Onychomycosis is a chronic and intractable disease whose prevalence increases during aging. In elderly patients, if onychomycosis is left untreated and progresses to a severe stage, it may cause functional decline of the lower limbs due to foot pain. This could lead to a decline in activities of daily living and secondary impairment such as cognitive decline. Thus, the treatment of onychomycosis in elderly patients is important.
These authors, from Hokkaido, Japan, have previously shown that fosravuconazole is relatively safe and effective for onychomycosis in elderly patients. Fosravuconazole was approved in Japan in 2018 for the treatment of fungal nail infections; it is not currently approved by the US Food and Drug Administration for use in the United States.
This study continued follow-up and investigated the efficacy of re-administration of fosravuconazole in patients with recurrent onychomycosis. One hundred and twenty-five patients age ≥65 years who had been initially diagnosed with onychomycosis at their hospital’s dermatology department, and who had responded well to fosravuconazole at 48 weeks after the initial treatment, were followed up until 144 weeks after the start of the initial treatment. Patients who experienced a recurrence within 24 weeks after the start of the follow-up were assigned to the short-term recurrence group, and those who experienced a recurrence after 24 weeks were assigned to the long-term recurrence group. All patients in both groups were re-treated with fosravuconazole to evaluate its efficacy.
The short-term and long-term recurrence groups consisted of 17 (14.3%) and 10 (8.4%) patients, respectively. The researchers found no significant differences in mean age and sex ratio between the 2 groups. There were no serious adverse effects in either group, and the toenail opacity ratio was significantly reduced after 12 weeks of re-treatment in both groups. The short-term and long-term recurrence groups were significantly more likely to have wedge-shaped onychomycosis and total dystrophic onychomycosis, respectively. The results suggest that re-administration of fosravuconazole is safe and as effective as the first administration for elderly patients with recurrent onychomycosis.
Source: Okubo A, Hanada M, Kodama S, Taniguchi N, Miyazaki Y. Long-term follow-up study of the efficacy of fosravuconazole in the treatment of onychomycosis in elderly patients. J Dermatol. 2024;51(8):1091-1097. doi: 10.1111/1346-8138.17254. © 2024 Japanese Dermatological Association; all rights reserved.
