Comparative efficacy of minoxidil and 5-alpha reductase inhibitors monotherapy for male pattern hair loss: Network meta-analysis study of current empirical evidence

Abstract

Treatment options for male androgenetic alopecia (AGA) range from pharmacologic agents—such as minoxidil, finasteride, and dutasteride—to newer procedural and experimental therapies. We determined the relative effect of the various dosages and administrative routes of minoxidil, finasteride and dutasteride through network meta-analysis (NMA) of relevant outcome measures. We conducted a systematic review to identify eligible studies. Our NMAs included studies that investigated monotherapy with minoxidil, finasteride, and dutasteride of any dosage and route on the following 5 outcomes: 24- and 48-week changes in total and terminal hair density, and 24-week change in independent observer assessment (IOA). We assessed evidence quality and performed sensitivity and node-splitting analyses of inconsistency. Each NMA produced estimates for pairwise relative effects and surface under the cumulative ranking curve (SUCRA) values. Results: Our search found 33 eligible studies across which 19 comparators (18 interventions and 1 control) were identified. The active comparators included minoxidil (oral, topical, sublingual), finasteride (oral, topical, mesotherapy) and dutasteride (oral, mesotherapy). The control node amalgamated placebo and vehicle arms. We found dutasteride 0.5 mg/day to be the most effective option. Among FDA-approved treatments, topical minoxidil 5% was the most effective topical monotherapy, while finasteride 1 mg/day was the most effective oral option. Dutasteride mesotherapy appears significantly less effective than oral administration (0.5 mg/day).