Male Alopecia Agents Ranked by Efficacy in Meta-Analysis
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Please read the article below
In the treatment of male androgenetic alopecia (AGA), low-dose dutasteride (0.5 mg/d), used off label in the US, tops a ranking of the most commonly used oral and topical agents in a new meta-analysis.
While up to 90% of men experience AGA in their lifetime, only three therapies are currently approved for the treatment of the condition by the US Food and Drug Administration (FDA) ― topical minoxidil, oral finasteride 1 mg, and low-level light therapy.
However, with the common use of off-label oral minoxidil, as well as oral dutasteride and higher doses of oral finasteride, the latter two being 5-α reductase inhibitors, Aditya K. Gupta, MD, Ph.D., of Mediprobe Research Inc, in London, Ontario, Canada, and colleagues sought to compare the data on the three agents. Their results were published this month in JAMA Dermatology.
They note that, while there have been recent comparisons between oral and topical minoxidil, “to our knowledge no study has determined the comparative effectiveness of these 2 [formulations] with that of local and systemic dutasteride and finasteride.”
For the meta-analysis, the authors identified 23 studies meeting their criteria, involving patients with mean ages ranging from 22.8 to 41.8 years.
For the primary endpoint of the greatest increases in total hair count at 24 weeks, the analysis showed the 0.5 mg/d doses of dutasteride topped the list, with significantly greater efficacy compared with 1 mg/d of finasteride (mean difference, 7.1 hairs per cm2).
The 0.5 mg/d dutasteride dose also showed higher efficacy than oral minoxidil at 0.25 mg/d (mean difference, 23.7 hairs per cm2) and 5 mg/d (mean difference, 15.0 hairs per cm2) and topical minoxidil at 2% (mean difference, 8.5 hairs per cm2).
For the secondary endpoint of the greatest increase in terminal hair count at 24 weeks, the 5 mg/d doses of minoxidil had significantly greater efficacy compared with the 0.25 mg/d dose of the drug, as well as with minoxidil’s 2% and 5% topical formulations.
The minoxidil 5 mg/d dose was also significantly more effective than 1 mg/d of finasteride for terminal hair count at 24 weeks.
In longer-term outcomes at 48 weeks, the greatest increase in total hair count at 48 weeks was observed with 5 mg/d of finasteride, which was significantly more effective compared with 2% topical minoxidil.
And the greatest increase in terminal hair count at 48 weeks was observed with 1 mg/d of oral finasteride, which was significantly more effective than 2% as well as 5% topical minoxidil.
Based on the results, the authors ranked the agents in decreasing order of efficacy:
· 0.5mg/d of oral dutasteride
· 5mg/d of oral finasteride
· 5mg/d of oral minoxidil