Severe onychomycosis management with oral terbinafine in a kidney transplantation setting: Clinical follow-up by image analysis.
Administration, Oral
Adult
Aged
Antifungal Agents
/ administration & dosage
Disease Management
Drug Tolerance
Female
Follow-Up Studies
Humans
Image Processing, Computer-Assisted
/ methods
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Onychomycosis
/ diagnostic imaging
Retrospective Studies
Severity of Illness Index
Terbinafine
/ administration & dosage
dermatophytes
kidney transplant recipients
onychomycosis
terbinafine
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
27
07
2020
revised:
25
09
2020
accepted:
06
10
2020
pubmed:
28
11
2020
medline:
3
9
2021
entrez:
27
11
2020
Statut:
ppublish
Résumé
Severe onychomycosis treatment in kidney transplant recipients (KTR) is challenging because of drug interactions and adverse events. Tacrolimus remains the antirejection treatment (ART) of choice in kidney transplantation but tolerance with systemic terbinafine for the management of severe onychomycosis has not been studied. This study illustrates severe onychomycosis management in a kidney transplantation setting and investigates systemic terbinafine tolerance profile in KTR. We retrospective analysed clinical data of KTR with a confirmed diagnosis of severe onychomycosis. We retrieved a total of 29 KTR with severe onychomycosis needing an oral treatment to manage onychomycosis. In 55.1% (16/29) KTR, altered renal biological parameters or lack of guidelines to manage severe onychomycosis were the main reasons to deterring clinicians from prescribing oral treatments. 13 patients received an oral terbinafine treatment (9, 3 and 1 with a tacrolimus, cyclosporine and everolimus-based ART, respectively). Clinical and biological follow-up did not reveal severe drug interactions. ART blood levels showed significant variations in 2 patients without clinical consequences in renal graft. Two patients reported mild adverse events but after only one dose of terbinafine. Using an open-source image analysis program, clinical evolution of onychomycosis could be retrospectively quantified and followed up. The results presented here suggest that oral terbinafine can be proposed to treat severe onychomycosis with an acceptable tolerance profile in KTR with different ART such as tacrolimus and highlight the need of multicentric studies to establish guidelines for onychomycosis treatment in KTR.
Sections du résumé
BACKGROUND
BACKGROUND
Severe onychomycosis treatment in kidney transplant recipients (KTR) is challenging because of drug interactions and adverse events. Tacrolimus remains the antirejection treatment (ART) of choice in kidney transplantation but tolerance with systemic terbinafine for the management of severe onychomycosis has not been studied.
OBJECTIVE
OBJECTIVE
This study illustrates severe onychomycosis management in a kidney transplantation setting and investigates systemic terbinafine tolerance profile in KTR.
PATIENTS/METHODS
METHODS
We retrospective analysed clinical data of KTR with a confirmed diagnosis of severe onychomycosis.
RESULTS
RESULTS
We retrieved a total of 29 KTR with severe onychomycosis needing an oral treatment to manage onychomycosis. In 55.1% (16/29) KTR, altered renal biological parameters or lack of guidelines to manage severe onychomycosis were the main reasons to deterring clinicians from prescribing oral treatments. 13 patients received an oral terbinafine treatment (9, 3 and 1 with a tacrolimus, cyclosporine and everolimus-based ART, respectively). Clinical and biological follow-up did not reveal severe drug interactions. ART blood levels showed significant variations in 2 patients without clinical consequences in renal graft. Two patients reported mild adverse events but after only one dose of terbinafine. Using an open-source image analysis program, clinical evolution of onychomycosis could be retrospectively quantified and followed up.
CONCLUSIONS
CONCLUSIONS
The results presented here suggest that oral terbinafine can be proposed to treat severe onychomycosis with an acceptable tolerance profile in KTR with different ART such as tacrolimus and highlight the need of multicentric studies to establish guidelines for onychomycosis treatment in KTR.
Substances chimiques
Antifungal Agents
0
Terbinafine
G7RIW8S0XP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
309-315Informations de copyright
© 2020 Wiley-VCH GmbH.
Références
Filho AMS, Ventura CG, Criado PR, et al. Hemodialysis and kidney transplantation as predisposing conditions to onychomycosis. Nephron. 2017;137(1):38-46.
Stewart CR, Algu L, Kamran R, Leveille CF, Abid K, Rae C, Lipner SR. Effect of onychomycosis and treatment on patient-reported quality-of-life outcomes: A systematic review. Journal of the American Academy of Dermatology. 2020;31020-31023. https://doi.org/10.1016/j.jaad.2020.05.143
Rouzaud C, Chosidow O, Brocard A, et al. Severe dermatophytosis in solid organ transplant recipients: a French retrospective series and literature review. Transpl Infect Dis. 2018;20(1):e12799.
Chai ZT, Oh CC, Chan MM, Foo M, Pang SM. Deep dermal fungal infection in an Asian renal transplant recipient. Int J Dermatol. 2017;56(3):269-271.
Brod C, Benedix F, Röcken M, Schaller M. Trichophytic Majocchi granuloma mimicking Kaposi sarcoma. J Dtsch Dermatol Ges. 2007;5(7):591-593.
Ergen EN, Donaldson SL, Stratton MS, Pavlidakey PG, Elewski BE. Image Gallery: Molluscum contagiosum-like facial lesions in a patient with a renal transplant: deep dermatophytosis due to Trichophyton rubrum. Br J Dermatol. 2018;178(5):e328.
Azib S, Ingen-Housz-Oro S, Foulet F, et al. Nodules on the legs in a renal transplant recipient. Deep dermal dermatophytosis caused by Trichophyton rubrum. JAMA Dermatol. 2013;149(4):475-480.
Lipner SR, Scher RK. Onychomycosis: treatment and prevention of recurrence. J Am Acad Dermatol. 2019;80(4):853-867.
Raschi E, Poluzzi E, Koci A, Caraceni P, Ponti FD. Assessing liver injury associated with antimycotics: concise literature review and clues from data mining of the FAERS database. World J Hepatol. 2014;6(8):601-612.
Gupta AK, Versteeg SG, Shear NH. Common drug-drug interactions in antifungal treatments for superficial fungal infections. Expert Opin Drug Metab Toxicol. 2018;14(4):387-398.
Lo AC, Lui SL, Lo WK, Chan DT, Cheng IK. The interaction of terbinafine and cyclosporine A in renal transplant patients. Br J Clin Pharmacol. 1997;43(3):340-341.
Lee KH, Kim YS, Kim MS, Chung HS, Park K. Study of the efficacy and tolerability of oral terbinafine in the treatment of onychomycosis in renal transplant patients. Transplant Proc. 1996;28(3):1488-1489.
Brunet M, van Gelder T, Åsberg A, et al. Therapeutic drug monitoring of Tacrolimus-personalized therapy: Second Consensus Report. Ther Drug Monit. 2019;41(3):261-307.
Gupta AK, Mays RR, Versteeg SG, Shear NH, Piguet V. Update on current approaches to diagnosis and treatment of onychomycosis. Expert Rev Anti Infect Ther. 2018;16(12):929-938.
Association GAotWM. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent. 2014;81(3):14-18.
Cribier BJ, Bakshi R. Terbinafine in the treatment of onychomycosis: a review of its efficacy in high-risk populations and in patients with nondermatophyte infections. Br J Dermatol. 2004;150(3):414-420.
Ginarte M, Garcia-Doval I, Monteagudo B, et al. Observer agreement in toenail disorders: implications for diagnosis and clinical research. Br J Dermatol. 2009;160(6):1315-1317.
Tavakkol A, Pollak R, Harkless L, et al. Toenail assessment tool for quantitation of visibly infected mycotic nail plate in onychomycosis. Cutis. 2007;80(6):488-494.
Werschler WP, Bondar G, Armstrong D. Assessing treatment outcomes in toenail onychomycosis clinical trials. Am J Clin Dermatol. 2004;5(3):145-152.
Carney C, Tosti A, Daniel R, et al. A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index. Arch Dermatol. 2011;147(11):1277-1282.
Gupta AK, Cooper EA. Comparison of visual assessments versus planimetry assessments in a large-scale clinical trial of onychomycosis. J Dermatolog Treat. 2014;25(3):256-259.
Gupta AK, Stec N, Summerbell RC, et al. Onychomycosis: a review. J Eur Acad Dermatol Venereol. 2020;34(9):1972-1990.
Gupta AK, Paquet M, Simpson F, Tavakkol A. Terbinafine in the treatment of dermatophyte toenail onychomycosis: a meta-analysis of efficacy for continuous and intermittent regimens. J Eur Acad Dermatol Venereol. 2013;27(3):267-272.
Baran R, Sigurgeirsson B, de Berker D, et al. A multicentre, randomized, controlled study of the efficacy, safety and cost-effectiveness of a combination therapy with amorolfine nail lacquer and oral terbinafine compared with oral terbinafine alone for the treatment of onychomycosis with matrix involvement. Br J Dermatol. 2007;157(1):149-157.
Shemer A, Gupta AK, Kamshov A, et al. Topical antifungal treatment prevents recurrence of toenail onychomycosis following cure. Dermatol Ther. 2017;30(5):e12545.
Zhang J, Tan J, Yang L, He Y. Tacrolimus, not triamcinolone acetonide, interacts synergistically with itraconazole, terbinafine, bifonazole, and amorolfine against clinical dermatophyte isolates. J Mycol Med. 2018;28(4):612-616.