Onychomycosis: Making Sense of the assessment of Anti-Fungal Drugs.

Abstract

After years of therapeutic triviality;we now have drugs with a major effect on onychomycosis;and;paradoxically;their very success will lead to the development of more such drugs. This note is concerned with improving their assessment by rationalizing the way in which efficacy is measured. The need for this will be apparent to anyone who has had to review studies of antifungal drugs for onychomycosis;especially those done for drug registration. To the more fortunate others;who can use these drugs without having to suffer the tedious analyses of "evidence";it is necessary only to say that the methodology for the assessment of response is a muddle;illogical in almost all its aspects. I will therefore consider all the procedures involved;examine their weaknesses and suggest some simple improvements. Do not confuse my purpose: this is not a review;nor an "overview";its duplicitous offspring while I base my case on an analysis (and increasingly desparing reading) of the literature;I do not intend to anatomize it.