Olafsson J H, Sigurgeirsson B, Baran R
Department of Dermatology, Landspitali University Hospital, Tverholt 18, 105 Reykjavik, Iceland.
Br J Dermatol. 2003 Sep;149 Suppl 65:15-8. doi: 10.1046/j.1365-2133.149.s65.2.x.
Combination therapy is one way of improving the cure rate of onychomycosis. The LION Study examined the efficacies of terbinafine and itraconazole. The Icelandic cohort of the study reported that after 5 years only 46% of the terbinafine-treated patients and 13% of the itraconazole-treated patients were still disease-free, suggesting that relapses and reinfections were common in the long term treatment of onychomycosis with monotherapy. Combination therapy is a well-established principle in mycology; the current strategy involves the combination of oral and topical antifungal treatments. A number of specific drug combinations have proved to be useful in the treatment of onychomycosis: tioconazole and griseofulvin, amorolfine and griseofulvin, amorolfine and terbinafine, and amorolfine and itraconazole. However, comparison of the combination trials can be difficult because of the short duration of some of the studies and variation in global cure rates. Although it is necessary to consider these factors it is clear that combination therapy offers advantages when compared with monotherapy. Combination therapy can be administered sequentially or in parallel. Parallel therapy is recommended for patients who are likely to fail therapy (e.g. patients with diabetes), whereas sequential therapy is recommended for patients who show a poor response to initial treatment.
联合治疗是提高甲癣治愈率的一种方法。LION研究考察了特比萘芬和伊曲康唑的疗效。该研究的冰岛队列报告称，5年后，接受特比萘芬治疗的患者中只有46%仍无疾病，接受伊曲康唑治疗的患者中这一比例为13%，这表明在甲癣的单药长期治疗中，复发和再感染很常见。联合治疗是真菌病学中一个既定的原则；目前的策略是口服和外用抗真菌治疗联合使用。一些特定的药物组合已被证明对甲癣治疗有效：噻康唑和灰黄霉素、阿莫罗芬和灰黄霉素、阿莫罗芬和特比萘芬以及阿莫罗芬和伊曲康唑。然而，由于一些研究的持续时间较短以及总体治愈率存在差异，比较联合治疗试验可能会很困难。尽管有必要考虑这些因素，但很明显，与单药治疗相比，联合治疗具有优势。联合治疗可以序贯给药或并行给药。对于可能治疗失败的患者（如糖尿病患者），建议采用并行治疗，而对于初始治疗反应不佳的患者，建议采用序贯治疗。
