For patients with tinea corporis/cruris (TCC), efficacy is significantly higher with 400 mg itraconazole compared with 100 or 200 mg, but considerable additional cost is incurred, according to a study published online Sept. 14 in JAMA Dermatology .

Ananta Khurana, M.D., from the Vajpayee Institute of Medical Sciences in New Delhi, India, and colleagues compared cure rates, treatment durations, safety profiles, and relapse rates of itraconazole 100, 200, and 400 mg/day for adults with treatment-naive TCC involving at least 5 percent body surface area. A total of 149 participants were randomly assigned to one of three treatment groups.

The researchers found no significant difference between the 100- and 200-mg groups in terms of the difference in cure rate, while the differences between the 100- and 400-mg groups and the 200- and 400-mg groups were significant. Mean treatment durations differed significantly for the 100- and 400-mg groups and the 200- and 400-mg groups, but the difference for the 100- and 200-mg groups was not significant. Overall, 47.4 percent of patients relapsed after treatment, with comparable relapse rates seen across groups. None of the patients discontinued drugs due to adverse effects. A 63 and 120 percent higher cost was seen in achieving cure with the 200-mg and 400-mg doses, respectively, versus the 100-mg dose.

"The itraconazole 400-mg dose achieves a higher cure rate than the 100- and 200-mg doses, but an almost 120 percent incremental cost in achieving cure with this dose may not justify its routine use," the authors write.

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