This was a randomized, controlled, parallel-group clinical trial with a blinded evaluator, designed to compare the efficacy and safety of the nail lacquer P-3051 with amorolfine 5% in the treatment of mild-to-moderate toenail onychomycosis. Patients were treated for 48 weeks with P-3051 daily, or twice weekly with amorolfine 5%. Out of 120 evaluable patients, 60 (50.0%) received P-3051 and 60 (50.0%) amorolfine 5%. At baseline, the two groups were homogeneous in terms of race, pathogens, number of affected toenails and severity of the infected target nail area. The statistical superiority of P-3051 versus amorolfine was achieved after 48 weeks (treatment success: 58.3% for P-3051 vs. 26.7% for amorolfine, p < 0.001; complete cure: 35.0% for P-3051 vs. 11.7% for amorolfine, p < 0.001). Mycological cure at week 48 was achieved in all patients treated with P-3051 compared to 81.7% of patients treated with amorolfine (p < 0.001). Moreover, fungal eradication by P-3051 was statistically superior at week 24. The results of this study, and of a previous pivotal study versus the insoluble formulation of ciclopirox 8%, led to consider P-3051 as the gold standard for the topical treatment of mild-to-moderate onychomycosis.

1.
Roberts DT: Prevalence of dermatophyte onychomycosis in the United Kingdom: results of an omnibus survey. Br J Dermatol 1992;126:23-27.
2.
Elewski BE, Charif MA: Prevalence of onychomycosis in patients attending a dermatology clinic in northeastern Ohio for other conditions. Arch Dermatol 1997;133:1172-1173.
3.
Sais G, Jucgl A, Peyr J: Prevalence of dermatophyte onychomycosis in Spain: a cross-sectional study. Br J Dermatol 1995;132:758-761.
4.
Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, Summerbell R, Sullivan S, Daniel R, Krusinski P, Fleckman P, Rich P, Odom R, Aly R, Pariser D, Zaiac M, Rebell G, Lesher J, Gerlach B, Ponce-De-Leon GF, Ghannoum A, Warner J, Isham N, Elewski B: A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol 2000;43:641-648.
5.
Sigurgeirsson B, Steingrímsson O, Sveinsdóttir S: Prevalence of onychomycosis in Iceland: a population-based study. Acta Derm Venereol 2002;82:467-469.
6.
Gupta AK, Jain HC, Lynde CW, Watteel GN, Summerbell RC: Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists' offices in Ontario, Canada - a multicenter survey of 2001 patients. Int J Dermatol 1997;36:783-787.
7.
Svejgaard EL, Nilsson J: Onychomycosis in Denmark: prevalence of fungal nail infection in general practice. Mycoses 2004;47:131-135.
8.
Welsh O, Vera-Cabrera L, Welsh E: Onychomycosis. Clin Dermatol 2010;28:151-159.
9.
Shear N, Drake L, Gupta AK, Lambert J, Yaniv R: The implications and management of drug interactions with itraconazole, fluconazole and terbinafine. Dermatology 2000;201:196-203.
10.
Ghannoum MA, Long L, Isham N, Bulgheroni A, Setaro M, Caserini M, Palmieri R, Mailland F: Ability of hydroxypropyl chitosan nail lacquer to protect against dermatophyte nail infection. Antimicrob Agents Chemother 2015;59:1844-1848.
11.
Monti D, Herranz U, Dal Bo L, Subissi A: Nail penetration and predicted mycological efficacy of an innovative hydrosoluble ciclopirox nail lacquer vs a standard amorolfine lacquer in healthy subjects. J Eur Acad Dermatol Venereol 2013;27:e153-e158.
12.
Baran R, Tosti A, Hartmane I, Altmeyer P, Hercogova J, Koudelkova V, Ruzicka T, Combemale P, Mikazans I: An innovative water-soluble biopolymer improves efficacy of ciclopirox nail lacquer in the management of onychomycosis. J Eur Acad Dermatol Venereol 2009;23:773-781.
13.
Paul C, Coustou D, Lahfa M, Bulai-Livideanu C, Doss N, Mokthar I, Turki H, Nouira R, Fazaa B, Ben Osman A, Zourabichvili O, Cazeau C, Coubetergues H, Picot S, Bienvenu AL, Voisard JJ: A multicenter, randomized, open-label, controlled study comparing the efficacy, safety and cost-effectiveness of a sequential therapy with RV4104A ointment, ciclopiroxolamine cream and ciclopirox film-forming solution with amorolfine nail lacquer alone in dermatophytic onychomycosis. Dermatology 2013;227:157-164.
14.
Elewski BE, Ghannoum MA, Mayser P, Gupta AK, Korting HC, Shouey RJ, Baker DR, Rich PA, Ling M, Hugot S, Damaj B, Nyirady J, Thangavelu K, Notter M, Parneix-Spake A, Sigurgeirsson B: Efficacy, safety and tolerability of topical terbinafine nail solution in patients with mild-to-moderate toenail onychomycosis: results from three randomized studies using double-blind vehicle-controlled and open-label active-controlled designs. J Eur Acad Dermatol Venereol 2013;27:287-294.
15.
Reinel D, Clarke C: Comparative efficacy and safety of amorolfine nail lacquer 5% in onychomycosis, once-weekly versus twice-weekly. Clin Exp Dermatol 1992;17(suppl):44-49.
16.
Laupacis A, Sackett DL, Roberts RS: An assessment of clinically useful measures of the consequences of treatment. N Engl J Med 1988;318:1728-1733.
17.
McQuay HJ, Moore RA: Using numerical results from systematic reviews in clinical practice. Ann Intern Med 1997;126:712-720.
18.
Gupta AK, Fleckman P, Baran R: Ciclopirox nail lacquer topical solution 8% in the treatment of toenail onychomycosis. J Am Acad Dermatol 2000;43(suppl):S70-S80.
19.
Elewski BE, Rich P, Pollak R, Pariser DM, Watanabe S, Senda H, Ieda C, Smith K, Pillai R, Ramakrishna T, Olin JT: Efinaconazole 10% solution in the treatment of toenail onychomycosis: two phase III multicenter, randomized, double-blind studies. J Am Acad Dermatol 2013;68:600-608, erratum in J Am Acad Dermatol 2014;70:399.
20.
Ghannoum M, Isham N, Catalano V: A second look at efficacy criteria for onychomycosis: clinical and mycological cure. Br J Dermatol 2014;170:182-187.
21.
Ghelardi E, Celandroni F, Gueye SA, Salvetti S, Senesi S, Bulgheroni A, Mailland F: Potential of Ergosterol synthesis inhibitors to cause resistance or cross-resistance in Trichophyton rubrum. Antimicrob Agents Chemother 2014;58:2825-2829.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.