Abstract

ANDRADE-CERQUERA, Ernesto. Efficacy and safety of oral terbinafine in intermittent or pulsatile pattern versus continuous pattern for the treatment of Onychomycosis in patients older than 18 years. rev.fac.med. [online]. 2016, vol.64, n.1, pp.59-66. ISSN 0120-0011.  https://doi.org/10.15446/revfacmed.v64n1.47890.

Background. Onychomycosis is a disease involving nails. It affects 5% of the world population. Objective. To determine the effectiveness and safety of oral terbinafine in intermittent pattern versus a continuous pattern for onychomycosis in patients older than 18 years. Materials and Methods. Through an online systematic search in Cochrane, MEDLINE, EMBASE, Latino-Americana [Literature] (LILACS) and Opengrey, parallel randomized clinical trials, excluding crusaders, conglomerates or cluster, were identified. RevMan 5.3 for systematic reviews of clinical trials was applied. Through a systematic search were identified parallel randomized clinical trials in ≥18 years, male or female, human, in English and Spanish, without time limit of publication and whose outcome was clinical and mycological cure, including mild adverse effects. The risk of bias was assessed. RR was used as a measure of effect, 95% CI for dichotomous variables. The unit of analysis was the patient and the pooled estimate was calculated using a random effects model for dichotomous variables, Mantel-Haenszel method in RevMan 5.3. Results. The pooled RR was 1.13 [95% CI: 1.06 - 1.2] which indicates that treatment failure with intermittent terbinafine is 1.1 times more likely to happen than that with continuous terbinafine. In turn, continuous terbinafine pooled RR was 0.923 [95% CI: 0.77 - 1.09] indicating a 7.7% higher chance of developing adverse events for the treatment with continuous terbinafine. Conclusions. Intermittent terbinafine is less successful in terms of clinical and mycological cure than the continuous treatment. Its corrected RR shows that the intermittent pattern is 13% less efficient than the continuous one. Clinically, these findings are significant but the studies lack power statistically and a larger clustered sample is necessary to improve the evidence.

Keywords : Onychomycosis; Clinical Trial; Trichophyton; Review; Effectiveness.

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