Gupta Aditya K, Daigle Deanne, Foley Kelly A
Department of Medicine, University of Toronto, Toronto, Ont., Canada; Mediprobe Research Inc., London, Ont., Canada.
Mediprobe Research Inc., London, Ont., Canada.
Skin Appendage Disord. 2015 Sep;1(2):74-81. doi: 10.1159/000433473. Epub 2015 Jun 26.
Many onychomycosis treatments have not been directly compared in head-to-head clinical trials.
To determine the relative efficacy of onychomycosis treatments using network meta-analysis (NMA).
We conducted a systematic review and NMA of mycological cure rates.
Nineteen trials were included in the network. Terbinafine 250 mg was significantly superior to all treatments except itraconazole 400 mg pulse therapy. The itraconazole 400 mg pulse regimen was significantly superior to all topicals except efinaconazole 10% nail solution. Itraconazole 200 mg was significantly superior to all topical treatments, while fluconazole 150-450 mg, efinaconazole 10% nail solution, tavaborole 5% nail solution, ciclopirox nail lacquer 8%, terbinafine nail solution, and amorolfine 5% nail lacquer were significantly superior to placebo.
Newly developed topicals have improved the odds ratios (ORs) of mycological cure, yet these ORs were not significantly greater than preexisting topical treatments. Further experience with these agents will reveal their clinical significance, and head-to-head trials are warranted. © 2015 S. Karger AG, Basel.
许多甲癣治疗方法尚未在直接对比的临床试验中进行比较。
使用网状Meta分析（NMA）确定甲癣治疗方法的相对疗效。
我们对真菌学治愈率进行了系统评价和NMA。
该网状分析纳入了19项试验。特比萘芬250mg显著优于除伊曲康唑400mg脉冲疗法之外的所有治疗方法。伊曲康唑400mg脉冲方案显著优于除10%艾氟康唑甲溶液之外的所有外用药物。伊曲康唑200mg显著优于所有外用治疗方法，而氟康唑150 - 450mg、10%艾氟康唑甲溶液、5%他氟硼甲溶液、8%环吡酮甲涂剂、特比萘芬甲溶液和5%阿莫罗芬甲涂剂显著优于安慰剂。
新开发的外用药物提高了真菌学治愈的优势比（OR），但这些OR并不显著高于现有的外用治疗方法。对这些药物的进一步研究将揭示其临床意义，有必要开展直接对比试验。© 2015 S. Karger AG，巴塞尔。
