Understanding Global Access to Topical Onychomycosis Therapy: A Systematic Review and Meta-Analysis.

IF 4.1 2区医学 Q1 DERMATOLOGY Mycoses Pub Date : 2024-09-01 DOI:10.1111/myc.13797

S M Nasereddin, J L Li, O S Malallah, G R McClelland, D Morgan, S Meadowcroft, A Bolhuis, S A Jones

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Abstract

Introduction: 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.

Methods: Two databases, PubMed and Web of Science, were used to identify relevant information published between 1990 and 2019. For the meta-analysis, human onychomycosis investigations using PCR analysis were included. Reviewers independently selected eligible articles, extracted data and assessed the study quality. A random-effects meta-analysis model with a Freeman-Tukey transformation was employed to the PCR data. For the meta-analysis, the global infection trends and regional differences in the infective organisms were determined.

Results: Of the 26 studies analysed, the PCR analysis in 18 studies confirmed onychomycosis in about half of the visually suspected cases (55%, CI 43%-67%). Across all 26 studies dermatophytes were the most prevalent infective organism (57%, CI 37%-76%), but a sub-group analysis showed yeasts predominated in females (31%, CI 0%-84%) (p < 0.0001), in fingernail infections (42%, CI 21%-65%) (p < 0.0001) and in arid countries (p < 0.0001). 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-spectrum agents. Countries in Africa had the poorest access to topical onychomycosis medicines.

Conclusion: This study identified that access to effective topical products for onychomycosis is a global problem. This issue appeared to be due to under-representation of candida infections in pivotal clinical studies of topical onychomycosis products. A head-to-head multicentre study for topical efinaconazole or a novel broad spectrum topical agent is needed to help resolve these access problems.

Protocol registration: PROSPERO-CRD42023464744.

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了解全球获得局部甲癣治疗的情况：系统回顾与元分析》。

导言：平等获取药物对于确保公众健康至关重要，但药物获取很难衡量，尤其是对于感染性疾病而言，感染种类的变化使得治疗选择高度动态化。本研究探讨了将感染流行率、药物疗效和监管可用性结合起来是否可以获得甲癣外用药物：方法：使用 PubMed 和 Web of Science 这两个数据库查找 1990 年至 2019 年间发表的相关信息。在荟萃分析中，纳入了使用 PCR 分析的人类甲癣调查。审稿人独立选择符合条件的文章，提取数据并评估研究质量。对 PCR 数据采用了 Freeman-Tukey 转换的随机效应荟萃分析模型。在荟萃分析中，确定了全球感染趋势和感染病原体的地区差异：在所分析的 26 项研究中，18 项研究的 PCR 分析证实了约一半的肉眼疑似病例（55%，CI 43%-67%）患有甲癣。在所有 26 项研究中，皮癣菌是最常见的感染性病菌（57%，CI 37%-76%），但一项亚组分析显示，酵母菌在女性中占多数（31%，CI 0%-84%）（P 结论：这项研究发现，获得治疗甲癣的有效外用产品是一个全球性问题。造成这一问题的原因似乎是念珠菌感染在甲癣外用产品关键临床研究中的代表性不足。需要对局部用药依芬康唑或新型广谱局部用药进行头对头多中心研究，以帮助解决这些问题：PROSPERO-CRD42023464744.

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来源期刊

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.