title: Recurrences of dermatophyte toenail onychomycosis during long-term follow-up after successful treatments with mono- and combined therapy of terbinafine and itraconazole.
abstract: BACKGROUND
  The influence of dosing regimens on the recurrence rates of onychomycosis has not been investigated.
  
  
  OBJECTIVE
  To compare recurrence rates for toenail dermatophyte onychomycosis between four dosing regimens.
  
  
  METHODS
  A prospective, investigator-blinded, long-term follow-up (1.25 to 7 years postenrolment) study of the following regimens was undertaken with or without booster therapy at week 36: overlapping continuous itraconazole and terbinafine (COMBO), continuous terbinafine (CTERB), intermittent terbinafine (TOT), and pulsed itraconazole (III).
  
  
  RESULTS
  One hundred six mycologically and 43 completely cured participants at week 48 were included. Recurrence rates (RR) for mycologically and completely cured participants were respectively termed mycologic recurrence (MRR) and complete cure recurrence (CRR) rates. No statistically significant difference was detected between the four regimens for the two rates. However, lower MRRs were obtained for CTERB (32%) and TOT (36%) compared to III (59%) and COMBO (57%). When participants who received booster therapy were excluded from the analysis, the MRR was lower for CTERB (21%) compared to TOT (39%).
  
  
  CONCLUSIONS
  Itraconazole therapy was associated with higher RRs than terbinafine therapy. Combined therapy did not reduce the RRs compared to monotherapies. A difference might exist between continuous and intermittent antifungal regimens, but additional randomized clinical trials are needed for confirmation.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada. agupta@execulink.com
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cooper
authors.forename: Maryse
authors.initials: M
authors.lastname: Paquet
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage; D003883:Arthrodermataceae / Q000302:isolation & purification*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000008:administration & dosage*; D014009:Onychomycosis / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D016037:Single-Blind Method; D000077291:Terbinafine; D013997:Time Factors; D016896:Treatment Outcome; D014344:Trypanocidal Agents
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D014344:Trypanocidal Agents; D017964:Itraconazole; D000077291:Terbinafine