Could Efinaconazole 10% Have An Impact For Onychomycosis?

Richard Pollak, DPM

   In addition to the reported clinical results, the patient assessed his satisfaction in terms of improvement and appearance of his toenails. At baseline, he noted yellowing or discoloration of his toenails, and found his condition very bothersome. Being embarrassed by the appearance of his nails, feeling self-conscious and wearing shoes were all very much problems. At the 52 week follow-up visit, he deemed his condition as only ‘slightly bothersome,’ presumably because other nails continued to be affected, but embarrassment, pain or discomfort had ceased to be problems. Overall, he was very satisfied with the improvement in the condition of his toenails.

Final Notes

Onychomycosis is notoriously difficult to treat and requires a long-term management program. The key aims are to eradicate the pathogens, restore a healthy nail and minimize recurrence. The slow growth of the toenail impacts the ability to assess clinical effectiveness quickly.12,13 Mycological cure is considered an important precursor in evaluating treatment success as it precedes clinical cure, often by several months.14 In this clinical case, mycological cure was apparent from Week 36 whereas I only saw complete cure (0% involvement of the target nail and mycologic cure) at Week 48 (the end of treatment).

   There is a reluctance to treat onychomycosis with topical agents because we do not have anything that is effective. Often our patients, like the one in this case, have suffered with the disease for many years. In addition, a number of nails are usually affected. The results of this case report using efinaconazole 10% solution are encouraging both in terms of mycologic and complete cure, and the patient’s self assessment of improvement. An effective topical antifungal for the treatment of onychomycosis will satisfy an unmet need in the management of onychomycosis, and we await more extensive data from the clinical program.

   Dr. Pollak is in private practice in San Antonio. Dr. Pollak has disclosed that he is an advisor to Valeant Dermatology, a subsidiary of Valeant Pharmaceuticals North America LLC, and was an investigator in the Phase 3 clinical trials of efinaconazole. Dr. Pollak thanks Brian Bulley, MSc, of Inergy Limited, for his assistance with this case study.


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