Canadian study ranks efficacy of various treatments for male pattern baldness

The relative efficacy of the three most commonly used drugs for androgenetic alopecia—minoxidil and the two 5-α reductase inhibitors (dutasteride and finasteride)—is uncertain. To examine this issue, Canadian researchers performed a meta-analysis to determine the relative efficacy of any dose and administration route of minoxidil, dutasteride and finasteride for the treatment of male androgenetic alopecia (male pattern baldness).1 The meta-analysis included 23 studies that investigated monotherapy with any dose and administration route of minoxidil, dutasteride and finasteride. Study end points were change in total and terminal hair count after 24 and 48 weeks of therapy.1 Results showed that the greatest increase in total hair count at 24 weeks (first end point) was with dutasteride 0.5 mg/d. It was significantly more effective than finasteride 1 mg/d, minoxidil 5 mg/d, minoxidil 0.25 mg/d and minoxidil 2% solution.1 Read: Quiz: Test your atopic dermatitis knowledge The greatest increase in terminal hair count at 24 weeks (second end point) was with minoxidil 5 mg/d. It was significantly more effective than minoxidil 0.25 mg/d, topical minoxidil 5% and topical minoxidil 2%. Minoxidil 5 mg/d was significantly more effective than finasteride 1 mg/d.1 The greatest increase in total hair count at 48 weeks (third end point) was with finasteride 5 mg/d. It was significantly more effective than topical minoxidil 2%.1 The greatest increase in terminal hair count at 48 weeks (fourth end point) was with finasteride 1 mg/d. It was significantly more effective than topical minoxidil 5% and topical minoxidil 2%.1 Read: Rinvoq approved for treatment of moderate to severe atopic dermatitis Overall, the authors conclude that oral dutasteride 5 mg/d has the highest probability of being the most effective treatment for male androgenetic alopecia, followed by these agents in decreasing order of efficacy: oral finasteride 5 mg/d, oral minoxidil 5 mg/d, oral finasteride 1 mg/d, topical minoxidil 5%, topical minoxidil 2%, and oral minoxidil 0.25 mg/d.1 An accompanying editorial notes that androgenetic alopecia affects 50% of men by age 50 and treatment options are limited. The editorial points out that although the meta-analysis attempted to rank the various agents in terms of relative efficacy, the study had certain limitations that could bring the rank order into question.2 The editorial authors stress that other factors must also be considered when using these drugs in clinical practice, including the adverse event profiles of the various agents, patient comorbidities and patient preferences. For example, 5-alpha reductase inhibitors have the potential to cause depressed mood and sexual adverse events, which must be considered as these side effects may adversely affect quality of life. Furthermore, although this study ranked dutasteride as having the highest efficacy, its adverse event profile is not as well studied as finasteride 1 mg, and patients should be made aware of this fact.2 Read: New guidelines for managing cutaneous lupus erythematosus Finally, the editorial points out that while the findings of this study help us understand the potential relative efficacy of available treatments for androgenetic alopecia, the study results also highlight the lack of therapeutic options for this condition. More effective and targeted treatments for androgenetic alopecia need to be developed.2 References 1. Gupta AK, Venkataraman M, Talukder M, et al. Relative efficacy of minoxidil and the 5-α reductase inhibitors in androgenetic alopecia treatment of male patients. A network meta-analysis. JAMA Dermatol 2022; published online February 2, 2022. (accessed February 3, 2022). 2. Huang KP, Senna MM. Hair are the rankings—5-α reductase inhibitors and minoxidil in male androgenetic alopecia. JAMA Dermatol 2022; published online February 2, 2022. (accessed February 3, 2022).

Canadian study ranks efficacy of various treatments for male pattern baldness

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