title: Network Meta-Analysis of Onychomycosis Treatments.
abstract: BACKGROUND
  Many onychomycosis treatments have not been directly compared in head-to-head clinical trials.
  
  
  OBJECTIVE
  To determine the relative efficacy of onychomycosis treatments using network meta-analysis (NMA).
  
  
  METHODS
  We conducted a systematic review and NMA of mycological cure rates.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ont., Canada; Mediprobe Research Inc., London, Ont., Canada.
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Mediprobe Research Inc., London, Ont., Canada.
authors.forename: Deanne
authors.initials: D
authors.lastname: Daigle
authors.affiliation: Mediprobe Research Inc., London, Ont., Canada.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Foley
keywords: Antifungals; Network meta-analysis; Onychomycosis; Systematic review