{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:06:31Z","timestamp":1790366791435,"version":"4.1.0"},"reference-count":66,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There is a paucity of evidence regarding the relative therapeutic efficacy of treatments for onychomycosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We determined the relative efficacy of monotherapies for dermatophyte toenail onychomycosis with Bayesian network meta-analyses (NMAs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched PubMed, Scopus, EMBASE (Ovid) and CINAHL to identify studies that investigated the efficacy of monotherapy with oral antifungals for dermatophyte toenail onychomycosis in adults. In this paper, \u2018regimen\u2019 corresponds to a given agent and its dosage. The relative effects and surface under the cumulative ranking curve (SUCRA) values of the various regimens were estimated; evidence quality was assessed at the study level and across networks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data from 21 studies were used. Our two efficacy-related endpoints were: (i) mycological and (ii) complete cure at 1\u2005year; safety-\u00adrelated endpoints were: (i) 1-year count of any adverse event (AE), (ii) 1-year odds of discontinuation due to any AE, (iii) 1-year odds of discontinuation due to liver issues. Thirty-five regimens were identified; the newer agents among these included posaconazole and oteseconazole. We compared the efficacy of newer regimens with traditional ones like \u2018terbinafine 250\u2005mg daily for 12 weeks\u2019 and \u2018itraconazole 200\u2005mg daily for 12 weeks. We found that an agent\u2019s dosage was associated with its efficacy; for example, the 1-year odds of mycological cure with terbinafine 250\u2005mg daily for 24 weeks (SUCRA = 92.4%) were significantly greater than those of terbinafine 250\u2005mg daily for 12 weeks (SUCRA = 66.3%) (odds ratio 2.62, 95% credible interval 1.57\u20134.54). We also found that booster regimens can increase efficacy. Our results showed that some triazoles could be more effective than terbinafine.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This is the first NMA study of monotherapeutic antifungals \u2013 and their various dosages \u2013 for dermatophyte toenail onychomycosis. Our findings could provide guidance for the selection of the most appropriate antifungal agent, especially amid the growing concerns about terbinafine resistance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjd\/ljad070","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T17:36:29Z","timestamp":1685468189000},"page":"12-22","source":"Crossref","is-referenced-by-count":8,"title":["Relative impact of traditional vs. newer oral antifungals for dermatophyte toenail onychomycosis: a network meta-analysis study"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8664-7723","authenticated-orcid":false,"given":"Aditya K","family":"Gupta","sequence":"first","affiliation":[{"name":"Mediprobe Research Inc. , London, ON , Canada"},{"name":"Division of Dermatology, Department of Medicine, University of Toronto School of Medicine , Toronto, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8543-8463","authenticated-orcid":false,"given":"Maanasa","family":"Venkataraman","sequence":"additional","affiliation":[{"name":"Mediprobe Research Inc. , London, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5610-375X","authenticated-orcid":false,"given":"Mary A","family":"Bamimore","sequence":"additional","affiliation":[{"name":"Mediprobe Research Inc. , London, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"key":"2023112114075622700_ljad070-B1","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1001\/archderm.1997.03890450124022","article-title":"Prevalence of onychomycosis in patients attending a dermatology clinic in northeastern Ohio for other 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