OBJECTIVES:

Onychomycosis is a common nail fungal infection. Patients with onychomycosis may experience discomfort and pain caused by a variety of nail abnormalities, such as discoloration, subungual hyperkeratosis, onycholysis, splitting and nail plate destruction. Currently there are four onychomycosis treatments available in Canada (ciclopirox, efinaconazole, itraconazole and terbinafine). This research aims to explore switch patterns among treatments of onychomycosis patients in Canada.

METHODS:

By utilizing IQVIA’s longitudinal Private Drug Plan database (PDP), patients who initiated any of four molecules (ciclopirox, efinaconazole, itraconazole and terbinafine) as their first onychomycosis treatment from January 1^st, 2015 to December 31^st, 2018 were selected and followed for up to 4 years. Patients were assigned into one of four treatment groups based on their index onychomycosis therapy and by number of years of follow-up.

For each group, patient demographic characteristics, the number of patients who switched onychomycosis treatment, as well as time to switch, were captured within each year of follow-up.

RESULTS:

A total of 266,171 patients were included, by index product this corresponded to 161,452 patients on efinaconazole, 53,926 on terbinafine, 36,999 on ciclopirox, and 13,794 on itraconazole.

Among patients with 4-years of follow-up (n = 41,922), 82.8% of patients did not switch treatment. However, this differed by index product; while only 7.5% of efinaconazole patients switched in the four years post-index, 35.5% of ciclopirox patients, 18.2% of itraconazole patients and 18.1% of terbinafine patients switched to another treatment. Among patients with 4 years of follow-up, the switch occurred on average between 15-22 months after treatment initiation.

CONCLUSIONS:

It is not common for patients to switch onychomycosis treatment, and overall, patients generally did not switch in the 4 years after starting on their index therapy. Among those that switched, the time from initiation to switch is comparable across all therapies.