinafine', 'itraconazole','dermatophyte','molds','yeast','candida','randomized controlled trials',and 'reviews'.All the double- blind randomized clinical trials which had compared the efficacy in the treatment of onychomycosis between terbinafine and itraconazole were included into this meta-analysis.Selection criteria1 Inclusion criteria(1)The objective of the trial was to compare the efficacy in the treatment of onychomycosis between terbinafine and itraconazole;(2) The patients recruited in the trials aged from 18 a to 60 a,had no systemic diseases and had normal liver function;(3)Patients in the trials had not received systemic antifungal therapy 3 mo before the trial started and had not received topical antifungal therapy 1 mo before;(4) The clinical diagnosis of onychomycosis was confirmed by positive results on mycological culture and microscopy(examination in potassium hydroxide);(5)The data of mycological cure rate were recorded in the paper.2 Exclusion criteria(1) Review articles and randomized clinical trials were not being designed as double- blind trial;(2) The aim of the clinical trial was not to compare the efficacy of these 2 agents in the treatment of onychomycosis;(3) Duplicated reports; (4) Onychomycosis of children and elderly men.Data extraction The titles and the abstracts were initially screened,and then the full texts of the randomized clinical trials were reviewed.The diagnostic criteria,randomized method,methods of drug administration,and cure criteria were recorded.Articles matching above criteria could be included in this meta-analysis.Statistical analysis The results of the meta-analysis were showed as relative risk(RR) and its 95%confidence interval(CI).ResultsLiterature search According to the above criteria,6 double- blind randomized clinical trials comparing the efficacy of terbinafine and itraconazole in the treatment of onychomycosis were included into this meta-analysis.They've all been published in English and all designed as multicenter,double -blind,and randomized trials.Four of these trials were to compare the efficacy between continuous terbinafine therapy and continuous itraconazole therapy.The other two were to compare the efficacy between continuous terbinafine therapy and itraconazole pulse therapy(3 or 4 cycles of 400mg/day for 1 wk,being repeated every 4 wk).(Tab 1). Mycological cure rate of terbinafine and itraconazole in the treatment of onychomycosis The mycological cure rate between the therapeutics of continuous terbinafine 250mg/day and itraconazole pulse 400mg/day had significant difference [RR=2.02,95%CI(1.47-2.78)].The mycological cure rate between the therapeutics of continuous terbinafine 250mg/day and continuous itraconazole 200mg/day also has significant difference[RR=1.25,95%CI(1.06-1.48)].That is to say,in the treatment of onychomycosis,continuous terbinafine therapy provided more superior mycological efficacy than either itraconazole pulse therapy or continuous itraconazole therapy.ConclusionTerbinafine is more effective than itraconazole in the treatment of onychomycosis.