Florence asked
This information here is all about Jublia and the big toe nail. What about fingernails? How can you do the step where you wash your hands with soap and water if you are using it on your fingernails. I can't believe it will take 48 weeks to clear up the fungus. If you have it on your fingernails, plus your big toe how in the world could anyone afford to pay for all this medication? It says a bottle only lasts 6 weeks for the big toe alone.
Answer
I only mentioned the big toe in my write-up about Jublia because the medication is only indicated and FDA approved to treat fungus under the toenails, not the fingernails. I don't know that there is a specific reason for this other than the fact that the clinical trials for Jublia only involved the toenails. There are other topical anti-fungal medications that are indicated for the fingernails such as Penlac (Ciclopirox).
The duration of therapy is quite common for topical anti-fungal preparations because fungus under the nails is just extremely difficult to treat due to the location. Onychomycosis (fungal infection of the nail) is typically treated one of two ways, topically or by taking an oral medication. The oral medication used (Lamisil) is more effective but also has to be used for a lengthy period of time and can cause liver problems. Almost all topical preparations need to be used for 6 months to a year to completely cure an infection. Much of this time is due to the fact that only small amounts of medication get through the nail to the fungus and the affected nail has to be completely regrow to replace the old infected fungus growth.
Unfortunately, a complete cure with topical use of products doesn't happen often. In the clinical trials for Jublia, after 52 weeks, only around 17% of patients had a full cure. 50% of people could visually see no fungus but when tested for remaining fungus, still showed signs. Nail fungus often takes a significant amount of time to get rid of!
In terms of cost, you are right that Jublia is expensive. it needs to be applied daily for 48 weeks...and it costs about $450 for a 4 mL bottle that lasts about 6 weeks for just one big toenail. If your insurance doesn't give you a good price on it, it is not affordable for many people. The interest in Jublia from the medical community comes from the fact that it doesn't have the systemic effects and drug interactions associated with oral antifungals, and it may be the most effective topical medication.
Having said that, Jublia doesn't work as well as some of the oral antifungals such as Lamisil. Jublia is simply a good choice for patients who can’t or won’t use oral therapy.
