{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T10:38:12Z","timestamp":1777027092554,"version":"3.51.4"},"reference-count":65,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T00:00:00Z","timestamp":1727222400000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Equal access to medicines is crucial to ensuring public health, but access is difficult to measure, especially for infections where changes in infective species make treatment choices highly dynamic. This study investigated if the combination of infection prevalence with medicine efficacy and regulatory availability could access medicines access of topical onychomycosis medicines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two databases, PubMed and Web of Science, were used to identify relevant information published between 1990 and 2019. For the meta\u2010analysis, human onychomycosis investigations using PCR analysis were included. Reviewers independently selected eligible articles, extracted data and assessed the study quality. A random\u2010effects meta\u2010analysis model with a Freeman\u2013Tukey transformation was employed to the PCR data. For the meta\u2010analysis, the global infection trends and regional differences in the infective organisms were determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 26 studies analysed, the PCR analysis in 18 studies confirmed onychomycosis in about half of the visually suspected cases (55%, CI 43%\u201367%). Across all 26 studies dermatophytes were the most prevalent infective organism (57%, CI 37%\u201376%), but a sub\u2010group analysis showed yeasts predominated in females (31%, CI 0%\u201384%) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), in fingernail infections (42%, CI 21%\u201365%) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and in arid countries (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Combining these results with medicine efficacy data showed that residents from 83 of the 92 countries assessed (90%) could not access the most efficacious topical product, and 22% could not access any broad\u2010spectrum agents. Countries in Africa had the poorest access to topical onychomycosis medicines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study identified that access to effective topical products for onychomycosis is a global problem. This issue appeared to be due to under\u2010representation of candida infections in pivotal clinical studies of topical onychomycosis products. A head\u2010to\u2010head multicentre study for topical efinaconazole or a novel broad spectrum topical agent is needed to help resolve these access problems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Protocol Registration<\/jats:title><jats:p>PROSPERO\u2014CRD42023464744<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13797","type":"journal-article","created":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T05:02:58Z","timestamp":1727326978000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Understanding Global Access to Topical Onychomycosis Therapy: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"67","author":[{"given":"S.\u00a0M.","family":"Nasereddin","sequence":"first","affiliation":[{"name":"College of Pharmacy Amman Arab University  Mubis Jordan"},{"name":"Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Sciences  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.\u00a0L.","family":"Li","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Sciences  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.\u00a0S.","family":"Malallah","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Sciences  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.\u00a0R.","family":"McClelland","sequence":"additional","affiliation":[{"name":"Centre for Pharmaceutical Medicine Research Institute for Pharmaceutical Science, Faculty of Life Sciences &amp; Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Centre for Pharmaceutical Medicine Research Institute for Pharmaceutical Science, Faculty of Life Sciences &amp; Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Meadowcroft","sequence":"additional","affiliation":[{"name":"Takeda UK Ltd  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Bolhuis","sequence":"additional","affiliation":[{"name":"Department of Life Sciences, and the Centre for Therapeutic Innovation University of Bath  Bath UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.\u00a0A.","family":"Jones","sequence":"additional","affiliation":[{"name":"Centre for Pharmaceutical Medicine Research Institute for Pharmaceutical Science, Faculty of Life Sciences &amp; Medicine  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,9,25]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"WHO \u201cAccess to Medicines: Making Market Forces Serve the Poor \u201d2017."},{"key":"e_1_2_12_3_1","unstructured":"M.Newton K.Stoddart M.Travaglio andP.Troein \u201cEFPIA_patient_wait_indicator_final_report \u201d2022."},{"key":"e_1_2_12_4_1","unstructured":"M.Christianah A.Malick A.Michela et\u00a0al. \u201cAccess to Medicine 2024 \u201d2023 www.accesstomedicinefoundation.org."},{"key":"e_1_2_12_5_1","unstructured":"OECD \u201cAddressing Challenges in Access to Oncology Medicines Analytical Report \u201d2020."},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589\u20107500(23)00025\u20100"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.21669"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128071\u2010200001010\u201000002"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102710.2009.01107.x"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2007.04.004"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20103083.2009.03225.x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20103083.2004.00988.x"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000353667"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20103083.2011.04373.x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000441569"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2000.109071"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20103083.2009.03164.x"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2015.04.010"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2012.10.013"},{"issue":"2","key":"e_1_2_12_20_1","first-page":"186","article-title":"Efinaconazole Solution in the Treatment of Toenail Onychomycosis: A Phase 2, Multicenter, Randomized, Double\u2010Blind Study","volume":"12","author":"Tschen E. 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