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Efinaconazole for Fungal Nail Infections: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines

Last updated: January 15, 2016
Project Number: RC0737-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report


  1. What is the clinical effectiveness and safety of efinaconazole for the treatment of fungal nail infections?
  2. What is the cost-effectiveness of efinaconazole for the treatment of fungal nail infections?
  3. What are the evidence-based guidelines regarding the treatment of fungal nail infections?

Key Message

Compared to vehicle alone, efinaconazole resulted in greater complete cure or mycological cure rates in adults with mild to moderate onychomychosis. A network meta-analysis showed that for treatment of onychomychosis, oral antifungal agents ranked higher than topical antifungal agents with respect to mycological cure; and among the topical antifungal agents, efinaconazole ranked the highest. Safety issues were not investigated in the network meta-analysis. No relevant economic studies of efinaconazole for the treatment of fungal nail infections were identified. A Canadian guideline recommended an oral antifungal agent (teribinafine) for severe disease, oral teribinafine or topical antifungal agent (efinaconazole) for moderate disease and efinaconazole for mild disease. According to a guideline from the United Kingdom, teribinafine was recommended as first line therapy. This guideline mentioned that antifungals such as efinaconazole may be used, however the recommendation was mentioned to be of low strength.