Which oral medication works best for toenail fungus? The winner seems to be terbinafine (Lamisil), based on a recent clinical evidence review. Researchers studied 48 trials that included more than 10,000 patients over 30 years. Terbinafine was compared to placebo and other oral antifungals, including the azole antifungals (ketoconazole, itraconazole, and fluconazole) and Griseofulvin. All three oral antifungal groups (terbinafine, azoles, and Griseofulvin) demonstrated higher cure rates than placebo, but terbinafine outperformed both the azoles and Griseofulvin in clinical and mycologic cure rates. Terbinafine also was associated with a lower recurrence rate than the other drugs. Terbinafine and the azoles were well-tolerated compared to placebo, but patients treated with Griseofulvin experienced more adverse events than terbinafine or the azoles. Although both terbinafine and the azoles are considered effective treatments, only 31-57% of patients achieved clinical cure, while 43-76% achieved mycological cure (JAMA 2018;319:397-398).
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