February 9, 2022 report
Ranking the efficacy of hair loss drugs
A team of researchers at Mediprobe Research Inc. has ranked the efficacy of hair loss drugs. In their paper published in JAMA Dermatology, the group also notes the pros and cons associated with the different kinds of hair loss treatments. Kathie Huang and Maryanne Senna, with Brigham and Women's Hospital and Massachusetts General Hospital, respectively, have published an editorial piece in the same journal issue outlining issues related to treating male androgenetic alopecia (AGA), commonly known as male pattern baldness, and the work done by the team in Canada.
Scientists have sought therapies for restoring hair in men for many years, but it was not until relatively recently that drugs were developed that actually worked as advertised. To date, three main treatments have been approved by the U.S. Food and Drug Administration—topically applied minoxidil, oral finasteride and low-level light therapy. Notably, each differs in effectiveness and in side effects. Another drug, dutasteride, has been allowed as a treatment for AGA in some countries, but not in the U.S. due to serious side effects—it has been approved for treating prostatic hyperplasia, however.
The researchers note that finasteride and dutasteride are both 5-α reductase inhibitors, which makes them effective in inducing hair follicles to produce hair. To date, finasteride has been associated with a wide variety of negative side effects, including erectile dysfunction, decreased libido and depression. It is assumed that dutasteride has similar negative side effects due to the similarity of the drugs (dutasteride is somewhat stronger) but it has not been well tested. And minoxidil is associated with pericardial effusion and cardiac tamponade when used in high doses.
The researchers note that despite sometimes serious negative side effects of hair loss treatments, they have found most men are far more interested in how well they work. They conducted a network meta-analysis of the options available to determine the efficacy of each and ranked them in decreasing order of efficacy: dutasteride, 0.5 mg given orally; finasteride, 5mg given orally; minoxidil, 1mg, 5% topical ointment; and minoxidil 0.25 mg given orally.
More information: Aditya K. Gupta et al, Relative Efficacy of Minoxidil and the 5-α Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients, JAMA Dermatology (2022). DOI: 10.1001/jamadermatol.2021.5743
Kathie P. Huang et al, Hair Are the Rankings—5-α Reductase Inhibitors and Minoxidil in Male Androgenetic Alopecia, JAMA Dermatology (2022). DOI: 10.1001/jamadermatol.2021.5625
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