Cochrane · systematic review · CD010031
Oral antifungal medication for toenail onychomycosis
Kreijkamp‐Kaspers, S, Hawke, K, Guo, L, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
SkinAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
30
current version
GRADE rated
22
No studies
8
Included studies
NR
No studies 8 · 26.7%Ungraded 0 · 0%Very low 3 · 10%Low 7 · 23.3%Moderate 8 · 26.7%High 4 · 13.3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Azole compared to terbinafine for toenail onychomycosis
Population: participants with confirmed toenail onychomycosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical cure Azole vs terbinafine | RR 0.82 [0.72, 0.95] | 15 studies · 2168 participants | Moderate Downgraded: risk of bias |
Mycological cure Azole vs terbinafine | RR 0.77 [0.68, 0.88] | 17 studies · 2544 participants | Moderate Downgraded: risk of bias |
Adverse events Azole vs terbinafine | RR 1 [0.86, 1.17] | 9 studies · 1762 participants | Moderate Downgraded: risk of bias |
Recurrence rate Azole vs terbinafine | RR 1.11 [0.68, 1.79] | 5 studies · 282 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Azole vs terbinafine | no estimate extracted | NR | No studies |
Terbinafine compared to placebo for toenail onychomycosis
Population: patients with confirmed toenail onychomycosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical cure Terbinafine vs placebo | RR 6 [3.96, 9.08] | 8 studies · 1006 participants | High |
Mycological cure Terbinafine vs placebo | RR 4.53 [2.47, 8.33] | 8 studies · 1006 participants | High |
Adverse events Terbinafine vs placebo | RR 1.13 [0.87, 1.47] | 4 studies · 399 participants | Moderate Downgraded: risk of bias |
Recurrence rate Terbinafine vs placebo | RR 0.05 [0.01, 0.38] | 1 study · 35 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Terbinafine vs placebo | no estimate extracted | NR | No studies |
Azole compared to placebo for toenail onychomycosis
Population: participants with confirmed toenail onychomycosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical cure Azole vs placebo | RR 22.18 [12.63, 38.95] | 9 studies · 3440 participants | High |
Mycological cure Azole vs placebo | RR 5.86 [3.23, 10.62] | 9 studies · 3440 participants | High |
Adverse events Azole vs placebo | RR 1.04 [0.97, 1.12] | 9 studies · 3441 participants | Moderate Downgraded: risk of bias |
Recurrence rate Azole vs placebo | RR 0.55 [0.29, 1.07] | 1 study · 26 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Azole vs placebo | no estimate extracted | NR | No studies |
Griseofulvin compared to azole for toenail onychomycosis
Population: participants with confirmed toenail onychomycosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical cure Griseofulvin vs azole | RR 0.94 [0.45, 1.96] | 5 studies · 222 participants | Moderate Downgraded: risk of bias |
Mycological cure Griseofulvin vs azole | RR 0.87 [0.5, 1.51] | 5 studies · 222 participants | Moderate Downgraded: risk of bias |
Adverse events Griseofulvin vs azole | RR 2.41 [1.56, 3.73] | 2 studies · 143 participants | Moderate Downgraded: risk of bias |
Recurrence rate Griseofulvin vs azole | RR 4 [0.26, 61.76] | 1 study · 7 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Griseofulvin vs azole | no estimate extracted | NR | No studies |
Griseofulvin compared to terbinafine for toenail onychomycosis
Population: participants with confirmed toenail onychomycosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical cure Griseofulvin vs terbinafine | RR 0.32 [0.14, 0.72] | 4 studies · 270 participants | Low Downgraded: risk of bias |
Mycological cure Griseofulvin vs terbinafine | RR 0.64 [0.46, 0.9] | 5 studies · 465 participants | Low Downgraded: risk of bias |
Adverse events Griseofulvin vs terbinafine | RR 2.09 [1.15, 3.82] | 2 studies · 100 participants | Low Downgraded: risk of bias, imprecision |
Recurrence rate Griseofulvin vs terbinafine | no estimate extracted | NR | No studies |
Quality of life Griseofulvin vs terbinafine | no estimate extracted | NR | No studies |
Combination terbinafine plus azole compared to terbinafine monotherapy for toenail onychomycosis
Population: participants with confirmed toenail onychomycosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical cure Combination terbinafine plus azole vs terbinafine monotherapy | RR 1.41 [1.01, 1.97] | 1 study · 176 participants | Very low Downgraded: risk of bias, imprecision |
Mycological cure Combination terbinafine plus azole vs terbinafine monotherapy | RR 1.41 [1.08, 1.83] | 1 study · 176 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Combination terbinafine plus azole vs terbinafine monotherapy | RR 0.64 [0.34, 1.21] | 1 study · 176 participants | Low Downgraded: risk of bias, imprecision |
Recurrence rate Combination terbinafine plus azole vs terbinafine monotherapy | no estimate extracted | NR | No studies |
Quality of life Combination terbinafine plus azole vs terbinafine monotherapy | no estimate extracted | NR | No studies |