Relative Efficacy of Minoxidil and the 5-α Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients: A Network Meta-analysis
Analysis of 23 trials indicate 5mg/d oral dutasteride has highest probability of being most efficacious treatment, followed by (in decreasing order of efficacy): 5mg/d oral finasteride (OF), 5mg/d oral minoxidil (OM), 1mg/d OF, 5% topical minoxidil (TM), 2% TM, & 0.25mg/d OM.
Source:
JAMA Dermatology
SPS commentary:
According to an editorial, when incorporating the study findings into clinical practice, adverse event profiles, patient comorbidities, and patient preferences, must be considered, as patients and physicians have different thresholds for risk in terms of adverse events, even when the frequency is low, as they may adversely affect quality of life, especially in the case of depressed mood and sexual adverse events associated with 5-alpha reductase inhibitors. It notes that although this study ranked dutasteride highest with regards to efficacy, the adverse event profile is not as well studied as that for finasteride 1mg, and patients should be counselled about this. It adds that while the findings of this network meta-analysis help in understanding the relative efficacy of available treatments, it also highlights the paucity of therapeutic options for this condition. It calls for well-designed studies that investigate pathogenesis so that more effective and targeted treatments can be developed.