Gupta A K, Mays R R, Dotzert M S, Versteeg S G, Shear N H, Piguet V
Mediprobe Research Inc., London, Canada.
Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.
J Eur Acad Dermatol Venereol. 2018 Dec;32(12):2112-2125. doi: 10.1111/jdv.15081. Epub 2018 Jul 11.
Androgenetic alopecia, or male/female pattern baldness, is the most common type of progressive hair loss disorder. The aim of this study was to review recent advances in non-surgical treatments for androgenetic alopecia and identify the most effective treatments. A network meta-analysis (NMA) was conducted of the available literature of the six most common non-surgical treatment options for treating androgenetic alopecia in both men and women; dutasteride 0.5 mg, finasteride 1 mg, low-level laser therapy (LLLT), minoxidil 2%, minoxidil 5% and platelet-rich plasma (PRP). Seventy-eight studies met the inclusion criteria, and 22 studies had the data necessary for a network meta-analysis. Relative effects show LLLT as the superior treatment. Relative effects show PRP, finasteride 1 mg (male), finasteride 1 mg (female), minoxidil 5%, minoxidil 2% and dutasteride (male) are approximately equivalent in mean change hair count following treatment. Minoxidil 5% and minoxidil 2% reported the most drug-related adverse events (n = 45 and n = 23, respectively). The quality of evidence of minoxidil 2% vs. minoxidil 5% was high; minoxidil 5% vs. placebo was moderate; dutasteride (male) vs. placebo, finasteride (female) vs. placebo, minoxidil 2% vs. placebo and minoxidil 5% vs. LLLT was low; and finasteride (male) vs. placebo, LLLT vs. sham, PRP vs. placebo and finasteride vs. minoxidil 2% was very low. Results of this NMA indicate the emergence of novel, non-hormonal therapies as effective treatments for hair loss; however, the quality of evidence is generally low. High-quality randomized controlled trials and head-to-head trials are required to support these findings and aid in the development of more standardized protocols, particularly for PRP. Regardless, this analysis may aid physicians in clinical decision-making and highlight the variety of non-surgical hair restoration options for patients.
雄激素性脱发，即男性/女性型秃发，是最常见的进行性脱发疾病类型。本研究的目的是回顾雄激素性脱发非手术治疗的最新进展，并确定最有效的治疗方法。对治疗男性和女性雄激素性脱发的六种最常见非手术治疗方案的现有文献进行了网状Meta分析；0.5毫克度他雄胺、1毫克非那雄胺、低能量激光疗法（LLLT）、2%米诺地尔、5%米诺地尔和富血小板血浆（PRP）。78项研究符合纳入标准，22项研究具备进行网状Meta分析所需的数据。相对疗效显示LLLT为最佳治疗方法。相对疗效显示PRP、1毫克非那雄胺（男性）、1毫克非那雄胺（女性）、5%米诺地尔、2%米诺地尔和度他雄胺（男性）在治疗后平均毛发计数变化方面大致相当。5%米诺地尔和2%米诺地尔报告的药物相关不良事件最多（分别为45例和23例）。2%米诺地尔与5%米诺地尔的证据质量高；5%米诺地尔与安慰剂的证据质量中等；度他雄胺（男性）与安慰剂、非那雄胺（女性）与安慰剂、2%米诺地尔与安慰剂以及5%米诺地尔与LLLT的证据质量低；非那雄胺（男性）与安慰剂、LLLT与假治疗、PRP与安慰剂以及非那雄胺与2%米诺地尔的证据质量非常低。该网状Meta分析的结果表明新的非激素疗法已成为有效的脱发治疗方法；然而，证据质量普遍较低。需要高质量的随机对照试验和头对头试验来支持这些发现，并有助于制定更标准化的方案，特别是针对PRP。无论如何，该分析可能有助于医生进行临床决策，并为患者突出各种非手术毛发修复选择。
