Efficacy of laser treatment for onychomycotic nails: a systematic review and meta-analysis of prospective clinical trials

TY - JOUR

T1 - Efficacy of laser treatment for onychomycotic nails

T2 - a systematic review and meta-analysis of prospective clinical trials

AU - Yeung, Kelvin

AU - Ortner, Vinzent Kevin

AU - Martinussen, Torben

AU - Paasch, Uwe

AU - Hædersdal, Merete

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Laser therapy for onychomycosis is emerging but its efficacy remains unestablished. To examine current evidence on efficacy of laser treatment of onychomycosis. A systematic review and one-arm meta-analysis, including all prospective clinical trials, identified on PubMed, Cochrane Library, and EMBASE databases. Trials with participants as unit of analysis (UOA), n = 13, were analyzed separately from trials with nails as UOA, n = 7. Summary proportions and 95% confidence intervals (95% CI) were calculated. Outcomes were mycological cure, clinical improvement, or complete cure. Twenty-two prospective trials (four randomized controlled trials and 18 uncontrolled trials) with a total of 755 participants were analyzed. Summary proportions with 95% CI for participants as UOA were mycological cure 70.4%, 95% CI 52.2–83.8%; clinical improvement 67.2%, 95% CI 43.2–84.7%; and complete cure 7.2%, 95% CI 1.9–23.5%. High statistical heterogeneity was detected (mycological cure I2 = 88%, P < 0.01; clinical improvement I2 = 69%, P < 0.01; complete cure I2 = 60%, P = 0.11). The current level of evidence is limited and with high heterogeneity, making it difficult to assess the true efficacy of laser treatment for onychomycosis. Larger randomized controlled trials with well-defined methodology are warranted.

AB - Laser therapy for onychomycosis is emerging but its efficacy remains unestablished. To examine current evidence on efficacy of laser treatment of onychomycosis. A systematic review and one-arm meta-analysis, including all prospective clinical trials, identified on PubMed, Cochrane Library, and EMBASE databases. Trials with participants as unit of analysis (UOA), n = 13, were analyzed separately from trials with nails as UOA, n = 7. Summary proportions and 95% confidence intervals (95% CI) were calculated. Outcomes were mycological cure, clinical improvement, or complete cure. Twenty-two prospective trials (four randomized controlled trials and 18 uncontrolled trials) with a total of 755 participants were analyzed. Summary proportions with 95% CI for participants as UOA were mycological cure 70.4%, 95% CI 52.2–83.8%; clinical improvement 67.2%, 95% CI 43.2–84.7%; and complete cure 7.2%, 95% CI 1.9–23.5%. High statistical heterogeneity was detected (mycological cure I2 = 88%, P < 0.01; clinical improvement I2 = 69%, P < 0.01; complete cure I2 = 60%, P = 0.11). The current level of evidence is limited and with high heterogeneity, making it difficult to assess the true efficacy of laser treatment for onychomycosis. Larger randomized controlled trials with well-defined methodology are warranted.

KW - Onychology

KW - Laser

KW - Mycology

KW - Systematic review

KW - Meta-analysis

KW - Evidence-based medicine

U2 - 10.1007/s10103-019-02802-8

DO - 10.1007/s10103-019-02802-8

M3 - Review

C2 - 31254131

SN - 0268-8921

VL - 34

SP - 1513

EP - 1525

JO - Lasers in Medical Science

JF - Lasers in Medical Science

IS - 8

ER -