Jublia and Kerydin - Do they work?
Two new topical prescription drugs have been approved by the FDA for the treatment of toenail fungus. These are Jublia (efinaconazole) and Kerydin (tacaborole). The agents were applied daily for 48 weeks and evaluated after one full year. Jublia resulted in a complete cure of nail fungus in 15 to 18% of study subjects. Daily use of Kerydin resulted in a cure rate for 6.5-9% of study subjects. Both products have potential side effects such as redness, itching, swelling or irritation of toes, but because they are applied to the nails and nail beds, they are not expected to affect the liver or interact with other drugs. One possible complication of Jublia is ingrown toenails. According to the prescribing information, it occurred in 2.3% of those applying the drug.
A complete cure rate of 15 to 18% after almost a year is not very impressive, especially when you factor in the price shock. We checked with one of the largest drugstore chains in the country and in our area a 4 ml bottle of Jublia would cost $629, which works out to $157.25 per ml. Also, it is not clear whether insurance will cover the cost.
Instructions indicate you are to apply 1 drop per affected small toenail and 2 drops per big toenail. So, if you have 2 small toenails plus a big toenail infected with fungus, you will need 4 drops per day. Since there are roughly 20 drops in a milliliter or 80 drops and a 4 ml bottle, that means you will go through one 4 ml bottle in about three weeks. But wait, the treatment is supposed to continue for 48 weeks. That means you would need 16 bottles. If you multiply 16 x $629 you end up with a total cost of $10,064. Without insurance, this would be cost prohibitive. And remember, the complete cure rate is at best 18% after 48 weeks.
Dr. Blackmer's treatment protocol is centered around the PinPointe FootLaser with a success rate of over 90% and an average fee of $878. The laser treatment is just part of our protocol which is covered in detail at your office visit.