Summary of findings for the main comparison. Azole compared to terbinafine for toenail onychomycosis.
| Azole compared to terbinafine for toenail onychomycosis | |||||
| Patient or population: participants with confirmed toenail onychomycosis Setting: outpatients clinics Intervention: azole Comparison: terbinafine | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with terbinafine | Risk with azole | ||||
| Clinical cure | Study population | RR 0.82 (0.72 to 0.95) | 2168 (15 RCTs) | ⊕⊕⊕⊝ Moderatea | |
| 575 per 1000 | 471 per 1000 (414 to 546) | ||||
| Mycological cure | Study population | RR 0.77 (0.68 to 0.88) | 2544 (17 RCTs) | ⊕⊕⊕⊝ Moderatea | |
| 682 per 1000 | 525 per 1000 (464 to 600) | ||||
| Adverse events | Study population | RR 1.00 (0.86 to 1.17) | 1762 (9 RCTs) | ⊕⊕⊕⊝ Moderateb | |
| 346 per 1000 | 346 per 1000 (298 to 405) | ||||
| Recurrence rate | Study population | RR 1.11 (0.68 to 1.79) | 282 (5 RCTs) | ⊕⊕⊝⊝ Lowc | |
| 333 per 1000 | 370 per 1000 (227 to 597) | ||||
| Quality of life | None of the studies addressed quality of life. | ||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio. | |||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
aDowngraded by one level for risk of bias because of large number of unblinded studies, lack of description of randomisation process and allocation concealment for most studies. bDowngraded by one level for risk of bias (large number of unblinded studies, lack of description of randomisation process and allocation concealment for most studies). cDowngraded by two levels for risk of bias (large number of unblinded studies, lack of description of randomisation process and allocation concealment for most studies) and imprecision (small numbers of participants in this comparison).