Department of Health Informatics, Universidade Federal de São Paulo, São Paulo, Brazil.
Discipline of Evidence-Based Medicine, Universidade Federal de São Paulo, São Paulo, Brazil.
J Eur Acad Dermatol Venereol. 2019 Sep;33(9):1792-1799. doi: 10.1111/jdv.15545. Epub 2019 Jun 28.
Alopecia areata (AA) is a complex immune and polygenic inflammatory disease that causes hair loss on some or all areas of the body; extent, severity and progression vary widely among individuals. Alopecia areata, considered one of the most frequently occurring immune diseases, affects 0.2% of the world population at any given time. Uncertainty prevails about the most appropriate intervention for AA. The aim is to evaluate the effectiveness and safety of over 80 interventions for AA, including minoxidil - one of the most promising interventions for patchy AA in children and adults of both sexes.
An extensive search was conducted of international medical literature involving randomized clinical trials (RCTs) of AA interventions. RCTs were evaluated qualitatively and quantitatively according to the previously published protocol and for seven specific outcomes.
The meta-analysis involving 5% minoxidil vs. placebo presented a significant difference in favor of 5% minoxidil with the moderate quality of evidence in children and adults with patchy AA (RR 8.37 [3.16-22.14], 95% CI). No severe adverse event was reported.
Treatment of patchy AA with 5% minoxidil proved effective, and clinically and statistically safe in studies with limited sample size; quality of evidence was moderate. Further studies with sound methodological quality, more participants and outcome observations lasting longer than 6 months are needed to address remaining uncertainties.
斑秃（AA）是一种复杂的免疫和多基因炎症性疾病，可导致身体某些或全部区域脱发；其严重程度和进展在个体之间差异很大。斑秃被认为是最常见的免疫疾病之一，任何时候都会影响全球 0.2%的人口。对于 AA，哪种干预措施最合适还存在不确定性。目的是评估 80 多种 AA 干预措施的有效性和安全性，包括米诺地尔——这是一种对儿童和男女两性斑片状 AA 最有希望的干预措施之一。
对国际医学文献进行了广泛的搜索，涉及 AA 干预的随机临床试验（RCT）。根据先前发表的方案和七个具体结果，对 RCT 进行了定性和定量评估。
涉及 5%米诺地尔与安慰剂的荟萃分析在儿童和成人斑片状 AA 中显示出 5%米诺地尔的显著优势，证据质量为中等（RR 8.37[3.16-22.14]，95%CI）。没有报告严重不良事件。
在样本量有限的研究中，5%米诺地尔治疗斑片状 AA 有效，且在临床和统计学上是安全的；证据质量为中等。需要进一步进行方法学质量良好、参与者更多、持续时间超过 6 个月的研究，以解决剩余的不确定性。
