Dutasteride may be most efficacious in androgenetic alopecia treatment
A 0.5 mg daily dose of oral dutasteride was superior to minoxidil and finasteride in total hair count at 24 weeks, according to findings of a study comparing multiple treatments for androgenetic alopecia.
“There are knowledge gaps regarding the relative efficacy of three commonly used drugs for androgenetic alopecia (AGA), namely, minoxidil and the two 5-alpha reductase inhibitors dutasteride and finasteride,” Aditya K. Gupta, MD, PhD, of Mediprobe Research Inc. in London, Ontario, and colleagues wrote.
In the systematic review of the PubMed database, Gupta and colleagues assessed the relative efficacy of any dose and administration of minoxidil, dutasteride and finasteride among men with AGA. After an initial search yielded 848 papers, 23 studies ultimately met eligibility criteria.
Change in total and terminal hair count as quantified by hairs per square centimeter after 24 weeks and 48 weeks of treatment served as the study’s main outcomes, though efficacy data for oral minoxidil and dutasteride were not available for 48-week results.
Patients were aged 22.8 years (standard deviation [SD], 3.3) to 41.8 years (SD, 12.3).
Results showed that the greatest increase in total hair count at the first time point was observed with the daily 0.5 mg dose of dutasteride. This drug and dose bested the daily 1 mg of finasteride by a mean difference of 7.1 hairs per cm2 (95% CI, 5.1-9.3). In addition, the daily 0.5 mg formulation of dutasteride was more efficacious than a number of minoxidil doses, including the daily 0.25 mg dose (mean difference, 23.7 hairs/cm2; 95% CI, 9.5-38), the daily 5 mg dose (mean difference, 15 hairs/cm2; 95% CI, 3.9-26.1) and the 2% solution (mean difference, 8.5 hairs/cm2; 95% CI, 4.8-12.3).
Looking at the second endpoint of terminal hair count at 24 weeks, the daily 5 mg dose of minoxidil yielded an improvement over a number of other formulations of the same drug, including the daily 0.25 mg dose (mean difference, 43.6 hairs/cm2; 95% CI, 29.7-57.7), the 2% topical formulation (mean difference, 29.3 hairs/cm2; 95% CI, 21.1-37.5) and the 5% topical formulation (mean difference, 29.8 hairs/cm2; 95% CI, 19.7-39.8).
The daily 5 mg minoxidil dose also showed a significant improvement in benefit compared with the daily 1 mg finasteride dose (mean difference, 10.4 hairs/cm2; 95% CI, 2.2-18.6).
Turning to the 48-week results, the daily 5 mg finasteride formulation bested 2% minoxidil by 20.7 hairs/cm2 (95% CI, 9.5-31.9) in terms of total hair count.
The most significant increase in terminal hair count at 48 weeks was observed in the daily 1 mg finasteride dose, which showed a significant improvement compared with 2% topical minoxidil (mean difference, 32.1 hairs/cm2; 95% CI, 23.9-40.3) and 5% topical minoxidil (mean difference, 26.2 hairs/cm2; 95% CI, 16.2-36.2).
“The results of this meta-analysis indicate that 0.5 mg per day of oral dutasteride has the highest probability of being the most efficacious treatment, followed by these agents in decreasing order of efficacy: 5 mg per day of oral finasteride, 5 mg per day of oral minoxidil, 1 mg per day of oral finasteride, 5% topical minoxidil, 2% topical minoxidil and 0.25 mg per day of oral minoxidil,” the researchers wrote.
“As efficacy data from head-to-head trials accumulate, there could be a better sense of the relative efficacy of the different doses of the 5-alpha reductase inhibitors and minoxidil.”