BACKGROUND: Oral antifungal therapy is the standard treatment for onychomycosis. However, many physicians still prefer topical agents because of concerns about adverse effects. OBJECTIVES: This study evaluated changes in hepatic and renal function parameters during fosravuconazole therapy and assessed the utility of an algorithmic approach for interpreting these abnormalities. METHODS: Laboratory parameters including aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ glutamyltransferase (γ-GTP), serum creatinine (sCr), and estimated glomerular filtration rate (eGFR) were compared between baseline and follow-up. Fold changes were calculated, and γ-GTP was classified according to the LiverTox database. Each parameter was assessed using an algorithm for managing hepatic and renal side effects. RESULTS: A total of 128 cases were analyzed. Median baseline values were AST 22 U/L, ALT 19 U/L, γ-GTP 25 U/L, sCr 0.75 mg/dL, and eGFR 74.9 mL/min/1.73 m². At follow-up, values were AST 22 U/L, ALT 22 U/L, γ-GTP 51.5 U/L, sCr 0.86 mg/dL, and eGFR 67.1 mL/min/1.73 m². γ-GTP showed significantly greater fold changes than other parameters (p < 0.001). Thresholds for discontinuation were met in 3 hepatic (2.3%) and 5 renal (3.9%) cases. No patient developed clinical symptoms, and only one discontinued treatment. CONCLUSIONS: Algorithm-based monitoring enabled safe fosravuconazole administration. This practical approach may help clinicians adopt oral antifungal therapy more confidently as first-line treatment for onychomycosis.
Shimoyama et al. (Thu,) studied this question.