Onychomycosis is a fungal infection of the toenail caused by a range of organisms, including dermophytes, non-dermophyte molds, and yeasts. Topical antifungals are often used for mild to moderate onychomycosis, especially when oral therapy is contraindicated. Generally, topical antifungal agents are well-tolerated with minimal side effects, but they are less effective than oral antifungal therapies due to poor nail penetration. Consequently, the current treatment period for topical onychomycosis products is \~12 months. Terbinafine is an antifungal drug approved by the FDA for the treatment of topical skin infections. A new formulation (AP4500) has been developed to increase terbinafine absorption through the nail in order to directly kill fungi at the site of onychomycosis infection. The goal of this clinical trial is to learn if AP4500 works to treat mild to moderate toenail fungus in adults. The main questions the study aims to answer are: Does AP4500 work to treat onychomycosis? Does AP4500 work best when applied once or twice per day? Does AP4500 treat onychomycosis faster than current treatments? Is AP4500 more effective than current treatments? Researchers will compare AP4500 to a vehicle control (a look-alike substance that contains no drug) and a commercial comparator product (Jublia) that has already been commercialized for the treatment of toenail fungus. Participants will: Apply topical formulations once or twice a day to an infected toenail for a period of 48 weeks Visit the clinic 4 times over this period for checkups and tests, with a subsequent follow up visit 4 weeks after treatment is completed
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
200
Novel topical terbinafine product designed to increase terbinafine absorption through the nail to the site of infection
Commercial topical efinaconazole formulation approved for the treatment of onychomycosis
Vehicle control formulation to act as a control for the experimental product
Number of patients with Complete Cure at Weeks 12, 24, 36, 48, and 52
Complete Cure is defined as 0% visible onychomycosis of the target great toenail upon examination and negative potassium hydroxide \[KOH\] fungal culture
Time frame: 52 weeks
Number of participants with Almost Complete Cure at Weeks 12, 24, 36, 48 and 52
Almost Complete Cure defined as onychomycosis affecting a maximum of 5% toenail after visual examination and negative KOH examination and fungal culture
Time frame: 52 weeks
Incidence, severity, and relationship to treatment of treatment emergent adverse events (TEAEs), serious adverse events (SAEs), and adverse events (AEs) as coded by MedDRA
A by participate adverse event data listing, including verbatim term, preferred term, system organ class, severity, and relationship to the investigational medicinal product are to be provided.
Time frame: 52 weeks
Time to Clinical Efficacy in participants over 48 weeks
Affected toenails will be visually assessed at 12, 24, 36, 48 and 52 weeks for Clinical Efficacy (defined as a maximum of 10% of the nail demonstrating onychomycosis)
Time frame: 52 weeks
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