The primary endpoint was stringently defined as the complete cure rate at Week 52, which means that the target nail showed no clinical involvement and no evidence of fungus present by both KOH testing and by a negative fungal culture.
In both studies, the primary endpoint of complete cure was statistically significant ( P < .001) in favor of efinaconazole topical solution 10%. In Study 1, 17.8% of subjects treated with efinaconazole were completely cured compared to only 3.3% of subjects treated with vehicle. In Study 2, 15.2% of subjects treated with efinaconazole were completely cured compared to only 5.5% of subjects treated with vehicle. Although no head-to-head studies have been conducted, these results are comparable to that reported with oral treatment of onychomycosis.
Both studies also found that mycologic cure rates were also statistically significant ( P < .001) in favor of efinaconazole topical solution 10%. In Study 1, 55.2% of subjects treated with efinaconazole demonstrated mycologic cure compared to only 16.8% of subjects treated with vehicle. In Study 2, 53.4% of subjects treated with efinaconazole demonstrated mycologic cure compared to only 16.9% of subjects treated with vehicle. Given that healthy toenails can take 78 weeks to grow completely, it is not surprising that mycologic cure rates are greater than complete cure rates. In addition, more patients treated with efinaconazole (Study 1: 26.4% and Study 2: 23.4%) achieved a complete or almost complete cure ( <5% clinical involvement and mycologic cure) compared with vehicle (Study 1: 7.0% and Study 2: 7.5%; both P <.001).
The adverse events that were reported were generally mild and transient and were similar between subjects treated with efinaconazole solution 10% and vehicle. Local site reactions were infrequently reported (e.g., dermatitis), and appeared to be more likely to occur with efinaconazole treatment (2%).
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