Tavaborole (AN-2690) for the treatment of onychomycosis of the toenail in adults

Abstract

Onychomycosis is a challenging nail disease that is difficult to treat due to the thickness and impermeability of the nail plate. At present, systemic agents are the first-line of treatment for this type of infection; however, topical treatment is recommended in milder cases (<50% involvement) or when oral treatment is contraindicated. Effective topical treatments capable of penetrating the nail plate and reaching the site of infection continue to be sought. Tavaborole, the first member of a new class of boron-containing antifungals, is a lightweight, water-soluble topical nail solution for the treatment of toenail onychomycosis. Tavaborole has a unique mechanism of action against fungal organisms and retains antifungal properties in the presence of keratin. Tavaborole 5.0% nail solution has shown a favourable safety and efficacy profile in Phase II/III clinical trials and is currently under review for licensing in the US by the US Food and Drug Administration.

Keywords::

• antifungal
• benzoxaborole
• dermatophytes
• onychomycosis
• protein synthesis inhibitor
• toenail
• topical

Financial & competing interests disclosure

AK Gupta is an advisory board member, consultant, investigator and speaker at Valeant Pharmaceuticals International Inc. D Daigle is employed by Mediprobe Research Inc., past site of clinical trials on onychomycosis and potential future site of trials on onychomycosis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Topical treatment of onychomycosis is recommended in cases of superficial white onychomycosis or in populations at greater risk of side effects and drug–drug interactions.

• Tavaborole is a new topical treatment for onychomycosis with a novel mechanism of action; the molecule binds to transfer RNA synthetases, thus preventing protein synthesis and causing fungal cell cycle arrest.

• Tavaborole exhibits an excellent safety profile, but may cause reversible erythema at the site of application.

• Tavaborole demonstrated satisfactory success rates in Phase III clinical trials.

• Tavaborole is a convenient topical: due to its low molecular weight, it is capable of penetrating nail keratin to the site of infection without manual assistance.

• Tavaborole appears to be a safe and effective topical treatment for onychomycosis.