Clinical use of Fosravuconazole for Patients with Onycomycosis in Our Clinic

Abstract

Efficacy and safety were investigated in 106 patients who were treated with fosravuconazole and followed up for at least 5 months. The turbidity ratios were obtained based on clinical images and were observed over time. Patients with turbidity ratios of 9 and 10 showed a rapid decrease from 89% at the start of the administration to 55% at 4 weeks and to 26% at 8 weeks. Patients with a turbidity ratio of 5 or less started to get cured after 4 weeks, increasing to 28% after 12 weeks, to 45% after 4 months, and to 62% after 5 months. The complete cure rate after 1 year was 67%. A comparison of the groups with and without total dystrophic onychomycosis (TDO) revealed that the group without TDO showed a better improvement tendency, indicating that TDO is intractable. When nail clipping was used in combination with TDO, an increased tendency for improvement was observed. Long-term follow-up showed cases of recurrence. Four patterns of recurrent cases were seen, namely, from distal and lateral subungual onychomycosis (DLSO) to DLSO, from TDO or superficial white onychomycosis (SWO) to SWO, and from dermatophytoma to dermatophytoma. In patients with recurrence from DLSO to DLSO, after some improvement, the recurrence seemed to be delayed. In these patients, the nail plate was separated from the nail bed, and we anticipated a possibility of survival for the dermatophytes in that area, which then recurred as there was no penetration of the drug from the nail bed. Hepatic dysfunction was seen in 26.4% of the patients, but the γ-GTP level was aberrant in half of the patients, and only two failed to complete the treatment. Hepatic dysfunction often develops after the initial 6 weeks of treatment, and hence, periodic checkups are necessary after 6 weeks.