Gupta A K, De Doncker P, Scher R K, Haneke E, Daniel C R, André J, Baran R
Department of Medicine, Sunnybrook Health Science Center, Toronto, Canada.
Int J Dermatol. 1998 Apr;37(4):303-8. doi: 10.1046/j.1365-4362.1998.00360.x.
The broad spectrum of activity of itraconazole in vitro manifests itself clinically with the drug being effective for the treatment of onychomycosis caused by dermatophytes, Candida and some non-dermatophyte molds. The pharmacokinetics of itraconazole in the nail results in drug remaining at therapeutic levels for 6-9 months after completion of therapy.
An overview of studies where continuous or pulse itraconazole therapy has been used in the treatment of fingernail and toenail onychomycosis.
Following continuous therapy at 200 mg/day for 3 months for toenail onychomycosis (n = 1741), the rates of clinical cure, clinical response and mycologic cure were: (meta-average +/- 95% standard error (SE)), 52 +/- 9%, 86 +/- 2%, and 74 +/- 3%, respectively, at follow-up 12 months following start of therapy. In fingernail onychomycosis (n = 211), the duration of therapy was 6 weeks and the corresponding efficacy rates at follow-up, 9 months after start of therapy, were meta-average (+/- S.E.) 82 +/- 5%, 90 +/- 2%, and 86 +/- 3%, respectively. In toenail onychomycosis treated with 3 pulses of therapy (n = 1389), the clinical response, clinical cure and mycologic cure were observed in meta-average (+/- S.E.) 58 +/- 10%, 82 +/- 3%, and 77 +/- 5% patients, respectively, at follow-up 12 months after the start of therapy. In fingernail onychomycosis treated with 2 pulses of therapy (n = 210), at follow-up 9 months after the start of therapy, the corresponding efficacy rates were meta-average (+/- S.E.) 78 +/- 10%, 89 +/- 6%, and 87 +/- 8%, respectively.
Both the continuous and pulse therapy regimens are safe with few adverse effects. Compared to continuous therapy, the pulse regimen has an improved adverse-effects profile, is more cost-effective, and is preferred by many patients.
伊曲康唑在体外具有广泛的活性，在临床上表现为对由皮肤癣菌、念珠菌和一些非皮肤癣菌霉菌引起的甲癣治疗有效。伊曲康唑在指甲中的药代动力学导致在治疗完成后药物可在治疗水平维持6 - 9个月。
对使用连续或脉冲式伊曲康唑疗法治疗手指甲和脚趾甲甲癣的研究进行综述。
对于趾甲甲癣（n = 1741），采用200 mg/天连续治疗3个月后，在治疗开始后12个月的随访中，临床治愈率、临床有效率和真菌学治愈率分别为：（荟萃平均值±95%标准误（SE）），52±9%、86±2%和74±3%。对于手指甲甲癣（n = 211），治疗持续时间为6周，在治疗开始后9个月的随访中，相应的有效率分别为荟萃平均值（±标准误）82±5%、90±2%和86±3%。对于采用3个脉冲疗程治疗的趾甲甲癣（n = 1389），在治疗开始后12个月的随访中，分别观察到荟萃平均值（±标准误）58±10%、82±3%和77±5%的患者有临床有效、临床治愈和真菌学治愈。对于采用2个脉冲疗程治疗的手指甲甲癣（n = 210），在治疗开始后9个月的随访中，相应的有效率分别为荟萃平均值（±标准误）78±10%、89±6%和87±8%。
连续和脉冲治疗方案均安全，不良反应少。与连续治疗相比，脉冲治疗方案不良反应较少，更具成本效益，且为许多患者所青睐。
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