신장이식환자에서 발생한 조갑진균증 환자에서 경구용 Terbinafine의 치료효과에 관한 연구

Abstract

Individuals with many types of immunodeficient states are at an increased risk for fungal infections. They include those with organ transplant, those who take immunosuppressants, and those with primary immunodeficiency. Onychomycosis is more prevalent in transplant patients than in normal controls. Because of development of new broad-spectrum antifungal agents-itraconazole, fluconazole, and terbinafine, the treatment of onychomycosis is generally satisfactory today. However, the choice of antifungal agents in the case of organ transplant is relatively difficult due to more common resistant causative organisms and interactions with cyclosporin. Cyclosporin is mainly metabolized by cytochrome P-450 enzymes. Drugs that are metabolized by these enzymes may interfere with the metabolism of cyclosporin. Both increased and decreased blood levels of cyclosporin may lead to undesired side effects. It has been shown that azole antifungal agents inhibited the metabolism of cyclosporin, both in vivo and in vitro. Terbinafine is an allylamine antifungal agent which has a broad-spectrum in vitro activity and a unique fungicidal action. Terbinafine is effective in the treatment of cutaneous fungal infections, and do not interfere with cytochrome P-450 enzyme unlike azole agents. So terbinafine have no effect upon the metabolism of cyclosporin both in vivo and vitro. The results of this study support the results of those investigations. Furthermore, the results suggest that long-term treatment of terbinafine for patients with onychomycosis would not induce an increase in the blood concentration of cyclosporin. Previous investigations demonstrated that the short course treatment of terbinafine for patients with onychomycosis was very successful and safe. The cure rates achieved with 6 weeks and 12 weeks for patients with onychomycosis of fingernail, toenail, respectively were comparable to those found in patients with onychomycosis in normal healthy persons. Delayed clinical cure was reconfirmed here. Adverse events were reported by about 5∼10% of the patients receiving oral terbinafine; the major side effect is gastrointestinal discomfort even though they develop transiently in the first 6 weeks of treatment. In this study, no adverse effects were seen in contrast to the results in earlier studies. Encouragingly, there were no important changes in the laboratory studies. Our results suggest that terbinafine is an effective and safe systemic antifungal treatment for patients with onychomycosis who has received renal transplantation and whom are taking cyclosporin.