Outcome of fosravuconazole treatment for onychomycosis refractory to topical antifungal agents

Abstract

AbstractFosravuconazole L‐lysine ethanolate (F‐RVCZ) is an oral antifungal agent approved in Japan for the treatment of onychomycosis. We treated 36 patients (mean age 77.6 years) with onychomycosis that had been refractory to long‐term topical treatment. The patients took F‐RVCZ (100 mg ravuconazole) once daily for a mean of 11.3 weeks, and were followed up for an average of 48 weeks (mean 48.3 ± 2.1 weeks). The mean rate of improvement of the affected nail area at 48 weeks was 59.4%, and 12 patients achieved complete cure. Patients with total dystrophic onychomycosis (TDO) showed a significantly lower improvement rate than those with distal and lateral subungual onychomycosis (DLSO), and those with an affected nail area of 76%–100% at the first visit showed a significantly lower improvement rate than those with an affected nail area of 0%–75%. Six patients had adverse events necessitating treatment discontinuation, but the symptoms and laboratory data improved without specific treatment in all of them. The data suggest that F‐RVCZ would be effective in various age groups, including the elderly, and even in patients with onychomycosis refractory to long‐term topical antifungal treatment. It was also suggested that its early use in mild cases might achieve a higher rate of complete cure. Furthermore, the average cost of oral F‐RVCZ therapy was lower than that for topical antifungal agents. Therefore, F‐RVCZ is considered to be much more cost‐effective than topical antifungal agents.